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Reading the CXR

Reading the CXR. Frank Schembri Pulmonary / Critical Care. Types of Densities. Basic Principles of the CXR. Types of views PA Lateral AP Apical lordotic Decubitus (R & L). PA vs AP. Lateral CXR. Apical Lordotic Chest. Decubitus Positioning. Approaching the CXR.

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Reading the CXR

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  1. Reading the CXR Frank Schembri Pulmonary / Critical Care

  2. Types of Densities

  3. Basic Principles of the CXR • Types of views • PA • Lateral • AP • Apical lordotic • Decubitus (R & L)

  4. PA vs AP

  5. Lateral CXR

  6. Apical Lordotic Chest

  7. Decubitus Positioning

  8. Approaching the CXR • Name, date, type of film • Type of film • Patient positioning / rotation • Inspiration • Penetration • White is underpenetrated • Black is overpenetrated

  9. Approaching the CXR • The systematic approach 1. Tubes / Hardware 2. Bones 3. Soft tissues 4.Pleura and diaphragm 5. Trachea and mediastinum 6. Lung parenchyma

  10. Rotation

  11. Rotation

  12. Inspiration

  13. Penetration

  14. Scanning the xray

  15. Scanning the xray

  16. # 1- Hardware

  17. #1- Hardware

  18. #1- Hardware

  19. #1- Hardware

  20. 2. Osseous Structures in the Chest

  21. 2. Osseous Structures of the Chest

  22. 3. Soft Tissues

  23. 4. Pleura and Diaphragm

  24. 5. Mediastinal Anatomy

  25. 5. Mediastinal Anatomy

  26. 5. Mediastinal Compartments

  27. 6. Parenchymal Anatomy

  28. Lateral View Anterior View

  29. 6. Parenchymal Anatomy

  30. Left Lung Right Lung

  31. Lobes Right upper lobe:

  32. Lobes (continued) Right middle lobe:

  33. Lobes (continued) Right lower lobe:

  34. Lobes (continued) Left lower lobe:

  35. Lobes (continued) Left upper lobe with Lingula:

  36. Lobes (continued) Lingula:

  37. Lobes (continued) Left upper lobe - upper division:

  38. Pneumonia

  39. Loss of volume Minor fissue Atelectasis mass Minor fissure Elevation of diaphragm

  40. Minor fissure Major fissure

  41. Pneumothorax • Collection of air in pleural cavity • Primary and secondary causes • Upright position air rises and separates the lung from the chest wall creating a line. Don’t be fooled by skin folds, clothing and bullae. • In the supine position air moves anteriorly. The lung will not be clearly separated from the chest wall.

  42. PTX

  43. Pneumothorax in the Supine Patient Enlarged hemithorax hyperlucent Mediastinal shift Deep sulcus sign Sharper cardiac border

  44. Tension

  45. Pneumothorax

  46. Bat-winged appearance Enlarged heart

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