1. Technique
1.1 Techniques available
2. Anatomy
2.1 Frontal CXR
2.2 Lateral CXR
2.3 Normal variants
3. In-built errors of interpretation
3.1 The eye–brain apparatus
3.2 The snapshot
3.3 Image misinterpretation
3.4 Satisfaction of search
3.5 Ignoring the ribs
4. The fundamentals of CXR interpretation
4.1 The silhouette sign
4.2 Suggested scheme for CXR viewing
4.3 Review areas
4.4 Pitfalls
5. Pattern recognition
5.1 Collapses
5.2 Ground glass opacity
5.3 Consolidation
5.4 Masses
5.5 Nodules
5.6 Lines
5.7 Cavities
6. Abnormalities of the thoracic cage and chest
wall
6.1 Pectus excavatum
6.2 Scoliosis
6.3 Kyphosis
6.4 Bone lesions
6.5 Chest wall / thoracic inlet
6.6 Thoracoplasty
7. Lung tumours
7.1 CXR features of malignant tumours
7.2 CXR features of benign tumours
7.3 Metastases
7.4 Bronchial carcinoma
7.5 The solitary pulmonary nodule
8. Pneumonias
8.1 Pulmonary tuberculosis
8.2 Pneumococcal pneumonia
8.3 Staphylococcal pneumonia
8.4 Klebsiella pneumonia
8.5 Eosinophilic pneumonia
8.6 Opportunistic infections
9. Chronic airways disease
9.1 Asthma
9.2 Chronic bronchitis
9.3 Emphysema
9.4 Bronchiectasis
10. Diffuse lung disease
10.1 Interstitial disease – the reticular pattern
10.2 LAM
10.3 Langerhan’s cell histiocytosis
10.4 Pulmonary sarcoid
10.5 Hypersensitivity pneumonitis
11. Pleural disease
11.1 Effusion
11.2 Pneumothorax
11.3 Pleural thickening
11.4 Pleural malignancy
11.5 Benign pleural tumours
12. Left heart failure
13. The heart and great vessels
13.1 Valve replacements
13.2 Cardiac enlargement
13.3 Ventricular aneurysm
13.4 Pericardial disease
13.5 Coarctation of the aorta
13.6 Aortic aneurysm
13.7 Atrial septal defect
13.8 Pacemakers
14. Pulmonary embolic disease
15. The mediastinum
15.1 The ‘hidden’ areas of the mediastinum
15.2 The hila
15.3 Stents
16. The ITU chest X-ray
16.1 Adult
respiratory distress syndrome
16.2 The CXR following thoracic surgery
17. The story films
Further reading
Index
Interpreting chest radiographs is one of the most – if not the most
– difficult yet routine radiologic activity. In some respects,
thoracic computed tomographic (CT) examinations are easier to
correctly analyze, because among other reasons, the 3-dimensional
anatomy is laid out much more clearly, and the density of
structures is more readily discerned. Similarly, teaching the
basics of chest radiographic (CXR) analysis can be surprisingly
difficult, especially to the beginner. In Interpreting Chest
X-Rays, a profusely- illustrated paperback book by the thoracic
radiologist Dr. Stephen Ellis, a substantial amount of ground is
covered on this difficult topic in 240 pages. Dr. Ellis is an
outstanding teacher, with an appealing approach and writing style.
I imagine, after reading this new introductory book, that anyone at
any level, after spending a few weeks with Dr. Ellis on a chest
imaging rotation, would learn an enormous amount of practical and
valuable information. The book is very well written and organized.
There are excellent, very instructive figure legends. Some points
and a few images are repeated within the book, but this serves to
reinforce important concepts. Helpful analogies are provided, as
are useful and clear drawings (particularly the diagrams of lobar
atelectasis). Some areas get minimal coverage (eg, CXR findings in
aortic dissection, although a single case is shown), whereas a few
unusual or rare disorders, which a beginning interpreter is highly
unlikely to ever encounter, are covered in some detail or briefly
mentioned (eg, Langerhans cell histiocytosis,
lymphangioleiomyomatosis, and pulmonary alveolar microlithiasis).
Overall, the cases shown are excellent, they cover substantial
ground, and demonstrate numerous valuable teaching points,
particularly for an introductory text. Putting together such a
collection of images is not easy. I very much like the CXR–CT
correlation, with universal superb reproduction of the CT images,
although most of the CT images are quite small, and the novice
interpreter may not be able to appreciate some of the findings on a
minority of these images. I also very much like the magnification
of areas of interest, which is provided for many of the chest
radiographs. The emphasis on "review areas," and the potential
pitfalls of CXR interpretation, is outstanding and relatively
comprehensive, and important material is provided and reviewed for
both the neophyte and the experienced health care practitioner.
Thoracic anatomy (with CT correlation) and pathology is
appropriately stressed throughout the text, as is the importance of
a systematic search pattern. The chapter on atelectasis is
extremely well done, and even seasoned CXR interpreters will
benefit from this section. There is a concise but good discussion
of pulmonary infection. The limitations of chest radiography for
interstitial lung disease are accurately explained and
demonstrated. Numerous pearls are included throughout the book (eg,
that patients with sarcoid appear better clinically than
radiographically), as are concise and relevant differential
diagnoses (eg, for hilar lymphadenopathy). A substantial percentage
of the CXRs illustrated are dark, with suboptimal contrast. This is
due to the reproduction of the images, rather than the original
images, and is my only major criticism of the book. Some of these
are worse than others, although for the most part, the findings can
be identified, particularly if attention is paid by the reader as
to how the images are examined relative to the incident light
falling on the book (however, this reviewer has not been exempt
from this problem in his own publication efforts, and Dr. Ellis is
likely as similarly frustrated by this as I have been). Hopefully,
this problem can be corrected in future printings/ future editions.
There are some charming "Britishisms", for example, "in theater"
and "patients are invariably nursed supine," as well as the use of
a few terms which will be foreign to American-based medical readers
(eg, "hilar point" and "surgical emphysema"). Neither these nor the
British spellings preclude the use of this book by Americans or
others not familiar with the United Kingdom form of English. There
are a few minor typographic errors (eg, Swan-Ganz, as in the
physicians for whom the vascular catheter is named, is misspelled),
one of which is rather amusing ("ecstatic" is used for a figure
caption, rather than "ectatic," when referring to a tortuous
aorta), and an atrial septal defect is referred to as a "right-to-
left shunt" (which is true only when Eisenmenger's syndrome
supervenes). A few captions incorrectly state the color or
plurality/singularity of arrows, although this is a minor point. I
could find essentially no substantial content errors, although one
could argue with the issue that the lateral CXR is no longer
used/should no longer be performed, or that a "limited volume CT"
is actually done in practice for problem solving. Interpreting
Chest X-Rays is highly recommended for anyone wishing to acquire a
basic yet relatively comprehensive approach to the chest
radiograph. The book is affordable, and is particularly suited for
trainees, including pulmonary medicine fellows, medical students on
a radiology rotation, physicians' assistant students or nursing
students on a critical care or pulmonary rotation, and first-year
radiology residents on a thoracic radiology rotation. Dr. Stephen
Ellis makes the difficult seem easy, with his instructive teaching
style and helpful approach to the surprisingly difficult topic of
chest radiography interpretation.
*Clinical Pulmonary Medicine*
Interpreting Chest X-rays is an excellent, simple book which will
be available to medical students, radiographers and medical staff,
including chest physicians and radiologists, providing an
understanding of techniques and basic knowledge required to
interpret plain chest radiographs.
The book includes over 300 high quality images and is laid out in
17 chapters covering technique, anatomy, in-built errors of
interpretation, fundamentals of chest x-ray interpretation and
pattern recognition with subsequent chapters of pulmonary, pleural,
cardiac, mediastinal disease and ITU chest x-ray abnormalities.
The author states that the book is concentrated on interpretive
skills and pattern recognition which will enable readers to
interpret chest radiographs in their clinical practice.
The book is reasonably priced and would be recommended to all
healthcare professionals who are involved with the interpretation
of plan chest radiographs.
*RAD Magazine*
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