Pocket Tutor Chest X-Ray Interpretation Mike Darby, Ladli Chandratreya
INDEX
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Abdominal drains 233
Abnormal signs 59
atelectasis 6985
diaphragm paralysis 106, 106
honeycombing 88, 88
lung opacities 5969
mediastinal abnormalities 97105
pleural abnormalities 8896
pneumoperitoneum 107, 107108
reticular opacities 8588, 86, 86
rib fracture and metastasis 108, 108111, 109, 110
ruptured diaphragm 107
subcutaneous emphysema 110, 111
ABPA see Allergic bronchopulmonary aspergillosis (ABPA)
Accessory fissures 24
Acute lung injury 221222
Acute respiratory distress syndrome (ARDS) 217, 221, 221222
Air-filled stomach 51
Airspace opacification 59, 60, 61
Airway disease 201
allergic bronchopulmonary aspergillosis 203205, 204, 204
alpha 1-antitrypsin deficiency 208209, 209
asthma 201203, 202
bronchiectasis and cystic fibrosis 210, 210213, 212214
chronic obstructive pulmonary disease 205208, 206, 207
inhaled foreign body 213215, 215
Allergic bronchopulmonary aspergillosis (ABPA) 203205, 204, 204
chest X-ray in 203205, 204, 204
diagnosis of 203, 204
Alpha 1-antitrypsin deficiency 208209, 209
Alveolar opacification see Airspace opacification
Alveolar rupture 191
Anteroposterior X-rays 5, 6
AP erect view 5, 6
Aortic anomalies 27
Aortic dissection 197199, 198
Apical and lordotic views 7
ARDS see Acute respiratory distress syndrome (ARDS)
Artefacts 39
body jewellery 41, 45
hair and clothing 41, 44
mastectomy 41, 42, 43
nipple shadows 39, 39
skin folds and skin lesions 3941, 40
Asbestosis 148, 150151
chest X-ray in 150, 150151
complications of 150
HRCT scan 151, 151
Aspergilloma 135136
air crescent sign 135, 136
diagnosis of 136
Aspergillus fumigatus 134
Asthma 201203, 202
airway narrowing in 202
bronchial hyperresponsiveness in 201
chest X-ray in 202, 203
hyperinflated lungs in 202, 203
Atelectasis 6985
adhesive 70
causes of 71
cicatrisation 70
linear 82, 8283
lobar 7281
obstructive or resorption 69, 72
partial 69
passive 69
radiographic findings 70
round 8384, 84, 85
whole lung 7071
Atrial septal defects 245
closure devices 245, 245
Azygos lobe/fissure 24, 25
B
Bacillus Calmette-Guérin (BCG) 120
Bariatric surgical treatment see Gastric band device
Beck triad 194
Blesovsky's syndrome see Round atelectasis
Bochdalek hernia 35, 36
Body jewellery 41, 45
Boerhaave's syndrome 266, 266
Breast implants 249, 249
Bronchiectasis 203, 210213, 212, 213
causes of 210
chest X-rays 211, 212
HRCT findings 211, 213
types of 211
Bronchogenic cysts 187, 187189, 188
chest X-ray 187
CT scan 188, 189
MRI scan 188, 189
Bronchogenic malignancy 155
as consolidation 160161, 162, 163
hilar masses 156, 156157
non-small cell carcinoma 155
obstructive lesions 158160, 159, 160
Pancoast tumours 157, 158
small-cell carcinoma 155
Bronchopneumonia 113, 115, 116, 117 see also Community-acquired pneumonia
Butterfly vertebra 3031
C
Cardiac system, normal variants and congenital anomalies 27
Cardiogenic pulmonary oedema 217221
acute pulmonary oedema 218
alveolar oedema 219, 220, 221
bat's wing appearance 220
increased pulmonary venous pressure 218
interstitial oedema 218219, 220
Cavitating lesions 6667, 68, 69, 70
Central venous lines and pacemakers 226227
correct positioning, chest X-ray for 227, 228
misplaced right jugular venous line 227, 230
pneumothorax by pacemaker insertion 227, 229
Cervical rib 31, 33
Cervical spine X-ray 31, 33
Chest anatomy, normal see also Normal variants and congenital anomalies
airways and fissures 20, 2022, 21
diaphragm 2223, 23
fissures 22
lateral chest X-ray 1719, 19
lung parenchyma 22
mediastinal features 2022
PA chest X-ray 17, 18
visualisation of edges 22
Chest drains 229230, 232, 233
Heimlich valve 230231, 234
Chest wall
anomalies 31
injuries 257263
Chilaiditi's syndrome 51
Chronic obstructive pulmonary disease (COPD) 205208, 206, 207
chronic bronchitis 205, 206
emphysema 205208, 207
Cognitive errors 1516
alliterative errors 16
anchoring 16
availability bias 15
capture 15
gambler's fallacy 15
overconfidence 16
satisfaction of search 15
Community-acquired pneumonia 113, 113114, 114
Computerised tomography (CT), in pneumococcal pneumonia 114, 115
Congenital anomalies 24 see also Normal variants and congenital anomalies
Congenital heart disease (CHD) 27
Congenital pulmonary airway malformation 27, 28
Contusions 263, 264
Coronary artery bypass grafting 57, 57
Costophrenic angles 50
Cystic fibrosis 210213, 214 see also Bronchiectasis
D
Decubitus views 6
Deterministic effects 2
Dextrocardia 27, 30
Diaphragm
anomalies 35, 36, 37, 38
eventration of 35, 38
high 23
normal 2223, 23
PA chest X-ray 23, 23
paralysis 106, 106
ruptured 107
Diaphragmatic rupture 268, 268, 269
Discoid atelectasis see Linear atelectasis
E
Embolisation coils 239, 241
Emphysematous bullae 207, 207208
Empyema
active tuberculosis 122, 122124
old tuberculous 129, 129
Endobronchial metastases 167
Endobronchial valves 235236, 237, 238
Endovascular repair of the thoracic aorta (TEVAR) 242
Errors of perception and interpretation 12
cognitive errors 1516
lesion identification 1415
mechanics of vision 1314
minimising errors 15
F
Flail segment 258
Folded lung syndrome see Round atelectasis
Foreign bodies, inhalation of 213215, 215
Frontal chest X-ray 35
anteroposterior (AP) view 5, 6
posteroanterior (PA) view 34, 4
Fungal infections of lung 134
allergic bronchopulmonary aspergillosis 135
aspergilloma (fungal ball) 135
invasive pulmonary aspergillosis 135
G
Gastric band device 245246, 246
slipped gastric band 246, 247
Gun shot injury 271, 271, 273
H
Haemothorax 256
Heimlich valve 230231, 234
Hemivertebra 2930, 31
Hiatus hernia 185187, 186
air–fluid level in retrocardiac opacity 186, 186187
rolling 185
sliding 185
High-resolution computerised tomography (HRCT) 141
asbestosis 151, 151
bronchiectasis 211, 213
idiopathic pulmonary fibrosis 147, 149
sarcoidosis 144, 144
silicosis 153, 153
Hilar masses 156, 156157
Histoplasma capsulatum 137
Histoplasmosis 137139
antifungal agents for 139
anti-inflammatory drugs for 139
bilateral infiltrates or nodules 137, 138
imaging features 138
Honeycombing 88, 88
Horner's syndrome 157
Hospital-acquired pneumonia 116, 118119
HRCT see High-resolution computerised tomography (HRCT)
Hypertrophic osteoarthropathy 176
Hypoplastic lung 2425, 26
I
Idiopathic interstitial pneumonias 145 see also Idiopathic pulmonary fibrosis (IPF)
Idiopathic pulmonary fibrosis (IPF) 145, 147148
chest X-ray in 147, 148
honeycomb cysts in 147
HRCT scans 147, 149
pirfenidone and nintedanib for 148
pneumomediastinum in 147, 149
steroids and immunosuppression for 148
ILR see Implantable loop recorder (ILR)
Implantable loop recorder (ILR) 242244, 243
Inferior accessory fissure 24
Inhalation of foreign bodies 213215, 215
Interstitial lung disease 141
asbestosis 148, 150151
causes of 141
idiopathic pulmonary fibrosis 145, 147148
presenting features of 141
sarcoidosis 141145
silicosis 151154
Intrapulmonary nodules 39
Ionising Radiation (Medical Exposure) Regulations 2017, UK 2
IPF see Idiopathic pulmonary fibrosis (IPF)
L
Laminar effusions 219
Lateral chest X-ray 5, 7
normal chest anatomy 1719, 19
Left ventricular partitioning device 244, 244
Linear atelectasis 82, 8283
Lobar atelectasis 50, 7281
left upper lobe atelectasis 75, 80, 81
lower lobe atelectasis 75, 78, 79
radiographic findings 7273, 73, 74
right middle lobe atelectasis 75, 76, 77
Lobar pneumonia 113 see also Community-acquired pneumonia
Lobectomy 55, 5556
Lung metastases 161162, 163165
Lung opacities
airspace opacification 59, 60, 61
pulmonary masses 5960, 62, 63
pulmonary nodules 6067
Lung volume reduction surgery (LVRS) 234235
bronchosopic insertion of coils 237238, 239
endobronchial valves 235236, 237, 238
Lymphangitis carcinomatosa 162, 166, 166
M
Macronodular opacities 6061, 63, 64
Mastectomy 41, 42
with breast implant 41, 43
Mediastinal adenopathy 162
Mediastinal disease 183
aortic dissection 197199, 198
bronchogenic cysts 187, 187189, 188
hiatus hernia 185187, 186
mitral regurgitation 193, 193194
pericardial effusion 194197, 195, 196, 196
pneumomediastinum 191192, 192
retrosternal goitre 189191, 190, 191
thymoma 183185, 184, 185
Mediastinal masses 97105
analysis of 97
anterior 99100, 103
differential diagnosis of 102
mediastinal divisions and 97, 100
middle mediastinal masses 102, 104
posterior mediastinal mass 102, 105
silhouette sign 98, 101
vs. lung masses 97, 98, 99
Mesothelioma 170
chest X-rays 171172, 171173
classification of 170
clinical features 170171
CT scan 173
diagnosis 174
nodular pleural thickening 173
pleural effusion without mediastinal shift 172
and pleural metastasis 172
pleural plaques in 174
unilateral pleural thickening 171
Metastases 161
endobronchial 167
lung 161162, 163165
pleural 169
Methicillin resistant S. aureus (MRSA) pneumonia 116
Micronodular opacities 6566, 66, 67, 68
Miliary nodules 65, 161 see also Micronodular opacities
Miliary tuberculosis 123, 124
Mitral regurgitation 193, 193194
Morgagni hernia 35, 37
Musculoskeletal system, normal variants and congenital anomalies 2838
Mycetoma see Aspergilloma
Mycobacterium tuberculosis 119
N
Nasogastric tubes 223225
incorrectly positioned tubes 223, 225, 226
pneumothorax by 223, 226
tube positioning 223, 224, 224
Nephrostomy tubes 233, 235
Nipple-areolar prosthesis 249, 250
Nipple shadows 39, 39
Normal chest anatomy see Chest anatomy, normal
Normal variants and congenital anomalies 24
accessory or incomplete fissures 24
azygos lobe or fissure 24, 25
Bochdalek hernia 35, 36
congenital pulmonary airway malformation 27, 28
dextrocardia 27, 30
eventration of diaphragm 35, 38
hypoplastic lung 2425, 26
Morgagni hernia 35, 37
pectus carinatum 35
pectus excavatum 32, 34, 34
rib anomalies 31, 32, 33
right-sided aorta 27, 29
vertebral anomalies 2831
O
Oblique views 7
Occipital nerve stimulation (ONS) system 250, 251
Oesophageal stent 233, 236, 246247
Oesophageal tear 266, 266267, 267
Oesophageal variceal embolisation coils 247248, 248
P
Pancoast syndrome 157
Pancoast tumours 157, 158
Parachute device see Implantable loop recorder (ILR)
Parapneumonic effusions 177
Pectus carinatum 35
Pectus excavatum 32, 34, 34
lateral chest X-ray 34, 34
Penetrating injuries 271274, 271274
Peribronchial cuffing 218
Pericardial effusion 194197, 195, 196, 196
causes of 196
chest X-ray 195
Picture archiving and communication system (PACS) 10, 12
advantages of 12, 13, 14
disadvantages of 12
Plate atelectasis see Linear atelectasis
Pleural abnormalities 8896
pleural effusions 89, 9192, 9194
pleural plaques 8889, 90
pleural thickening 9293, 95
pneumothorax 9395, 96
Pleural disease 169 see also Pleural effusions
pleural infection 176177, 178
pleural masses 169170, 170 (see also Mesothelioma)
pleural thickening in 169
pneumothorax 177181
solitary fibrous tumours of pleura 174176, 175, 176
Pleural effusions 89, 9192, 9194, 169, 176177, 178, 256
causes of 169
loculated effusions 92, 94
with mediastinal shift 91, 92
radiographic findings 89, 91
subpulmonary effusion 91
supine pleural effusion 9192, 93
tuberculous 122, 122124
Pleural thickening 9293, 95
calcified 93
malignant 93, 95
Pleural vent see Heimlich valve
Plombage treatment, of tuberculosis 130131
with Lucite balls 132
sponge plombage 130, 131
Pneumatoceles 116, 118, 119
Pneumoconioses 141 see also Interstitial lung disease
Pneumocystis jiroveci 131
Pneumocystis pneumonia 131134, 133, 134
black bronchus sign 133, 134
bronchoscopy with bronchoalveolar lavage for 133
corticosteroids for 134
diffuse opacification in lungs 133, 133
in HIV-infected patients 132
trimethoprim-sulfamethoxazole for 134
Pneumomediastinum 191192, 192, 263
Pneumonectomy 54, 5455
Pneumonia 113
community-acquired 113, 113114, 114
hospital-acquired 116, 118119
lung cancer and 160
Pneumoperitoneum 107, 107108, 270, 270
Pneumothorax 9395, 96, 116, 162, 177181, 191, 192, 255256
chest X-ray 177178, 179
management algorithm 180, 181
primary 93, 177
radiographic findings 95, 96
secondary 94, 177, 181
size of, determination of 94, 96
small apical 94
tension 177
Positioning of patient, and image taking 38
frontal chest X-ray 35
lateral chest X-ray 5, 7, 8
Posteroanterior X-rays 34, 4, 8
in expiration 4
normal chest anatomy 17, 18
Postsurgical appearances, on chest X-ray 54
coronary artery bypass grafting 57, 57
lobectomy 55, 5556
pneumonectomy 54, 5455
thoracotomy 56, 56
Pulmonary arteriovenous malformation (AVM) 239 see also Embolisation coils
Pulmonary infection see Thoracic infections
Pulmonary injury 263, 264
Pulmonary masses 5960, 63
differential diagnosis of 62
radiographic findings 60, 63
sarcoma 63
Pulmonary nodules
cavitating lesions 6667, 68, 69, 70
macronodular opacities 6061, 63, 64
micronodular opacities 65, 66, 67, 68
small nodular opacities 62, 64, 65
Pulmonary oedema 166, 217
acute lung injury 221222
acute respiratory distress syndrome 221, 221222
cardiogenic 217221
noncardiogenic 217, 221222
Pulmonary tuberculosis 119, 120
active tuberculosis 119126
old tuberculosis 126129
plombage 130131, 130132
surgical treatment 129130
R
Radiographic artefact see Artefacts
Radiographic densities 9
air 9
bone and calcific lesions 9
calcified nodules 9, 9
description of abnormalities 10
nodule assessment 9
silhouette sign 10, 11
soft tissues 9
Respiratory system, normal variants and congenital anomalies 2427
Reticular opacities 8588, 86, 86, 87
Retrosternal goitre 189191, 190, 191
chest X-ray 190, 190
CT scan 191
Reviewing chest X-rays, systematic approach to 41, 45
abnormal densities 5152
artefacts 51
below the diaphragm 51
bones and soft tissues 51, 53
checking technical factors 4247
degree of inspiration 44, 47, 48
diagnosis 52
diaphragm 50, 5051
erect or supine position 47
fissures 49
hila 50
identification of X-ray and clinical information 42
lungs 48
mediastinum and heart 49, 49
patient rotation 4344, 47
positioning 4243, 46
review areas 53
side markers 43
silhouette sign 49
trachea and root of neck 48
Rib anomalies 31, 32
Rib fractures 258, 260
and metastasis 108, 108111, 109, 110
Right-sided aortic arch 27, 29
Röntgen, Wilhelm 1
Round atelectasis 8384, 84, 85
S
Sarcoidosis 141145, 143146
aortopulmonary adenopathy 142, 143
bronchovascular bundles 144, 144
in chest 142
chest X-ray findings 142, 143
corticosteroids for 146
fibrosis in 145
paratracheal adenopathy 142, 143
PET-CT in 145, 146
staging of 142, 142
Septal (Kerley B) lines 219, 220
Silhouette sign 49, 98, 99, 101
Silicosis 66, 151154
chest X-ray 152, 153
high resolution CT 153, 153
progression to progressive massive fibrosis 152, 153
Situs inversus totalis 27
Skin folds 3940, 40
Skin lesions 4041
Small nodular opacities 62, 64, 65
Soft tissue injury 257
Solitary fibrous tumours of pleura 174176
chest X-rays 174, 175
CT of thorax 174, 175
and refractory hypoglycaemia 174
surgical excision of 176, 176
Spinal fractures 258, 261, 261262, 262
Stab injury 271, 272
Staphylococcus aureus 116
Sternal fractures 262, 263
Stochastic effects 2
Streptococcus pneumoniae 113
Subcutaneous emphysema 110, 111, 258, 259
Superior sulcus tumour see Pancoast tumours
Supine views 6
T
Tamponade 194
Tension pneumothorax 256, 257
Thoracic aortic injury 257
Thoracic aortic stent 242, 243
Thoracic devices positioning and pitfalls 252254, 253
Thoracic infections 113
aspergilloma 134136
community-acquired pneumonia 113, 113114, 114
histoplasmosis 137139
hospital-acquired pneumonia 116, 118119
Pneumocystis pneumonia 131134, 133, 134
tuberculosis, active 119126
tuberculosis, old 126131, 127129
Thoracic trauma 255
chest wall injuries 257263
diaphragmatic rupture 268, 268, 269
flail segment 258
haemothorax and pleural effusion 256
lines and tubes 274, 275, 275
oesophageal tear 266, 266267, 267
penetrating injuries 271274, 271274
pneumoperitoneum 270, 270
pneumothorax 255256
pulmonary injury 263, 264
rib fractures 258, 260
soft tissue injury 257
spinal fractures 258, 261, 261262, 262
sternal fractures 262, 263
subcutaneous emphysema 258, 259
tension pneumothorax 256, 257
thoracic aortic injury 257
tracheal and bronchial injuries 263265, 265
Thoracic ultrasound, in pleural disease 177
Thoracoplasty 130
Thoracotomy 56, 56
Thymoma 183185
CT scan 184, 185
differential diagnosis 184
hilum overlay sign 184
Tracheal and bronchial injuries 263265, 265
Tracheal and bronchial stents 238, 240
complications of 239
Tracheal intubation 228229, 231
Transjugular intrahepatic portosystemic shunt (TIPS) 248, 249
Tuberculosis, active 119126
in immunocompromised patients 120
miliary tuberculosis 123, 124
postprimary tuberculosis 120
primary tuberculosis 120
tree-in-bud appearance 124, 126
tuberculous adenopathy 120122, 121
tuberculous cavities 124, 125
tuberculous infiltrates and endobronchial tuberculosis 124, 125, 126
tuberculous pleural effusion and empyema 122, 122124
Tuberculosis, old 126131, 127129
Tuberculous adenopathy 120122, 121
U
Usual interstitial pneumonia (UIP) 145 see also Idiopathic pulmonary fibrosis (IPF)
V
Vascular system, normal variants and congenital anomalies 27
Ventriculoperitoneal shunt 233, 236
Vertebrae, anomalies of 2829
butterfly vertebra 3031
hemivertebra 2930, 31
Vision 1314
W
Whole lung atelectasis 7071, 72, 160
X
X-rays 1
attenuation 12
image production 2
production 1, 1
radiation risks and use 23
wavelength of 1
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Chapter Notes

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