Pulmonology Book

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Chest XRay Interpretation

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  1. Systematic Review
    1. General
      1. See XRay Interpretation
      2. Compare findings from side to side
    2. Alignment
      1. Note if patient is lordotic or kyphotic
      2. Note patient rotation
        1. Spinous processes midway between clavicle heads
    3. Specific points of exam
      1. Lines and Tubes
      2. Bones
      3. Soft tissues
      4. Pleural spaces
      5. Mediastinum
      6. Cardiovascular structures
      7. Lung parenchyma
      8. Infradiaphragmatic areas
    4. Standard Checks
      1. Hilum is higher on the left
      2. Hemidiaphragm is lower on the left
        1. May be variable in older patients
      3. Right hemidiaphragm sharply outlined
      4. Left hemidiaphragm sharply outlined lateral to apex
      5. Localize any lesion on both lateral and AP
      6. Endotracheal Tube should be above carina
        1. Usually overlies 5-6th vertebrae
      7. Trace intravenous lines along entire course
      8. Trace Nasogastric Tubes along entire course
  2. Findings
    1. Widened Mediastinum (>6-8cm)
      1. Aortic Dissection
    2. Pneumomediastinum
      1. Esophageal Rupture
    3. Silhouette Sign
      1. Infiltrate, fluid or air
    4. Air Bronchogram
      1. Lung consolidation
      2. Atelectasis
    5. Lobar Collapse (Atelectasis)
      1. Bronchial obstruction
    6. Hilar Node Enlargement
    7. Straight Pulmonary Lines
    8. Pulmonary Infiltrates
    9. Pulmonary Edema
    10. Pleural Space
  3. References
    1. Marini (1987) Respiratory Medicine, Williams & Wilkins

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