Pulmonology Book

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Chest XRay

Aka: Chest XRay, CXR Evaluation, Chest Radiograph, X-Ray Chest, Thoracic Radiography
  1. See Also
    1. Lung Ultrasound
  2. Protocol: Standard Views
    1. Standing (Upright Chest XRay)
      1. Posteroanterior (PA) Film
      2. Left Lateral XRay
        1. Request right lateral film if right-sided finding
        2. Normally more dark in the retrocardiac space and inferior spine approaching the diaphragm
          1. Increased white density ("spine sign") is seen in Pneumonia, aspiration, mass or Pleural Fluid
          2. Medjek (2015) Br J Radiol 88(1050): 20140378 +PMID:25827203 [PubMed]
        3. More sensitive than PA for abdominal free air
          1. Woodring (1995) AJR 165:45-7 [PubMed]
    2. Supine (Portable Chest XRay)
      1. Anteroposterior (AP) Film
        1. Magnifies heart and anterior mediastinum
        2. Emphasizes rib and Calcium contrast
        3. Lung parenchyma may appear washed out
  3. Protocol: Special Views
    1. Inspiration and Expiration Film Indications
      1. Pneumothorax accentuated on expiration
      2. Unilateral diaphragmatic paralysis
      3. Unilateral obstruction of major Bronchus
    2. Lordotic View Indications
      1. Posterior Apical Disease
      2. Middle Lobe disease
    3. Reverse Lordotic View Indications
      1. Anterior apical disease
    4. Oblique Film
      1. Peripheral small lesions
        1. Separated from overlying chest shadows
        2. Lesions poorly seen on lateral Chest XRay
      2. Rib Fractures (at axillary lines)
    5. Lateral decubitus Film
      1. Detect small areas of air at uppermost pleural space
      2. Detect small areas of dependent Pleural Fluid
        1. Measure size and mobility of fluid collection
        2. Accessible with sampling needle (>1 cm size)
      3. Uncover Lung tissue obscured by Pleural Fluid
        1. Place side of interest up
      4. Mobility of mediastinal or pleural masses
      5. Assess mobility of solids and fluids within cavities
      6. Assist with maximizing inspiration of uppermost lung
    6. High Penetration Film with moving grid (Bucky Film)
      1. Obesity
      2. Dense pleural or pulmonary opacities
      3. Calcified lesions
      4. Lesions obscured by heart or diaphragms
      5. Air Bronchograms in densely infiltrated areas
    7. Intrathoracic Pressure Maneuvers
      1. Valsalva Maneuver: shrinks pulmonary vessels
      2. Muller Maneuver: distends pulmonary vessels
      3. Indications
        1. Distinguish blood vessel from Lymph Node
        2. Distinguish A-V malformation from solid lesion
    8. Barium Swallow
      1. Enlarged retro-mediastinal nodes
      2. Define Posterior intrathoracic mass
      3. Confirm ruptured diaphragm or Diaphragmatic Hernia
      4. Impaired Swallowing with aspiration
    9. Diagnostic Pneumothorax (instill air in pleural space)
      1. Distinguish peripheral Lung Mass from pleural lesion
      2. Define Mesothelioma
      3. Parenchymal disease extending towards chest wall
  4. Evaluation: Circumstances that decrease Chest XRay quality
    1. Semi-upright position (neither standing nor supine)
      1. May enlarge normal structures
      2. Changes air-fluid levels
    2. Lordosis or vertical axis rotation
      1. Widens heart and mediastinum
    3. Inadequate sustained inspiration
      1. Breathing film
        1. Lung structures and diaphragm blurred
      2. Expiration film
        1. Basilar infiltrates accentuated
        2. Interstitial structures accentuated
          1. Vessels
          2. Pleural Fluid
        3. Increased heart size
    4. Supine Film
      1. Decreases Lung Volume
        1. Highlights infiltrates and interstitium
      2. Increases venous return to heart
        1. Distends azygous vein and pulmonary vein
      3. Diaphragm rises and intracardiac pressure increases
        1. Heart and mediastinal structures enlarge
      4. Fluid and air migrate
        1. Pleural Effusions disappear
        2. Small Pneumothorax disappears
        3. Air-Fluid levels (e.g. Lung Abscess) disappear
      5. Pneumothorax signs on supine film
        1. Deep Sulcus sign
          1. Costophrenic angle sharply outlined by air
          2. Diaphragm-mediastinal junction sharply outlined
        2. Hyperlucency superimposed over liver shadow
  5. Images
    1. Azygous Vein
      1. radlungcxrazygusvein.jpg
  6. Resources
    1. LITFL: Chest XRay Interpretation
      1. https://lifeinthefastlane.com/investigations/cxr-interpretation/
  7. References
    1. Marini (1987) Respiratory Medicine, Williams & Wilkins
    2. Katz (1999) Clin Chest Med 20(3):549-62 [PubMed]

Plain chest X-ray (C0039985)

Definition (NCI) An x-ray examination of the chest.
Definition (NCI_NCI-GLOSS) An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
Definition (CSP) X ray visualization of the chest and organs of the thoracic cavity; not restricted to visualization of the lungs.
Concepts Diagnostic Procedure (T060)
ICD10 58500-00
SnomedCT 55587003, 399208008
CPT 71035, 1010335, 1010354
LNC LA16043-4
Italian Radiografia del torace, Radiografia NAS del torace
Dutch CXR, röntgenfoto NAO borstkas, borstkasröntgenfoto
French Radio thorax, Radiographie SAI du thorax, Radiographie du thorax
German Roentgen NNB des Brustraums, CXR, Roentgen Thorax
Portuguese RX do tórax, Raios X NE do tórax, Radiografia do tórax
Spanish Radiografía NEOM torácica, examen radiológico de tórax, radiografía de tórax (procedimiento), Rx de tórax, radiografía de tórax, radiografía simple de tórax (procedimiento), radiografía simple de tórax, Radiografía torácica
Japanese 胸部X線NOS, 胸部X線, キョウブXセンNOS, キョウブXセン
English chest X ray, chest radiography, chest xray, X-ray NOS chest, CXR, x-ray of chest (procedure), x-ray of chest, chest x-ray, thoracic x-ray, X-ray;chest, chest x ray, chest x rays, cxr, thoracic x rays, thorax x-ray, X-ray of chest, Radiography of chest (procedure), Radiologic examination, chest, Radiologic examination, Chest--Radiography, Plain chest X-ray, CXR - Chest X-ray, Chest X-ray, Chest exclusion X-ray, Chest x-ray, Radiography of chest, Plain chest X-ray (procedure), Radiologic examination of chest, Radiography of chest, NOS, Radiologic examination of chest, NOS, Chest x-ray, NOS, Chest Radiography, thoracic radiography, X-ray of chest NOS, chest X-ray
Czech Rentgenové vyšetření NOS hrudníku, Rentgenové vyšetření hrudníku
Hungarian Mellkasröntgen, Mellkas röntgen, Mellkas röntgen k.m.n.
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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