CXR (Chest X-Ray) Cases

Two identical chest radiographs. This is an example of an air bronchogram caused by severe bilateral consolidation. The air bronchogram is marked in green on the inferior radiograph. (You can also see: endotracheal tube in situ, nasogastric tube in situ, ECG leads and large cannula in superior vena cava.) 🩻 @CXRcases

Two identical chest radiographs. This is an example of an air bronchogram caused by severe bilateral consolidation. The air bronchogram is marked in green on the inferior radiograph. (You can also see: endotracheal tube in situ, nasogastric tube in situ, ECG leads and large cannula in superior vena cava.) 🩻 @CXRcases

Air bronchogram It can appear when there is consolidation (e.g. pneumonia), collapse or pulmonary oedema in the surrounding alveoli. 🩻 @CXRcases

Two identical chest radiographs showing left lower lobe consolidation. The patchy airspace shadowing corresponds to the left lower lobe and there is no loss of lung volume. We know the consolidation is in the left lower lobe as there is loss of definition of the left hemidiaphragm. The right radiograph shows the consolidation marked in green. 🩻 @CXRcases

Two identical chest radiographs showing consolidation in the lingula. There is patchy airspace shadowing and no loss of lung volume. We know the consolidation is in the lingula as there is loss of the left heart border. The right radiograph shows the consolidation marked in green. 🩻 @CXRcases

Two identical chest radiographs showing middle lobe and left lower lobe consolidation. The patchy airspace shadowing corresponds to the middle lobe and left lower lobe and there is no loss of lung volume. We know the consolidation is in the middle lobe as there is loss of the right heart border and the superior border is the horizontal fissure. We know the consolidation is in the left lower lobe as there is loss of definition of the left hemidiaphragm and the left heart border is still visible. The right radiograph shows the consolidation marked in green. 🩻 @CXRcases

Two identical chest radiographs showing middle lobe consolidation. The patchy airspace shadowing corresponds to the middle lobe and there is no loss of lung volume. We know the consolidation is in the middle lobe as there is loss of the right heart border and the superior border is the horizontal fissure. The right radiograph shows the consolidation marked in green. 🩻@CXRcases

Two identical chest radiographs showing right upper lobe consolidation with sparing of the apical segment. The patchy airspace shadowing corresponds to the right upper lobe and there is no loss of lung volume. The right radiograph shows the consolidation marked in green. 🩻@CXRcases

Two identical chest radiographs showing consolidation. There is consolidation in both lungs with moderate sparing of the apical segment of the right upper lobe (seen as darker than the rest). There is patchy airspace shadowing, no loss of lung volume and if you look carefully, you can see air bronchograms in both lungs. The right radiograph shows the consolidation marked in green. (You can also see: endotracheal tube in situ, nasogastric tube in situ, ECG leads and large cannula in superior vena cava.) 🩻 @CXRcases

Consolidation/Airspace shadowing 🔴 Patchy shadowing : non - uniform shadowing and the border is not well demarcated. 🔴 Lobar or segmental density : the density should correspond anatomically to a lobe or lung segment. 🔴 Air bronchogram: the presence of an air bronchogram would confirm that the density (fluid/pus) was in the alveoli and not the larger airways. Bronchial breathing is the clinical equivalent of the air bronchogram. 🔴 No loss of lung volume : lung volumes may actually increase in the early stages of consolidation. In later stages there can be a small loss of lung volume due to secretions obstructing airways; however, as a general rule, there is no significant loss of lung volume in consolidation. 🩻 @CXRcases

Two identical chest radiographs showing widening of the carinal angle. The carinal angle is greater than 100 ° . The right radiograph shows the trachea, right mainstem bronchus and left mainstem bronchus marked in blue. 🩻 @CXRcases

Carinal angle Normally the angle is between 40 ° and 100 ° . An increase in the carinal angle is an indirect sign of pathology in the heart, mediastinum or lungs. • sub - carinal mass (a mass below the carina, e.g. bronchial carcinoma, hiatal hernia) • left atrial enlargement , cardiomegaly or a pericardial effusion • right or left upper lobe collapse (pulling the mainstem bronchus upwards). 🩻 @CXRcases

Two identical chest radiographs showing right tracheal deviation. The trachea is shown in blue on the right radiograph. (You can also see: mass lesion in the right lung and hilum, with resultant middle lobe collapse, pulling the trachea to the right.) 🩻 @CXRcases

Tracheal deviation 🔴 Deviated towards diseased side – lung collapse – pneumonectomy (removal of a lung) or lobectomy (removal of just one lobe) – unilateral fibrosis – agenesis of lung (also called lung aplasia – complete absence of a whole lung and its bronchus). 🔴 Deviated away from diseased side – tension pneumothorax – pleural effusion (large) – mediastinal masses – para - tracheal masses. 🩻 @CXRcases

E – Everything else 🔴Look at the hemidiaphragms specifically for air under the diaphragm. 🔴Look at the edges of the body and all over the film for surgical emphysema . 🔴 In a female patient look for the breast shadows . 🔴Look for foreign bodies and ‘ other unnatural presences ’ . 🩻 @CXRcases

A normal chest radiograph. Rotating the radiograph makes it easier to look for fractures or bony abnormalities. 🩻 @CXRcases