Radiology of

respiratory
system
ASSIST PROF VALENTINA OPANCINA, MD, PHD
Types of Densities
Basic Principles of the CXR

 Types of views
 PA
 Lateral
 AP
 Apical lordotic
 Decubitus (R & L)
PA and LL

1. In PA,
the patient stands with his/her chest
against the film cassette and xrays go
posterior to anterior
2. Asyou know, any area of film that is struck
by xrays will be exposed and turn black.
Any area that is blocked, will remain white
3. In Lateral
x-rays, by convention patients
stand with left side against the film
1. Minimizes magnification of heart
AP
1. For AP, patient is in bed, sitting upright. Xrays
coming from front, film is behind.
Demonstrate the enlarging principles by
putting hand in front of projector
 5. Apical lordotic moves clavicles out of the
way. Of note, in review of medicolegal
cases, the most missed pathology occurs in
the RUL
 5. Generally 4 different densities: Air, fluid
(soft tissue), fat, bone. Densities appear
based on the abiliy of the substance to
BLOCK the xray from hitting the film. If it
blocks, film stays white.
 6. Remember, we can only distinguish
anatomical margins when 2 structures of
DIFFERING densities abut each other!
PA vs AP
Lateral CXR
Approaching the CXR

 Name, date, type of film

 Type of film
 Patient positioning / rotation
 Inspiration
 Penetration
 White is underpenetrated
 Black is overpenetrated
Approaching the CXR
 The systematic approach
1. Tubes / Hardware
2. Bones
3. Soft tissues
4.Pleura and diaphragm
5. Trachea and mediastinum
6. Lung parenchyma
Rotation
Rotation
Inspiration
Penetration
Scanning the xray
# 1- Hardware
#1- Hardware
#1- Hardware
#1- Hardware
2. Osseous Structures in the
Chest
2. Osseous Structures of
the Chest
3. Soft Tissues
4. Pleura and Diaphragm
5. Mediastinal Anatomy
5. Mediastinal Anatomy
5. Mediastinal
Compartments
6. Parenchymal Anatomy

 Right lung has 3 lobes, left lung has 2 lobes.

Lingula is considered part of the LUL. Lobes are
separated by fissures, sometimes you can see
them on xray (especially if they are thickened or
fluid-filled)
 Lateral View

Anterior View
6. Parenchymal Anatomy
 2
1
3

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HOBP
Hydropneumothorax
Pneumonia
Atelectasis

Loss of volume

mass Minor fissue

Minor fissure

Elevation of
diaphragm
Minor fissure

Major fissure
Pneumothorax

 Collection of air in pleural cavity

 Primary and secondary causes
 Upright position air rises and separates
the lung from the chest wall creating
a line. Don’t be fooled by skin folds,
clothing and bullae.
 In the supine position air moves
anteriorly. The lung will not be clearly
separated from the chest wall.
PTX
 Pneumothorax in the
Supine Patient
Enlarged
hemithorax

Mediastinal shift
hyperlucent

Deep sulcus
sign

Sharper cardiac
border
1.Other signs: Kerly B lines (engorgement of the
lymphatics in interlobular septa), vascular
engorgement, small effusions
Enlarged heart roughly estimated by heart size >50%
thoracic cavity width
Bat-winged appearance

Enlarged heart
Kerley B lines
1.Fluid in between the parietal and viceral pleura.
First collects in dependent spaces like costophrenic
angle. Obliterates diaphragm.
Minscus sign.
Cannot determine nature of effusion based solely on
the CXR.
Effusions
Normal
Round Pneumonia
Blastomycosis
Segmental Pneumonia
Aspiration Lung Abscess
Plate like atelectasis
Diffuse adhesive atelectasis
ARDS
Diffuse alveolar infiltrates
Pulmonary edema
Butterfly pattern
Lobar
Air bronchogram
Pulmonary hemorrhage
Chronic diffuse aleveolar
Alveolar proteinosis
Miliary nodules
Interstitial disease
Tuberculosis
Unilateral haziness
Left lung atelectasis
Pleural effusion
LUL cavity
Tuberculosis
Massive effusion
Sub pulmonic
Effusion