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Dat aInt erpr et ationseries Ches tX-ayInterpretation DeliverDr Alireza Sherafat MBBS (Hons), SFP FY1 Doctor Delivered byDisclaimer BIDA SW teaching is led by students with supervision of junior doctors and consultants across the UK. These teachings are created to support students’ learning but should not replace your local Medical School teaching material.Learning Outcomes Review Review the basic principles of interpreting a plain film radiograph of the chest Describe and be able to recognise the key features Recognize of a plain film radiograph of the chest Recognise the following on chest X-ray (CXR): pleural effusion, pneumothorax, consolidation, Apply cavitation, space occupying lesions and cardiomegalyBasic principles Patient Details: Technical Factors: Name Age and DOB Quality of X ray – RIPE Date taken Previous X-rays Method: ABCDE Normal plain chest radiograph (1) RIPE • Rotation (equal space between medial aspects of clavicles to spinous processes), • Inspiration (>7 anterior and 9 posterior ribs) • Projection • Exposure (visible vertebral bodies behind the heart) • Recommended resource for visual explanation: https://www.radiologymasterclass.co.uk ABCDE AIRWAYS BREATHING CARDIAC DIAPHRAGM EXTRA • Trachea • Carina AIRWAYS • Left and right main bronchus Conditions that shift trachea Conditions that shift trachea towards the disease away from the disease Atelectasis (lung Pneumothorax collapse) Pleural fibrosis Masses/ tumors Pneumonectomy Pleural effusion Normal plain chest radiograph (2) Look for trachea deviation!BREATHING Compare the lung parenchyma left to right and between zones see whether there is a difference. Look for foreign body, opacification,subcutaneous air,etc Lung fields can be divided into zones: upper, middle, and lower zones Normal plain chest radiograp(2)2)CARDIAC • Aortic knuckle • Aortopulmonary Window • AorticArch • Heart borders • Cardiomegaly • Pericardial effusion • Left ventricular hypertrophy In a PAchest radiograph, the heart should not be more than 50% the total width of the diaphragm. If that’s the case consider: Normal plain chest radiograph (2) DIAPHRAGM • Diaphragm • Gastric air bubble • Costophrenic angles Normal plain chest radiograph (2) EXTRA • Clavicle • Medial border of scapula • Ribs • Vertebras Look for ribs and clavicular fractures! Normal plain chest radiograph (2)Case 1 A 20-year-old athletic man came to the emergency room with complaints of difficulty breathing and chest pain on the left side. He states that the pain began suddenly while on a flight from Malaysia to London. He has no previous medical history and does not smoke. Case 1 (3)Case 2 A 55-year-old man came to the emergency department with complaints of shortness of breath and pain on the right side of his chest after falling off a ladder. Case 2 (4)Case 3 A 40 years years old female patient presented to A&E with an acute onset shortness of breath. She has medical history of severe pulmonary hypertension and COPD. She is waiting to have a chest X ray Case 3 (5)Case 4 A 50 years old female presented with cough, chest pain and shortness of breath after her thyroid operation. Case 4 (6)Case 5 A75 years old male patient presented with a 5 days history of productive cough and fever. Case 5 (7)Case 6 A 63 years old male with 4 months history of dyspnoea and nocturnal orthopnoea. Case 6 (8)Case 7 An 80 years old male presents to A&E with shortness of breath and history of Atrial fibrillation Single lead permanent pacemaker (PPM) in situ (9)Case 8 A 45 years old unwell patient who presents to A&E with history of fever, breathlessness and history of advanced HIV. Mobile AP erect resuscitation image. (10) Case 9 • A 25 years old male presents with an acute onset chest pain. Case 9 (11)Case 10 A 2 years old male presents after ground nut aspiration with associated cough Case 10 (12)SBAQ 1 A25 years old male presented with acute onset shortness of breath and chest pain. Which of the following is the most likely diagnosis based on the provided chest X-ray? a) Ride sided pneumothorax b) Right sided tension pneumothorax c) Left sided pneumothorax d) Left sided tension pneumothorax e) Lung collapse SBAQ (13) (2)SBAQ 2 A40 years old female presented with 6 weeks history of productive cough, fever, night sweets and weight loss. Which of the following is the most likely diagnosis based on the provided chest X-ray? 1. Pneumonia – Right upper lobe 2. Pneumonia – Right middle lobe 3. Pneumonia – left upper lobe 4. Pulmonary fibrosis 5. Pulmonary tuberculosis SBAQ 2 (14)SBAQ 3 A40 years old female presented with 6 weeks history of productive cough, fever, night sweets and weight loss. Which of the following is the most likely diagnosis based on the provided chest X-ray? 1. Pneumonia – Right upper lobe 2. Pneumonia – Right middle lobe 3. Pneumonia – left upper lobe 4. Pulmonary fibrosis 5. Pulmonary tuberculosis SBAQ 3 (15)SBAQ 4 A60 years old female with lifelong history of heavy smoking presented to her GP complaining of haemoptysis. Which of the following is the most likely pathology you would expect to see on her chest X ray? 1. Consolidation 2. Cavitation 3. Space occupying lesion 4. Foreign body 5. Cardiomegaly SBAQ 4 (16)SBAQ 4 A60 years old factory worker female presented to her GP complaining of acute on chronic shortness of breath and dry cough . Which of the following is the most likely diagnosis based on her chest X ray? 1. Pneumonia 2. Pulmonary fibrosis 3. Cancer metastasis to the lung 4. Heart failure 5. Pulmonary tuberculosis SBAQ 4 (16) SBAQ 4 (17)References 1. Radiology quiz 18394 [Internet]. Radiology Quiz 18394. [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/18394/play?lang=gb 2. Koksal. How to read chest X-rays [Internet]. International Emergency Medicine Education Project. 2018 [cited 2023Jan22]. Available from: https://iem-student.org/how-to-read-chest-x-rays/ 3. Sorrentino SA. Right-sided pneumothorax due to rib fracture: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/right-sided- pneumothorax-due-to-rib-fracture?lang=gb 4. Bickle I. Large spontaneous pneumothorax: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/large-spontaneous- pneumothorax ] 5. Babu V. Pulmonary arterial hypertension: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/pulmonary-arterial- hypertension-7?lang=gb 6. Smith D. Left phrenic nerve palsy: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/left-phrenic-nerve-palsy?lang=gbReferences 7. Knipe H. Right Lower Lobe Consolidation - pneumonia: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/right-lower-lobe- consolidation-pneumonia?lang=gb 8. Gaillard F. Congestive cardiac failure: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/congestive-cardiac-failure-1?lang=gb 9. Gaillard F. Acute pulmonary oedema: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/acute-pulmonary-oedema-1?lang=gb 10. Bell DJ. ECG chest leads: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/ecg-chest-leads?lang=gb 11. Bickle I. Cleavage jewellery on chest radiograph: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/cleavage-jewellery- on-chest-radiograph?lang=gb 12. Patel MS. Foreign body in airway: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/foreign-body-in-airway-2?lang=gbReferences 13. Gaillard F. Tension pneumothorax: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/tension-pneumothorax-8?lang=gb 14. Sukosd H. Primary pulmonary tuberculosis - ranke complex: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/primary- pulmonary-tuberculosis-ranke-complex-1?lang=gb 15. Knipe H. Cavitating lung lesion - tuberculosis: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/cavitating-lung- lesion-tuberculosis-2?lang=gb 16. Knipe H. Cavitating lung lesion - tuberculosis: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan22]. Available from: https://radiopaedia.org/cases/cavitating-lung- lesion-tuberculosis-2?lang=gb 17. https://radiopaedia.org/articles/pulmonary-fibrosis?lang=gb.FOR FEEDBACK AND QUERIES: Email @ info@bidasw.com