wikiRadiography - Recently Updated Pages

Applied Radiography - by M.J.Fuller

M.J.Fuller — Tue, 09 Mar 2010 15:39:39 CST

"understanding what you are seeing is its own reward - image interpretation skills add an extra dimension to your work and afford additional meaning to your role."

These articles written by M.J.Fuller involve case studies, techniques and image evaluation for both the student and seasoned radiographer.

Radiographic Technique
General
The Fundamental Tenets of Radiographic Technique
Conventions, Customs, Cultures, Common Practices and Quirks in Radiography

Aluminium Filter Techniques in Radiography
Radiography in the Round
Top 20 Tips for Radiography in the Operating Theatre
Artifacts and Artefacts
Using the Lead Snake to reduce Scatter Radiation
Imaging Nail Gun Injuries
Passe Radiography
Geometric Concepts in Radiography
Foreign Body Radiography
Radiography for Ingested/Aspirated Foreign Bodies
Sesamoid Bone Radiography
Breathing Exposure Techniques in Radiography
High Contrast is not always Good !
Upper Extremities
Imaging Severe Hand Trauma
What Constitutes a True Lateral Wrist Position?
Functional Views of the Wrist
Scaphoid Radiography
Imaging Radial Head Fractures
Imaging Supracondylar Fractures of the Elbow
Elbow Supracondylar fractures- Cases
The Lateral Elbow
Orthopaedic Clinic Wrist Radiography
Is the Screw in the Joint?
Lower Extremities
Supine Intercondylar Knee Radiography
The Skyline Patella View
Lateral Toe Radiography
Lateral Ankle Radiography
The Lateral Ankle Trap
Imaging Talar Fractures
Tarsal Bone Fractures
Imaging Tibial Plateau Fractures
Lateral Knee Radiography
Abdomen
Neonatal Abdominal Radiography
Neonatal Tubes, Lines and Catheters
Nasogastric tube position confirmation
The Lateral Decubitus Abdominal Plain Film
Abdominal Calcifications
Abdominal Anatomy
Abdominal Artifacts and Devices
Abdominal Radiography of the Morbidly Obese Patient

Pelvis
Modified Trauma Lateral Hip Radiography
Pubic Rami Fractures
Judets Views
Radiography of Hip Dislocations
Periprosthetic Hip Fractures
Spine
Lumbar
Lumbar Spine Radiography
Lateral Lumbar Spine Radiography
Lumbar Spine AP Breathing Technique
Lateral Lumbar Spine Breathing Technique
Lumbar Spine Obliques
Imaging Wedge Fractures
Thoracic
AP Thoracic Spine Breathing Technique
The Swimmers View
Modified Lateral Thoracic Spine Technique
Imaging Wedge Fractures
Cervical
Oblique Cervical Spine Technique
Trauma Obliques of the Cervical Spine
Trauma Lateral cervical Spine
The Odontoid Peg View
Odontoid-Lateral Mass Asymmetry
The Swimmers View
Transthoracic Lateral Shoulder

Shoulder
Clavicle Radiography
Lateral Scapula Radiography
Shoulder- SI vs Lateral Scapula
Radiography of the Bicipital Groove
Imaging Shoulder Dislocations
Acromioclavicular Joint Radiography
Imaging Scapular Fractures
Chest
Lateral Sternum from Lateral Chest - Digital Double Dipping
Lateral Chest Paravertebral Gutter Positioning Technique
Notes on Chest Radiography
Lateral Chest X-ray Digital Double-Dipping
Lordotic Chest Technique
Nasogastric tube position confirmation
Digital Double Dipping in Chest Trauma Radiography
Rib Radiography
Chest Radiography for Inhaled Foreign Body
Digital Double Dipping in Chest Trauma Radiography
Paediatric Chest Radiography Positioning Aids

Skull and Face
The "Leaning Tower" view of the Paranasal Sinuses
Lateral Facial Bones Technique
Slit Basal and Teacup Views of the Zygoma
Imaging mandible fractures
Radiography of Intracranial devices
Radiography of Orbital Foreign Bodies

Radiography in the Neonatal Unit
Neonatal Abdominal Radiography Technique
Neonatal Abdominal Pathology
Neonatal Tubes, Lines and Catheters
Neonatal Chest Radiography
Neonatal Chest Pathology
Hyaline Membrane Disease (syn RDS) and BPD

Positioning Aids and Radiographic Accessories

Using the Lead Snake to Reduce Radiation Scatter
The Fronsko dripstand Base
The Smart Cone
Leddra Skyline Patella View Cassette Holder
Supine Intercondylar Knee Radiography
Bucky Markers
The Stent Board
Head Clamps for Skull Radiography
The Binocular Cone
Using Baker Cones in the Neonatal Intensive Care Unit
Aluminium Filter Techniques in Radiography
Radiography in the Round

Using the Lead Snake to reduce Scatter Radiation

Named Radiographic Techniques
Fuch's View of the Odontoid Process

Paediatrics
Chest Radiography for Inhaled Foreign Body

Fluoroscopic Procedures
Arthrography
-Wrist
-Shoulder
-Elbow
Myelography
- lumbar
- thoracic
- Cervical
Discography
-Lumbar
-Cervical
Facet Joint Injection
-Lumbar
-Cervical

Trigeminal Nerve block
Hysterosalpingogram
Dacrocystography
Micturating Cystourethogram
Urethrography
Cystogram
T-tube cholangiogram
Venogram
Gastrostomy Tube check

Quality Control

Simple Quality Control Testing
Artifacts and Artefacts

Other
Preparing Images for the Web in Photoshop
Mach Bands and other Optical Illusions

Image Evaluation, Pathology, Normal Variants
General
osteochondroses
Salter-Harris Fractures
Patterns of Misdiagnosis in Plain Film Radiography
Fracture Types and Mechanisms of Injury
Soft Tissue Calcification
Soft Tissue Signs in Orthopaedics
Soft Tissue Signs-The Elbow
Soft Tissue Signs- Knee Trauma
Soft Tissue Signs- knee nontrauma
Soft Tissue Signs-The Ankle
Soft Tissue Signs- Wrist
Soft Tissue Signs- Shoulder

Soft Tissue Signs- Thoracic Spine
Soft Tissue Signs- Skull and Facial Bones
Soft Tissue Signs- Cervical Spine
Satisfaction Syndrome
Orthopaedic Internal Fixation Failure
Orthopaedic Scews, Plates and Prosthesis
Mechanisms of Injury
fall onto an outstretched hand
Systemic Disease
Renal osteodystrophy

Upper Extremities
The forearm
Monteggia and Galeazzi Unstable fracture-dislocations of the forearm

The Elbow
The Paediatric Elbow
Imaging Radial Head Fractures
The Axial Elbow View
Medial Condyle Fractures
Elbow Dislocations
Lateral Condylar Elbow Fractures
Imaging Olecranon Fractures
Radial Head Dislocations
Imaging Supracondylar Fractures of the Elbow

The Wrist
Paediatric Wrist Trauma
Radiography of subtle wrist fractures
Subluxation of the Distal Radio-ulnar Joint
Wrist Measurements
Colles' Fracture
Dislocations and Subluxations of the Carpus
DISI and VISI Deformities
Functional Views of the Wrist
Imaging Carpal Bone Fractures
Imaging Scaphoid Fractures
Triquetral Fractures
Hamate Fractures
Pisiform Fractures

The Hand
Imaging Severe Hand Trauma
Fractures of the Base of the Thumb
Metacarpal Fractures

Lower Extremities
The Lateral Ankle Trap
Pellegrini-Stieda Disease
Calcaneal Fractures
Posterior Malleolus Fractures of the Ankle
Dislocations and subluxations of the knee
Talus Fractures
Osgood Schlatter Disease
Fifth Metatarsal Fractures

Abdomen
Normal Plain Film Abdominal Anatomy
Common abdominal pathologies an Normal Anatomical Variants
The Abdominal Plain Film in Clinical Context

Abdominal Plain Film Terminology
The Erect Abdominal Plain Film
The Abdominal Plain Film- Differentiating Large and Small Bowel
The Abdominal Plain Film- Ileus
The Abdominal Plain Film- Gasless vs Featureless
Pneumoperitoneum
Pneumoperitoneum- Radiographic Techniques

Nasogastric Tube Position Confirmation
Small Bowel Obstruction
Large Bowel Obstruction

The Abdominal Plain Film- Appendicitis

The Abdominal Plain Film- Intramural Gas
The Abdominal Plain Film- Emphysematous Cystitis

Normal Bowel Patterns in Sedentary Patients

Imaging Abdominal Hernias
Imaging Incisional Hernias
Neonatal Tubes, Lines and Catheters
Neonatal Abdominal Pathology

Pelvis
Pelvis Anatomy, Artifacts Normal Variants

Pelvic Calcifications
Pelvis Trauma Radiography
Neck of Femur Fractures
Neck of Femur Fractures- Cases
Pubic Rami Fractures
Paediatric Hip Pathology

Spine
Common Cervical Spine fractures
Terminology- the "spondyls"

Shoulder
Clavicle Radiography

Vacuum Phenomenon of the Shoulder
Imaging Shoulder Dislocations
Imaging Scapular Fractures
Bankart and Hill-Sachs Lesions

Chest
Pneumothoraces
Pneumothorax Cases
Pleural Effusions
Imaging Subpulmonic Effusions
The Supine Pneumothorax
Dextracardia in the Resus Room
Neonatal Chest Pathology
What is the Value of the Lateral Chest Projection?
Nasogastric tube position confirmation
Chest Normal Anatomical Variants
Juxtaphrenic Peaks
Coarctation of the Aorta
Causes of Asymmetrical Lung Density

Patterns of Consolidation
Lung Anatomy
False Consolidation

RUL
RML
RLL
LUL
LLL

Patterns of Collapse
Lung Anatomy
RUL
RML
RLL
LUL
LLL

Named Fractures, Pathologies, Signs and Normal Variants
A
Anterior Triangle sign
Arcuate Sign

B
Bennett Fracture
C
Colles' Fracture
D
Dupuytren's Fracture
E
Ewart's sign
F
Flat Waist sign
free spine sign
J
Jones Fracture
L
Luftsichel Sign
Lipohaemarthrosis
M
Madelungs Deformity
Mayersbach sign

N

Nightstick Fracture
Nutcracker Fracture of the Cuboid

O
Open Book Fracture
Osgood Schlatter Disease
P
Pneumothorax

R
Reverse Bennett Fracture

S
Segond Fracture
'S' sign of Golden
Snow Globe Effect
T
The Terry-Thomas Sign
Tenneb Fracture

U
Ulnar Bennett Fracture

Image Interpretation Self Testing
- with answers

Chest Trauma 1
Chest Trauma 2
Acute Abdomen 1
Knee Trauma 1
Elbow Trauma 1

Image Interpretation
-without answers

Ankle Trauma 1 (level 1-10)
Ankle Trauma 2 (level 1-10)
Ankle Trauma 3 (level 1-10)
Ankle Trauma 4 (level 1 - 3)
Ankle Trauma 5 (level 5 -10)
Knee Trauma 1 E (level 5 -10)
Wrist Trauma 1E (level 4 - 10)

Normal Paediatric Anatomy (under Construction)
Upper Limb
Hand
Wrist
Elbow
Shoulder
Lower Limb
Foot
Ankle
Knee
Hip/Pelvis
Spine
Cervical
Thoracic
Lumbar

Skull/Face
AP
Lateral
Chest
PA
Lateral

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Lateral Chest Case 3

M.J.Fuller — Tue, 09 Mar 2010 15:38:39 CST

Preamble

This is the answer page to Case 3 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

What is the Value of the Lateral Chest Projection?
Patterns of Consolidation
Pneumoperitoneum
Pneumoperitoneum- Radiographic Techniques

PA Chest


This 39 year old male was admitted to hospital with "Inflammation of the colon ? Crohns disease" He was noted to have bibasal ''crackles'' and was referred for chest radiography with a question of chest infection PA erect chest radiography was performed.

This 39 year old male was admitted to hospital with "Inflammation of the colon ? Crohns disease"
He was noted to have bibasal ''crackles'' and was referred for chest radiography with a question of chest infection
PA erect chest radiography was performed.


There is suboptimal inspiration There is loss of visualisation of the right heart border (silhouette sign) suggesting right middle lobe disease. There is retrocardiac lung density and airbronchogram lines indicating RLL airspace opacity. The appearance is complicated by atelectasis and suboptimal inspiration. The radiographer noted a subtle sign of subdiaphragmatic air (arrowed)

There is suboptimal inspiration
There is loss of visualisation of the right heart border (silhouette sign) suggesting right middle lobe disease.
There is retrocardiac lung density and airbronchogram lines indicating RLL airspace opacity. The appearance is complicated by atelectasis and suboptimal inspiration.
The radiographer noted a subtle sign of subdiaphragmatic air (arrowed)

Lateral

The lateral projection image demonstrates air interposed between the liver and diaphragm


The lateral projection image demonstrates air interposed between the liver and diaphragm


There is a large air/fluid level in the stomach The lateral projection image demonstrated air interposed between the liver and diaphragm (arrowed) This appearance indicates pneumoperitoneum from perforated hollow abdominal visus. Contrary to popular belief, research findings and the author's experience suggest that the lateral chest centred on the diaphragm is the most sensitive projection for detection of pneumoperitoneum. see Pneumoperitoneum and Pneumoperitoneum- Radiographic Techniques

There is a large air/fluid level in the stomach
The lateral projection image demonstrated air interposed between the liver and diaphragm (arrowed)
This appearance indicates pneumoperitoneum from perforated hollow abdominal visus.
Contrary to popular belief, research findings and the author's experience suggest that the lateral chest centred on the diaphragm is the most sensitive projection for detection of pneumoperitoneum.
see Pneumoperitoneum and Pneumoperitoneum- Radiographic Techniques

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Medical Abbreviations

AndyC — Tue, 09 Mar 2010 02:10:38 CST

This page contains medical abbreviations that radiographers should be familiar with to enable interpretation of request forms.

Medical Abbreviations

0	Not Present OR No abnormality	Also in superscript e.g. ……..o
+/-	Uncertain/equivocal
+	Present or Noted
++	Present Significantly
+++	Present in Excess	eg BMI +++
=	Equivalent to
3	OK or satisfactory
A	Ankle Jerk/Reflex	Hitting the ankle with a patella hammer to test reflexes
AAA	Abdominal Aortic Aneurysm	Dilatation of abdominal aorta
AAL	Anterior Axillary Line	Imaginary line drawn from the front arm pit down the chest wall
ABG	Arterial Blood Gas "Sats"	Blood test to see how much oxygen there is in the blood (percentage ‘saturation’ with oxygen)
ACL	Anterior Clavicular Line or Anterior Cruciate Ligament	An imaginary line down the front of the body from the inner end of the collarbone OR a ligament in the knee
A.d	As Directed
A/E	Air Entry to Lungs OR Accident & Emergency
AF	Atrial Fibrillation	Irregular heart beat
AI/R	Aortic Incompetence/regurgitation	Leaking heart valve.
AoR	Aortic Valve Replacement	AVR
AS	Abdominal System OR Aortic Stenosis	Aortic Stenosis is a narrowed heart valve
AXR	Abdominal X-Ray
bd/bid	Twice a Day
B	Biceps Jerk/Reflex	Hitting the arm with a patella hammer to test reflexes
BCC	Basal Cell Carcinoma	Skin Cancer – Very Low Malignancy
BMI	Body Mass Index	A measure of body size relating to height and weight
BNO	Bowels Not Opened
BOR	Bowels Open Regularly
BP	Blood Pressure
BPd	Diastolic Blood Pressure	The lower blood pressure (heart relaxed)
BPs	Systolic Blood Pressure	The higher blood pressure (heart contracted)
CA or Ca (also indicated by "*")	Carcinoma	Cancer
CABG/S or CAG/S	Coronary Artery (Bypass) Graft/Surgery	Heart surgery to bypass blocked blood supply
CFS	Chronic Fatigue Syndrome	Also called ME
CNS	Central Nervous System
C/o or C.o	Complains of
COAD	Chronic Obstructive Airways Disease	Chronic lung disease
COPD	Chronic Obstructive Pulmonary Disease	Chronic lung disease
CT or CAT	Computerised Axial Tomography	Body Scan
CVA	Cerebrovascular Accident	Stroke
CVS	Cardiovascular System	The heart and blood vessels
CX or Cx	Cervix OR Cervical Spine	Cervix is the neck of the womb For example, Cx smear = Cervical smear
CXR	Chest X-ray
D+V	Diarrhoea and Vomiting
D/H	Drug History
DIP, PIP	Dorsal/proximal interphalangeal joints	Finger joints
DLE	Discoid Lupus Erythematosus	A connective tissue disorder
DNA	Did Not Attend
DS	Disseminated (Multiple) Sclerosis
DU	Duodenal Ulcer
DVT	Deep Vein Thrombosis	Blood clot
DXT	Deep X-ray Treatment	Radiotherapy
EAM	External Auditory Meatus	Ear canal opening
ECG	Electrocardiograph	Electrical heart trace
EMU	Early Morning Specimen of Urine
ENG	Head engaged (Baby)	Head of baby low in pelvis (in Womb)
ENT	Ear, Nose & Throat
ESR	Erythrocyte Sedimentation Rate	A blood test for inflammation
FBC	Full Blood Count
FBG/S	Fasting Blood Glucose/Sugar
FD	Forceps Delivery
F/H or FH	Family History
FHH/R	Foetal Heart Heard/Regular	Baby’s heartbeat in the womb
FROM	Full Range of Movement
FTD	Formal Thought Disorder	Psychiatric disorder
FTND	Full Term Normal Delivery
GCS	Glasgow Coma Scale	Consciousness state; score out of 15
GI or GIT	Gastro Intestinal/Tract	To do with the intestines
GORD	Gastro-Oesophageal Reflux Disease	Back flow of stomach acid into the gullet
GU or GUT or GUS	Genito Urinary/Tract/ System	Relating to kidneys, bladder & genitals
GU	Gastric Ulcer
GUM	Genito-Urinary Medicine	For sexually transmitted diseases/infections
Hb	Haemoglobin	A measure of blood count (eg in Anaemia)
HH	Hiatus Hernia	Part of stomach displaced above diaphragm
HI	Head Injury
HNPU	Has Not Passed Urine
HR	Heart Rate
HS	Heart Sounds
HT	Height
Hx	History (of complaint)
IBS	Irritable Bowel Syndrome
IGT or IGTN	In Growing Toenail
IMB	Intermenstrual Bleeding	Vaginal bleeding between periods
ISQ	"In Status Quo" - Nothing has Changed
IVP	Intravenous Pyelogram	X-ray of kidneys using an injected dye
Ix	Investigations
JVP	Jugular Venous Pressure	Neck Vein – back pressure from the heart
K	Knee Jerk/Reflex OR serum potassium
KUB	Kidneys, Ureters, Bladder	X-ray or ultrasound of renal track (IVP)
LFT	Liver Function Test	Blood tests for liver function
LIF	Left Iliac Fossa	Left groin
LIH	Left Inguinal Hernia	Hernia of left groin
LKKS	Liver, kidney, kidney, spleen	Result of examination
LOC	Loss of Consciousness
LN	Lymph Node
LP	Lumbar puncture	Needle inserted into the spine for diagnostic purposes
L/R/ IH	Left or Right Inguinal Hernia	Hernia of groins
LS	Lymph System
LSCS or LUSCS	Lower (Uterine) Segment Caesarean section
LUQ	Left Upper Quadrant	Left upper part of abdomen
Mane	In the Morning
M&C (S)	Microscopy & Culture Sensitivity of Bacteria	Of a sample e.g. urine
MCL	Mid Clavicular Line	An imaginary line down the body from the middle of the collarbone to the described area
MCV	Mean Corpuscular Volume	A measure of the size of red blood cells
ME	Myalgic Encephalomyelitis	Also called Chronic Fatigue Syndrome
MET/S	Metastases	Cancer spread
MI	Myocardial Infarction OR Mitral Incompetence	Heart attack OR leaking heart valve (sometimes MR)
mitte or mite	Dispense this number of tablets
MRI	Magnetic Resonance Imaging	Body/Brain Scan
MS	Multiple Sclerosis OR Mitral Stenosis	Mitral Stenosis is a narrowed heart valve
MSS	Musculo-Skeletal System
MSE	Mental State Examination
MSU or MSSU	Mid-Stream Urine Sample
NAD	Nothing Abnormal Discovered
NBI	No Bone Injury
Nocte	At Night
NFR	Not For Resuscitation
N&V	Nausea & Vomiting
OA	Osteoarthritis	‘Wear & Tear’ Arthritis
OC/COC	( Combined) Oral Contracepti ve
OCT	Orthotopic Cardiac Transplant	Heart Transplant
o.d.	Once a Day
O/E or o.e	On Examination
OGD	Oesophago-gastro-duodenoscopy	Telescope examination of stomach and gullet
on	At Night
om	In the Morning
OM (R/L)	Otitis Media	Ear infection
ORIF	Open Reduction and Internal Fixation (of fracture)	Operation to set a broken bone
otc	Over the counter (bought medication)
P	Pulse
PC	Post Cibum	After a meal
PCB	Post Coital Bleeding	Vaginal bleeding after intercourse
PCC	Post Coital Contraception	"Morning after" pill
PE	Pulmonary Embolism	Blood clot on the lung
PERLA	Pupils equal and reacting to light and accommodation	On examination of nervous system/eyes
PF(R)	Peak Flow (Rate)	Breathing test – speed of expiration
PID	Pelvic Inflammatory Disease OR Prolapsed Intervertebral Disc	Gynaecological infection OR Slipped vertebral Disc
PM	Post mortem examination
PMH also PHx	Previous Medical History
PND	Paroxysmal Nocturnal Dyspnoea	Short of breath at night
PO	Per Orim	By Mouth
POP	Progesterone Only Pill OR Plaster of Paris	Minipill Cast
PPs	Peripheral pulses	Pulses felt for example in the feet, ankles etc…
PR	Per Rectum	Rectal examination
PRN	As Required
PTCA	Percutaneous transluminal coronary angioplasty	Opening up the main arteries of the heart using a balloon inserted usually near the groin
PTSD	Post Traumatic Stress Disorder
PU	Peptic Ulcer OR Passed urine	Peptic Ulcer – Stomach or Duodenal Ulcer
PV	Per Vagina	Vaginal examination
PVD	Peripheral Vascular Disease	Arterial disease of the limbs
qds (or) qid	Four times a day
R (R)	Respiration (Rate)	Rate of breathing in breaths per minute
RA	Rheumatoid Arthritis
RDS	Respiratory Distress Syndrome	Difficulty in breathing – usually in premature babies
RFT	Renal (Kidney) Function tests OR Respiratory Function tests
RIF	Right Iliac Fossa	Right lower abdomen
RIH	Right Inguinal Hernia	Hernia in right groin
R/L	Right/Left
R/L HC	Right/Left Hypochordrium	Right/Left upper abdomen
R/LIF	Right/Left Iliacfossa	Right/Left groin
R/LOL or RLOP	Right/Left occipito lateral / posterior	Position of baby’s head in womb
RS	Respiratory System
RSI	Repetitive Strain Injury	Usually of wrist
RTA	Road Traffic Accident	Car smash
RUQ	Right Upper Quadrant	Right upper abdomen
Rx	Prescription or Treatment	Usually prescription
S	Supinator (jerk /reflex)	Hitting the am with a patella hammer to test reflexes
SBG	Serum Blood Glucose	Blood Sugar Level
SLR	Straight Leg Raising
SMR	Submucosal Resection	Nasal operation
SOB	Short of Breath
SOL	Space Occupying Lesion	Tumour, usually of head
SOM	Secretary Otitis Media	Middle ear infection/glue ear
SOS	In an Emergency
SR	Sinus rhythm	Normal heart beat
Stat	Immediately
STD	Sexually Transmitted Disease
STI	Sexually Transmitted Infection
SVD	Spontaneous Vertex Delivery	Normal delivery
Sx	Symptoms
SkXR	Skull X-ray
T	Triceps Jerk/Reflex OR Temperature	Hitting the arm with a patella hammer to test reflexes
Tá â	Temperature raised upwards or downwards
T (usually with a circle with a dot in the centre)	Trachea Central	Breathing tube not displaced. If displaced, direction of displacement usually indicated by an arrow
TATT	Tired all the Time
TB	Tuberculosis
TCI	To come in-date or fact that a person is due to be admitted to hospital
tds (or) tid	Three Times a Day
TFTs	Thyroid Function Test
THR	Total Hip Replacement
TIA	Transient Ischaemic Attack	Small, short lived stroke – often recurrent
TKR	Total Knee Replacement
TLC	Tender Loving Care	Treat only with symptom relief and nursing care, usually meaning that this is all that is needed.
TM or Tm	Tympanic Membrane	Ear drum
TOC	Tightness of Chest
Trauma Series	Cervical Spine, Chest and Pelvis Xray	Frquently requested after major trauma
Ts&As	Tonsilectomy and Adenoidectomy
TShR	Total Shoulder Replacement
TTO/A	To take home/away (medication)
TU(R)P	Transurethral (resection) of Prostate	Operation on the prostate gland carried out through the penis
UC	Ulcerative Colitis
U&Es	Urea and Electrolytes	Blood test for kidney function
US	Ultra Sound Scan
UTI	Urinary Tract Infection
VF	Ventricular Fibrillation	Rapid uncoordinated heart beat usually leading to collapse, and need for defibrillation (electric heart shock)
V/S/TOP	Vaginal suction termination of pregnancy
VT	Ventricular Tachycardia	Fast heart beat
wbc	White Blood Cell Count
Wt	Weight

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These abbreviations are based on a list from the The Royal College of General Practitioners the professional membership body for family doctors in the UK and abroad.

Related Links

Lateral Chest Case 1

M.J.Fuller — Mon, 08 Mar 2010 23:23:50 CST

Preamble

This is the answer page to Case 1 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect

This 37 year old male was referred for chest radiography with a history of pyrexia of unknown origin (POU)
There is abnormal retrocardiac density
There is loss of visualisation of the left hemidiaphragm and airbronchogram lines.
Appearances are consistent with left lower lobe consolidation/collapse.


This 37 year old male was referred for chest radiography with a history of pyrexia of unknown origin (POU) There is abnormal retrocardiac density There is loss of visualisation of the left hemidiaphragm and airbronchogram lines. Appearances are consistent with left lower lobe consolidation/collapse.

Lateral

There is abnormal retrocardiac density
There is complete loss of visualisation of the left hemidiaphragm (silhouette sign)


There is abnormal retrocardiac density There is complete loss of visualisation of the left hemidiaphragm (silhouette sign)

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Lateral Chest Case 15

M.J.Fuller — Mon, 08 Mar 2010 23:22:37 CST

Preamble

This is the answer page to Case 15 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect

There is increased lung density behind the left heart shadow and left hemidiaphragm
Appearances are consistent with consolidation of the posterobasal segment of the LLL.


There is increased lung density behind the left heart shadow and left hemidiaphragm Appearances are consistent with consolidation of the posterobasal segment of the LLL.

Lateral Projection

There is loss of visualisation of the left hemidiaphragm (silhouette sign) and increased lung opacity posteriorly particularly projected over the lower thoracic vertebral bodies.
Appearances are consistent with consolidation of the posterobasal segment of the LLL.


There is loss of visualisation of the left hemidiaphragm (silhouette sign) and increased lung opacity posteriorly particularly projected over the lower thoracic vertebral bodies. Appearances are consistent with consolidation of the posterobasal segment of the LLL.

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Lateral Chest Case 14

M.J.Fuller — Mon, 08 Mar 2010 23:21:22 CST

Preamble

This is the answer page to Case 14 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

What is the Value of the Lateral Chest Projection?

PA Chest

This 54 year old female presented to the Emergency Department with a chest infection.
She had a recent history of overseas travel.
There is no clear evidence of lung disease.
The right subdiaphragmatic region was noted to be denser when compared to the left- this can be a very subtle sign of basal lung disease


This 54 year old female presented to the Emergency Department with a chest infection. She had a recent history of overseas travel. There is no clear evidence of lung disease. The right subdiaphragmatic region was noted to be denser when compared to the left- this can be a very subtle sign of basal lung disease

Lateral

There is abnormal retrocardiac density demonstrated superimposed over the thoracic spine (arrowed)
There is loss of visualisation of the right hemidiaphragm posteriorly (silhouette sign)
This patient is likely to have a pneumonic infection resulting in abnormal alveolar opacity


There is abnormal retrocardiac density demonstrated superimposed over the thoracic spine (arrowed) There is loss of visualisation of the right hemidiaphragm posteriorly (silhouette sign) This patient is likely to have a pneumonic infection resulting in abnormal alveolar opacity

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Lateral Chest Case 13

M.J.Fuller — Mon, 08 Mar 2010 23:19:00 CST

Preamble

This is the answer page to Case 13 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect

This 31 year old female presented to the Emergency Department with fever, left pleuitic chest pain and left lung 'crackles'.


This 31 year old female presented to the Emergency Department with fever, left pleuitic chest pain and left lung 'crackles'.

There is a dense retrocardiac opacity (black arrows) with at least one airbronchogram line (grey arrow)


There is a dense retrocardiac opacity (black arrows) with at least one airbronchogram line (grey arrow)

Lateral

There is abnormal lretrocardiac ung opacity
The appearances are consistent with LLL consolidation.


There is abnormal lretrocardiac ung opacity The appearances are consistent with LLL consolidation.

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Lateral Chest Case 12

M.J.Fuller — Mon, 08 Mar 2010 23:17:27 CST

Preamble

This is the answer page to Case 12 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect

This 24 year old female was referred for chest radiography with a possible axillary DVT.
The chest radiography was preformed to assess possible cervical ribs.
Imaging was performed with a DR system
There is loss of visualisation of the right heart border
There is a mild scoliosis concave to the left
11 posterior ribs are seen above the diaphragm indicating overexpansion of the lungs
Note the upward curvature of the posterior ribs that can be associated with pectus excavatum


This 24 year old female was referred for chest radiography with a possible axillary DVT. The chest radiography was preformed to assess possible cervical ribs. Imaging was performed with a DR system There is loss of visualisation of the right heart border There is a mild scoliosis concave to the left 11 posterior ribs are seen above the diaphragm indicating overexpansion of the lungs Note the upward curvature of the posterior ribs that can be associated with pectus excavatum

Lateral

There is pectus excavatum (arrowed) which is associated with loss of visualisation of the right heart border
Pectus excavatum refers to the depressed inferior sternum.
This condition can leave insufficient space for the heart between the sternum and thoracic vertebral bodies causing the heart to displace to the left.
It is this displacement to the left that results in the failure of visualisation of the right heart border


There is pectus excavatum (arrowed) which is associated with loss of visualisation of the right heart border Pectus excavatum refers to the depressed inferior sternum. This condition can leave insufficient space for the heart between the sternum and thoracic vertebral bodies causing the heart to displace to the left. It is this displacement to the left that results in the failure of visualisation of the right heart border

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Lateral Chest Case 11

M.J.Fuller — Mon, 08 Mar 2010 23:12:02 CST

Preamble

This is the answer page to Case 6 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect Projection

This 76 year old lady presented to the Emergency Department with a 2 month history of productive cough.
On examination she was reported to have bilateral ronchi
The PA chest image shows some loss of visualisation of the left heart border of uncertain cause (can be normal finding).


This 76 year old lady presented to the Emergency Department with a 2 month history of productive cough. On examination she was reported to have bilateral ronchi The PA chest image shows some loss of visualisation of the left heart border of uncertain cause (can be normal finding).

Lateral

The lateral chest demonstrates collapse/consolidation within the lingular segment of the left upper lobe.


The lateral chest demonstrates collapse/consolidation within the lingular segment of the left upper lobe.

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Lateral Chest Case 10

M.J.Fuller — Mon, 08 Mar 2010 23:09:00 CST

Preamble

This is the answer page to Case 10 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

What is the Value of the Lateral Chest Projection?

PA Erect Projection

This 84 year old lady presented to the Emergency Department with PUO (fever).
She was referred for chest radiography with clinical information of "septic screen".
There is abnormal opacity projected over the cardiac shadow and right mid-lower chest.
The appearances are consistent with diaphragmatic hernia of which the hiatus hernia is the most common type
However, the appearances suggest bowel content rather than stomach content


This 84 year old lady presented to the Emergency Department with PUO (fever). She was referred for chest radiography with clinical information of "septic screen". There is abnormal opacity projected over the cardiac shadow and right mid-lower chest. The appearances are consistent with diaphragmatic hernia of which the hiatus hernia is the most common type However, the appearances suggest bowel content rather than stomach content

Lateral

The large retrocardiac hernia is well demonstrated on the lateral projection image.
The hernia contains large bowel (small bowel does not contained faeces)
The appearances are consistent witha Bochdalek hernia


The large retrocardiac hernia is well demonstrated on the lateral projection image. The hernia contains large bowel (small bowel does not contained faeces) The appearances are consistent witha Bochdalek hernia

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Lateral Chest Case 9

M.J.Fuller — Mon, 08 Mar 2010 23:06:11 CST

Preamble

This is the answer page to Case 9 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect Chest

This 38 year old male presented to the Emergency Department with a history of headache and fever.
He was referred for chest radiography


This 38 year old male presented to the Emergency Department with a history of headache and fever. He was referred for chest radiography

There is increased left retrocardiac density and airbronchogram lines (black arrows)
There is also a suggestion of loss of visualisation of the left hemidiaphragm medially (can be normal).
There is also increased density adjacent to the right heart border [white arrows]


There is increased left retrocardiac density and airbronchogram lines (black arrows) There is also a suggestion of loss of visualisation of the left hemidiaphragm medially (can be normal). There is also increased density adjacent to the right heart border [white arrows]

Lateral Chest

There is loss of visualisation of both hemidiaphragms posteriorly
There is loss of the normal darkening of the thoracic vertebral bodies inferiorly.
The appearances are consistent with bibasal collapse/consolidation.


There is loss of visualisation of both hemidiaphragms posteriorly There is loss of the normal darkening of the thoracic vertebral bodies inferiorly. The appearances are consistent with bibasal collapse/consolidation.

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Lateral Chest Case 8

M.J.Fuller — Mon, 08 Mar 2010 23:01:10 CST

Preamble

This is the answer page to Case 8 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

What is the Value of the Lateral Chest Projection?

PA Erect Chest

This 93 year old patient was referred for chest radiography with a history of "? renal failure".
There is evidence of increased bone density
? AC joint changes


This 93 year old patient was referred for chest radiography with a history of "? renal failure". There is evidence of increased bone density ? AC joint changes

Lateral Chest

The increased bone density is clearly seen particularly in the thoracic vertebral bodies (more prominent near endplates)
The appearances are likely to be related to renal osteodystrophy


The increased bone density is clearly seen particularly in the thoracic vertebral bodies (more prominent near endplates) The appearances are likely to be related to renal osteodystrophy

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Lateral Chest Case 7

M.J.Fuller — Mon, 08 Mar 2010 22:59:24 CST

Preamble

This is the answer page to Case 7 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect Chest

This 76 year old male presented to the Emergency Department with chest pain
The right heart border is not clearly demonstrated.
There is eventration of the right hemidiapharagm
There is bilateral apical pleural thickening


This 76 year old male presented to the Emergency Department with chest pain The right heart border is not clearly demonstrated. There is eventration of the right hemidiapharagm There is bilateral apical pleural thickening

Lateral Chest

There is evidence of pectus exavatum which is a normal variant and known cause of apparent loss of the right heart border.
Pectus excavatum refers to the depression of the sternum inferiorly (arrowed)
? small bilateral pleural effusions


There is evidence of pectus exavatum which is a normal variant and known cause of apparent loss of the right heart border. Pectus excavatum refers to the depression of the sternum inferiorly (arrowed) ? small bilateral pleural effusions

Discussion

The lateral chest revealed the patient's pectus excavatum deformity which explained the apparent loss of the right heart border. This appearance can be mistaken for a silhouette sign indicating RML disease.

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Lateral Chest Case 6

M.J.Fuller — Mon, 08 Mar 2010 22:56:09 CST

Preamble

This is the answer page to Case 6 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect Projection

This 24 year old male presented to the Emergency Department with "cough, fever, crepetation LL zone"
The patient was referred for chest radiography
This is a PA erect chest projection image taken with CR system

There is a suggestion of thick walled bronchii and airbronchogram lines within the LLL behind the heart shadow (arrowed)
This is undeniably subtle but correlates well with the patient's clinical presentation
A lateral projection image may provide additional diagnostic confidence


This 24 year old male presented to the Emergency Department with "cough, fever, crepetation LL zone" The patient was referred for chest radiography This is a PA erect chest projection image taken with CR system


There is a suggestion of thick walled bronchii and airbronchogram lines within the LLL behind the heart shadow (arrowed) This is undeniably subtle but correlates well with the patient's clinical presentation A lateral projection image may provide additional diagnostic confidence

Lateral Projection

There is prominence of the posterior basal retrocardiac lung markings


There is prominence of the posterior basal retrocardiac lung markings

The lung markings arrowed are prominent.
The thoracic vertebral bodies should appear to darken evenly as from top to bottom. In this patient they appear to become lighter near the hemidiaphragm
The appearances may reflect early pneumonitis


The lung markings arrowed are prominent. The thoracic vertebral bodies should appear to darken evenly as from top to bottom. In this patient they appear to become lighter near the hemidiaphragm The appearances may reflect early pneumonitis

Comment

This patient's PA chest findings were subtle (although they were noted by the radiographer). The lateral chest projection image provided additional confidence to the diagnosis and may have been influential in treatment decisions. It is at least possible (if not likely) that this finding would have been missed in an after-hours situation where no radiologist was present. I would also suggest that the risk of misdiagnosis would be higher if a lateral projection image was not provided.

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Lateral Chest Case 5

M.J.Fuller — Mon, 08 Mar 2010 22:50:30 CST

Preamble

This is the answer page to Case 5 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

PA Erect

This 54 year old female presented to the Emergency Department with anemia and shortness of breath
She was referred for chest radiography


This 54 year old female presented to the Emergency Department with anemia and shortness of breath She was referred for chest radiography

There is a large retrocardiac density (arrowed) that is likely to represent a hiatus hernia


There is a large retrocardiac density (arrowed) that is likely to represent a hiatus hernia

Lateral

The large retrocardiac density is seen to contain an airfluid level


The large retrocardiac density is seen to contain an airfluid level

This appearance is typical of a large hiatus hernia
Collapse/consolidation is not excluded


This appearance is typical of a large hiatus hernia Collapse/consolidation is not excluded

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Lateral Chest Case 4

M.J.Fuller — Mon, 08 Mar 2010 22:47:22 CST

Preamble

This is the answer page to Case 4 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

AP sitting Projection

Unlabelled

The child is in an AP sitting position with a 15 degree wedge sponge behind his/her chest
The image is taken with a CR system
8 posterior ribs are demonstrated.
The child is in a slightly lordotic position
The patient is not significantly rotated although the appearance of the right clavicle suggests the the child's right shoulder is positioned forward
see below for labelled image


The child is in an AP sitting position with a 15 degree wedge sponge behind his/her chest The image is taken with a CR system 8 posterior ribs are demonstrated. The child is in a slightly lordotic position The patient is not significantly rotated although the appearance of the right clavicle suggests the the child's right shoulder is positioned forward see below for labelled image

There are airbronchogram lines (arrowed) demonstrated behind the left heart shadow suggesting left lower lobe (LLL) consolidation.
These lines are caused by airspace (alveolar) opacity in the LLL associated with a LLL infection (pneumonia)
This is an example of silhouette sign


There are airbronchogram lines (arrowed) demonstrated behind the left heart shadow suggesting left lower lobe (LLL) consolidation. These lines are caused by airspace (alveolar) opacity in the LLL associated with a LLL infection (pneumonia) This is an example of silhouette sign

Lateral

The lateral projection was produced with the child in an erect sitting position with a 15 degree wedge sponge behind the child's chest.
The child's soft tissues can be seen posteriorly to pucker up over the top of the 15 degree sponge.

The right hemidiaphragm is demonstrated (black arrow)
The left hemidiaphragm is demonstrated partially (white arrow) and becomes obscured posteriorly.
There is abnormal opacity overlying the lower thoracic spine region (grey arrows)


The lateral projection was produced with the child in an erect sitting position with a 15 degree wedge sponge behind the child's chest. The child's soft tissues can be seen posteriorly to pucker up over the top of the 15 degree sponge.


The right hemidiaphragm is demonstrated (black arrow) The left hemidiaphragm is demonstrated partially (white arrow) and becomes obscured posteriorly. There is abnormal opacity overlying the lower thoracic spine region (grey arrows)

Discussion

This child has a left lower lobe consolidation which is likely to represent an acute pneumonia. The significant clue on the AP projection image is the presence of airbronchogram lines behind the heart. Whilst this condition can be diagnosed from the AP sitting projection by any person with skills in image interpretation, a less skilled observer could easily have missed this finding if a lateral projection image was not available. This is the sort of patient that turns up to the Emergency Department three days later in a considerably worse state than they presented the first time.

The pneumonitis is much easier to diagnose on the lateral projection image. There is abnormal posterior basal opacity with a silhouette sign involving the left hemidiaphragm. Another significant clue is that the thoracic spine should not appear lighter as you look from top to bottom- if anything, it should appear slightly darker as you look down the spine (until you reach diaphragm)

If this was your patient, would they have gone home with an undiagnosed left lower lobe pneumonia?

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Lateral Chest Case 2

M.J.Fuller — Mon, 08 Mar 2010 22:31:11 CST

Preamble

This is the answer page to Case 2 from the page titled What is the Value of the Lateral Chest Projection?

Other Relevant Wikiradiography Pages

What is the Value of the Lateral Chest Projection?

AP Sitting

This 54 year old male presented to the Emergency Department after a fall.
He was referred for chest radiography.
There is a small area of subcutaneous emphysema demonstrated above the left shoulder (arrowed).


This 54 year old male presented to the Emergency Department after a fall. He was referred for chest radiography. There is a small area of subcutaneous emphysema demonstrated above the left shoulder (arrowed).

Lateral

The lateral projection image demonstrates subcutaneous emphysema tracking posteriorly (arrowed)
The patient may have fractured ribs during the fall and the subcutaneous air may be associated with fractured ribs/pneumothorax.


The lateral projection image demonstrates subcutaneous emphysema tracking posteriorly (arrowed) The patient may have fractured ribs during the fall and the subcutaneous air may be associated with fractured ribs/pneumothorax.

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What is the Value of the Lateral Chest Projection?

M.J.Fuller — Mon, 08 Mar 2010 02:13:50 CST

Introduction

Some institutions (or even countries/continents) perform lateral chest radiography as a routine view whilst others almost never do. Is the lateral chest X-ray useful and, if so, is it useful enough to warrant its inclusion as a routine view? Has the cost/benefit equation changed with the introduction of digital imaging? Some radiologists have argued that the lateral chest view is never required- all pathology can be seen on the AP/PA.... but these radiologists are usually not around at 0300hrs in the Emergency Department when the image interpretation/treatment decision could be taking place.

You could argue that the lateral chest projection is required on the basis of selected case studies where it can be shown to reveal or clarify significant chest pathology. But wouldn't this be an argument for performing chest radiography as a screening tool on asymptomatic patients? (if you randomly perform chest radiography on the asymptomatic population you will find significant pathology)

Would the health care resources spent on lateral chest radiography provide a better yield if spent elsewhere?

If you are only performing AP/PA chest radiography, could an argument be made for more bedside chest radiography in the wards?

The Cases

If you are one of those people that advocate a "PA only" approach to chest radiography, consider the cases below. Each case has had AP/PA and lateral views of the chest. Can you confidently identify the pathology without the aid of the lateral projection?

Some cases are quite easy in terms of image interpretation and some are difficult

Case 1

Answer

Case 2

Answer

Case 3

Answer

Case 4

Answer

Case 5

Answer 5

Case 6

answer

Case 7

answer

Case 8

Answer

Case 9

Answer

Case 10

Answer

Case 11

Answer

Case 12

Answer

Case 13

Answer

Case 14

Answer

Case 15

Answer

Case 16

Case 17

Case 18

The Exceptions

Not every patient who is referred for chest radiography should be subject to a lateral view. B Golberg refers with great wit to the "fish and Chips" lateral...

I have written mainly... about what I classify as the
"fish and chips" lateral view-a request made purely from habit
or conditioned reflex. In the same week as I received the annotated
form mentioned in the first paragraph a casualty officer,
on his first day at the hospital, requested

posteroanterior and
lateral views " ? pneumothorax."

An experienced radiographer did the correct examination-namely, views in inspiration and expiration, only to receive patient and form back immediately
with the insistence that a lateral view be done. Such a view is certain to be useless if he really was looking for a pneumothorax. If there was something else on his mind it was certainly not on the request form.

B Golberg, BRITISH MEDICAL JOURNAL 29 MARCH 1980, p 909

Links

http://education.thoracicrad.org/2007/BTB/735/player.html

Discussion

I am hoping that there will be some attempt(s) to interpret these images without the lateral view. You can post your comments using the "post a new thread" link at the bottom of this page. Once a few brave souls have had a go, I will post the lateral chest images.

I have very little doubt that an expert in chest image interpretation will correctly identify the pathologies on this page without the benefit of the lateral chest image. This is arguably not the point- the person who views the image and acts upon the findings needs to be furnished with images that allow him/her to arrive at the correct diagnosis. It is often the case that pathologies that are sited behind the heart shadow or below the diaphragm are easier to appreciate with the aid of a lateral image. Are you left wondering how many chest pathologies you have missed over the years?

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Nasal Bones Radiographic Anatomy

AndyC — Sun, 07 Mar 2010 18:45:23 CST

This page contains radiographic anatomy of the adult nasal bones

Images on this page

Nasal Bones

Nasal Bone Positioning

Nasal Anatomy

Nasal Bone - Paediatric

Nasal Bone Positioning Video

Nasal Bone - OM

Sinuses Radiographic Anatomy

AndyC — Sun, 07 Mar 2010 17:57:37 CST

This page contains radiographic anatomy of the adult sinuses

Images on this page

Sinuses

Sinuses Positioning

Sinuses Radiographic Anatomy

Sinuses - Paediatric

Sinuses Video Positioning

Sinuses Miscellaneous

Leaning tower view of Sinuses

wikiRadiography - Recently Updated Pages

Applied Radiography - by M.J.Fuller

Lateral Chest Case 3

Medical Abbreviations

Lateral Chest Case 1

Lateral Chest Case 15

Lateral Chest Case 14

Lateral Chest Case 13

Lateral Chest Case 12

Lateral Chest Case 11

Lateral Chest Case 10

Lateral Chest Case 9

Lateral Chest Case 8

Lateral Chest Case 7

Lateral Chest Case 6

Lateral Chest Case 5

Lateral Chest Case 4

Lateral Chest Case 2

What is the Value of the Lateral Chest Projection?

Nasal Bones Radiographic Anatomy

Adult Nasal Bones - Lateral View

Adult Nasal Bones - Superoinferior (Axial) View

Adult Nasal Bones - Occipito Mental (OM) (Waters) View

Sinuses Radiographic Anatomy

Adult Sinuses - PA 15 Caldwell

Adult Sinuses - Occipito Mental OM (Waters)

Adult Sinuses - Lateral

	I have written mainly... about what I classify as the "fish and chips" lateral view-a request made purely from habit or conditioned reflex. In the same week as I received the annotated form mentioned in the first paragraph a casualty officer, on his first day at the hospital, requested posteroanterior and lateral views " ? pneumothorax." An experienced radiographer did the correct examination-namely, views in inspiration and expiration, only to receive patient and form back immediately with the insistence that a lateral view be done. Such a view is certain to be useless if he really was looking for a pneumothorax. If there was something else on his mind it was certainly not on the request form.
	B Golberg, BRITISH MEDICAL JOURNAL 29 MARCH 1980, p 909