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Search pattern for Chest X-ray, How to read CXR systematically?

in this tutorial, there is simple but important steps you will learn in order to not missing anything in the CXR

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Search pattern for Chest X-ray, How to read CXR systematically?

  1. 1. Search pattern for CXR Systematic reading of Chest X-ray Abbas A. A. Shawka
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  3. 3. • Always you are vieing the graph from the patients anterior face. (Whaether it was an AP or PA views) • Start reading every radiograph—chest or otherwise—by scanning the areas of least interest first, working toward the more important areas. You are less likely to miss secondary but important findings this way. For the chest x-ray, start in the upper abdomen, then look at the thoracic cage (soft tissues and bones), then the mediastinal structures, and finally the lung. Look at each lung individually, then compare left lung and right lung. • Correct sequence: • 1—Abdomen • 2—Thorax (soft tissues and bones) • 3—Mediastinum • 4—Lung—unilateral • 5—Lungs—bilatera
  4. 4. 1- Abdomen • Search pattern for abdomen
  5. 5. • Notice the normal gas bubble below the heart represent stomach fundus • Lateral to it is the gas bubble of splenic fleure • The liver and R. Hemidiaphragm are not destingusished • Usually R. Hemidiaphragm is higher than the left one.
  6. 6. • Upper abdominal disease (subphrenic abscess, perforated viscus, pancreatitis, and cholecystitis) may mimic lung disease clinically. Similarly, basilar lung disease (pneumonia, pleurisy) may mimic upper abdominal disease. This is real!
  7. 7. 2. Thorax • start at the right base (*), looking at the soft tissues (e.g., muscles, breast) of the chest wall, the ribs, and the shoulder girdle in sequence. • Finish by reversing the order down the left side. • Note that the posterior ribs tend to be horizontal, while the anterior ribs descend from lateral to medial.
  8. 8. 2. Thorax
  9. 9. • Identify the structures ? • A. Right breast , B. 6th posteriro rib , C. Scapula, D. Clavicle , E. 4th anterior rib , F. Stomach bubble, G. Liver.
  10. 10. 3. Mediastinum • An organized search of the mediastinum is complicated because there are multiple overlapping structures. Start with a global look at the mediastinum for contour abnormalities (i.e., focal or diffuse widening). Figures 3-5A and 3-5B show three rapid searches of the mediastinum: A = for the trachea and carina; B = for the aorta and heart; C = for the hilum
  11. 11. • ✅ 3 searching patterns for mediastinum • 1. For trachea and carina • 2. For heart and aorta • 3. For hila
  12. 12. • 1. Trachea , 2. Carina , 3. Aortic knuckle , 4. Ascending aorta, 5. Descending aorta, 6. Heart, 7. Hila
  13. 13. 4. Lungs • Most chest x-rays are ordered to evaluate lung disease, so the lungs are examined last. The lungs are so important that we search them twice. • Start in the right costophrenic angle (*) as outlined in Figure 3-6A, examining the right and then left lung. The second look involves a side-by-side comparison of the lungs (Figure 3-6B). This also should give you a second look at costophrenic angles and the hilum. Practice this search pattern in Figure 3-7A. Are There Many Lung Lesions?
  14. 14. • Try to apply this searching pattern, do you notice any nodule everywhere.
  15. 15. • For the novice, subtle, and not so subtle, abnormalities are easy to miss. In searching the lungs, three helpful strategies to minimize oversights are (1) searching the lungs individually, (2) searching the lungs side by side, and (3) taking advantage of old graphs, if available.
  16. 16. • The lateral is a valuable but often ignored radiograph. Don’t ignore it! The search pattern is identical (ATMLL). In Figure 3-8A, start by searching below the diaphragm (A). Continue at the lower spine (B), searching the soft tissues and bones posteriorly, then anteriorly (C). Return to the trachea and work your way down the mediastinum (D). In Figure 3-8B, crisscross the superimposed lungs and costophrenic angles (E)
  17. 17. searching pattern for lateral films.
  18. 18. apply the search pattern in this lateral chest x ray
  19. 19. What is the interstital lung diseases and the alvolar diseases? • in interstitial lung diseases the supporting vonnective tissue of alveoli will affected and thickens and this will appear as a radiodense lines with normal alveoli (black) indicating a well aerated lung. • Thickened lung marking • in alveolar diseases, alveoli are filled with fluids or any thing, that is they will be radiodense and appears as a patchy whites on films. • consolidated • Invisible lung marking • the pulmonary vessels are not visible in the peripheral third of lungs normally because of the resolutiin of CT or X ray are munimum, so in interstitial lung diseases these may appear at the periphery. (kerely B lines)
  20. 20. • Try to gues wich film repesent an interstitial disease and which one represent an alveolar disease?
  21. 21. • Search this CXR systematically, what are the radiological findings? • ANSWER • rotated film, displaced trachea, right lung is rsdiolucent • diagnosis is right mastectomy
  22. 22. • search this CXR aystematically, what are the findings? • Diagnosis is perforated viscus