Lordotic CXR

A relatively   indistinguishable irregular fibrotic opacity in right apex gets separately delineated by lordotic projection 

Teaching points by Dr MGK Murthy

1. Chest X ray is the  commenest Radiological investigation performed  anywhere  even in todays world ,with some enthusiasts  referring to it , as an extension  of clinical examination beyond auscultation

2. My personal view point is any significant  systemic disease of whatever aetiology  has  its  reflection, if not  representation in  the chest .

3.Four blind regions on classical teaching of chest X-ray include  Apices, Hila, Retrocardiac and CP angles (needing relook as  routine)

4. Apical lordotic projection is performed by simply placing the patient supine , with shoulders rolled forwards (to stay clear of lungs)  with the central Xray beam projected cephalad (with angles varying from 20-40 degrees) 

5. Apical view is under-utilised possibly because of poor understanding and lack of expertise, and  of course is practically replaced by CT scans 

6. Though it is not an alternative to  CT chest, could  contribute immensely  in avoiding CT scans, if used  particularly in apical Tuberculosis, apart from being cost effective .