1 Basic CXR Basic CXR interpretation nterpretation

Objective
Basic CXR interpretation
Prof.Dr.Wipa Reechaipichitkul
Have basic knowledge of CXR interpretation
Division of Pulmonary and Critical Care,
Department of Medicine,
Khon Kaen University
Before interpretation
Before interpretation
9 - 10 posterior ribs or 5 - 6 anterior ribs
2. Correct film
Exposure
correct: branching, tapering bronchovascular
structures (Lt heart shadow,
beneath Rt hemidiaphragm)
Position (stand or sit upright)

1. Correct patient: name, age, sex

2. Correct film


Full, deep inspiration
upright, PA film: scapula, air in stomach
Rotation
distance between spinous process of 2-3 upper
thoracic and head of clavicle
Other position

Upright, PA, at end of expiration:

pneumothorax
Inspiratory and expiratory film:
obstructive emphysema

Lateral CXR:
objects can localized in 3 diamensions
10% is seen better
confirm suspected on PA view
1
“FB obstruction”
Other position
 Lordotic
 Lateral
 Others:
Fully inspired film
view
decubitus
AP, Portable
Fully exspired film
“Left pleural effusion”
“Scar cancer (CA lung)”
Homogeneous haziness
at left upper lung &
fibroreticular lesions
at both upper lungs
Film lordotic view:
Lytic ribs
Homogeneous haziness
at left lower lung
Left lateral decubitus
Linear shadows
 Pleural
 Plate
line
“Pleural line”
atelectasis
 Major
fissure
 Minor
fissure
 Kerley
Miliary tuberculosis
and right pneumothorax
lines: A, B, C
2
Horizontal fissure
(minor fissure)
Plate atelectasis
(Discoid atelectasis)
Major and minor fissure
Cardiomegaly with
Interstitial pulmonary edema
Kerley A lines
Kerley B lines
Kerley’s A lines:
linear opacities
extending from
periphery to hilar
(anastomotic
channels between
peripheral and
central lymphatics)
Enlarge cardiac shadow,
Dilated azygos vein,
Redistribution of blood vv,
Peribronchial cuffing,
Kerley’s A, B, C lines
Kerley’s C lines:
reticular opacities
at the lung base
linear opacities
(Kerley’s B lines en
face)
Interstitial pulmonary edema Central zone to hilum
(edema of central pul septa)
Kerley B lines
Kerley A lines
3
Kerley’s B lines:
short horizontal
lines perpendicular
to pleural surface
at the lung base
(edema of
interlobular septa)
“Partial atelectasis RUL”
Homogenous density at
right middle lung zone:
Horizontal fissure
(pleural effusion)
Upward shift of right
horizontal fissure, elevated
right dome diaphragm
“Phantom tumor”
4