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X RAY Interpretation PowerPoint Presentation

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Description : If deviated to one side : Pushed away by pleural effusion or tension pneumothorax Pulled towards collapse......

Tags : x-ray,heart and vessels,diaphragm

Published on : Apr 22, 2022 | Views : 4223 | Downloads : 31

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X RAY interpretation Dr. aboubaker aldhib
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Before you interpret … check for the following : Name Date Orientation : Left, right Position : erect , supine , PA or AP Inspiration, expiration Rotation : central or tilted Distance from the medial end of each clavicle to the spinous process of the vertebra at the same level Exposure : You must barely see the thoracic vertebrae behind the heart Identify both costophrenic angles and lung apices
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Name Date Orientation Adequate inspiration 9 ribs posteriourly Exposure Adequate tissue penetration Adequate anatomical exposure Gastric air bubble Rotation
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Underpenetrated
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Under-penetrated
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Systematic Approach Trachea and mediastinum Heart and vessels Hila Diaphragm Lung fields Bones
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PA Film
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Trachea and Mediastinum Ensure trachea is visible If deviated to one side : Pushed away by pleural effusion or tension pneumothorax Pulled towards collapse The carina, (60 –100 degrees) Angle of the carina increases left atrial enlargement, lymph node enlargement and left upper lobe collapse (left main bronchus is pulled up) Check for a widened mediastinum : Mass lesions (eg tumour, lymph nodes, aneurysm)
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Heart and vessels Heart size and heart borders Check aorta : Widening, calcification Check SVC, IVC, azygos vein widening
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LV Pulmonary conus Aortic knuckle RA Rt and Lt Pulmonary arteires SVC IVC Heart and vessels Vascular pedicle
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Hila Note position and size bilaterally Check for enlarged lymph nodes Calcified nodes or nodules Mass lesions Pulmonary arteries (normally < 1.5cm )
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Diaphragm Right hemidiaphragm slightly higher than the left If right is much higher than the left : ? effusion, lobar collapse, diaphragmatic paralysis Haziness : consider lung infiltrate (eg pneumonia) or effusion Air under the diaphragm : perforated viscus
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Lung fields Parenchymal infiltrates : 1- Determine location : Loss of heart borders or of the contour of the diaphragm E.g. : Right middle lobe consolidation blurs the heart border The lingula blurs the left side border of the heart 2- Identify the pattern of infiltration : Interstitial pattern → reticular Alveolar → patchy or nodular pattern Patchy infiltrates may be homogenous or heterogenous
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Lung fields (cont’d) Check also for : Lobar collapse Lobar consolidation : Look for air bronchograms Pulmonary nodules Apices Effusions Kerley B lines Fissures : they become wide if there is fluid collection Costophrenic angle The pleura : Thickening, loculations, calcifications and pneumothorax
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The minor fissure which separates the right upper lobe from the right middle lobe.
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Bone Fractures, dislocation, subluxation, osteoblastic or osteolytic lesions in clavicles, ribs, thoracic Spine and humerus including osteoarthritic changes soft tissues for subcutaneous air, foreign bodies
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Lateral Film
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Left Lateral Right Lateral
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Self Assessment
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Right middle lobe infiltrates (or early consildation)
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Hilar mass ( ? Enlarged ymph node)
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Pneumothorax
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Left pleural effusion
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Emphysema
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Left pleural effusion
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Left upper lobe mass
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Air under diaphragm
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Right upper lobe collapse and consolidation . Lobar density . Air bronchogram . No loss of lung volume
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RUL infiltration with air bronchogram + atelectasis Right upper lobe collapse . Segmental or lobar density Compensatory hyperinflation of normal lung
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Right middle lobe consolidation
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LUL consolidation
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Left lower lobe consolidation
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pacemaker
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Tension pneumothorax Tension pneumothorax (Left)
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Pulmonary hypertension Prominent pulmonary conus Enlarged pulmonary artery Cardiomegaly
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Pleural effusion Enlarged pulmonary arteries Pleural effusion Prominent transverse fissure
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metastasis Multiple round lesions ? Metastases
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pneumothorax Small Pneumothorax
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Metastatic Ca colon
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Infected hydatid cyst Lung Abscess
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Figure 7: Right middle lobe pneumonia Right middle lobe pneumonia
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Kerley B lines
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Obvious ! Pulmonary edema
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Obvious ! Pulmonary edema
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Pulmonary fibrosis Obvious !
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Right upper lobe collapse
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- - - - - - - - Right upper lobe collapse
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Right middle lobe collapse
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Cavitary tumour with air-fluid level
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Cavitary lesion
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Pleural effusion Obvious !
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Pulmonary nodule
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Obvious ! Metastases
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Hilar lymph node
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Any suggestion???? Large Hiatus hernia
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Any suggestion???? Bilateral numerous small dots Miliary Tuberculosis
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Good Luck