Chest x-ray

When studying the x-ray anatomy of the chest, pay attention to the x-ray structure of the visible bones and soft tissues of the chest ; the shape and transparency for the x-rays of the areas onto which the lung tissue is projected (the so-called "lung fields"), as well as their structure formed by the shadows of the lung vessels ("lung pattern"); location and structure of the roots of the lungs ; position, shape of the domes of the diaphragm and sinuses of the pleural cavities ; the shape and size of the shadow of the mediastinum (including the heart ).

Chest x-ray helps to identify pathological changes in the soft tissues, chest bones and anatomical structures located in the chest cavity ( lungs , pleura , mediastinum ). Most often, radiography diagnoses pneumonia and congestive heart failure. Along with diagnostic purposes, chest X-ray is used as a screening method for assessing the state of lung tissue, in particular, in persons with occupational hazards (for example, miners) ^[2] .

In some diseases of the chest organs, radiography is good as a screening method, but it has insufficient diagnostic value; in these cases, additional studies are carried out ( computed tomography , bronchoscopy , etc.).

It should be borne in mind that in some cases, chest x-ray may not be informative (that is, demonstrate a false-negative result). Such situations can be caused by projection layering of the shadow of the pathological focus on the shadow of the normal anatomical structure (for example, the diaphragm, mediastinum), low focus of the focus (for example, initial inflammatory manifestations, especially in conditions of agranulocytosis ^[3] ), inadequate projection of the study (especially, in the case of pathology of the mediastinum or fractures of the ribs, sternum). If radiography is not informative, the computed tomography, devoid of the above disadvantages, is the method of choice.

During chest x-ray, the patient is placed between the x-ray tube and the film (detector). Usually used direct (front and rear) and side (left or right) projection. When examining in the front direct projection, the patient is placed facing the detector (film), while examining in the rear direct projection - vice versa. If necessary, additional studies are carried out: in the patient’s supine position (to detect hydrothorax moving with a change in body position), arched back (lordotic x-ray, for better visualization of the apex of the lungs, for example, with the exception of the Pancost tumor ), on exhalation (for better diagnosis of pneumothorax ), in oblique projections.

Additional or absent shadow elements (darkening and enlightenment, reducing or increasing the transparency of the pulmonary background, enrichment or depletion of the pulmonary pattern, etc.) in the shadow picture of the lung tissue indicate pathology. Each of the additional shadow elements has certain characteristics (position, number, shape, size, intensity, structure, contours, displacement), not only of clinical importance, but also contributing to differential diagnosis , as well as having practical value in planning bronchoscopy , biopsy , surgical interventions, etc.

Among the pathological radiological findings, foci or foci (limited areas of darkening of the lung tissue), air cavities (areas of enlightenment against the background of the lung tissue), pleural effusion (dimming of the pleural sinuses and interlobar fissures or parietal dimming of various prevalence), air in the pleural cavity (can be traced) are distinguished thin line of visceral pleura, separated from the chest by a section of enlightenment devoid of pulmonary pattern), various types of diffuse changes (reticular, miliary st, cystic, like “frosted glass” , diffuse consolidation zones).

The differential diagnosis of diseases of the lungs and mediastinum is facilitated by the assessment of additional signs, such as the volume of lung tissue, the position and structure of the roots of the lungs and domes of the diaphragm, the position and shape of the shadow of the mediastinum, airiness of the bronchi, etc.

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  Processed digital chest radiograph (pulmonary fields in a positive image, with increased contrast).

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  Chest x-ray in lateral projection.

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  Poor radiograph of the chest.

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  Chest x-ray showing a solitary pulmonary node in the upper lobe of the left lung.

• Chest X-ray