Chest X-ray

 

notes by  dr Claudio Italiano

The thorax has different anatomical structures, with different ability to retain X-rays, ribs, vertebrae, soft parts, pulmonary parenchyma, mediastinal organs with vessels, lymph nodes, heart etc. The fundamental thorax projections are the anterior-posterior, to visualize the pulmonary parenchyma and the two lateral ones, to visualize the retrosternal and retrocardial areas and to get a better idea of opacification that, otherwise, would appear to be ascribable to masses and, that, instead, side views reveal different types of affections: an example is the inflammatory infiltrate of the medium lobe, which takes the triangular shape.

What to read in a chest X-ray?

sotto il port-au-cat, una prima lesione nodulare ed un altra al di sotto nel campo medio  ed apicale del polmome di destra.

Chest x-ray: n ° 2 nodular lesions; under the port-au-cat, a first nodular lesion and another underneath in the middle and apical field of the right polmome. The lesions were lung tumors,

tumore con estesa consolidazione a sinistra

It's documented extensive consolidation that massively affects the inferior pulmonary lobe of sn, the lingula and part of the superior lobar segments of sn with volume reduction atelectasico of the consolidated segments and ipsilateral traction of the mediastinal structures.

Opacity: a) extensive and diffused, b) multiple to spot, c) round and solitary d) to striae and reticular e) transparency.

- Massive opacities can be caused by inflammatory processes, neoplasms and malformations; for example. the opacity of a lobar pneumonia shows a homogeneous appearance and affects an entire lung lobe, preserving the shape and the size of the lobe, unlike an atellectasic area in which the lung collapses on itself and draw to itself the mediastinal structures and adjacent ones. The margins, as mentioned above, of a lobar pneumonia of the right middle lobe, are better observed in L-L (latero-lateral), with an almost triangular or cuneiform opacity aspect (see pulmonary nodules: general

- The form of massive lobar opacity by classical streptococcus pneumoniae pneumonia. It's characterized by a dense and homogeneous opacity appearance; viral pneumonial infiltrations, on the other hand, will be at blurred limits, as of homogeneous and milky veils, expression of interstitial infiltration and not, as for frank pneumonia, of endoalveolar serum-fibrinous exudate.

addensamento polmonare del lobo destro. Non si trattava di tumore ma di focolaio broncopneumonico

Chest X-ray: pulmonary thickening of the suspected right lobe: in this case it was not a tumor but a bronchopneumonitis outbreak with pericardial effusion


Other massive opacities are those related to hemorrhagic pulmonary infarction, with a cuneiform aspect that extends towards the periphery of the pleura, from emboli starting from venous districts of the pelvis, pelvis, especially in the enticed subjects that have undergone bone fracture reduction interventions. femur, or in the post-partuum and in the abdominal and pelvic surgery in general.

- The atelectatic lobes, for example for endobronchial carcinoma occluding the lumen of the main bronchus, determine the atelectasis of an entire lung: it derives the opaque image of an entire hemitorace with a displacement to the left of the mediastinum.

- Pleurisy and deposits, on the other hand, are present at Rx as opacity collected in the sloping parts of the pleura, visible for spills of 300-400 ml, with concavities upwards and inwards, movable in the lateral decubitus, if not massive and with opacification of the costofrenic recesses.

- Acute cardiogenic pulmonary edema is characterized by extensive diffuse nubular opacity and relative transparency, due to the confluence of large opacity spots of alveolar transudates.

- Massive opacities can be caused by inflammatory processes, neoplasms and malformations; for example. the opacity of a lobar pneumonia shows a homogeneous appearance and affects an entire lung lobe, preserving the shape and the size of the lobe, unlike an atellectasic area in which the lung collapses on itself and draw to itself the mediastinal structures and adjacent ones. The margins, as mentioned above, of a lobar pneumonia of the right middle lobe, are better observed in L-L (latero-lateral), with an almost triangular or cuneiform opacity aspect (see pulmonary nodules: general
 

Chest X-ray: candida pneumonia, cotonose appearance

rx torace, tbc esiti, bronchiectasie

Bronchiectasis and nodular appearance and interstitiopathies, in elderly subjects with tbc outcomes

Il lobo apicale di destra presenta una lesione tubercolare e tralci fibrosi

Tuberculous lesions, multiple opacities, pleurisy into lobar fissure

Tuberculosis Multiple and spotty opacities

The small patchy shadows are perhaps the most frequent findings of the radiogram: if they are affected the parenchyma will appear as small densities of 1-2 mm, point-like, up to 1.5 -3 mm, as miliary stains, and 3-10 mm, nodular spots. If the interstitium is affected by the process then the appearance will be linear and reticular opacity. Examples are the Kerley striations of type A of the perilary region and of type B of the periphery of the pulmonary bases, referable to lamellar atelectatic areas due to obstruction of the small bronchi.
- Tuberculous outbreaks may appear in the upper fields, sometimes with central calcium inclusions;
- Non-specific bronchopneumonitis give rise to faint opacities with blurred limits, located in the lower pulmonary fields;
- Miliary tuberculosis: it gives an appearance to small miliary spots spread over all lung fields, mainly in the middle and lower fields.

Bronchiolitis: swollen lungs, with small spots. with thickening of ilari shadows.

Link di gastroepato correlati al tema: Imaging e lesioni polmonari:


Radiografia standard del torace: altri esempi (versamenti e brocopolmoniti)
Esempi di Radiografia standard del torace  toracentesi e lastre
Esempi di Radiografia standard del torace: tumori e versamenti imponenti
Un caso di pneumotorace, le lastre 
diagnostica e stadiazione del tumore del polmone
noduli polmonari: generalità
noduli polmonari: diagnosi di natura
polmonite tubercolare acuta e forme miliari di tbc
Le polmoniti
> segue rx torace_p2

 

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