Chest X-ray interpretation

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Chest X-ray interpretation

• Julee Waldrop, MS, PNP
• School of Nursing
• UNC

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Chest X-ray

• Generally get AP and Lateral views
• Fullest inspiration if possible (see example of
  difference in expiration and inspiration in
  module)
• Dimensions
• AP lt 2 years 11
• gt 2 years 21

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Normal Chest X-ray

• Cardiac Structures
• Position
• More central in younger infants and children
• More on the L side in older infants and teens
• Size
• In AP view if lt 2 years take up to 65
• If gt 2 years - 50

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Normal Chest X-ray

• 1. Soft tissue structures
• Shadows, most commonly, breast
• 2. Bony structures
• Count the ribs
• 8 9 ribs should be visible on inspiration
• Clavicle placement at 2-3 intercostal space (if
  not, may be malrotated)

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Normal Chest X-ray

• 3. Diaphragm
• Contour
• Rounded with sharp pointed costophrenic and
  costocardiac angles
• Right diaphragm is usually 1-2 cm higher

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Normal Chest X-ray

• 4. Lungs
• Start at the top and compare the R and L
• Trachea should be midline over the thoracic
  vertebrae and air filled
• Lung parenchyma becomes lighter as you go down
  the lung. If not, it may indicate a lower lobe
  or pleural effusion

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Abnormal Chest X-ray

• Radiopacity (whiteness) means increased density
• Radiotranslucency (blackness) means decreased
  density
• Radiopacity can be of 3 causes
• Alveolar pattern fluffy, soft, poorly
  demarcated opacifications lt 1 cm in diameter
• Possible causes
• Pulmonary edema
• Viral pneumonia
• Pneumocystis
• Alveolar cell carcinoma

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Note ground glass appearance of the lungs here
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Tracheal deviation to the Right caused by
posterior tumor
Posterior chest wall tumor
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Abnormal Chest X-ray

• Interstitial pattern
• Consolidation of interstitial tissue (alveolar
  walls, intralobular vessels, interlobar septa and
  connective tissue)
• Looks like branching lines radiating toward the
  periphery of the lung
• Possible causes
• Interstitial pneumonitis
• Pulmonary fibrosis

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Middle lobe infiltration
Boot shaped heart enlarged heart
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Abnormal Chest X-ray

• Vascular pattern assessment of the pulmonary
  arteries and capillaries
• If there is an increase in the size of the
  pulmonary arteries as they extend out into the
  lung pulmonary hypertension
• If there is a decrease in size, truncation, or
  obliteration of a pulmonary artery embolus
• Lack of vascular making in the periphery -
  pneumothorax

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Trace the lung vascular markings out to the
border of the rib cage. When the lung markings
stop short of the rib cage and thrre is increased
radiolucency in the pleural space, the patient
has a pneumothorax.