PLAIN RADIOGRAPHY OF THE CHEST (CXR)

CRITERIA OF A GOOD X-RAY OF THE CHEST

ROTASI
EXPOSURE
PROJECTION
INSPIRATION

Patient central : a-Sterno-

clavicular junction equidistant
from midline (spinous process)
Exposure : Vertebral Thoracal I-IV.
Intervertebral disc spaces and
anterior end of ribs not seen
through cardiac shadow

Projection and position : PA or AP

Lung apices
Inspiration: The diaphragm shouldappear
be and lower 3
cervical
found at about the level vertebrae,
of the 9th - Costo-phrenic
and cardio-phrenic
10th posterior rib or 5th-6th anterior are seen
rib on good inspiration.
 Arcus aorta:
Dilatasi : > 3,5 cm from border
Dilated superior midline
vena cava > 2 cm Elongatio : < 2 cm length
between the top of aortic arch
and incisura jugularis sterni
Dilated pulmonary artery :
“ inverted coma sign” in Prominent
right hilus pulmonary artery
and LAA

Right border : < 1/3 from Straigtening of the

linea sternalis CTI : A/B= < 50% left heart border

apex rounded or
grounded  cardio-
The highest point of the phrenic
right diaphragm is usually
1.5 cm higher than that of
the left
• Right atrial
enlargement
– Lenght heart border
exceeds 1/3 of
mediastinal
cardiovascular
shadow
• Left atrial enlargement : double contour,
prominent LAA/straight cardiac wrist, left
main broncus is flat
 Kerley’s B lines (white arrowheads) are
short horizontal lines situated
perpendicularly to the pleural surface at
the lung base; they represent edema of
the interlobular septa

Kerley’s C lines (black arrowheads)

are reticular opacities,
representing Kerley’s B lines

Kerley’s A lines (arrows) are linear opacities

extending from the periphery to the hila;
they are caused by distention of
anastomotic channels between peripheral
and central lymphatics
 Pulmonary Edema
Pulmonary Pulmonary
Cephalization
Interstitial Alveolar
: 10-15 mmHg
Edema : 15-25 Edema> 25

THANK YOU
 Radiographic Features That May Help to Differentiate Cardiogenic from Noncardiogenic Pulmonary Edema.

Ware LB, Matthay MA. N Engl J Med 2005;353:2788-2796.