How is the chest examination done?


Chest x-ray is a classic projection x-ray of the chest used to diagnose pathological changes in the chest, chest organs, and nearby anatomical structures. Chest x-ray is one of the most common radiographic examinations.

Computed tomography (CT) of the chest provides more accurate data. When performing CT, a series of x-rays are taken, which the computer analyzes. Sometimes during a CT scan, a contrast agent is injected intravenously or through the mouth, which helps to clarify the structure of some structures in the chest

Magnetic resonance imaging (MRI) also provides detailed images, which is especially valuable when a doctor suspects a blood vessel disease in the chest, such as an aortic aneurysm. Unlike CT, X-rays are not used in MRI - the device registers the magnetic characteristics of atoms.

Ultrasound examination (ultrasound) creates an image of the internal organs on the monitor due to the reflection of ultrasonic waves from them. This study is often used to detect fluid in the pleural cavity (the space between the two layers of the pleura). Ultrasound can be used as a means of control when introducing a needle to aspirate fluid.

A radionuclide study of the lungs using a micro-quantity of short-lived radionuclides allows the analysis of gas exchange and blood flow in the lungs. The study consists of two stages. In the first person, he inhales a gas containing a radionuclide marker. Ultrasound makes it possible to see how gas is distributed in the airways and alveoli. In the second stage, the radionuclide substance is injected into a vein. With the help of an ultrasound, the doctor determines how this substance is distributed in the blood vessels of the lungs. Such a study allows you to detect blood clots in the lungs (pulmonary embolism). A radionuclide study is also used during the preoperative examination of patients with malignant lung cancer.

Angiography makes it possible to accurately assess the blood supply to the lungs. A contrast agent, which is visible on x-rays, is injected into the blood vessel. Thus, images of arteries and veins of the lungs are obtained. Angiography is most often used for suspected pulmonary embolism. This study is considered the reference for the diagnosis or exclusion of pulmonary embolism.

Radionuclide study of regional ventilation and perfusion of the lungs.

However, the radionuclide method, scintigraphy, became the main radiation method for studying physiology and identifying functional lung pathology. It allows you to assess the state of ventilation, perfusion and pulmonary capillary blood flow, and to obtain both qualitative and quantitative indicators characterizing the flow of gases into the lungs and their excretion, as well as the exchange of gases between the alveolar air and blood in the pulmonary capillaries.

In order to study the pulmonary pulmonary blood flow, perfusion scintigraphy is performed, ventilation and bronchial patency - inhalation scintigraphy. In both studies, a radionuclide image of the lungs is obtained (Fig. III.9, III. 10). To perform perfusion scintigraphy, the patient is labeled with OT1 / L6min particles (microspheres or macroaggregates) intravenously. When they enter the bloodstream, they are carried into the right atrium, right ventricle and then into the pulmonary artery system.

In order to evaluate perfusion scintigrams, qualitative and quantitative ana giz are performed. A qualitative analysis determines the shape and size of the lungs in 4 projections: the front and back straight, right and left lateral. The distribution of the radiopharmaceutical but the pulmonary fields should be uniform. For quantitative analysis, both pulmonary fields on the display screen are divided into three equal parts: upper, middle and lower. The total accumulation of radiopharmaceuticals in both lungs is taken as 100%. The relative radioactivity, i.e. accumulation of radiopharmaceuticals in each department of the pulmonary field, separately left and right. Normally, according to the right pulmonary field, higher accumulation is recorded - by 5-10%, and the concentration of the radiopharmaceutical in the field increases from top to bottom. Violations of capillary blood flow are accompanied by a change in the above ratios in the accumulation of radiopharmaceuticals in the fields and departments of the lungs

Inhalation scintigraphy is performed using inert

gases - shKh or "" Kg. An air-xenon mixture is introduced into the closed spirograph system. Using a mouthpiece and a nasal clamp, a closed spirograph-patient system is created. After achieving dynamic equilibrium, a scintigraphic image of the lungs is recorded on a gamma camera and then its qualitative and quantitative processing is carried out in the same way as perfusion. Areas of impaired ventilation correspond to places of reduced accumulation of radiopharmaceuticals. This is observed with obstructive lung lesions: bronchitis, bronchial asthma, local pneumosclerosis, bronchial cancer, etc.

X-ray and radionuclide examination of the cardiovascular system, methods, indications and fields of application.

X-ray techniques - radiography, fluoroscopy, computed tomography - allow with the greatest degree of certainty to determine the position, shape and size of the heart and major vessels. These organs are located among the lungs, so their shadow is clearly distinguished against the background of transparent pulmonary fields.

Among the radiological research methods, in addition to the main ones (fluoroscopy, radiography and fluorography), special ones are used (angiocardiography, coronarography, angiography, pharmacoangiography, digital subtraction arteriography, phlebography, lymphography, etc.). To study the function of the heart and large vessels, methods of detecting movements are used - video-magnetic recording, X-ray diffraction, electro-x-ray diffraction.

ANGIOCARDIOGRAPHY (ACG) - an X-ray examination of the cavities of the heart and the great vessels after the administration of a contrast agent.

Indications: diagnosis of congenital and acquired heart defects, anomalies in the development of the great vessels. ACG allows you to determine the location and nature of the defect, as well as its hemodynamic features. In recent years, the method has not been applied as widely as it was in the first years of its introduction into practice. Currently, the range of indications for the use of this method is limited, since ultrasound (Doppler ultrasound) and conventional X-ray examination allow a fairly complete study of the morphological and functional features of the heart.

Contrast agents, aqueous solutions of organic compounds of high iodine concentration (65-89%) - hypak, verographin, urographin, triyot-rust, ultra-vist, omniopak, etc.

Complications: the same as with angiopulmonography.

CORONAROGRAPHY - contrasting of vessels supplying the heart muscle according to the Seldinger method.

Indications: coronary heart disease.

Contrast media: 50-70% hypak, ultra-vist, omniopak

PHARMACOANGIOGRAPHY - the method is used for differential angiological diagnosis between benign and malignant neoplasms. Pharmacological agents are used that affect the tone of the vascular wall - vasoconstrictors and vasodilators, the introduction of which pathologically altered vessels react in a special way. For example, under the influence of adrenaline, the normal vessels of the kidney in the region of segmental branches narrow until the lumen is completely closed, and the altered vessels (tumor process) do not respond to the introduction of adrenaline due to the lack of muscle wall.

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X-ray on examination of the chest

The easiest way to examine your internal organs is to take a picture using special equipment. Depending on the type and power of the device, the images will be of different quality and depth:

  • Fluorography (FLG). Digital or film shot of the lungs. The picture is taken due to x-ray radiation of a very small dose. This is the most common type of research, safe enough even for children. The image of the lungs turns out to be not very clear, but quite informative. FLG is traditionally used to prevent tuberculosis.
  • X-rays of light. The picture is clearer than with FLG due to the high dose of radiation. But because of this, x-rays are undesirable for pregnant women and people with poor health.
  • Ultrasound procedure. Absolutely safe way of examination. Technically, it can be used to examine all organs of the chest, but usually with their help they try to detect fluid in the pleural cavity.

For FLG and X-ray, you will be asked to undress and stand in front of the device that will take the picture. It is necessary to remove all jewelry from the neck, as in the picture they will overlap the body.

For ultrasound examination, the body is covered with gel so that the sensor glides better, and they examine the desired area of ​​the chest.

Using tomography

Tomography is one of the key non-invasive methods for examining the chest. Its undoubted advantages: high image quality and almost complete safety for the patient. Two types of tomography are used to examine the chest organs:

  • Magnetic resonance imaging. Allows a detailed examination of the entire cardiovascular and respiratory systems. It is contraindicated for people with large excess weight - the apparatus table is designed for 120-130 kg. In addition, it can harm those who have metal implants and pacemakers. But MRI is safe for children, pregnant and lactating mothers, since it does not use x-rays.
  • CT scan. With its help, a volumetric model of internal organs is obtained. CT works on the basis of x-rays, but has no other contraindications, except for age and pregnancy.

Before conducting a CT scan, you will be asked in the network of our diagnostic centers to fill out a contract for the provision of medical services, consent to the processing of personal data and a questionnaire with information about your health status - the latter will help the radiologist to focus on important points in the study.

Next you will be accompanied by a radiologist. He will tell you about the progress of the study, and then he will spend it in the locker room. Usually, tomography does not require undressing completely: it is enough to remove clothes with metal objects (zippers and buttons), shoes, glasses and jewelry.

You will be taken to the office where you will lie on the table of the tomograph. The laboratory assistant will monitor the progress of the study. So if you suddenly become ill, you can ask to stop the study. But if there are no contraindications, the patient always feels comfortable. All that is required of you: listen to the laboratory assistant’s commands and hold your breath at the right time. If you need to lie still while performing an MRI, then with CT, small movements will not distort the finished image.

If you need to conduct a study with contrast, then after a series of shots the laboratory assistant will inject you a contrast agent intravenously - the amount depends on your weight. After this, the procedure is resumed for a couple of minutes.

The entire study lasts no more than fifteen minutes. After that, the laboratory assistant enters the office again, helps you up and escorts to the locker room. The conclusion with the transcript is ready immediately after the procedure.

Endoscopy in lung studies

As part of endoscopy, a tool with a camera is introduced into the body through natural pathways. A good quality image is transmitted to the monitor, so you can consider the desired area.

Bronchoscopy - The only method for non-surgical endoscopy of the chest. It is used both for diagnosis and treatment. Using an endoscope, you can remove mucus, pus, and foreign bodies, inject medications, and take sputum and tissue samples for analysis.

The study can not be done with respiratory failure, exacerbation of asthma, aneurysm, heart attack and blood clotting disorders. And before the examination, you will definitely be prescribed tests:

  • fluorography
  • ECG,
  • blood tests for HIV and hepatitis,
  • coagulogram.

Examination of the chest with surgery

Of course, no doctor will perform abdominal surgery simply for examination. But there are two types of endoscopy that are performed under general anesthesia through chest incisions:

  • Thoracoscopy - study of the surface of the lungs and pleural cavity. An endoscope and instruments are introduced through the incisions: you can take tissue samples and introduce the necessary medicines.
  • Mediastinoscopy - examination of the mediastinum, which is performed to assess a lung tumor or to establish the cause of the enlargement of the lymph nodes.

It is impossible not to mention pleural puncture and pleural biopsy. The doctor inserts a needle into the body and takes a piece of tissue or pleural fluid for analysis.

A more serious type of operational examination is thoracotomy. The doctor independently examines all internal organs, opening the chest. A significant plus of thoracotomy is the ability to take samples of any tissue for examination and surgical treatment.

In which cases are prescribed examinations

The simpler the examination of the chest organs, the more often it is prescribed. X-ray is recommended to be taken once a year for prevention. If at work you are in contact with people and food, the results of FLG will be required to access the work.

No one will prescribe other types of examinations without serious indications. ARI or angina is not a reason to do endoscopy and MRI. With pneumonia, tomography and bronchoscopy can be prescribed. And other types of studies are prescribed for serious and dangerous symptoms:

  • X-ray dimming
  • foreign body in the airways,
  • suspicion of oncology,
  • hemoptysis,
  • abscesses and cysts in the airways and lungs,
  • pleural inflammation,
  • swollen lymph nodes
  • trauma and suppuration in the chest.

Research has very few contraindications:

  • in X-ray and CT - pregnancy and the period of breastfeeding,
  • MRI - overweight, metal implants, pacemakers, claustrophobia,
  • bronchoscopy - exacerbations of asthma,
  • all types of endoscopy - impaired blood coagulation, internal bleeding, acute pulmonary failure, heart attacks and peritonitis.

Research is necessary for serious diseases, since without them it will be difficult to establish the causes of the ailments. In addition, almost all types of examinations allow you to immediately carry out treatment, if possible. Therefore, despite the complexity of their implementation, they are very popular in all diseases of the respiratory system.

Methods of clinical examination of the chest

Before starting the examination of the patient, the doctor must collect an anamnesis.The doctor finds out what the patient complains about, asks when the first symptoms of the disease appeared, and studies the patient’s medical records to clarify information about past or chronic illnesses.

The methods of general examination of the chest include: examination of the patient, palpation, percussion and auscultation.

Examination and palpation of the chest

When examining the chest, the doctor determines its size, shape and symmetry, the degree of participation in the respiratory movements of its both halves, the frequency, depth and type of breathing, the ratio and duration of inspiration and expiration, and the participation of auxiliary muscles in the breathing process.

During palpation, the condition of the subcutaneous tissue, possible damage to the ribs, painful areas are revealed. A check is also performed for the so-called voice jitter. The patient is asked to pronounce certain phrases. At this time, the doctor checks the symmetry of the vibration behind the sternum.


The method of percussion is based on tapping the chest organs, as a result of which oscillatory movements of tissues occur. By the nature of the resulting sound, the doctor can determine the density of organs, their airiness, elasticity and volume.

Percussion can be carried out in a mediocre and direct way. The mediocre method involves tapping one finger on the finger of the other, applied to the patient’s body, and with direct percussion, the doctor directly taps the fingers at different points on the chest. Depending on the intensity of the impact, you can approximately determine the depth of localization of the pathological process: from 7 cm with severe percussion to 1.5 - 2 with the quietest. Except in cases of bilateral pneumonia, percussion is performed symmetrically on both sides.


This examination method is based on listening to the physiological sounds of the chest organs during breathing. Auscultation is performed using a stethoscope or phonendoscope.

All arising noises are divided into main and additional. The main ones are related to the physiology of the breathing process. And additional ones, such as dry or wet rales, appear only during inflammatory processes in the organs of the chest or due to their traumatic damage during fractures of the ribs.

Radiation Diagnostic Methods

Radiation diagnostics is an integral part of a comprehensive examination of the chest. First, a panoramic x-ray of the organs is made, and then, if necessary, further research is carried out.

Radiation diagnostic methods include:

  • Roentgenography.
  • Fluorography.
  • X-ray, but with the development of more modern methods of radiation diagnostics, it is used less and less because of a fairly strong radiation load on the patient's body.
  • Computed and magnetic resonance imaging.
  • Contrasting research methods.
  • Ultrasound
  • Radionuclide examinations.


When conducting x-rays, pictures are taken in two projections - the side and the front. To improve the contrast of the lungs, the study is done on a deep breath and breath holding.

On the x-ray, all organs and the bone skeleton of the chest, large blood vessels are quite clearly visible. Deviations from the norm are foci of dimming or lightening on the lungs, a change in their shape and pulmonary pattern. Depending on the size and location of such deviations, pneumonia, pleurisy, pneumothorax, fluid accumulation, and tumors can be diagnosed. The image also shows damage to the ribs.

Contrast and radionuclide methods of radiation diagnostics

An X-ray examination with the simultaneous administration of an X-ray contrast drug is required to obtain a clearer image. The fact is that such a tool gradually fills all areas of the chest organs and allows you to get a series of detailed pictures. The methods of contrast radiation diagnostics include:

  • Angiography. During this procedure, a small circle of blood circulation is examined. To do this, using a catheter, a water-soluble iodine-containing drug is introduced into the patient's body. Next, a series of images is taken, in which the arterial phase of the blood flow is determined first, and then the venous phase. This technique allows you to determine the presence of blood clots, aneurysms, constrictions or anatomical disorders of the structure of blood vessels.
  • Pneumomediastinography. This method is used in oncological practice to determine the exact location of tumors.
  • Pleurography, in which a contrast agent through the drainage is injected directly into the pleural cavity.
  • Fistulography is performed with external fistulas of the chest to determine their type, size, and also to detect the source of the purulent process.

Radionuclide examination of organs located in the chest is somewhat similar to examination using contrast. The essence of this method is the introduction of radioactive isotopes into the patient's body. At the first stage, they are inhaled as part of a mixture of gases, and in the second they are administered intravenously. Isotope distribution is monitored by ultrasound. A similar examination is carried out mainly to assess the effectiveness of the treatment of malignant neoplasms in the lungs.

Computed and magnetic resonance imaging, ultrasound

Ultrasound examination for the diagnosis of respiratory diseases is rarely used. Ultrasound is usually performed to control the introduction of a puncture needle.

CT and MRI appeared relatively recently, but were very widespread due to the relative safety and high quality of the images compared with x-rays and contrast studies.

With computed tomography, a series of layered x-ray images of the chest organs is obtained, which are analyzed by a computer and displayed on a monitor screen. Sometimes, radiopaque preparations are also administered to improve image quality.

The MRI method is based on the fact that body tissues are capable of emitting an electromagnetic field under the influence of radio frequency pulses. The received signals are converted by computer into high-quality images of organ sections.

Instrumental methods for examining the chest

Such examinations are carried out in cases where a clinical analysis of lung or bronchial tissue, as well as fluid accumulated there, is necessary. In addition, some of these techniques allow you to visually assess the condition of the respiratory tract.

  • Bronchoscopy is performed using a special tool - a bronchoscope. Thus, the doctor can not only examine the larynx and bronchi, but also inject drugs directly into the chest cavity, take sputum for analysis or perform a puncture. Also during bronchoscopy, accumulations of mucus, pus or foreign objects that have fallen into the respiratory tract are removed.
  • Bronchoalveolar lavage is done to analyze sputum from the small airways. To do this, during bronchoscopy, they are filled with saline, which is then sucked through a bronchoscope. Then carry out bacteriosis and microscopic examination of the resulting fluid. Thus, it is possible to identify malignant tumors and determine the bacterial causative agent of pneumonia.
  • During the biopsy, exudate accumulated in the pleural cavity, small pieces of pleural tissue or lungs are taken for analysis. It is done under general or local anesthesia with a special biopsy needle, which at the end has a device for capturing organ tissue. In the process of manipulation, if necessary, sucked up the fluid accumulated in the chest.
  • Thoracoscopy is a visual examination of the surface of the lungs and pleura. The procedure is carried out only under general anesthesia. The doctor makes a small incision on the chest and inserts a thoracoscope. During the procedure, it is also possible the introduction of a drug or removal of exudate.
  • Mediastinoscopy will allow you to examine the space between the two lungs and find out the cause of the enlargement of the lymph nodes or determine the degree of tumor growth. Manipulation is done in much the same way as thoracoscopy.
  • Thoracotomy is a diagnostic operation on the chest. It is carried out in exceptional cases when all other research methods have failed.

Today, almost every doctor has access to a lot of methods for a comprehensive examination of the chest. This allows you to quickly and accurately diagnose and prescribe the necessary treatment.


Watch the video: Chest Assessment Nursing. Heart & Lung Assessment. Head-to-Toe Exam (April 2020).