X-RAYSX-RAYS
By
Prof Dr IBRAHIM DAWOUD
Prof of Surgery
Mansoura University
How to read
Plain X-ray
Plain x-ray (describe the region).
View (PA, lat, oblique).
Position (erect, supine).
Quality.
Exposure.
Chest: Centralization, Bony frame work. Costophrenic angle, Soft tissue shadow.
Abdomen: well prepared or not, radio-opaque shadow, gas shadow.
Bone: Fracture, tumor, inflammation.
Soft tissue mammogram.
Normal Chest X-ray
How to readHow to read
Plain x-ray chest.
Postero-anterior view.
Erect Position . Good Quality. Good Exposure.
Chest: more or less Centralized.
Bony frame work : free .
Costophrenic angle : free on both sides,
Soft tissue shadow: Rt lung collapse with presence of air in the Rt pleural space.
Presence of chest tube in the Rt side of the chest.
Diagnosis most probably
Rt Pneumothorax
Questions:Questions:
Causes Causes
Artificial Spontaneous Traumatic
1- Therapeutic 1- Emphysem bullae 1- Open
2- Diagnostic 2- TB cavity 2- closed
3- Lung cyst
TypesTypes
1- Simple (closed) Pneumothorax
2- Open Pneumothorax
3- Tension Pneumothorax
TreatmentTreatment
How to readHow to read
Plain x-ray chest.
Postero-anterior view
Erect Position . Good Quality. Good Exposure.
Chest: more or less Centralized.
Bony frame work : fracture ribs on the Rt side .
Costophrenic angle : Obliterated on the Rt side with transverse air-fluid level and free on the left side.
Soft tissue shadow: Free
Diagnosis most probably
Rt Hemo-pneumothorax
QuestionsQuestions
Causes Causes
Postoperative Pathological Traumatic
1- Thoracotomy 1- Lung tumors 1- Open
2- Puncture 2- BL disease 2- Closed
Source of bleedingSource of bleeding
1- Systemic: Intercostal V, Heart and great V, Abd organs
2- Pulmonary: From lung parenchyma
PathologyPathology
1- Systemic bl is progressive, pulmon bl rapidly stopped
2- Bl at first defibrinated, then clotting occurs
then organized into F.T. then 2ry inf Empyema
Clinical PictureClinical Picture
InvestigationInvestigation
TreatmentTreatment
1- Systemic
{a} Aspiration {b} Bl Transfusion {c} U.W.S. (site?)
{d} Thoracotomy For major vessel injury
2- Pulmonary
Conservative treatment
3- Clotted H
Thoracotomy---- Decortication may be required
4- Infected H
Early---- Aspiration Late------ Open drainage & Decortication
How to readHow to read
Plain x-ray chest.
Postero-anterior view.
Erect Position . Good Quality. Good Exposure.
Chest: more or less Centralized.
Bony frame work : Multiple simple Fracture ribs on the Rt side (2nd,3rd, 4th, and 5th ribs).
Costophrenic angle : free on both sides,
Soft tissue shadow: Free on both sides.
Diagnosis most probably
Multiple Simple Fracture Ribs
How to readHow to read
Plain x-ray chest.
Postero-anterior view
Erect Position . Good Quality. Good Exposure.
Chest: more or less Centralized.
Bony frame work : Multiple segmented fracture ribs on the left side.
Costophrenic angle : Obliterated on the left side.
Soft tissue shadow: Lt lung collapse with presence of air in the lt pleural space.
Diagnosis most probably
Multiple Segmented Fracture Ribs
(Flail Chest)
QuestionsQuestions
Causes Causes
Direct Violence
Indirect Violence
Muscular Violence
TypesTypes
1- Simple Fracture ribs
2- Stove in Chest
3- Flail Chest
Clinical PictureClinical Picture
InvestigationInvestigation
TreatmentTreatment
1- Simple Fracture
{a} Analgesic {b} Adhesive strapping
{d} Local Novocain Injection
2- Stove In Chest
External Traction by Towel Clips for 2 w
3- Flail Chest
{a} At the scene of the accident
{b} At the casualty room
{c} Definitive treatment
Conditions Requiring Urgent CorrectionConditions Requiring Urgent Correction
Air Way Obstruction Air Way Obstruction
Removal of mechanical debris &Extension of the neck
Tracheostomy or Catheter through the cricothyroid mem
Endotracheal intubation
Tension PneumothoraxTension Pneumothorax
Life-saving large-bore needle followed by UWS
Open PneumothoraxOpen Pneumothorax
Massive Flail ChestMassive Flail Chest
Massive HemothoraxMassive Hemothorax
1500 ml of bl or more
Conditions Requiring Urgent ThoracotomyConditions Requiring Urgent Thoracotomy
Continued Intrapleural Bleeding Continued Intrapleural Bleeding
Rate exceeding 100 ml/H or more for 6 H
Massive Air LeakMassive Air Leak
Complete unilateral atelectasis in the face of a large air leak
Symmetrical downward displacement of the bilateral hila
Acute pericardial tamponadeAcute pericardial tamponade
Acute Ht failure 2ry to valve or septal injuryAcute Ht failure 2ry to valve or septal injury
Widened or widening mediastinumWidened or widening mediastinum
Perforation of intrathoracic esophagusPerforation of intrathoracic esophagus
How to readHow to read
Plain x-ray chest.
Postero-anterior view (1) --- Lateral view (2)
Erect Position . Good Quality. Good Exposure.
Chest: more or less Centralized.
Bony frame work : free .
Costophrenic angle : free on both sides,
Soft tissue shadow: Consolidated area in the Rt lower segment with cavitations and air fluid level inside the cavity
Diagnosis most probably
Rt Lung Abscess
QuestionsQuestions
Causes Causes
1ry necrotizing pneumonia Aspiration pneumonia
Bronchial obstruction Systemic infection
Pulmonary trauma Direct from surrounding
Clinical pictureClinical picture
1- stage of pneumonitis
2- stage of abscess
3- stage of chronicity
Investigations:Investigations:
1- Radiography
2- Sputum examination
3- Bronchoscopy
TreatmentTreatment
1- Antibiotics and internal drainage
By {a} cough {b} bronchoscopy
2- External drainage
{a} Tube pneumonostomy
{b} Pneumonotomy
through a generous incision with rib resection
3- Pulmonary resection:
Indicated in
{a} chronicity with symptoms
{b} serious hemorrhage
{c} Suspicion of associated carcinoma
How to readHow to read
Plain x-ray chest.
Postero-anterior view (1st) lateral view (2nd)
Erect Position . Good Quality. Good Exposure.
Chest: more or less Centralized.
Bony frame work : free .
Costophrenic angle : free on both sides,
Soft tissue shadow: Apical opacity ( coin shadow) in the apex of the left lung.
Diagnosis most probably
Bronchogenic Carcinoma Left lung
(Pancoast tumor)
QuestionsQuestions
PathologyPathology
1- Incidence ( age- sex- site )
2- Etiology (p.p) :(smoking- air pollution- adenoma…)
3- N/E: ( fungating- nodular- ulcer- infiltrating)
4- MP: (Sq CC- small CC- Adenocarcinoma- large CC- other)
5- Complications (including spread)
6- Staging
Clinical PictureClinical Picture
InvestigationsInvestigations
TreatmentTreatment
How to readHow to read
Plain x-ray chest.
Postero-anterior view
Erect Position . Good Quality. Good Exposure.
Chest: more or less Centralized.
Bony frame work : free .
Costophrenic angle : Massive obliteration of the left side
of the chest
Soft tissue shadow: Tracheal and mediastinal shift
to the opposite side.
Diagnosis most probably
Malignant pleural effusion
TYPESTYPES
TansudateTansudate
1- Congestive HF 2- Nephrotic Syndrome
3- Cirrhosis 4- Hypoproteinemia
5- Myxedema 6- Peritoneal dialysis
ExudateExudate
1- Malignancy (1ry or 2ry)
2- Infection
3- Infarction
4- Traumatic
5- Sympathetic ( Pancreatitis- Subphrenic abscess….)
6- Collagen disease
How to readHow to read
Plain x-ray chest.
Postero-anterior view
Erect Position . Good Quality. Good Exposure.
Chest: more or less Centralized.
Bony frame work : free .
Costophrenic angle : free on both sides,
Soft tissue shadow: Multiple opacities (coin shadows) occupying the whole of both lungs.
Diagnosis most probably
Cannon-ball metastases of the lung
How to readHow to read
SOFT TISSUE MAMMOGRAPHYA well defined rounded mass in the upper part of the
breast. It has a rounded border. No pathological calcification. Normal breast architecture. Normal overlying skin. No retraction of the nipple
Mostly Benign Breast Disease
Fibrodenoma
How to readHow to read
SOFT TISSUE MAMMOGRAPHY
A dense shadow(s) in the breast with a very irregular outline, and with fine stippling of calcification .
Disturbed breast architecture. Thickening of the overlying skin. Retraction of the nipple
Mostly Malignant in nature
Biopsy is recommended
MAMMOGRAPHIC CRITERIA
OF CANCER BREAST
MalignantBenign
1ry
signs
High densityLow density
Non-homogenous opacityHomogenous opacity
Irregular borderSmooth outline
MicrocalcificationNo or macrocalcification
2ry
signs
Disturbed architectureNormal
Increased vascularityNormal
Perifocal hazinessRare
Radiological size smaller than clinical size
Same or larger
Retracted nipple, thickened skin
Normal
How to readHow to read
Plain x-ray neck and thoracic inlet.
Postero-anterior view.
Good Quality. Good Exposure.
Patient is more or less Centralized.
Bony frame work :
Presence of bilateral extraribs on both sides of the neck connected to the 7th cervical vertebra and the first rib.
Diagnosis most probably
BILATERAL CERVICAL RIBS
Postoperative
Postoperative
How to readHow to read
Plain x-ray neck and thoracic inlet.
Postero-anterior view.
Good Quality. Good Exposure.
Patient is more or less Centralized.
Bony frame work :
Presence of extrarib on the Rt side of the neck connected to the 7th cervical vertebra and the first rib.
Diagnosis most probably
RIGHT CERVICAL RIBS
How to readHow to read
Plain x-ray skull and mandible.
Lateral view.
Presence of soft tissue shadow in the saubmandibular region with multiple radio opaque shadows.
Diagnosis most probably
Chronic Submandibular Sialadenitis
with Submandibular Stones
How to readHow to read
Plain x-ray skull and mandible.
Lateral view.
Presence of radio opaque shadow in the submandibular region.
Diagnosis most probably
Submandibular Stone