Posterior-Anterior (Pa) Chest X-ray
• In cases where lung pathology is suspected, the first thing to do is radiological examination.
• Tube-film distance should be at least 1 meter.
In an ideal chest X-ray
1) The clavicles should be equidistant from the midline (spinous processes).
2) Intervertebral disc spaces should be seen above the heart, while intervertebral discs should not be seen behind the heart (to show that the film was taken at the optimal dose)
3) The ribs are counted to show the degree of inspiration. 6 ribs from the front and 9 from the back should be counted.
4) In the expiratory film, the hilus and heart size are seen larger than normal, and the diaphragm is seen higher than normal.
cardiothoracic ratio
The line passing through the middle of the sternum is lowered vertically from the far points of the heart to the right and left, and their lengths are added up.
The quotient of this to the chest wall diameter should be 50%.
Apicolordotic graphy
The aim is to see the apex better by taking the clavicle and 1st rib up.
Go 30 cm forward and the shoulders lean back. An anterior-posterior radiograph is taken.
Side decubitus graph
Its main indication is to detect pleural fluid on the downstream side.
In addition, small pneumothorax can be seen much better with this examination.
The side where the pneumothorax is considered should be up.
Thorax CT Indications
• Its main function is to overcome limitations caused by X-ray overlap and poor contrast resolution.
• Today, with a multislice spiral CT (MDCT), masses scans can be made with a breath hold.
Indications for IV iodinated contrast agent
1) Arteriovenous malformation
2) Lung masses
3) Atelectasis-tumor distinction
4) Investigation of pulmonary thromboembolism
5) Differentiation of hilar lymphadenopathy from lung cancer
6) Mediastinal masses
7) Aortic aneurysm, dissection or trauma
8) Coronary CT angiography examination
High Resolution CT (HRBT-HRCT)
• No contrast material is used.
• It is an examination for the lung parenchyma.
HRCT indications
Patients with normal chest X-ray but suspected diffuse lung disease
Evaluation of lung parenchymal disease (sarcoidosis, interstitial lung diseases, etc.)
Indication of open lung biopsy and investigation of the appropriate region
Thorax Ultrasonography
Its main indication is to show pleural fluid.
Major Radiopathological Changes in the Lung
silhouette sign
• Neighboring lesions of equal density in the lung erase each other's contours, this is called the silhouette mark.
• The silhouette mark is used to locate a focal lung lesion.
• A silhouette sign can be seen in many areas in the lung.
• Lesions on the chest wall do not have a silhouette sign.
air bronchogram
• Distal bronchi are not seen on direct radiographs. Normally, only the right and left main bronchi are visible.
• If there is a loss of aeration due to any reason around the alveoli (blood, fluid, pus, tumor, etc.), distal bronchi become visible and an air bronchogram is formed.
Reasons
pneumonia
pulmonary edema
bronchoalveolar carcinoma
Alveolar type pulmonary lymphoma
Pulmonary infarction
hyaline membrane disease
