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  1. X-ray (chest), PA, Pericardial Effusion, Adult Male

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    Description: 1. Cardiomegaly with water bottle sign. The widest diameter of the heart (A) is compared with the width of half the thorax at its widest point (B). This is known as the cardiothoracic ratio. The normal heart should be less than the diameter of the hemithorax (see the normal comparison study). This should be measured on an upright PA radiograph with adequate inspiration (Right cardiophrenic junction overlies 10th and 11th ribs posteriorly). AP portable studies, poor inspiration, patient rotation, and the patient not in an upright position can cause falsely elevated estimation of heart size. This example study does not have technically adequate inspiration as it shows only to the 9th rib. 2. Note also the pericardium has sagged like a water balloon that has been set on a table. Note the distortion of the normal contours of the heart visible on the comparison study. This is described as a “water bottle” shaped heart. This finding is associated with very large, slowly accumulating pericardial effusions. It is not sensitive for small, rapidly developing hemodynamically significant pericardial effusion. An acute, rapidly developing pericardial effusion that is causing cardiac tamponade frequently presents with a normal size heart on the chest radiograph.
    Keywords: Roentgenography, Diagnostic X-Ray, X-Ray Radiology, Diagnostic, Chylopericardium, Diagnosis, X-Ray, Diagnostic, Radiology, Diagnostic X-Ray, Radiography, Diagnostic X-Ray Radiology, Hemopericardium

  2. X-ray (chest), PA, Pericardial Effusion, Adult Male, Numbered

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    Description: 1. Cardiomegaly with water bottle sign. The widest diameter of the heart (A) is compared with the width of half the thorax at its widest point (B). This is known as the cardiothoracic ratio. The normal heart should be less than the diameter of the hemithorax (see the normal comparison study). This should be measured on an upright PA radiograph with adequate inspiration (Right cardiophrenic junction overlies 10th and 11th ribs posteriorly). AP portable studies, poor inspiration, patient rotation, and the patient not in an upright position can cause falsely elevated estimation of heart size. This example study does not have technically adequate inspiration as it shows only to the 9th rib. 2. Note also the pericardium has sagged like a water balloon that has been set on a table. Note the distortion of the normal contours of the heart visible on the comparison study. This is described as a “water bottle” shaped heart. This finding is associated with very large, slowly accumulating pericardial effusions. It is not sensitive for small, rapidly developing hemodynamically significant pericardial effusion. An acute, rapidly developing pericardial effusion that is causing cardiac tamponade frequently presents with a normal size heart on the chest radiograph.
    Keywords: Radiography, Roentgenography, Diagnostic X-Ray, X-Ray, Diagnostic, Radiology, Diagnostic X-Ray, Chylopericardium, Hemopericardium, Diagnosis, Diagnostic X-Ray Radiology, X-Ray Radiology, Diagnostic

  3. X-ray (chest), PA, With Annotations, Adult Male, Normal

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    Description: (A) right clavicle (B) right scapula (C) right fourth anterior rib (D) right costophrenic angle (E) left lung apex (F) aortic arch (G) hilum (H) heart (I) left lung base (J) right hemidiaphragm (white arrow)
    Keywords: Radiography, Thoraces, Chest, Diagnostic X-Ray, Roentgenography, X-Ray, Diagnostic, Diagnosis, Radiology, Diagnostic X-Ray, Diagnostic X-Ray Radiology, X-Ray Radiology, Diagnostic

  4. X-ray (chest), PA, With Annotations, Adult Male, Normal

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    Description: (A) right clavicle (B) right scapula (C) right fourth anterior rib (D) right costophrenic angle (E) left lung apex (F) aortic arch (G) hilum (H) heart (I) left lung base (J) right hemidiaphragm (white arrow)
    Keywords: X-Ray Radiology, Diagnostic, Diagnosis, Radiology, Diagnostic X-Ray, Thoraces, Radiography, Diagnostic X-Ray Radiology, Roentgenography, Diagnostic X-Ray, Chest, X-Ray, Diagnostic

  5. X-ray (chest), PA, Miliary Tuberculosis (TB), Adult Male, Numbered

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    Description: 1. Miliary pattern of lung disease with innumerable discrete opacities usually the size of a millet seed (1-3 mm) more or less evenly distributed throughout both lungs. This finding is highly suggestive of disseminated M. tuberculosis, but may also be seen with fungal, viral, parasitic, bacterial, neoplastic, and inflammatory lung diseases as well. 2. Tracheostomy tube suggests this is a very sick patient. 3. Indistinct opacities that distort the mediastinal contour suggest mediastinal lymph node enlargement. Note the mediastinal borders on the comparison view. 4. Indistinct heart border demonstrating silhouette sign. Note distinct borders on comparison view.
    Keywords: Kochs Disease, Gram-Positive Bacterial Infections, Diagnostic X-Ray Radiology, Diagnosis, Radiography, X-Ray, Diagnostic, Koch's Disease, Radiology, Diagnostic X-Ray, X-Ray Radiology, Diagnostic, Roentgenography, Diagnostic X-Ray

  6. X-ray (chest), PA, Miliary Tuberculosis (TB), Adult Male, Answers

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    Description: 1. Miliary pattern of lung disease with innumerable discrete opacities usually the size of a millet seed (1-3 mm) more or less evenly distributed throughout both lungs. This finding is highly suggestive of disseminated M. tuberculosis, but may also be seen with fungal, viral, parasitic, bacterial, neoplastic, and inflammatory lung diseases as well. 2. Tracheostomy tube suggests this is a very sick patient. 3. Indistinct opacities that distort the mediastinal contour suggest mediastinal lymph node enlargement. Note the mediastinal borders on the comparison view. 4. Indistinct heart border demonstrating silhouette sign. Note distinct borders on comparison view.
    Keywords: Diagnostic X-Ray Radiology, Gram-Positive Bacterial Infections, Diagnostic X-Ray, Diagnosis, X-Ray Radiology, Diagnostic, Roentgenography, Radiology, Diagnostic X-Ray, X-Ray, Diagnostic, Radiography

  7. X-ray (chest), PA, Miliary Tuberculosis (TB), Adult Male

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    Description: 1. Miliary pattern of lung disease with innumerable discrete opacities usually the size of a millet seed (1-3 mm) more or less evenly distributed throughout both lungs. This finding is highly suggestive of disseminated M. tuberculosis, but may also be seen with fungal, viral, parasitic, bacterial, neoplastic, and inflammatory lung diseases as well. 2. Tracheostomy tube suggests this is a very sick patient. 3. Indistinct opacities that distort the mediastinal contour suggest mediastinal lymph node enlargement. Note the mediastinal borders on the comparison view. 4. Indistinct heart border demonstrating silhouette sign. Note distinct borders on comparison view.
    Keywords: Kochs Disease, Radiography, Diagnostic X-Ray, Radiology, Diagnostic X-Ray, Koch's Disease, Diagnosis, Roentgenography, X-Ray Radiology, Diagnostic, Diagnostic X-Ray Radiology, X-Ray, Diagnostic, Gram-Positive Bacterial Infections

  8. X-ray (chest), PA, Metastatic Cancer, Adult Male

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    Description: 1.Multiple bilateral spherical masses (greater than 30 mm diameter) and nodules (less than 30 mm) characteristic of metastatic cancer. Many types of primary cancers metastasize to the lungs but the most common are breast, colon, prostate, and bladder cancer. 2. Fluid meniscus-shaped blunting of left costophrenic angle from pleural effusion. 3. Annotation #3 marks the radio-opaque strip built into an endotracheal tube. The tip of endotracheal tube surrounded by air-filled balloon. The ideal position for the endotracheal tube tip is in the mid trachea, 3-5 cm from the carina, or approximately the mid point between the clavicles and the carina (the division of the right and left mainstem bronchi - just superior to annotation C). The minimal safe distance from the carina is 2 cm because movement of the patient's head can lead to right main stem bronchus intubation. If the tip of the endotracheal tube is too high it can be dislodged by movement of the patient's head leading to extubation. Unrecognized displacement of the endotracheal tube in either direction rapidly becomes a very hazardous situation for the patient. Frequently the exact position of the carina can be difficult to ascertain, particularly on portable AP studies. Its location can be estimated by drawing a line that bisects the midpoint of the aorta at a 45-degree angle running inferiorly to the right (please see second x-ray). 4. Gastric tube with tip in stomach. Once a patient is endotracheally intubated a nasogastric or oralgastric tube is typically immediately placed to decompress the stomach helping to prevent aspiration as well as vent out air that may have been forced into the stomach during bag-valve mask ventilation. A air-distended stomach can prevent effective ventilation, particularly in pediatric patients. Remembering this pearl under pressure of a pediatric resuscitation may save a potentially salvageable pediatric patient during your career.
    Keywords: X-Ray, Diagnostic, Diagnostic X-Ray Radiology, X-Ray Radiology, Diagnostic, Diagnostic X-Ray, Diagnosis, Roentgenography, Radiography, Radiology, Diagnostic X-Ray

  9. X-ray (chest), PA, Metastatic Cancer, Adult Male

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    Description: 1.Multiple bilateral spherical masses (greater than 30 mm diameter) and nodules (less than 30 mm) characteristic of metastatic cancer. Many types of primary cancers metastasize to the lungs but the most common are breast, colon, prostate, and bladder cancer. 2. Fluid meniscus-shaped blunting of left costophrenic angle from pleural effusion. 3. Annotation #3 marks the radio-opaque strip built into an endotracheal tube. The tip of endotracheal tube surrounded by air-filled balloon. The ideal position for the endotracheal tube tip is in the mid trachea, 3-5 cm from the carina, or approximately the mid point between the clavicles and the carina (the division of the right and left mainstem bronchi - just superior to annotation C). The minimal safe distance from the carina is 2 cm because movement of the patient's head can lead to right main stem bronchus intubation. If the tip of the endotracheal tube is too high it can be dislodged by movement of the patient's head leading to extubation. Unrecognized displacement of the endotracheal tube in either direction rapidly becomes a very hazardous situation for the patient. Frequently the exact position of the carina can be difficult to ascertain, particularly on portable AP studies. Its location can be estimated by drawing a line that bisects the midpoint of the aorta at a 45-degree angle running inferiorly to the right (please see second x-ray). 4. Gastric tube with tip in stomach. Once a patient is endotracheally intubated a nasogastric or oralgastric tube is typically immediately placed to decompress the stomach helping to prevent aspiration as well as vent out air that may have been forced into the stomach during bag-valve mask ventilation. A air-distended stomach can prevent effective ventilation, particularly in pediatric patients. Remembering this pearl under pressure of a pediatric resuscitation may save a potentially salvageable pediatric patient during your career.
    Keywords: Radiology, Diagnostic X-Ray, Diagnosis, Neoplasms, cancer, metastatic cancer, Radiography, Roentgenography, Diagnostic X-Ray, X-Ray Radiology, Diagnostic, X-Ray, Diagnostic, Diagnostic X-Ray Radiology

  10. X-ray (chest), Metastatic Cancer, Adult Male

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    Description: 1.Multiple bilateral spherical masses (greater than 30 mm diameter) and nodules (less than 30 mm) characteristic of metastatic cancer. Many types of primary cancers metastasize to the lungs but the most common are breast, colon, prostate, and bladder cancer. 2. Fluid meniscus-shaped blunting of left costophrenic angle from pleural effusion. 3. Annotation #3 marks the radio-opaque strip built into an endotracheal tube. The tip of endotracheal tube surrounded by air-filled balloon. The ideal position for the endotracheal tube tip is in the mid trachea, 3-5 cm from the carina, or approximately the mid point between the clavicles and the carina (the division of the right and left mainstem bronchi - just superior to annotation C). The minimal safe distance from the carina is 2 cm because movement of the patient's head can lead to right main stem bronchus intubation. If the tip of the endotracheal tube is too high it can be dislodged by movement of the patient's head leading to extubation. Unrecognized displacement of the endotracheal tube in either direction rapidly becomes a very hazardous situation for the patient. Frequently the exact position of the carina can be difficult to ascertain, particularly on portable AP studies. Its location can be estimated by drawing a line that bisects the midpoint of the aorta at a 45-degree angle running inferiorly to the right (please see second x-ray). 4. Gastric tube with tip in stomach. Once a patient is endotracheally intubated a nasogastric or oralgastric tube is typically immediately placed to decompress the stomach helping to prevent aspiration as well as vent out air that may have been forced into the stomach during bag-valve mask ventilation. A air-distended stomach can prevent effective ventilation, particularly in pediatric patients. Remembering this pearl under pressure of a pediatric resuscitation may save a potentially salvageable pediatric patient during your career.
    Keywords: Radiography, metastatic cancer, Roentgenography, Radiology, Diagnostic X-Ray, Diagnostic X-Ray, X-Ray Radiology, Diagnostic, Diagnostic X-Ray Radiology, X-Ray, Diagnostic, Neoplasms, Diagnosis, cancer