Chest X-ray interpretation

Julee Waldrop, MS, PNP School of Nursing UNC

Chest X-ray
Generally get AP and Lateral views Fullest inspiration if possible (see example of difference in expiration and inspiration in module) Dimensions
A:P < 2 years 1:1 > 2 years 2:1

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 < 2 years take up to ~ 65% If > 2 years - ~ 50%

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)

Normal Chest X-ray

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

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

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 < 1 cm in diameter Possible causes:
Pulmonary edema Viral pneumonia Pneumocystis Alveolar cell carcinoma

Note:
ground glass appearance of the lungs here

Tracheal deviation to the Right caused by posterior tumor

Posterior chest wall tumor

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

Middle lobe infiltration

Boot shaped heart: enlarged heart

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

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.