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Basic
Interpretation of
Chest X.rays And
common diseases

Understanding Chest X Rays - Dr Khan Health Blogs

Five Radiographic Opacities
Air Fat Soft tissue Bone Metal
least opaque to most opaque
most lucent to least lucent
Black to White

• Left upper lobe with Lingula:

Portable (AP or Antero-
posterior)
FILM

PA vs AP views
PA view
 Scapula is seen in
periphery of thorax
 Clavicles project
over lung fields
 Posterior ribs are
distinct
AP view
 Scapulae are over
lung fields
 Clavicles are above
the apex of lung
fields
 Anterior ribs are
distinct

• Lobar consolidation:
– Alveolar space filled
with inflammatory
exudate
– Interstitium and
architecture remain
intact
– The airway is patent
– Radiologically:
• A density corresponding
to a segment or lobe
• Air bronchogram, and
• No significant loss of lung
volume
Consolidation

Congestive Heart Failure
 Increased heart size:
cardiothoracic ratio
>0.5

CongestiveHeartFailure
 Alveolar edema
(Bat’s wings)
 Kerley B lines
(Interstitial edema)
 Cardiomegaly
 Dilated prominent
upper lobe vessels
 Pleural effusion

ARDS
 Congestion
 Interstitial and
alveolar edema
 Collapsed or
distended alveoli
 Bilateral

Right side
tension
pneumothorax

A single, 3cm relatively thin-walled cavity is noted in the left
midlung.This finding is most typical of squamous cell carcinoma
(SCC). One-third of SCC masses show cavitation

Right Middle and Left Upper Lobe Pneumonia

Cavitation : cystic changes in the area of consolidation due to the
bacterial destruction of lung tissue. Notice air fluid level.

COPD: increase in heart diameter, flattening of the diaphragm,
and increase in the size of the retrosternal air space. In addition
the upper lobes will become hyperlucent due to destruction of
the lung tissue.

CHF:a great deal of accentuated interstitial markings,
Curly lines, and an enlarged heart. Normally indistinct
upper lobe vessels are prominent but are also masked
by interstitial edema.

24 hours after diuretic therapy

Chest wall lesion: arising off the chest wall and not the lung

Pleural effusion: Note loss of left hemidiaphragm. Fluid
drained via thoracentesis

Right Middle Lobe Pneumothorax: complete lobar collapse

Post chest tube insertion and re-expansion

5. 65 yo male admitted for sepsis. CHF or ARDS?

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Understanding Chest X Rays - Dr Khan Health Blogs

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