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Titlebook: Chest X-Ray in Clinical Practice; Rita Joarde,Neil Crundwell Book 2009 Springer-Verlag London 2009 X-ray.computed tomography (CT).diagnosi

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Chest RadiographyIt is important to understand how an X-ray image is generated. Artifacts and other pseudo-abnormalities can be much more easily explained if you are aware of how they may be created.
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The Normal Chest X-ray: An Approach to InterpretationBeing able to recognize normal appearances and structures as seen on a chest X-ray (CXR) is key to being able to correctly interpret any abnormal findings. In order to do this, we must first understand why we are able to see structures such as the heart border and the ribs as separate entities to surrounding tissues.
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The Mediastinum and Hilar RegionsThe mediastinum is divided into anterior, middle, and posterior regions, subdivided into superior and inferior regions (Fig. 3.1). We see the outline of the mediastinum because structures are adjacent to other structures of differing radiodensity. This is generally soft tissue against air.
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NodulesMany disease processes result in the appearance of nodules on a chest X-ray. It is not always possible to determine the exact cause from a single plain film. Recognition of a pattern of abnormality will, however, enable a reasonable differential of the appearances to be drawn up.
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Pleural AbnormalitiesPleural effusions are a common finding. Further investigation of a pleural effusion, in addition to a detailed history and examination, may include a pleural tap. This establishes whether the effusion is a result of an exudate or a transudate. This knowledge further helps elucidate the cause of the effusion Table 5.1.
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Pleural Thickening and CalcificationIt can sometimes be difficult to distinguish pleural thickening from an effusion purely on a plain film, particularly when the degree of thickening is small. As mentioned before, comparison with previous imaging or assessment with ultrasound is very useful.
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PneumothoraxThe confident diagnosis of a pneumothorax is a good example of an abnormality that may cause a diagnostic challenge to a junior doctor. There is clearly significance to the diagnosis as intervention in the form of a chest drain may be required.
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Soft Tissues and Bony StructuresWhen examining a chest X-ray it is very important to consider the peripheral structures. Details of a review of areas have been given in Chapter 2 and we will now return to these as they apply to soft tissue structures and bones.
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Foreign Structures and Other Devices on Chest X-raysThere are a variety of other findings on chest X-rays that re-late to either previous surgical procedures or line/tube place-ment. This chapter gives a range of examples that may be useful.
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