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Tutorial introduction I nclusion Projection Rotation I nspiration and lung v olume Penetration Artifact Tutorial conclusion
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Key points
Always assess inspiration and lung v olumes Incomplete inspiration can lead to exaggeration of lung markings and heart size Lung hyperexpansion is a sign of obstructiv e lung disease
Assessing inspiration
To assess the degree of inspiration it is conv entional to count ribs down to the diaphragm. The diaphragm should be intersected by the 5th to 7th anterior ribs in the mid-clav icular line. Less is a sign of incomplete inspiration.
Expiration
Hov er ov er image to show findings
Expiration
(Same patient as next image) Anteriorly only the third rib intersects the diaphragm at the mid-clav icular line The lung bases are white - Is there consolidation ? How big is the heart?
Inspiration
Hov er ov er image to show findings
Inspiration
(Same patient as prev ious image) Anteriorly the sixth rib intersects the diaphragm at the midclav icular line The lungs are not consolidated The heart size is clearly normal
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4/6/2013 12:07 AM
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Normal expansion
Hov er ov er image to show findings
Normal expansion
This patient has taken a good breath in such that the diaphragm is intersected by the 6th rib in the mid-clav icular line. The hov er ov er image shows an imaginary line (dotted) between the costophrenic and cardiophrenic angles. The distance between this line and the diaphragm (green line) should be greater than 1.5cm(asterisk) in normal indiv iduals. In practice this is rarely measured and a quick assessment of diaphragm shape is all that is necessary.
Hyperexpansion
Hov er ov er image to show findings
Hyperexpansion
It is often quicker to assess for hyperexpansion by looking at the hemidiaphragms. These are clearly flattened (red line) in this patient. The ribs are difficult to count as they hav e lost density. This is due to long term steroid treatment for the patient's emphysema. There is also consolidation of the lung bases due to pneumonia.
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4/6/2013 12:07 AM
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