chest x ray mediastinum cohs febr 2014

8/12/2019 Chest X Ray Mediastinum Cohs Febr 2014

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Chest X ray

Mediastinum

COHS

February 2014



Goals

• To understand the basic terminology and techniques

of chest x-rays

• To gain familiarity with "the normal chest x-ray“

• To learn and practice a standardized sequence of

chest x-ray interpretation

• To learn and be able to recognize several

common chest x-ray abnormalities



Lung zones



Pulmonary arteries



ediastinum

• Many structures can be identified within

the mediastium;

• Heart, blood vessels, main airways,esophagus, lymph nodes, thymus ..…



TWO SHADOWS/MAGNIFICATION

DISTANT STRUCTURES



SHADOWS MERGE

ADJACENT STRUCTURES



How many structures can you identify?



LV

RV

SVCAortic pulmonary

recess

Left

Aortic

arch

RA

LA

Right

pulmonary

artery

Right

pulmonary

artery

(lower lobe)

Vascular

pedicle



Postero-Anterior (PA) View

SVC

IVC




RA




RV




PA




LA




LV




Aorta




• Right border

– Superior vena cava

– Right atrium

– Inferior vena cava




• Right border

– Superior vena cava

– Right atrium

– Inferior vena cava

• Left border

– Aortic knob

– Main pulmonary trunk

– Left ventricle




• Pulmonary Arteries

– Right




Pulmonary Arteries

Right

Left





– Right

– Left

• Pulmonary VeinsLA



How many structures

can you identify?



Gastric air

bubble

Left upper

lobe

bronchus

IVC

Righthemidiaphragm

LV

LARV

Pulmonary

outflow

tract

Aorta

Right upper

lobe bronchusRPALPA

Confluence of

pulmonary

veins

Brachiocephalic

vessels Trachea

Left

hemidiaphragm



Lateral View

RA

SVC

IVC



Lateral View

RV



Lateral View



Lateral View

LA



Lateral View

LV



Lateral View

Aorta



Lateral View

LV



Lateral View

• Aorta

• Main Pulmonary Artery

• Inferior vena cava



Lateral View


– Left

– Right

• Pulmonary Veins



Which valve has been replaced?




Aortic valveNote the orientation of the

valve perpendicular to the

plane of the PA film.




PulmonicThe pulmonary outflow

tract is more superior

and lateral than many

people think.



Last one, name the valves…



The Vascular Pedicle

• Found in the superior mediastinum.

• Right and left margins are normally formed by the

superior vena cava and the descending portion of the

aortic arch, respectively.• A widened vascular pedicle can have several

etiologies including elevated intravascular volume,

aortic trauma, or pericardial effusion.



Vascular

pedicle

Aortic

arch

Superior

vena cava



Intravascular volume

depletion


elevationvs.



Vascular

pedicleVascular

pedicle


depletion


elevation

Intravascular volume elevation resulting in an expanded SVC should not be mistaken

for hematoma, which would have a less distinct border and more opacified

appearance.

vs.

Superior

vena cava

AortaSuperior

vena cava Aorta



Trauma patient with an aortic transection

Note the vascular pedicle’s “fuzzy”, opacified right border.

Wh i h i h ?



What is happening here?

Wh i h i h ?




Can you follow the heart borders?

Wh t i h i h ?




The wide vascular

pedicle here results

from a pericardial

effusion

The pacemaker

wires roughly

outline the right

atrium border

If you look closely you can

make out the superior

pericardial border

The left heart border

can be seen within theeffusion

effusioneffusion

Comparing this with older films can also help make the diagnosis.



Other ediastinal Structures

• Esophagus

• Thyroid

• Thymus

• Lymph nodes

•These are generally not seen unless there ispathology



What could be the source of this anterior mediastinal mass?



What could be the source of this anterior mediastinal mass?

Ddx: Lymphoma/leukemia, germ cell tumors (e.g., teratoma), thymic

mass (e.g., thymoma, cyst), enlarged thyroid, vascular (e.g.,

hematoma, aortic aneurysm).

This patient has a thymoma.



How about this one?



How about this one?

This patient has a an enlarged thyroid gland.



A. Anteriorposterior chest radiograph obtained on

supine position shows mediastinal widening withenlarged and indistinct aortic knob and

aortopulmonary window opacification (a).

B. Contrast-enhanced axial

CT scan shows a rupture

of the aorta with apseudoaneurysm (star)

projecting anteromedially.

Also noted are mediastinal

hematoma and bilateral

hemothoraces.

C. 3-D volume rendering

image well demonstrates a

pseudoaneurysm (arrow)

of the aorta at isthmic

portion.

B

A

Traumatic Aortic RuptureCase 1. 68/M

C



A. Chest radiograph appears normal.

B. Tc99m –MDP scan shows hot uptake at junction

between left 1st rib and manubrium.

C and D. Axial (C) and 3-D reconstruction (D) CT

scans reveal fracture of calcified left 1st costal

A C

D

B

Case 1. 49/M Fracture of the left 1st Costal Cartilage

chest x ray mediastinum cohs febr 2014

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