Chapter 2 Recognizing Nor! a Technically Ade oii ve strategy for deciding what the. abner First (and second) things first. This chapter will fn ine ™ Fars (eee normal ches radiographic anatomy) and fa reaetage the technical adequacy ofa radiograph BY Se nore tana wt ihe dighos ‘THE NORMAL FRONTAL CHEST RADIOGRAPH the normal anatomie feature Figure 2-1 displays som omtal chest rad f Vessels and bronchi: normal lung markings rizally all of the “white lines” you rap are blood vessels. Blood vessels Charactenstically branch and. taper gradual fila cesrally 10 he peripheral margins of the lung. Yc unmor aceurately differentiate berween pulmonary arte fesand pulmonary veins on a conventival rad + Bronch are mostly graph Because they’ are norm ont dey ste surrounded by ai * Pleurs: normal anatomy * Thepleura is composed of two layers, the outer pari 1aland inner visceral, withthe pleural space between them, The visceral pleara is adherent to the lung and enfolds o\form the major and minor fissures. + Normally several milliliters of fluid, but no air, are in the pleural space * Neither the parietal pleura nor the visceral pleura is normally visible on a conventional ches. radiograph, except ion oceasion where the two layers of vise Pleura enfold to form the fissures. Even then, they are Usually no thicker than a line drawn with the point of sharpened pencil ly very thin-walled, they THE LATERAL CHEST RADIOGRAPH * Aspan ol the sundard Wwo-view chestexammnation, paticris sully have an upright, frontal chest radiograph and ve tener tnd ead alspays * rte on ae tet os Wy ool a the lateral My an help you et vy dented nfm the pr ate disease not visi Fig image EAS ON THE LATERAL Ligdelies \ND TABLE 2-1) XRAY (FIG. 2-2 Al » The retrosternal clear space f The hilar region # The fissures = The thoracic spine The diaphragm and posterior costophrenic sule, ‘The Retrosternal Clear Space eee cere ut ese es Pitfall: Be careful not to mistake the soft tissue of Patients superimposed arms for space. Although patients are asked! to their head for a lateral chest exposure, many are too we raise their arms. ould he able to iden autents humerus (Fig. 2-5 * Solution: You by spotting t The Hilar Region " The hila may be difficult vo asse y especially if both hila are slightly enka son with the opposite normal side i = The lateral view may help. Most of th made up of the pulmonary aneric mass is visible in the hila on the lateralCor ihe) Figuie 2-1 Well-exposed frontal view of anoemal ches. Novce steph herby and acutely angled. The whit de fe minor horizontal ins lung mashings that tly higher th ile the Bock" Nes Wes on theposterior 7d the right. The white“ ‘onthe anton 3 rb. = When there is. hilar mass, enlargement of hilar lymph nod cast a distinet, lobulated massiike shadow radiograph (Fig. 2-6). The Fissur ‘© On the lateral film, both the major (oblique) and minor (horizontal) fissures may he visible asa fine, white lin {about asthick as aline made with the point of a shar pencil © The major fissures course obliquely. r level of the 5” thoracie vertebra to 3 p dhaphragmauic surface of the pleura a few centimeters behind the sternum. + The minor fissure lies at the level of the rib (on the right side only) and is horizontally onent (see Figs, 2-1 and 2-2), + Both the major and minot fisutes may be visible on the Jateral view, but because ofthe oblique plane of the major fissure, only the minor fissure is usuallly visible on the frontal view f# The fissures demarcate the upper and lower lobes or th Jef and the upper, middle, and lower lobes on the nght ‘© When a fissure contains fluid or develops fibrosis (rom a chronic process, it will become thickened (Fig, ighly from the interior behind the stern isa tothe alapheagry b mally touches the anton aspect of th phragm an ea cores houetes i The supsrir surface ofthe om « frequemly seen cortinuousy fom be fo the hear and anteror ta the spine: this wil m9 ‘ardiomegaly(Chaptes 9}, The black ne ie BOON + Thickening of the fissure by fluid is almost alway associated with other signs of tluid in the chest B lines and + Thickening of the fissure by fibrosis if there are no other signs of Muid in the ches The Thoracic Spine = Normally, the thoracic vertebral bod! angular in shape allels the endplate of the vertet nd each below it = Each intervertebral disk than or remains the same a:fetrosternal clear space. In this example, the der ams over her head forthe latera! chess instructed to do in order to eliminate the ping the lateral chest. The humer are lear space (soid black retrosternal for an abnormality such as antenc: behind the sternum (sold Figure 2-6 Hilar mass on lateral radiog hows a discrete lobulated ma ‘rr0W3), Normally, fa projection. This patient had t sarcoidosis but any cause of hilar aderopat hilum would have similar appearance12 | Recognising morn Chest Anatomy ar <_ lng of 8 om Posterior i bla costophrentc sulcus lageral comaphrente sue posterior costophrenic sulcus (also } phrenic angles (se + Takes only abou posterior costophrenic angle on the | i takes about 250-300 ce to blunt phrenic angles on the frontal fin EVALUATING THE CHEST RADIOGR FOR TECHNICAL ADEQUACY five technical factors fa che aph is adequate Penetration Inspiration Rotation Magnification Angulation «+ Normally, all of the costophrenic sulci are sharp outlined and acutely angled *T eaphreic ee flingsn te sit upnight, This is called blunt Hnhunt the il film, while feral costo