chest xray interpretation question

[anhtran]

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I wonder on chest xray the upper one third of lung and the middle one,also the middle one and the lower one are imaginarily separated by what,i mean do they have their border?please help me (ps my english is terrible but i hope you guys understand what i am asking about)

 

[colbgw02]

If you're talking about a frontal view only, then I just divide the lungs into thirds. I'm not aware of any standardization on this topic. If there's a finding sufficiently high, then I'll just say upper lobe even without a lateral view because I know the lower lobe apical segments don't go up that far.

If there is an abnormality seen on two orthogonal images, then you should be able to isolate it to a lobe, which are - of course - separated by the fissures.

 

[anhtran]

Because my teacher said that when a patient took his xray while standing vessels shouldnt be seen on the upper one third of lung...so we say this is normal or this is abnormal just because we think so?..

 

[jazzman84]

It sounds like your teacher was talking about the redistribution of pulmonary vascular supply that can happen in chronic processes like CHF. Normally the upper lobe pulmonary vessels are smaller than the lower lobe vessels because of gravity preferentially supplying the dependent portion. In chronic lung or heart disease, there will either be shunting into the upper lobe vessels or congestion that makes them appear larger to the point that they are the same size or larger than the lower lobe vessels. It isn't abnormal to see vessels in the upper lungs on a normal chest radiograph, they just should be smaller than the vessels in the lower lungs.

 

[deleted103644]

Google image search "cephalization". (Might need to include CXR or radiology.)

 

[Dr.VT5179]

I wonder on chest xray the upper one third of lung and the middle one,also the middle one and the lower one are imaginarily separated by what,i mean do they have their border?please help me (ps my english is terrible but i hope you guys understand what i am asking about)

yes, indeed they are separated, and yes, by imaginary lines that divide the lung into three zones.
upto 2nd rib- 1st zone
2nd-4th rib- 2nd zone
4th to 6th rib- 3rd zone

Reference-

http://medicforyou.blogspot.com/2015/09/xray-chest-basics-of-reading-chest-xray.html

Hope that helps. 🙂