Chest

The chest X-ray step by step, its signs and findings, and chest CT.

22 pages

Finding

• A nodule or a mass on the chest X-rayA round spot in the lung is called a nodule if it is 3 cm or less and a mass if it is bigger
• Cardiomegaly and pulmonary oedema on the chest X-rayIn heart failure the heart looks big and fluid backs up into the lungs
• Cavities and air-fluid levels in the lungA cavity is a hole with a wall inside the lung, where tissue has died and drained; it may hold…
• Chest trauma imaging: ribs, contusion, haemothorax and the aortaAfter a chest injury, a quick X-ray and bedside ultrasound look for problems that kill fast; a…
• Consolidation and air bronchogramsConsolidation means the air in part of the lung has been replaced by fluid or pus, so that part…
• CT pulmonary angiography for pulmonary embolismA CT scan taken while contrast fills the lung arteries
• Free air in the chest: pneumomediastinum and subcutaneous emphysemaAir escapes into the middle of the chest or under the skin
• High-resolution CT patterns: ground glass, crazy paving, tree-in-budHigh-resolution CT uses very thin slices of the lungs; a few named patterns, like hazy glass or…
• Interstitial patterns: lines, nodules and honeycombingWhen the lung's thin supporting tissue thickens, the X-ray shows a net of fine lines, many tiny…
• Lobar collapse (atelectasis) on the chest X-rayWhen a lobe loses its air it shrinks and turns white, and the structures around it are pulled…
• Pleural effusion on the chest X-rayFluid around the lung sinks to the bottom of the chest and shows as a white area with a curved…
• Pneumothorax on the chest X-rayAir leaks into the space around the lung and the lung pulls away from the chest wall
• The child's chest X-ray: thymus, foreign body, croup and epiglottitisA child's X-ray has its own normal: a big thymus near the heart
• The white hemithorax: collapse, effusion, pneumonia or pneumonectomyOne side of the chest X-ray is completely white
• The widened mediastinum and the hilaThe middle of the chest X-ray holds the heart, great vessels, airway and lymph nodes; if it…

Reading

• Is this chest X-ray good enough? Projection, rotation, inspiration and exposureBefore reading a chest X-ray, check it was taken well: the right view, the patient straight, a…
• Lines and tubes on the chest X-ray: where each tip should beAfter a breathing tube, feeding tube or central line goes in, an X-ray checks where its tip…
• Reading a chest CT step by stepA chest CT is a stack of slices; reading it in the same order every time, in three windows…
• Reading a chest X-ray step by stepRead every chest X-ray in the same order, from the tubes to the bones, so nothing is missed even…

Modality

• The heart on CT and MRI: coronary CT, calcium score and cardiac MRIHeart-synchronised CT shows the coronary arteries and their calcium; cardiac MRI measures how…

Sign

• The silhouette sign: which lobe is it?On an X-ray, two things of the same density that touch lose the edge between them

Choosing a study

• Which chest study to order: X-ray, CT, CT angiography or ultrasoundMost chest questions start with an X-ray

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← Radiology and diagnostic imaging

Educational content; it does not replace a radiologist's report and is not a clinical instruction. Each study is ordered on the patient's assessment and your institution's protocols.

Representative model, for educational purposes only.