This document contains a 46-page guide to interpreting chest x-rays written by Dr. S. Aswini Kumar. It begins by describing the process and proper views for taking a chest x-ray. It then details how to analyze different anatomical structures and pathological findings visible on chest x-rays such as lung opacities, nodules, masses, effusions, pneumothorax, fibrosis, and atelectasis. The guide provides illustrations and explanations for accurately reading and diagnosing conditions from chest radiograph images.

1. Chest Roentgenogram DR. S. ASWINI KUMAR. MD Professor of Medicine Medical College Hospital Thiruvananthapuram

2. Chest Roentgenogram 4/15/2010 2 X-Ray machine X-Rays produced by it Pass through the human body Black and white film Placed on the opposite side

3. Chest X-Ray-Views 4/15/2010 3 PA view Postero-anterior view X-Rays-Posterior to anterior Delineates the heart and lungs Spine is not in focus

4. Chest X-Ray Views 4/15/2010 4 Lateral view Lesions of lung and mediastinum Right or left lateral view Spine posteriorly - heart anteriorly Useful in detecting the lobe of lung

5. Densities 4/15/2010 5 The background - black The soft tissues - light white The bone - dense white Fluid, blood - white as well The air - black

6. How do you read a Chest X-Ray PA 4/15/2010 6 Soft tissue shadows Position of trachea and mediastinum Costo and cardiophrenic angles Study the lung parenchyma Study the heart shadow

7. The fissures and lobes of Lung 4/15/2010 7

8. Right Upper Lobe 4/15/2010 8

9. Right Upper Lobe in the lateral view 4/15/2010 9

10. Right Middle Lobe in the PA view 4/15/2010 10

11. Right lower lobe consolidation 4/15/2010 11

12. Right Middle Lobe Silhouette in Lateral View 4/15/2010 12

13. Extend of left upper lobe of lung 4/15/2010 13

14. Extend of left lower lobe of lung 4/15/2010 14

15. Consolidation of lung 4/15/2010 15

16. Pleural Effusion Left Side 4/15/2010 16 Dense homogenous opacity Left lower zone outer aspect A higher level in axilla Obliteration of angles No air bronchograms

17. Massive Pleural Effusion Right Side 4/15/2010 17 Tracheal shift to left side Dense homogenous opacity No air bronchograms Obliteration of cardiophrenic Obliteration of costophrenic

18. Bilateral pleural Effusion 4/15/2010 18 Trachea & mediastinum central 2 shadows both lower zones Higher levels in axillae Cardiophrenic angles obliteralted Costophrenic angles obliteralted

19. Encysted Pleural effusion 4/15/2010 19 Rounded and oval shadows Correspond to the fissures One to horizontal fissure The other oblique fissure CP and CP angles are free

20. Cavity - Left Lung 4/15/2010 20 Right lung is normal Thin walled cavity - left middle Homogenous opacity - lower part An air fluid level above opacity CP and CP obliteralted

21. Lung abscess - Right side 4/15/2010 21 Left lung is normal A thick walled cavity Rt middle Hhomogenous opacity lower part An air fluid level above opacity CP & CP angles not obliteralted

22. Lung abscess - Left upper lobe 4/15/2010 22 Right lung is normal Thick walled cavity left upper A thick opacity - lower part Air fluid level above the opacity CP & CP angles not obliteralted

23. Infilterative lesions of lung 4/15/2010 23 A close up of apex left lung Non-homogenous opacities Thin walled cavities Minimal air fluid levels early lesions of PTB

24. Breaking down Consolidation 4/15/2010 24 left lung - few infiltrates Involvement of Rt UZ Non-homogenous opacity Breaking down of opacity Formation of a cavity

25. Cavity - Right upper lobe 4/15/2010 25 The left lung is normal Disease of Rt upper zone/lobe Thin walled cavity No air fluid levels inside Cavity characteristic of PTB

26. Fibrosis – Left Upper Lobe 4/15/2010 26 The right lung - few infiltrates The trachea is shifted to left Mediastinum is shifted to left Intercostal spaces are narrowed There are cavities inside

27. Bilateral Upper lobe Fibrosis 4/15/2010 27 Trachea shifted to right The mediastinum is central Both upper zones thin cavities Fibrotic bands Compensatory emphysema

28. Miliary Mottling 4/15/2010 28 All areas both the lung fields Multiple small 1-2 mm rounded Best seen in middle and lower Miliary mottling Hematogenous spread of TBB

29. Reticulo-nodular Opacities 4/15/2010 29 All areas both the lung fields Multiple small 2-4 mm rounded Middle and lower zones Reticulonodular shadows Granulomatous spread of TB

30. Bronchopneumonia 4/15/2010 30 Patient with acute dyspnoea Both the lung fields are involved Middle and lower zones Fluffy non-homogenous opacities No air bronchograms

31. Adult Respiratory Distress Syndrome 4/15/2010 31 Patient with acute dyspnoea Both the lung fields are involved Middle and lower zones Fluffy non-homogenous opacities No air bronchograms

32. Emphysema of lungs 4/15/2010 32 Chest is elongated Diaphragm pushed down Ribs are horizontally placed Lung markings are reduced Heart elongated and tubular

33. Pneumothorax Right side 4/15/2010 33 The chest is emphysematous Minimal tracheal shift Right side no lung markings Complete collapse compression Air in the pleural cavity

34. Hydro-Pneumothorax Right side 4/15/2010 34 Left lung normal lung markings Right lung has no lung markings Right lung-completely collapsed Compression by the air Air-fluid level in pleural space

35. Massive Hydropneumothorax Left side 4/15/2010 35 Homogenous opacity left thorax Small air fluid level at the apex No higher level in the axilla Left heart border not visible CP & CP angles obliteralted

36. Bronchiectasis in Plain X-Ray Chest 4/15/2010 36 Both the lung fields are affected Nonhomogenous opacities No air bronchgrams Bilateral and basal Few cystic lesions also

37. Mass lesion in the lungs 4/15/2010 37 Right lung parenchyma A homogenous opacity Central hyperdense lesion Peripheral streaks No air bronchograms

38. Lung mass with Collapse 4/15/2010 38 The right lung is involved Dense homogenous opacity No air bronchgrams Tracheal shift to the right side Collapsed right upper lobe

39. Solitary Nodule of Lung 4/15/2010 39 The right lung is involved Dense homogenous opacity RMZ No air bronchgrams Round shadow & clear margins Could be a mass lesion or an inter lobar effusion

40. Cannon Ball shadows 4/15/2010 40 Both the lung fields are affected throughout Dense homogenous opacities middle and lower zones Again there are no air bronchgrams Rounded shadow with not so clear margins Could be a secondaries from any other primary site

41. Pleural Calcification 4/15/2010 41 Both the lung fields are relatively clear Dense homogenous opacity lateral part of middle zone It is dense and white with irregular margins These are due to pleural thickening May be there is additional calcification of pleura

42. Emphysematous Bulla 4/15/2010 42 The chest is emphysematous and elongated There is an additional area of hypertransleucencies There is a large air space in the left middle zone laterally The wall of the lesion is very thin There is no mediastinal shift to suggest pneumothorax

43. Right Upper Lobe Collapse 4/15/2010 43 A dense opacity in upper zone There is a lower margin Absorption collapse of the lobe Due to bronchial obstruction Right Upper Lobe Atelectasis

44. Right Middle lobe Collapse 4/15/2010 44 A more diffuse type of shadow Seen in the right middle zone a linear triangular shadow in the lateral view suggestive Right Middle Lobe Atelectasis

45. Right Lower lobe Collapse 4/15/2010 45 A linear opacity near the right diaphragm shift of the right border of heart Posterior triangular shadow in Seen in a lateral view-

46. Thank You For The Patient Hearing 4/15/2010 46