2. Normal chest X-ray(PA view)
Index:
ā¢ a ļ aorta;
ā¢ ca ļ carina;
ā¢ cl ļ clavicle;
ā¢ cpa ļ costophrenic angle;
ā¢ g ļ gastric air bubble;
ā¢ la ļ left atrium;
ā¢ p ļ main pulmonary artery;
ā¢ s ļ scapula;
ā¢ t ļ trachea.
3. Normal chest X-ray(PA view)
Index:
ā¢ Aļ aorta;
ā¢ Apwļ aortopulmonary window;
ā¢ Capļ cardiophrenic angle;
ā¢ g ļ gastric air bubble;
ā¢ ip ļ interlobar (or descending)
pulmonary artery;
ā¢ L ļ liver;
ā¢ lv ļ left ventricle;
ā¢ rts ļ right tracheal (or paratracheal)
stripe;
ā¢ sp ļ spleen;
4. Normal chest X-ray(PA view)
Index
ā¢ A ļ aorta
ā¢ Ajlļ anterior junction line
ā¢ Apwļ aortopulmonary window
ā¢ Ipļ interlobar (or descending)
pulmonary artery
ā¢ Pjlļ posterior junction line
5. Normal Chest X-ray (lateral view)
Index:
ā¢ a ļ aorta
ā¢ bi ļ bronchus intermedius
ā¢ cpa ļ costophrenic angle
ā¢ d ļ diaphragm
ā¢ e ļ esophagus
ā¢ ivc ļ inferior vena cava
ā¢ lpa ļ left pulmonary artery
ā¢ lul ļ left upper lobe bronchus
ā¢ lv ļ left ventricle
ā¢ m ļ manubrium
ā¢ mf ļ minor fissure
ā¢ MF ļ major fissure
ā¢ rpa ļ right pulmonary artery
ā¢ rul ļ right upper lobe bronchus
ā¢ rv ļ right ventricle
ā¢ st ļ sternum
ā¢ svc ļ superior vena cava
ā¢ t ļ trachea
ā¢ v ļ vertebral body
6. Introduction to pleural space
ā¢ Contain 2 layers i.e. Visceral and Parietal pleura
ā¢ Visceral pleura is outer lining of the lung
ā¢ Parietal pleura is lining of the chest cavity
ā¢ Normally, these surfaces are smooth and are separated by a minimal
amount of pleural fluid
ā¢ Provides nearly friction-free environment for movement of the lung
within the thorax
ā¢ Normally contains no more than 3 to 5 mL of pleural fluid
7. Reasons for accumulation of fluid
ā¢ Increase pulmonary capillary pressure (transudate)
ā¢ congestive heart failure
ā¢ hypoproteinemia
ā¢ fluid overload
ā¢ liver failure
ā¢ nephrosis
ā¢ Alter thoracic vascular or lymphatic pathways
ā¢ Alter pleural capillary or lymphatic permeability(Exudate)
ā¢ Infection or inflammation
ā¢ pulmonary embolism
ā¢ neoplasms
ā¢ Affect diaphragmatic peritoneal and pleural surfaces
ā¢ pancreatitis
ā¢ subphrenic abscesses
ā¢ liver abscesses
ā¢ ovarian tumors
ā¢ peritonitis
ā¢ ascites
8. Pleural effusion
ā¢ Most common radiographic sign is pleural meniscus
ā¢ Volume of fluid to produce pleural meniscus within costophrenic
angle varies in individual
10. Pleural effusion(lateral view)
ā¢ Approx 100 mL of pleural fluid
will cause appreciable blunting of
the posterior costophrenic angle
on the lateral view
11. Pleural effusion(PA view)
ā¢ 200 mL will cause blunting of the
lateral costophrenic angle on the
PA projection in an upright
patient
12. Pleural effusion(lateral decubitus view)
ā¢ A lateral decubitus chest
radiograph, with the side
containing the pleural effusion
placed down (dependent),
demonstrate smaller amounts of
free-flowing pleural effusions
ā¢ 1 millimeter of thickness of
pleural fluid in the lateral
decubitus = approx 20 mL of
pleural fluid
13. Sub-pulmonic pleural effusions
ā¢ Sub-pulmonic pleural
effusions elevate the lung
base
ā¢ Mimics an elevated
diaphragmatic leaflet
ā¢ On the left side, a marked
separation (>2 cm) of the
lung from the stomach
bubble suggests a sub-
pulmonic effusion. Right Sub-pulmonic effusion
with elevated right hemi-
diaphargm
15. The apex of the curvature at the lung base is shifted laterally,
and its slope slants sharply towards the lateral costophrenic
sulcus
The rock of Gibraltar sign
18. Features
ā¢ Typical configuration of a loculation along the chest wall, often described
as pleural or extrapleural sign
ā¢ Angles of interface between the pleural āmassā and the chest wall are
obtuse, and the mass displays tapered borders
ā¢ Surface of the āmassā is usually smooth, poorly marginated when seen
PA, and only partially visualized when displayed in an oblique
projection (āincomplete margin signā)
ā¢ Homogeneous content
ā¢ āmassā droops on upright images owing to its liquid content
19. References
ā¢ Michael Y. M. Chen, Thomas L. Pope, David J. Ott. Basic Radiology.
2nd ed. Mc. Grow hill. P-115-9.
ā¢ Cochard, Larry R.,Netter, Frank H. Netter's Introduction to Imaging.
Elseiver. P-37-9.