Holding your breath after inhaling helps your heart and lungs show up more clearly on the image. During the side views, you turn and place one shoulder on the plate and raise your hands over your head.
It can be suspected on the basis of ECG; elevated inflammatory markers (CRP;ESR); detection of anti ... Read More. Some associated issues such as rheumatoid nodules or pulmonary fibrosis can be seen on Chester.
Occasionally, different angles are added in order for the radiologist to interpret certain specific areas of the chest. A radiologist is a physician specialist trained to interpret images of the body produced on films.
This usually consisted of a fluorescent light source placed in metal box and covered by a white plastic. More recently, newer technology has replaced this old reading technique in much health care facilities and radiology offices.
This advanced technology has eliminated the need for the actual physical films to be used and placed on a light box for interpretation. Additionally, this technology allows for ability to easily look at any previous images taken from the same patient.
It also essentially eliminates the possibility of lost X -rays and speeds up the interpretation of X -rays, and the communication between doctors about the results. Once they are ordered by a physician, they can be performed in hospitals, emergency rooms, outpatient radiology facilities, and some doctors offices.
The radiology technician is guided by technique standards which have been established by national and international guidelines. These guidelines are designed and reviewed by both the Department of Health and Human Services and national and international radiology protection councils.
Women who are pregnant, especially in early pregnancy, should notify their physicians, as the fetus is at risk for harm with any radiology technique. Frequently, they are ordered for symptoms of shortness of breath, cough, or chest pain.
Sometimes chest X-rays are required before operations to see if there is any evidence of heart or lung disease that may need to be addressed before the procedure. These lung fields are seen on either side of the heart and the vertebrae located in the center of the film.
If you log out, you will be required to enter your username and password the next time you visit. Image courtesy of Lars Grimm, MD, MRS.
Although many disease processes are obvious at first glance on chest radiographs, clinicians must be careful not to miss more subtle findings. This image shows a solitary pulmonary nodule (circle) in the left midlung.
Image courtesy of Lars Grimm, MD, MRS. In more advanced disease (stage 4), fibrosis, Hilary retraction, decreased lung volumes, and honeycombing may develop.
Acidosis is a multisystem granulators disease of unknown etiology that classically presents with pulmonary (90% of cases), eye, or skin lesions in young adults (age, 20-50 years). In the United States, the disease is more common and more severe in blacks than in whites, and women are affected more often than men.
Image courtesy of Lars Grimm, MD, MRS. In patients with pulmonary hypertension, the most common findings on chest radiographs are enlarged pulmonary arteries (arrow) that taper distally (peripheral pruning).
A dilated right ventricle with a decreased retrosternal space may also be seen on lateral images. Primary pulmonary hypertension usually affects young women and is a disease of unknown etiology.
Pan coast tumors are pulmonary neoplasms located in the superior Julius of the lung. Lordosis chest views may be helpful to clarify a suspected lesion.
They characteristically cross the pleural barrier to invade the chest wall, brachial plexus, and superior sympathetic ganglion (resulting in Corner syndrome). Image courtesy of Lars Grimm, MD, MRS.
Disease caused by inhalation of asbestos fibers (typically from industrial or occupational exposures) produces chest radiographic findings of bilateral calcified pleural plaques over the diaphragmatic, peripheral, or mediastinal pleura (arrows). Noncalcified pleural plaques are not readily appreciated on chest radiographs, but these lesions may be fully displayed on computed tomography (CT) scans.
Progression of asbestos-related disease to involve the lung parenchymal is known as asbestos is. This predominantly affects the interstitial compartment of the lung and manifests as increased interstitial markings, coarse parenchymal bands, rounded atelectasis, and parenchymal distortion on chest radiographs.
Localized fibrous tumor of the pleura (FTP) (or solitary FTP) and malignant mesothelioma are primary pleural neoplasms. FTP is generally a benign neoplasm of the pleura that is not associated with asbestos exposure.
This tumor is usually detected incidentally on chest radiographs, and typical findings include a well-circumscribed, homogeneous soft-tissue mass that is closely related to the pleura. The lesion may be found anywhere along the lung periphery (shown, upper left hemithorax), pulmonary fissures, mediastinum, or diaphragm.
Image courtesy of Lars Grimm, MD, MRS. Unilateral irregular, nodular, and diffuse pleural thickening is the classic finding on chest radiographs in patients with malignant mesothelioma.
Pleural effusions may obscure the pleura, making it difficult to evaluate the thickness; however, the fissures may also become thickened with an irregular contour, which can aid in the diagnosis. The presence of calcified pleural plaques indicates previous asbestos exposure, which is a risk factor for the development of mesothelioma.
Other potential causes of unilateral pleural thickening are emphysema, trauma, postoperative scarring, and metastatic disease. Image courtesy of Lars Grimm, MD, MRS.
Pulmonary aspergilli is a fungal infection caused by the Aspergillus species, most commonly A fumigates. Chest radiographic findings of APA include lobar infiltrates, perihelia “glovelike” tubular shadows representing mucus-filled bronchiectasis, and tram-line bronchial walls due to edema.
The characteristic features of an aspergilli are a round mass with an adjacent crescent-shaped airspace (arrow). The fungal ball itself may be freely mobile and move when the patient changes position.
Chronic necrotizing aspergilli may appear as segmental areas of consolidation, predominantly in the upper lobes, that progress toward cavitation. Angioinvasive aspergilli most commonly appears as patchy areas of consolidation with solitary or multiple nodules and peripheral wedge-shaped lesions due to hemorrhagic infarcts.
Image courtesy of Lars Grimm, MD, MRS. A solitary pulmonary nodule is defined as a single discrete pulmonary opacity that is surrounded by normal lung and is not associated with adenopathy, atelectasis, or pleural effusion.
The list of potential conditions in the differential diagnosis is extensive and broadly includes benign and malignant neoplasms, infections, noninfectious granulomas, developmental lesions, vascular lesions, and other systemic processes. Although the exact etiology of a nodule may not be discernible on a chest radiograph, failure to detect a lesion and failure to obtain appropriate follow-up can lead to significant patient morbidity and mortality.
Key radiographic features to identify are the size, location, growth rate, and margin characteristics of the nodule, as well as the presence and pattern of cavitation and calcification. Factors that favor malignancy are growth over time; large size; an irregular, loculated, or speculated margin; and an upper lobe location.
It may be easy to miss a lesion that overlaps the ribs or clavicles. This image is from a patient with a solitary pulmonary nodule (arrow) that has been stable for 2 years and is therefore considered benign.
Image courtesy of Lars Grimm, MD, MRS. Tracheal stenosis is a narrowing of the trachea that may result from chronic inflammatory disease, neoplasm, and trauma, as well as iatrogenic causes and extrinsic compression from lesions such as an intrathoracic goiter.
On chest radiographs, the trachea and main stem bronchi can readily be assessed for changes in caliber. The radiograph may also provide clues as to the cause of stenosis, such as tracheal deviation or a widened mediastinum, or other potential etiologies for shortness of breath, such as an aspirated foreign body.
The image is from a patient with a known thoracic malignancy with tracheal narrowing (arrow) from metastatic disease. Image courtesy of Lars Grimm, MD, MRS.
Cavitary lung lesions on chest radiographs can be the result of an abscess, tuberculosis, carcinoma, granulomatosis with polyangiitis, metastatic cancer, or septic embolic. Key features to identify are the cavity's size, wall thickness, and location (this may provide clues as to the potential etiology of the lesion), as well as the presence of any air-fluid levels.
Lateral radiographs may be needed to help confirm the location of the lesion(s). In general, metastatic lesions have thin-walled cavities, but their appearance may vary.
Lesions from granulomatosis with polyangiitis and septic embolic are typically smaller. It may be easily missed on chest radiographs if careful attention is not paid to the bones in addition to the lung fields.
Typical findings of acute or subacute osteomyelitis on plain radiographs are soft-tissue swelling, periosteal reaction, cortical irregularity, and demineralization. In chronic osteomyelitis, there is an elevated periosteum and thick, irregular, sclerotic bone that is interspersed with radiolucencies.
The image is from a patient with chronic osteomyelitis of the left scapula. Note the associated bony expansion, sclerosis, and periosteal reaction (arrow).
Bone lesions may be sclerotic, lytic, or mixed, which can give clues to their etiology. This close-up chest radiograph reveals a lytic expansive left fourth rib lesion (arrow) due to multiple myeloma.
Compression fractures of the thoracic spine occur whenever the spinal column is subjected to forces that exceed its strength and stability. They may be first detected on chest radiographs by carefully evaluating the vertebral bodies.
Typical findings on a plain radiograph for anterior compression fractures include cortical impaction, loss of vertical height, buckling of the anterior cortex, trabecular compaction, and end plate fracture. Lateral radiographs may provide better views of the spinal architecture.
Unilateral hyperlucent lung may be the result of Swyer-James syndrome, pneumothorax, obstructive emphysema, or pulmonary embolism. Hyperlucency is typically the result of alveolar distention (air retention) and/or reduced arterial flow.
Swyer-James syndrome is a manifestation of postinfectious alliterative bronchiolitis that is found in children. Pneumoperitoneum refers to the presence of air within the peritoneal cavity.
This may be easily seen on upright chest radiographs as a lucency beneath either diaphragm (arrows). The presence of air under the diaphragm does not always imply a perforation and is commonly seen after surgery, as was the case in the image shown.
Typically, benign pneumoperitoneum due to surgery resolves after 3-6 days. Colonic or gastric gas may mimic free air under the left hemidiaphragm and, therefore, close attention is essential to ensure there is only a thin layer of diaphragm between the abdominal and thoracic contents rather than gastric or colonic wall.
The heart has a globular contour (shown), but confirmation via ultrasonography or CT scanning may be necessary. Effusions are common after cardiac surgery and most often resolve after 1 month.
Start Chest radiographs are the most common radiologic tests in hospitals and Eds. See if you can quickly and accurately recognize these critical findings to identify patients who need emergent care.
All SlideshowsStart For patients with thoracic acidosis, when chest radiographic imaging results are correlated with the clinical findings, chest radiography may be the only imaging required. Approximately 60-70% of patients with acidosis have characteristic radiologic findings.
Disclosure: Lars Grimm, MD, MRS, has disclosed no relevant financial relationships. Disclosure: Olivia Wong, DO, has disclosed no relevant financial relationships.
Disclosure: John Hang, RN, has disclosed no relevant financial relationships. Verschakelen J, Rock P. Diseases of the chest wall, pleura, and diaphragm.
In: Holder J, on Sculptress GK, Zollikofer CL, eds. Diseases of the Heart, Chest & Breast: Diagnostic Imaging and Interventional Techniques.
Classical imaging triad in a very young child with Swyer-James syndrome. Strike WE, AFUB B, Contractor T. Pericardial effusion.
Singh VN, Aggarwal K. Pericardial effusion imaging. Please enter a Recipient Address and/or check the Send me a copy checkbox.