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RESPIRASI

dr. SUCIATI DAMOPOLII, Sp.Rad(K)TR,M.Kes


Posterioranterior and Lateral
The standard chest examination consists of a PA (posterioranterior) and lateral chest x-ray. The films
are read together. The PA exam is viewed as if the patient is standing in front of you with their right
side on your left. The patient is facing towards the left on the lateral view. Comparison films can be
invaluable - Old Gold! If you have comparison films, the old PA film is displayed adjacent to the new
PA film and the old lateral is displayed adjacent to the new lateral.

On the left is a simulated patient in position for a standard PA (posterioranterior) chest


x-ray. On the right is a normal PA film.
On the left is a simulated patient in position for a lateral chest x-ray and on the right is a normal lateral film.
Note that the receptor or film is against the left chest.
The AP shows magnification of the heart and widening of the
mediastinum. Whenever possible the patient should be imaged in
an upright PA position. AP views are less useful and should be
reserved for very ill patients who cannot stand erect.

Left, in the supine AP (anteriorposterior) position the x-ray tube is 40 inches


from the patient.
Lateral decubitus position
The patient can also be examined in a lateral decubitus position. This could be helpful
to assess the volume of pleural effusion and demonstrate whether a pleural effusion
is mobile or loculated. You could also look at the nondependent hemithorax to
confirm a pneumothorax in a patient who could not be examined erect. Additionally,
the dependant lung should increase in density due to atelectasis from the weight of
the mediastinum putting pressure on it. Failure to do so indicates air trapping.

Left shows a patient in position for a right lateral decubitis position.


The right is an example of a decubitus film in this case showing a mobile pleural effusion (arrows).
Technically adequate
Inspiration
The patient should be examined in full inspiration. This greatly helps the
radiologist to determine if there are intrapulmonary abnormalities. The
diaphragm should be found at about the level of the 8th - 10th posterior rib or
5th - 6th anterior rib on good inspiration.
Opacity

Mass vs. Infiltrate


PA film of a patient with pulmonary edema showing
cephalization of pulmonary veins and indistinctness of
the vascular margins. The heart is enlarged.
The patient above is suffering from congestive heart
failure resulting in interstitial edema.
Notice the Kerley's B lines in right periphery (arrows).
The left image demonstrates a patient with a
severe pulmonary edema as a result of CHF. The
right image is the same patient after significant
resolution
The right heart border is silhouetted out.
This is caused by a pneumonia, can you determine which lobe the
pneumonia affects
These are PA and lateral films of RML pneumonia (arrows).
Note the indistinct borders, air bronchograms, and
silhouetting of the right heart border
PA and Lateral films of RUL pneumonia
PA and Lateral films of a patient with right upper lobe
hemorrhage. Notice the large pleural effusion in the left hemithorax.
The right heart border is silhouetted out.
This is caused by a pneumonia, can you determine which lobe the
pneumonia affects
PA and lateral film of a patient with bilateral pleural effusions.
Note the concave menisci blunting both posterior
costophrenic angles.
PA and lateral of hiatal hernia. Can you see the air-
filled "mass" posterior to the heart?
What is the most likely diagnosis on the following chest x-
ray?

Atelectasis
Pulmonary edema
Bilateral pneumonia
Pneumothorax
Admission PA and Lateral chest radiograph of a trauma patient with a left-
sided pleural effusion demonstrates what other notable abnormality ?

- Right tension pneumothorax


- Left pulmonary opacity representing pulmonary hemorrhage
- Left pulmonary opacity representing pneumonia
- Left pneumothorax
Identify the abnormality shown in the image below?

Bilateral basilar atelectasis


Right middle lobe pneumonia
Hampton's hump
Bilateral pleural effusions
Identify the abnormality shown in the image below.

Large pleural effusion


Tension pneumothorax
Left lower lobe pneumonia
None of the above.
Identify the abnormality shown in the images below.

Right pleural effusion


Hydropneumothorax
Right basilar pneumothorax
Right lower lobe atelectasis
What sign is seen in the image below?

Concave margin sign


Indistinct margin sign
Crescent sign
Silhouette sign
All of the above
Identify the abnormality shown in the images below.

Hiatal hernia
Bochdalek hernia
Morgagni hernia
Eventration
Pada pemeriksaan X-ray:

Dirty chest/ corakan bronkovaskular yang kasar


TERIMAKASIH