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Chest X-Ray Interpretation
Mike Darby, Anthony Edey, Ladli Chandratreya, Nick Maskell
CHAPTER 1:
First principles
1.1 Physics of X-rays
X-ray production
X-ray attenuation
Image production
Radiation risks and use
1.2 Positioning the patient and obtaining the image
Frontal chest X-ray
Posteroanterior X-rays
Anteroposterior X-rays
Anteroposterior erect X-ray
Lateral chest X-ray
Other views of the chest
1.3 Radiographic densities
The silhouette sign
Description of abnormalities
1.4 Picture archiving and communication systems: image optimisation and pitfalls
Disadvantages of picture archiving and communication systems
Advantages of PACS systems
1.5 Errors of perception and interpretation
The mechanics of vision
Lesion identification
Cognitive errors
CHAPTER 2:
Understanding the normal chest X-ray
2.1 Normal chest anatomy
Normal views
Posteroanterior chest X-ray
Lateral chest X-ray
Assessing normal anatomy
Airways and fissures
The normal diaphragm
2.2 Normal variants
Azygos lobe or fissure
Accessory or incomplete fissures
Right-sided aorta
Dextrocardia
Rib anomalies
Diaphragm variants
Bochdalek hernia
Eventration of the diaphragm
2.3 Artefacts
Nipple shadows
Skin folds and skin lesions
Mastectomy
Body jewellery, hair and clothing
2.4 Systematic approach to reviewing the chest X-ray
Step 1: identification of the X-ray and clinical information
Step 2: checking technical factors
Positioning
Side markers
Patient rotation
Degree of inspiration
Erect or supine position
Step 3: examination
Trachea and root of the neck
Lung fields
Silhouette sign
Mediastinum and heart
Fissures
Hila
Diaphragm
Below the diaphragm
Bones and soft tissues
Artefacts
Abnormal densities
Step 4: diagnosis
Review areas
2.5 Postsurgical appearances
Pneumonectomy
Lobectomy
Thoracotomy
Coronary artery bypass graft
CHAPTER 3:
Recognising abnormal results
3.1 Lung opacities
Airspace opacification
Radiographic findings
Pulmonary masses
Radiographic findings
Pulmonary nodules
Macronodular opacities
Small nodular opacities
Radiographic findings
Micronodular opacities
Cavitating lesions
3.2 Atelectasis
Types of atelectasis
Radiographic findings
Whole lung atelectasis
Radiographic findings
Lobar atelectasis
Radiographic findings
Linear atelectasis
Mechanism
Radiographic findings
Round atelectasis
Mechanism
Radiographic findings
Management
3.3 Reticular opacities
Honeycombing
3.4 Pleural abnormalities
Pleural plaques
Radiographic findings
Management
Pleural effusions
Subpulmonary effusion
Supine pleural effusion
Loculated pleural effusion
Pleural thickening
Pneumothorax
Radiographic findings
3.5 Mediastinal abnormalities
Analysis of mediastinal masses
Distinguishing mediastinal from lung masses
Mediastinal divisions
The silhouette sign
Anterior mediastinal masses
Radiographic findings
Middle mediastinal masses
Radiographic findings
Posterior mediastinal masses
Radiographic findings
3.6 Diaphragm, subdiaphragmatic area and chest wall abnormalities
Diaphragm paralysis
Ruptured diaphragm
Pneumoperitoneum
Rib fracture and metastasis
Subcutaneous emphysema
CHAPTER 4:
Thoracic infections
4.1 Community-acquired pneumonia
Key facts
Radiographic findings
Management
4.2 Active tuberculosis
Primary tuberculosis
Postprimary tuberculosis
Tuberculous adenopathy
Radiographic findings
Tuberculous pleural effusion and empyema
Radiographic findings
Miliary tuberculosis
Tuberculous infiltrates, endobronchial tuberculosis and tuberculous cavities
Management
4.3 Old tuberculosis
Old tuberculosis empyema
Radiological evidence of surgical treatment in tuberculosis
Plombage
4.4 Pneumocystis pneumonia
Key facts
Radiographic findings
Management
4.5 Fungal infection: aspergilloma
Aspergillom
Key facts
Radiographic findings
Management
CHAPTER 5:
Interstitial lung diseases
5.1 Sarcoidosis
Key facts
Radiographic findings
Management
5.2 Usual interstitial pneumonia
Key facts
Radiographic findings
Management
5.3 Asbestosis
Key facts
Radiographic findings
Management
5.4 Silicosis
Key facts
Radiographic findings
Management
CHAPTER 6:
Bronchogenic malignancy and metastatic disease
6.1 Bronchogenic malignancy
Hilar masses
Key facts
Radiographic findings
Management
Pancoast tumours
Key facts
Radiographic findings
Management
Obstructive lesions
Key fact
Radiographic findings
Management
Bronchoalveolar cell carcinoma
Key facts
Radiographic findings
Management
6.2 Metastatic disease
Lung metastases
Radiographic findings
Lymphangitis carcinomatosa
Radiographic findings
Endobronchial metastases
CHAPTER 7:
Pleural disease
7.1 Mesothelioma and other pleural malignancies
Clinical features
Radiographic findings
7.2 Solitary fibrous tumour of the pleura
Key facts
Radiographic findings
Management
7.3 Pleural infection
Radiographic findings
7.4 Pneumothorax
Radiographic findings
Management
CHAPTER 8:
Mediastinal disease
8.1 Thymoma
Key facts
Radiographic findings
Management
8.2 Hiatus hernia
Key facts
Radiographic findings
Management
8.3 Bronchogenic cyst
Key facts
Radiographic findings
Management
8.4 Retrosternal goitre
Key facts
Radiographic findings
Management
8.5 Pneumomediastinum
Key facts
Radiographic findings
Management
8.6 Mitral regurgitation
Key facts
Radiographic findings
Management
8.7 Pericardial effusion
Key facts
Radiographic findings
Management
8.8 Aortic dissection
Key facts
Radiographic findings
Management
CHAPTER 9:
Airway pathology
9.1 Asthma
Radiographic findings
9.2 Allergic bronchopulmonary aspergillosis
Radiographic findings
9.3 Churg–Strauss syndrome
Key facts
Radiographic findings
9.4 Chronic obstructive pulmonary disease
Key facts
Radiographic findings
9.5 Alpha 1-antitrypsin deficiency
Key facts
Radiographic findings
9.6 Bronchiectasis and cystic fibrosis
Key facts
Radiographic findings
9.7 Inhaled foreign body
Radiographic findings
Management
CHAPTER 10:
Pulmonary oedema
10.1 Cardiogenic pulmonary oedema
Radiographic findings
10.2 Acute lung injury and acute respiratory distress syndrome
Key facts
Radiographic findings
CHAPTER 11:
Positions of lines and tubes in the chest
11.1 Nasogastric tubes
Key facts
Radiographic findings
11.2 Central venous lines and pacemakers
11.3 Tracheal intubation
11.4 Chest drains
11.5 Other devices and the intensive care situation
INDEX
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