Chest X-Rays for Medical Students

Chest X-rays for Medical Students offers a fresh analytical approach to identifying chest abnormalities, helping medical students, junior doctors, and nurses understand the underlying physics and basic anatomical and pathological details of X-ray images of the chest. The authors provide a memorable framework for analysing and presenting chest radiographs, with each radiograph appearing twice in a side-by-side comparison, one as seen in a clinical setting and the second highlighting the pathology.

This new second edition includes significant revisions, improved annotations of X-rays, expanded pathologies, and numerous additional high-quality images. A comprehensive one-stop guide to learning chest radiograph interpretation, this book:

    Aligns with the latest Royal College of Radiologists’ Undergraduate Radiology Curriculum
    Offers guidance on how to formulate normal findings
    Features self-assessment tests, presentation exercises, and varied examples
    Includes sections on radiograph quality X-ray hazards and precautions

Chest X-rays for Medical Students is an ideal study guide and clinical reference for any medical student, junior doctor, nurse or radiographer.

Table of contents

Preface vii

Acknowledgements viii

Learning objectives checklist ix

Part 1 1. Introduction to X-rays 1

What are X-rays? 1

How are X-rays produced? 1

How do X-rays make an image? 2

The 5 densities on an X-ray 2

How are X-ray images (radiographs) stored?

Hazards and precautions 3

Ionising radiation hazards 3

The Ionising Radiation (Medical Exposure) Regulations (IRMER) 3

In women of reproductive age 3

2. Chest X-ray views 4

PA erect chest X-ray 4

Other views 4

3. Radiograph quality 5

Inclusion 5

Rotation 5

Inspiration 6

4. Normal anatomy on a PA chest X-ray 5

Right and left 5

Lung zones 5

The mediastinum 6

Normal pulmonary vasculature 7

Normal anatomy 1 8

Normal anatomy 2 8

Bronchial and lobar anatomy 9

5. Presenting a chest radiograph 10

Part 2 Overview of the ABCDE of chest X-rays 14

6. A - Airway 15

Tracheal deviation 21

Carinal angle 22

7. B - Breathing 16

Consolidation/Airspace opacification 23

Air bronchogram 27

Collapse (atelectasis) overview 29

Right upper lobe collapse 30

Middle lobe collapse 31

Right lower lobe collapse 32

Left upper lobe collapse 34

Left lower lobe collapse 36

Complete lung collapse 38

Pneumonectomy 39

Solitary mass lesion 41

Multiple mass lesions 44

Cavitating lung lesion 47

Fibrosis 49

Pneumothorax 53

Tension pneumothorax 56

Hydropneumothorax 58

Pleural effusion 60

Pulmonary oedema 65

‘Bat’s wing’ pattern opacification 67

Septal lines 69

Asbestos-related lung disease

Benign pleural disease

Asbestosis

Mesothelioma

8. C – Circulation 18

Dextrocardia 71

Cardiomegaly (enlarged heart) 72

Left atrial enlargement 73

Widened mediastinum 74

Hilar enlargement 77

Hiatus hernia 79

9. D – Disability 19

Fractures 80

Sclerotic and lucent bone lesions

10. E – Everything else (review areas) 20

Gas under the diaphragm (pneumoperitoneum) 82

Subcutaneous emphysema/surgical emphysema 84

Mastectomy 87

Medical and surgical objects (iatrogenic)

Foreign bodies 88

Part 3 Common conditions and their radiological signs 94

Pulmonary embolism (PE) 94

Primary lung malignancy 94

Pneumonia 95

Chronic obstructive pulmonary disease (COPD) 97

Heart failure

Tuberculosis (TB) 98

Glossary 122

Index 128

Dr Christopher Clarke, Consultant Radiologist at Nottingham University Hospitals NHS Trust, UK. He is a member of the British and European Societies of Gastrointestinal and Abdominal Radiology.

Dr Anthony Dux, Former Consultant Radiologist, University Hospitals of Leicester NHS Trust, UK