1. Chest X-ray interpretation
Julee Waldrop, MS, PNP
School of Nursing
UNC

2. Chest X-ray Generally get AP and Lateral views
Fullest inspiration if possible (see example of difference in expiration and inspiration in module)
Dimensions
A:P < 2 years – 1:1
> 2 years – 2:1

4. Normal Chest X-ray Cardiac Structures Position Size
More central in younger infants and children
More on the L side in older infants and teens
Size
In AP view if < 2 years – take up to ~ 65%
If > 2 years - ~ 50%

5. Normal Chest X-ray 1. Soft tissue structures 2. Bony structures
Shadows, most commonly, breast
2. Bony structures
Count the ribs
~ 8 – 9 ribs should be visible on inspiration
Clavicle placement at ~ 2-3 intercostal space (if not, may be malrotated)

6. Normal Chest X-ray 3. Diaphragm Contour
Rounded with sharp pointed costophrenic and costocardiac angles
Right diaphragm is usually 1-2 cm higher
Blunting of costalphrenic or costocardiac angles suggests plueral effusion

7. Normal Chest X-ray 4. Lungs Start at the top and compare the R and L
Trachea should be midline over the thoracic vertebrae and air filled
Lung parenchyma becomes lighter as you go down the lung. If not, it may indicate a lower lobe or pleural effusion

8. Abnormal Chest X-ray Radiopacity (whiteness) means increased density
Radiotranslucency (blackness) means decreased density
Radiopacity can be of 3 causes
Alveolar pattern – fluffy, soft, poorly demarcated opacifications < 1 cm in diameter
Possible causes:
Pulmonary edema
Viral pneumonia
Pneumocystis
Alveolar cell carcinoma

9. Note: ground glass appearance of the lungs here
Abnormalities:
R side: radiolucency – air (pneumothorax)
L side: “ground glass” appearance of radiopacity – pleural effusion

10. Tracheal deviation to the Right caused by posterior tumor
Posterior chest wall tumor

11. Abnormal Chest X-ray Interstitial pattern
Consolidation of interstitial tissue (alveolar walls, intralobular vessels, interlobar septa and connective tissue)
Looks like branching lines radiating toward the periphery of the lung
Possible causes:
Interstitial pneumonitis
Pulmonary fibrosis

12. Middle lobe infiltration
Boot shaped heart: enlarged heart
Right middle lung field infiltrate
Enlarged heart

13. Abnormal Chest X-ray
Vascular pattern – assessment of the pulmonary arteries and capillaries
If there is an increase in the size of the pulmonary arteries as they extend out into the lung – pulmonary hypertension
If there is a decrease in size, truncation, or obliteration of a pulmonary artery – embolus
Lack of vascular making in the periphery - pneumothorax

14. Trace the lung vascular markings out to the border of the rib cage
Trace the lung vascular markings out to the border of the rib cage. When the lung markings stop short of the rib cage and thrre is increased radiolucency in the pleural space, the patient has a pneumothorax.