Chest X-Rays for Medical Students

Christopher Clarke, Anthony Dux

• Publisher: Wiley-Blackwell
• Year: 2020
• ISBN:
  9781119504122
• Edition: 2
• Topic: Medicine
• Subtopic: Radiology, Radiotherapy & Nuclear Medicine

Chest X-rays for Medical Students offers a fresh analytical approach to identifying chest abnormalities, helping medical students, junior doctors, and nurses understand the underlying physics and basic anatomical and pathological details of X-ray images of the chest. The authors provide a memorable framework for analysing and presenting chest radiographs, with each radiograph appearing twice in a side-by-side comparison, one as seen in a clinical setting and the second highlighting the pathology.

This new second edition includes significant revisions, improved annotations of X-rays, expanded pathologies, and numerous additional high-quality images. A comprehensive one-stop guide to learning chest radiograph interpretation, this book:

• Aligns with the latest Royal College of Radiologists' Undergraduate Radiology Curriculum
• Offers guidance on how to formulate normal findings
• Features self-assessment tests, presentation exercises, and varied examples
• Includes sections on radiograph quality X-ray hazards and precautions

Chest X-rays for Medical Students is an ideal study guide and clinical reference for any medical student, junior doctor, nurse or radiographer.

II
The ABCDE of chest X‐rays

It is important to use a systematic approach when looking at a chest radiograph. The following ABCDE approach is easy to remember, so when it comes to your exams and you have a moment of panic after being asked to talk about a chest X‐ray, you can stick to these basics even if you don’t have a clue what’s going on!

A is for Airway:

• Look at the trachea and right and left main bronchi.

B is for Breathing:

• Look to see if the lungs are uniformly expanded and compare the lung fields.
• Look around the edges of each lung.
• Look at the costophrenic angles and the four silhouettes.

C is for Circulation:

• Look at the cardiac size.
• Look at the great vessels (pulmonary vessels and aorta).
• Look at the mediastinum and hila.

D is for Disability:

• Look for a fracture, especially of the ribs or shoulder girdle.

E is for Everything else (review areas):

• Look for gas under the diaphragm.
• Look for surgical emphysema.
• Look for both breast shadows.
• Look for foreign bodies and medical interventions.

6
A – Airway

How to review the airway

Start at the top and follow the trachea (1) inferiorly. It should lie in the midline. It divides at the carina (2) to give off the right main bronchus (3) and left main bronchus (4) (Figure 6.1). On a normal radiograph you will often not be able to visualise the more distal airway branches.

Figure 6.1 The airways of the lung.

What to look for

Tracheal deviation	p. 24
Carinal angle	p. 25

Tracheal deviation

The trachea is considered to be deviated if a portion, anywhere along its length, is completely to the left or right of the midline (the midline being the centre of the vertebral column as indicated by the spinous processes).

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Note: Be sure to check that the radiograph is not rotated, as a rotated radiograph can give the impression of tracheal deviation when the trachea is actually central.

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If you suspect that the trachea is deviated, look for a possible cause.

• Deviated towards diseased side (conditions that pull the trachea):
  • lung collapse;
  • pneumonectomy (removal of a lung) or lobectomy (removal of just one lobe);
  • unilateral fibrosis;
  • agenesis of lung (also called lung aplasia – complete absence of a whole lung and its bronchus).
• Deviated away from diseased side (conditions that push the trachea):
  • tension pneumothorax;
  • massive pleural effusion;
  • mediastinal masses;
  • para‐tracheal masses.

The mos...