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How to read a
Chest X-RayDr. Felix AcostaWest Medical Review
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Initial ChecksMake sure you have the right patientNae! "urnae
Age#atient $istory
Date o% the radiography
&ptii'e roo lighting
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Verify Technique&rientation
Inspiration
Rotation
#enetration
(xposure
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&rientation#A
A#
)ateral"upine)ow *uality
Decu+itus
)aying on yourside
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When do you use an #A,-old "tandard
I% patient can stand up
-ravity pulls a+doen downetter view o% chest
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When do you use an A#,When patient is +ed ridden
Distorts heart and ediastinu
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When do you use a
lateral,When you need to locali'ea lesion
"ee parts o% the lung norally covered
ehind the heart! and +ases /covered +ydiaphra0
Fluids! +ut decu+itus is +etter
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When do you use supine,Alost never
&nly i% patient is really deteriorated in +ed
and can1t +e oved)ow *uality
A+doen copresses all chest structures
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When do you use
decu+itus,2o look at3Fluids
Air&+struction
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Inspiration or (xpirationAde*uacy o% inspirationNine pairs o% ri+s should +e seen posteriorly
(xpiration#neuothorax
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RotationDistance %ro the edial end o% each clavicle
to the spinous process o% the verte+ra at thesae level! should +e e*ual
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#enetration&ne should +arely see the thoracic verte+rae
+ehind the heart
Noral
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(xposure /tie +ased0&ne needs to +e a+le to identi%y +oth
costophrenic angles and lung apices
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Radiological checklistAirway
ones
CardiacDiaphra
(4usions
Fields /)ung Fields0
-astric Air +u++le
$ilu
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Airway /2rachea0#ushed away#leural e4usion!
2ension #neuothorax
#ulled towardsAtelectasis /collapsed lung0
2u+es or %oreign +odies
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2ension #neuothorax
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Atelectasis /)oss o% lungvolue0
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onesCheck %or %ractures dislocation! su+luxation!
osteo+lastic or osteolytic lesions in clavicles!ri+s! thoracic
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CardiacCheck heart si'e
Cardiothoracic ratio)ess than 5.6
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Cardioegaly
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DiaphraRight heidiaphrag"hould +e higher than the le%t
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(4usions)ook %or +lunting o% the costophrenic angle
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FieldsCheck %or in7ltrates
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-astric Air +u++leeware o% hiatal hernia
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$ilu(nlarged lyph nodes
Calci7ed nodules
Mass lesions
#ulonary arteries! i% greater than 8.6cthink a+out possi+le causes o% enlargeent
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C2 "can
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Case scenario3 2
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$elical /"piral0 C2 "can2hink
pulonarye+olis
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Common Chest X-Raysfor USMLE)o+ar pneuonia
ronchopneuoniaInterstitial pneuonia
"arcoidosis
CD
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)o+ar #neuonia
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9pper lo+e pneuonia
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Middlelo+e pneuonia
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)ower lo+e #neuonia
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ronchopneuonia
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Interstitial pneuonia
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"arcoidosisilateral hiliar
lyphadenopathy
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CD&verexpanded:hyperin;atedlungs
Flatteneddiaphrag
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CD /ephysea0arrel chest
Flattening o% thediaphra
Increased
retrosternalairspace
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Noral vs CD
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#neuothorax /low yield0