name the 2 major fissures and 1 minor fissure
R oblique fissue (major), L oblique fissure (major), and R horizontal fissure (minor)
what lobes does the R oblique fissure separate
R upper and middle lobes from the R lower lobe
what level does R oblique fissure begin, where does it extend, where does it end
extends obliquely down and forward
ends at anterior pleural gutter of diaphragm
Which is more vertical: right oblique fissure or left oblique fissure
left oblique fissure
describe the radiology of the R oblique fissure
• May be visible on the lateral film
• Will NOT be seen on PA chest film
• Identify which side oblique fissure by which diaphragm it intersects with
• Horizontal fissure will run into Right Oblique fissure but will not cross it
what does the right horizontal fissure separate
- separates Anterior segment of R Upper Lobe from R Middle Lobe
beginning, extension, and ending of R horizontal fissure
- begins at R Oblique Fissure at mid-axillary line
- runs horizontally anteriorly to sternal end of 4th costal cartilage
R horizontal fissure radiology
• Absent or incomplete on 25% of individuals
• Seen in ~54% of PA chest x-rays
• Runs from anterior 4th rib posteriorly to the R oblique fissure
what does the L oblique fissure separate
- separates L Upper Lobe from Left Lower Lobe
beginning, extension, and end of L oblique fissure
- begins at level of T5
- extends obliquely down and forward
- ends at anterior pleural gutter of diaphragm
To Differentiate Right from Left:
- use other landmarks
- Magenblasse = gas in the fundus of the stomach
- Which diaphragm the fissure crosses
location of RUL
apical, anterior, & posterior
lateral & medial
superior, medial basal, anterior basal, lateral basal, & posterior basal
apical-posterior, anterior, superior lingular, & inferior lingular
o corresponds to RML
o LUL is analogous to RUL and RML combined
superior, medial basal, anterior basal, lateral basal, posterior basal
o LLL is the same as LRL
location of lingular lobes
located in left upper lobe, bordering the heart
anatomical parts responsible for the cardiac contours on the PA chest film
anterior: Right heart border, left heart border, ascending aorta
posterior: Descending thoracic aorta, aortic knob (posterior portion of aortic arch)
Which views are included in routine plain film examination of the chest?
Minimum Diagnostic Series (both on full inspiration):
• Left Lateral
How does a thoracic spine plain film study differ from a chest study?
Chest Technique: 72” FFD, High kVp, Low mA and short time
• Chest films must include all air spaces of the lungs vs. tightly collimated thoracic spine film
Positioning: PA Chest vs. AP Thoracic
Left Lateral Chest vs. Either Lateral Thoracic
What condition or anatomical region is best demonstrated by the apical lordotic view?
Lung Apices: apical refers to the anatomy and lordotic refers to the patient position/technique
-can Dx a Pancoast tumor, Tuberculosis
-can be used to demonstrate the middle lobe of the right lung and the lingula segment of the left upper lobe.
Is the routine chest x-ray taken with inspiration or expiration?
Routine CXR = Full inspiration
o Breath held on inspiration
o Expands lung fields
o depresses diaphragm
o Provides contrast (air vs. tissue)
Describe the difference in appearance between inspiration and expiration chest films.
Need good inspiration for chest film. You should see first 10 ribs posteriorly and a breath in will lower the diaphragm. Without a deep inspiration the heart will look enlarged and the lungs will be condensed and more radio-opaque.
What condition is better demonstrated upon expiration than inspiration?
Pneumothorax – upright expiration is more sensitive. Look for mediastinal displacement. (Atelectasis maybe though too?)
What is the appearance of interstitial disease?
Thickened interlobular septa, alveolar walls. Usually a diffuse pattern of involvement. Often combined with consolidation.
What is the appearance(s) of alveolar/air-space disease?
Air space disease, or alveolar lung disease, is a process in which there is a filling of the lung's alveoli / acini.
Radiographic features: lobar or segmental distribution, poorly marginated, airspace nodules, tendency to coalesce, air bronchograms, bat's wing (butterfly) distribution, rapidly changing over time
4 patterns of “white lung” disease (lung opacification on chest films) and a differential list for each.
3. Solitary mass/nodule
5. Multiple masses/nodules
describe Diffuse "white lung" disease
Diffuse – usually bilateral and symmetric; suggests more systemic/widespread dz
DDx: Pulmonary edema, Unusual infections (Pneumocysitis carinii, opportunistic, immune compromised) Sarcoidosis, Histoplasmosis, TB, Bronchiolaveolar carcinoma, Idiopathic pulmonary hemorrhage
describe Localized/Lobar "white lung"
• Usually only a portion of one lung
• Most common presentation of infection
•DDx: Acute bacterial pneumonia, Pulmonary TB, Pulmonary infarct, Bronchopulmonary sequestration, Pancoast tumor, Atypical pneumonia (viral, mycoplasma)
describe Solitary mass/nodule "white lung"
Smaller, fairly well defined area. Common presentation of neoplasm.
•DDx: Bronchogenic carcinoma, Hematogenous metastasis, Hamartoma, Tuberculoma (and other granulomas), Lung abscess, Hydatid cyst, Hematoma, Bronchopulmonary sequestration