CXR INTERPRETATION

BASIC TEST INTERPRETATION

 Pleural : effusion,
Interstitial : fibrosis,
01 plaques, pneumothorax, 03
mass
mesothelioma

Bronchiole-alveolar : Mediastinal : mass,

02 oedema, emphysema, 04 lymphadenopathies,
bronchiectasis, COPD aneurysms

LEARNING OUTCOMES
 Pleural Effusion
Complicated
Hemothorax Empyema Chylothorax
effusion

Features in CXR
★ Blunting of costophrenic & cardiophrenic
angle
★ Fluid within the horizontal / oblique fissures
★ Meniscus seen
★ Mediastinal shift away from effusion
Pleural Effusion

Lateral Films

Subpulmonic effusion

Peak of hemidiaphragm
shifted laterally

Increased distance between

lower lobe air & gastric bubble
 Pleural Effusion
Serous pleural fluid formed > absorbed

Transudate causes Exudate causes

➢ Cardiac failure ➢ Bronchial carcinoma
➢ Nephrotic syndrome VS ➢ Pulmonary embolism
➢ Cirrhosis ➢ Pneumonia
➢ Trauma ➢ Tuberculosis
Light’s criteria
Plaques

Features in CXR
★ “Incomplete border sign”
★ Well-defined inner margin
★ Indistinct tapering outer
margin
★ Holly leaf plaques, with
thickened rolled & nodular
edges
 Plaques

Macroscopically Microscopically
Dense hyalinised
Grey-white regions,
collagen, arranged in a
thickest at the margin
loose ‘basket-weave’
‘Holly-leaf appearance’
pattern

Strongly associated with inhalational

exposure to asbestos
Pneumothorax

Features in CXR
★ Visible visceral pleural edge
★ No lung markings
★ Radiolucent peripheral space
★ Lung may completely collapse
★ Mediastinum should no shift
away (unless tension
pneumothorax is present)
★ Subcutaneous emphysema
★ Pneumomediastinum
 Pneumothorax

Primary spontaneous Secondary spontaneous Iatrogenic / traumatic

Percutaneous biopsy
Emphysema
Marfan syndrome Barotrauma
Lung abscess
Ehlers-Danlos syndrome Tracheo-bronchial
Pulmonary infarction
rupture
Mesothelioma

Features in CXR
★ Pleural opacity
★ Ipsilateral shift of mediastinum
★ Rib destruction / extension
beyond chest wall margins
★ + mediastinal lymphadenopathy
★ + pleural effusion
Pulmonary oedema

Bilateral fan-shape opacities

‘Batwing’ pattern

Increasingly homogenous
lung opacification

Air bronchograms
 Pulmonary oedema

Direct pressure-
Central perihilar
induced damage to
pattern
alveolar epithelium

Often preceded by Usually develops once

interstitial pulmonary pulmonary venous
edema pressure > 30 mmHg
Bronchiectasis

Tram-track opacities Bronchi end may

[cylindrical appear as ring
bronchiectasis] shadows

Air-fluid levels Ill-defined pulmonary

[cystic bronchiectasis] vasculature

Increased broncho-
vascular markings
 Bronchiectasis
- Causes -

Allergic & autoimmune

Idiopathic
conditions

Impaired host defences Obstruction

Postinfective conditions Congenital conditions

 COPD

Flattened
diaphragm

“Barrel chest” with

widened AP diameter
 COPD
Histologic changes
(irreversible & gradually progress)

Chronic bronchitis Emphysema

Diffuse hyperplasia of Destruction of alveolar septa

mucous glands & pulmonary capillaries
Interstitial Lung Disease

Infiltrative opacification mainly

in the peripheries of the lungs

Patterns vary among the

different etiologies
Interstitial Lung Disease
 Interstitial Lung Disease
- Causes -

Dusts (organic
Smoking Gases / fumes Drugs
& inorganic)

Underlying
Radiation Infection
disease
 Interstitial Lung Mass

Air-space disease,
nodular opacities,
mass-like lesions, Lymphadenopathy
interstitial disease, and pleural effusions
cavitation, miliary
disease

Traversal of lung
Air space fissures
consolidation and
mass-like opacities
 Mediastinal Mass

Compartments of mediastinum

● Superior
● Inferior
● Anterior
● Middle
● Posterior

Causes: a wide variety of neoplastic and non-neoplastic pathologies

 Mediastinal Lymphadenopathy
- Causes -

Sarcoidosis primary
lung cancer
Metastatic
malignancies

Infective etiology

Occupational lung
disease
 Mediastinal Aneurysm

May present as:

Exact pathogenesis is
- Mediastinal mass
- Acute SVC obstruction not well known
- Dysphagia

Background conditions reported:

- Silicosis - Recurrent infection
- Bronchiectasis - Thoracic trauma
- Lung cancer - Rendu-Osler-Weber
syndrome 2
 LIST OF RESOURCES

● El-Feky, M. (2023). Pleural effusion. Radiology Reference Article | Radiopaedia.org.

● Yap, J. (2022). Pleural plaque. Radiology Reference Article | Radiopaedia.org.
● Niknejad, M. (2022). Pneumothorax. Radiology Reference Article | Radiopaedia.org.
● Knipe, H. (2022). Mesothelioma. Radiology Reference Article | Radiopaedia.org.
● Rock, P. J. (2021). Pulmonary alveolar oedema.
● Niknejad, M. (2022). Pulmonary emphysema. Radiology Reference Article | Radiopaedia.org.
● Kasáč, Z. (2022). COPD (summary). Radiology Reference Article | Radiopaedia.org.
● Baba, Y. (2022). Bronchiectasis. Radiology Reference Article | Radiopaedia.org.
● Weerakkody, Y. (2022). Interstitial lung disease. Radiology Reference Article | Radiopaedia.org.
● Bell, D. J. (2022). Pulmonary blastomycosis. Radiology Reference Article | Radiopaedia.org.
● Foley, R. (2021). Mediastinal mass. Radiology Reference Article | Radiopaedia.org.
● Bell, D. J. (2020). Mediastinal lymphadenopathy in interstitial lung disease. Radiology Reference Article |
Radiopaedia.org.
● Weerakkody, Y. (2022). Bronchial arterial aneurysm. Radiology Reference Article | Radiopaedia.org.
 THANK YOU
CHEST X-RAY INTERPRETATION
BASIC TEST INTERPRETATION