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Scut Report: Chest X-Ray

1. A chest x-ray should first be compared to any previous x-rays of the patient. 2. When reading a chest x-ray, key things to examine include adequacy of penetration and inspiration, location and size of organs in the central zone, any opacities or changes in the lungs and soft tissues. 3. Common findings that may be observed include signs of conditions such as pneumonia, pulmonary edema from congestive heart failure, COPD, atelectasis, pneumothorax, and pleural effusions.

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James Booth
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3K views1 page

Scut Report: Chest X-Ray

1. A chest x-ray should first be compared to any previous x-rays of the patient. 2. When reading a chest x-ray, key things to examine include adequacy of penetration and inspiration, location and size of organs in the central zone, any opacities or changes in the lungs and soft tissues. 3. Common findings that may be observed include signs of conditions such as pneumonia, pulmonary edema from congestive heart failure, COPD, atelectasis, pneumothorax, and pleural effusions.

Uploaded by

James Booth
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF or read online on Scribd

SCUT REPORT: CHEST X-RAY

WHAT’S THE 1ST THING TO LOOK FOR?


ANSWER: A PREVIOUS CHEST X-RAY (WHEN POSSIBLE)

DETAILED READING METHOD:


1. Label Name, Date, Type
2. Adequacy Penetration - vert. just visible thru heart?
Rotation - clav. heads’ relation to spine?
Inspiration - see at least 9 ribs?
Angulation - clavicles over 3rd rib?
3. Central Zone Trachea - midline? ET tube?
Carina - ET tube 3-5cm above?
Mediastinum - widened?
Hilum - vascular prominence? enlarged?
Heart - less than half of thoracic width?
4. Middle Zone Lungs - opacities? lung markings? lucencies?
Diaphrams - sharp CP angle? free air?
5. Outer Zone Soft Tissues - neck, breasts, habitus
Bones - vertebrae, ribs, clavicles, shoulders
6. Equipment CVCs, DHTs, Ports, PICCs, AICDs, etc

GENERAL TERMINOLOGY:
Interstitial “Too many markings”, discrete,
inhomogeneous, no air bronchograms
Reticular Fine, coarse, network of linear densities
Nodular Miliary (tiny), nodule (<3cm), mass (>3cm)
Alveolar/Airspace “Fluffy”, indistinct, homogeneous,
Air bronchograms, may be localized

CONGESTIVE HEART FAILURE:


Pulmonary Edema Interstitial & alveolar types
Diffuse, bilateral opacifications/haziness
Kerley B Lines Thickened interlobular septa
COPD:
Fine, thin, horizontal, peripherial, 1-2cm
Flattened diaphrams, hyperinflated lungs
Peribronch. Cuffing Little donuts/rings; fluid around bronchials
(tall & square), increased AP diameter, long
Pleural Effusions Blunting of costophrenic angles
narrow heart, bullae
Fluid in Fissures Long, thickened fissure lines
Cardiomegaly Heart >50% of thoracic width
ATELECTASIS:
Vasc. Congestion Increased prominence of hilar vasculature
Collapse, loss of lung volume, structures &
Cephalization Increased prominence of upper vasculature
fissures deviate toward opacities, discoid
type = linear densities at lung bases
PNEUMONIA:
Lobar Segmental, homogenous consolidation
PNEUMOTHORAX:
Bronchopneumonia Multifocal, patchy, segmental distribution
Visceral pleural white line, absent lung
Interstitial Classically diffuse, maybe patchy, “atypical”
markings peripherally, if structures deviate
Air Bronchogram Fluid/infiltrate surrounding air-filled bronchus
away = tension pneumo
Silhouette Signs Obliteration of interface; helps localize lesion
RML interfaces w/ right heart border
PLEURAL EFFUSION:
RLL & LLL interface w/ hemidiaphrams
Blunting of costophrenic angles, struc-
RUL & LUL interface w/ aorta
tures shift away from opacification, 300cc
needed to see blunting in upright PA film
The Scut Report (http://www.scutreport.com) James Booth, M.D. (Updated 04/29/09)

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