From the viewing the image above you can clearly see that it is of the thoracic spine. However look closely and see if you notice anything unusual! Use your ABCs of evaluating radiographic images and tell me as much as you can about this image. Why did they take this image? Is it male or female? What age is the subject? Is the image AP or PA? How can you tell each of these or can you. You do not all need to comment on everything you see, just pick out one or two. If you disagree with your classmates that is ok, just explain why! Each of you should comment about something and please dont just use everyone elses prior comments. Go out on a limb and make a judgement on your own. Its ok if you are not right. Viewing and interpreting images in a skill and art! Even the best radiologists miss the mark sometimes! Good luck!
This is an AP image and I'm thinking that this image was taken due to suspicion of TB osteomyelitis. I thought of TB due to the loss of vertebral body height of mid T spine, sclerosis of the vertebral endplates, and diminshed disk spaces.
ReplyDelete-Rachael Hughes
•Image is an AP view – heart is on left.
ReplyDelete•Appears to be decreased joint space between T3-T4, T4-T5.
•Appears to be increased separation of right clavicle from SC joint.
•There may be an enlargement of heart as well.
•Person appears to be of at least early adulthood due to size of image and structures.
•I think this is of a female due to increased density at bottom of x-ray secondary to overlapping of mammary glands.
•AP views of thoracic spine are taken to demonstrate the vertebral bodies; disk spaces; alignment of pedicles, spinous processes, transverse processes, and articular processes; and costovertbral joints and posterior ribs. Can be taken to view heart and lungs as well.
From the radiograph, this is a 30 year old male, and it would appear to be an AP view, as the R side of the image is designated, and also because of the position of the heart and the L lung. I am going to agree with Rachael about imaging for following up on suspicion of osteomyelitis due to decreased intervertebral space with the appearance of sclerotic endplates between T3-4, and T4-5, and I would also add in T2-3. This may be grasping at straws, but I would throw out the possibility of some indication of lung fibrosis in this radiograph as well. This is a good radiograph for viewing a variety of both bony and soft tissue structures in the thoracic region.
ReplyDeleteThe first unusual thing that caught my eye was what I thought might be an enlarged heart. After further investigation of common pathologies seen on thoracic radiographs, I agree with my classmates that have posted already, that this image was taken to determine possible osteomyelitis. The shadow surrounding the thoracic vertebrae suggests abscess formation, which in combination with osseous changes in T3 and T4 of collapsed anterior vertebral bodies, indicates osteomyelitis. There appears to be decreased disk space between T2-3, T3-4 and T4-5. There also appears to be rotation (to the right) of T1 due to the displacement of the spinous process away from midline. I do not think is of clinical importance for this particular patient. This is an AP image due to the position of the heart. The subject may be in his/her early adulthood due to the size and denisty of the bones (besides the pathologies areas).
ReplyDeleteThis is an AP image as the heart is on the pt's left. The left clavicle at the articulation with the sternum appears bigger than the right. There appears to be decreased disk space between some of the middle and upper thoracic segments starting with T2-3. Also, the contour of some of the ribs doesn't look continuous, but I can't tell if that is due to the overlap of the lungs or other tissues. There may be a rib foramen on the 9th right rib as there is a radiolucent area, but again this may be from the lungs or other overlapping tissues.
ReplyDeleteLooking at the markers on the radiograph at the top, you are able to identify that this is an anterior/posterior view of the thoracic spine of a 30 year old male. It appears that the right clavicle is possibly displaced as it does not align with sternum in the same way as the left. There also looks to be degeneration of the thoracic disks due to the decreased disk space between T2-T3, T3-T4, T4-T5 vertebrae.
ReplyDeleteThis is an AP view of the t-spine. The spinous processes of T4-T7 do not appear to be centered, therefore the vertebral bodies are rotated to the right. There is also decreased joint space in this area (T3-T7). The proximal end of the left clavicle looks englarged as well.
ReplyDeleteAP View, which is evident secondary to position of the heart. No idea if it's a male or female.
ReplyDeleteAligment: R clavicle doesn't appear in line at the SC joint - increased space.
Bone Density: It almost looks like bone density of the vertebrae decreases in the c-spine compared to the thoracic and lumbar spine, but it could be due to all of the overlapping structures - or like everyone else is saying it is abscess around the t-spine, leading us to believe the radiograph was taken due to possible tuberculous osteomyelitis (looks similar to the picture on pg. 252).
Cartilage Spaces: Definitely decreased disc space between approx T2-5 which makes me believe that is abnormal and that the pt is really middle-aged (35ish) due to the normal joint space in the lumbar region.
This is an AP view of a 30 Y male according to data at the top of the image. The first thing that caught my eye is the fibrotic appearance of the lung tissue. T1 does appear to be slightly rotated to the R. There is decreased joint space from T2-T6, most evident at T4-5 and T5-6. The image also leads me to wonder if cardiomegaly and/or hepatomegaly are concerns for this patient.
ReplyDeleteI agree with Chelsea, there is fibrotic lung tissue maybe from cystic fibrosis? Also, the alignment of the clavicle on the R differs from the left, as do the lower right ribs. There seems to be something different between C7 and T1 on the right as well.
ReplyDeleteThis is a 30 year old male as described in the upper left corner. It is an AP image determined by the R labeled on the left side of the image. It appears that the left clavicle is larger than the right, possibly indicating a posterior dislocation of the left or anterior dislocation of the right clavicle. The difference of size could be due to one being closer to the image receptor just as a PA demonstrates anterior ribs and AP demonstrates posterior ribs due to those areas being closer to the image receptor in their respective positions.
ReplyDeleteThis is an AP image as designated by the R label and the fact that the spinous processes are clearly defined meaning that they were closer to the image receptor making it an AP view. This is a 30 year old male as designated by the labeling at the top of the radiograph. Also when checking ABC’s one of the things that first stood out is the joint spaces being narrowed in the upper thoracic spine which may be causing some issues. However, it also appears that the clavicles are not aligned the same and maybe there are some SC joint issues on the R due to it appearing rotated/dislocated as compared to the other. I also agree with my classmates in that there appears to fibrotic tissue on the L lung and possible enlargement of the heart as well which could be the reason the radiograph was taken.
ReplyDeleteThis AP image is from a 30 year old male and this was determined by the information written on the x-ray in the upper left corner. I do believe that this individual has an enlarged heart secondary to the increased cardiothoracic ratio. This could be a deceiving finding because it may just appear to be enlarged if the image was taken at expiration not inspiration. Another thing to note is the decreased joint space between the upper thoracic vertebrae and disarticulation of the R clavicle with the sternum. I would say that this individual injured themselves while lifting weights or playing basketball and had to go to the ER for these radiographs of the R clavicle dislocation. There were no apparent fractures seen, but a gas bubble on the L dome of the diaphragm.
ReplyDeleteThis image is an AP view of the thoracic region of a 30 y/o male. The most prominent aspect is the size of the heart compared to the rest of the thoracic structures as it seems to be larger than normal. There also appears to be some mild R thoracic scoliosis from approx T3-T6. The R transverse process of T3 also appears to be slightly misaligned with the adjacent rib as well. A noticeable radioluscent patch in the L diaphragm would seem to suggest some sort of lesion allowing a concentration of air/gas in that area that would/should not normally be present. There may also be a form of GI distress judging by the air/gas bubbles present in the area of the stomach
ReplyDeleteSimilar to what my classmates have said this is an AP view of the thoracic spine of a 30 year old male. It appears he has decreased joint space in T2-T6. The right clavicle also appears to be displaced.
ReplyDeleteThis is an AP view of a 30 y.o. male. I agree that there are alignment differences in the clavicles, signifying possible dislocation. I would agree with most of what my classmates have posted; however, I would also consider abnormal posterior rib articulations in the T3-5 region, but this could be due to the angle that this radiograph was taken.
ReplyDeleteThis is an AP radiograph of a 30 year old male, as determined by the notation on the upper corners of the film. It does appear that this patient has a slightly enlarged heart, but I don't believe this is why the radiograph was obtained. I think it was obtained following trauma (ER indicates a possible emergency) resulting in dislocation of the SC joint on the R. I believe the dislocation occurred on the right secondary to decreased joint space, and increased density where the joint should be aligned - likely indicating an overlap of bone. However, I am not sure if this is an anterior or posterior dislocation.
ReplyDeleteLike everyone has said, this is indeed an AP radiograph, but what I haven't seen anyone touch upon is the idea that the image direction can be deduced, aside from the aforementioned attributes, by the definition of the ribs, defined in this case by the posterior ribs, as seen through the attachments of the thoracic vertebrae, and thus a landmark attribute of the AP image of the chest. The first landmark that caught my eye was the asymmetrical findings near the top of the thoracic spine per spinous processes, which made me linger to the asymmetrical clavicular attachment sites. And going out on a limb here, the findings indicate a possible anterior dislocation/displacement force, as seen through associated vertebral body rotation, which in this case I believe is to the left.
ReplyDeleteThis is a radiograph of a 30 year old male taken in the ER. I agree with my classmates that this is an AP view. I noticed some slight rotation of the upper thoracic spine, but suspect this is due to positioning or postural patterns, or possible have something to do with the dislocation of the R clavicle my classmates mentioned. When first viewing the X-ray, I thought I saw fractures of the R ribs 5-9, but upon closer inspection realized it was increased fibrotic tissue of the right lung.
ReplyDeleteLike previous posts, this is an AP thoracic view of a 30 year old male. The patient appears to have a displaced right clavicle; an enlarged heart; and decreased joint space between T3-4, T4-5, and T5-6. I'll add that it almost looks like the patient has some pleural effusion on the L side.
ReplyDeleteThis radiograph is an AP view of the thoracic region that was taken of a 30 year old male. It seems like the main reason for taking the radiograph could be the dislocation of the right SC joint. I would also agree with my classmates that a secondary finding from this radiograph is that there is decreased joint space between T3 and T4 vertebral bodies as well as T4 and T5 vertebral bodies.
ReplyDeleteI think the L clavicle is displaced. Probably clavicle displaced posteriorly and medially to sternum, which could contribute to all the internal damage. The trauma that the patient appears to have experienced was directed towards left side. The slightly increased lumbar curve and appearance of translucent areas on L diaphragm as others have noted lead to me to believe this as a possibility.
ReplyDeleteThis radiograph is an AP view of the thoracic spine of a 30 year old male; you can tell it is an AP view because of the heart’s position, with a larger portion being to the left of midline. One of the first things I noticed is that the intervertebral disc spaces of the thoracic spine appear to be decreased, most notably at the levels of T2-T3, T3-T4, T4-T5, and T9-T10. As other classmates have mentioned, this could be due to the presence of osteomyelitis. At first I thought that the 9th and 10th ribs on the right were fractured near the vertebral column but after comparing these ribs to the ribs above, I believe that what I had thought were fractures are actually the articulations of the 9th and 10th ribs with their respective transverse processes; I think it’s interesting that the joint space of each of these costotransverse joints appears wider compared to the costotransverse articulations of the other ribs.
ReplyDeleteThis is an AP radiograph of a 30 year old male that was likely taken following a traumatic event. Some radiographic indicators that tell me it is an AP and not PA are the sharper image of the heart (because the heart is positioned more anterior) along with direction the heart is facing. It appears that he has a R anterior SC joint dislocation. I came to the conclusion that it was an anterior dislocation because the right clavicle seems to be slightly upwardly rotated and possibly more prominent. I also thought the articulation of his right 4th rib costosternal joint looked to be a little off but after researching it a little, I decided that the manubrium was causing it to appear malaligned.
ReplyDeleteAccording to the radiograph, this is an AP view of a 30 year old male. There does appear to be trauma at the right SC joint that could be a dislocation. I also agree that there is decreased intervertebral disc spaces in the upper thoracic spine that is most prominent in the T3-T6 region. In order to focus more on the right SC joint, another helpful radiograph would be a posterior oblique with the patient positioned in a right anterior oblique (RAO) position. This type of radiograph would allow for a clearer view of the sternum without superimposition of the thoracic spine.
ReplyDeleteBased on identification markers on the top left, the radiograph is of a 30 year old male. It's an AP view, R - right is also marked on the radiograph. At first glance, I noticed the patient had an enlarged heart and right SC dislocation. I agree with most of my classmates that there is decreased joint space from T2-T6. I do think there might be rib fractures or dislocations at ribs 8-10 as they do not look similar at the vertebral borders like the other ribs do but this could be due to the contrasts/different radiodense material of the lungs that might be obscuring my view.
ReplyDeleteAt first, I decided this image was an AP view because I could see the costocentral and costotransverse attachments of the ribs and also, the heart is on the left gives it away (and then I noticed the image says it is an AP image)! The image is of a 30 yo male (also stated at the top of the radiograph).
ReplyDeleteAlignment: Malalignment R SC joint with increased space. Upper thoracic vertebrae look slightly rotated to the right (spinous process look slightly left of midline)
Bone Density: It appears there is a decrease in bone density in the lower cervical/upper thoracic (C7-T3) because these vertebrae appear darker than the others, but this could be due to overlapping of structures.
Cartilage Spaces: decreased intervertebral disk space in mid thoracic region.
This is an AP view of a 30 y/o male. There appears to be increased joint space at the right SC joint and possible rotation of the R clavicle. I agree that this is a radiograph of a patient with osteomyelitis. The upper and mid thoracic spine show decreased disk space and sclerosis. The paravertebral shadow on the left may be a paraspinal abscess.
ReplyDeleteI would have to agree with the previous posts about the age and type of view of this image. I would also agree with previous posts about the abnormal alignment of the clavicles, possibly from either dislocation or even poor posture. Also, there seems to be decreased disk height at levels previously mentioned, possibly due to degenerative changes or even bad posture and body mechanics causing abnormal movement and thus the decreased disk height. The heart also seems to be enlarged compared to normal.
ReplyDeleteThis is an AP view of a 30 year old male (age, DOB, and Sex on upper left corner of film). There is decreased disc space at levels T2-T3, T3-T4, and T4-T5. At T5 and T6 the distance between the pedicles and spinous processes are not of equal distance indicating spinal canal may be compromised at these levels and may indicate fracture or dislocation.
ReplyDeleteThis is an Anteroposterior projection of the Thoracic Spine. It is a 30 year old male, wish I could say I figured this out on my own, but in the top corner it states it :/.
ReplyDelete-You can see he may have some major gas issues, there seems to be a gastric bubble on the right, his left.
-The superimposing mass covering his thoracic spine is his heart
-You can see where his diaphragm starts and where his liver would be on his right
-This is me going on a limb, but it looks like he may have a couple rib fractures on his right, close to where the ribs articulate with the thoracic spine.
-I would have to disagree with comments about his disc height, seem proportionate with each level.
- Another random thought, his heart looks to be a bit enlarged???
Ah... when do we find out the answer???
The first thing I noticed was that there is decreased joint space in the mid to lower T spine, as well as an apparent rotation of the upper and mid cervical spine noted by the alignment of the spinous processes. Also, like others, I would have to agree that the heart looks larger than normal.
ReplyDeleteGreat job on posts! You are all very imaginative. I actually dont think this 30 year old male AP radiograph shows an enlarged heart. It is actually just a normal image of the thoracic spine. Although I have to agree with a lot of you that it does appear to demonstrate increased joint space between the right clavicle and sternum!
ReplyDeleteI like the great effort that you all gave with this post. You are clearly looking very close at the images. Keep up the good work. I will put up a new post tonight!
See you all on Friday!
Rob
An AP radiograph will make the heart appear larger on a radiograph due to its location to the bucky. Much like making shadow puppets on a wall, the position of your hand nearer or farther from the wall where your shadow falls will be less distorted if closer to the receptor.... this is why PA's are preferred in thoracic radiographs compared to APs
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