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. 2018 Oct;74(4):337-345.
doi: 10.1016/j.mjafi.2017.07.010. Epub 2017 Aug 30.

Revisiting anatomical variants on screening chest radiographs in Indian adolescents: A cross sectional observational pilot study

Jyotindu Debnath  1 , C M Sreedhar  2 , Ruchira Mukherjee  3 , V K Maurya  4 , Seema Patrikar  5 , Y R N Reddy  6
Affiliations

Revisiting anatomical variants on screening chest radiographs in Indian adolescents: A cross sectional observational pilot study

Jyotindu Debnath et al. Med J Armed Forces India. 2018 Oct.

Abstract

Background: Knowledge of normal variation and measurements on a chest radiograph is essential to interpret any abnormality. There is paucity of information about normal measurement ranges and variations in young adolescents, particularly from Indian subcontinent. The aim of this study was to analyze certain normal variations on screening chest radiographs of healthy Indian adolescents and the objectives were to measure/assess (1) degree of inspiration, (2) cardiothoracic ratio (CTR), (3) presence of gastric fundic bubble, (4) fundocupolic distance, (5) presence of splenic flexure, (6) difference in height of diaphragmatic domes and (7) effect of inspiration on the CTR.

Methods: Digital chest radiographs obtained during routine medical examinations for all consecutive medical graduate aspirants in the year 2016 at a medical college, were analyzed for the above mentioned parameters using DICOM viewing software.

Result: A total of 558 chest radiographs were analyzed. The mean age of the subjects was 18.50 (SD = 1.002) (range: 17-22 years). There were 497 (89.1%) male and 61 (10.9%) female. Degree of inspiration was at 5th, 6th, 7th and 8th ribs in 29 (5.1%), 259 (46.4%), 264 (47.3%) and 6 (1%) respectively. Mean maximum transverse cardiac diameter, internal thoracic diameter, CTR were 1153.22 ± 120.01, 2935.24 ± 224.86 and 0.39 ± 0.03 respectively. Females had slightly higher CTR (0.40 ± 0.035) as compared to the males (0.39 ± 0.032) (p = 0.009). Gastric fundic bubble was visualized in 91% subjects. Mean fundo-cupolic distance was 8.75 ± 8.00. Mean value for difference in the level of two domes of diaphragm was 15.28 ± 5.38.

Conclusion: The study highlights normal range of inspiration, CT ratio, fundocupolic distance and diaphragmatic dome level difference on screening chest radiographs in healthy Indian adolescents.

Keywords: Cardiothoracic ratio; Chest radiograph; Diaphragm; Fundocupolic distance; Indian adolescents.

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Figures

Fig. 1
Fig. 1
Method of measuring maximum transverse cardiac diameter, maximum internal thoracic diameter and cardiothoracic ratio (CTR). A vertical line is drawn in the mid sagittal plane as shown in the figure. A perpendicular line is drawn at the level of maximum transverse dimension of the right heart border and distance is measured (A). Another perpendicular line is drawn to the maximum transverse dimension of the left heart border and distance is measured (B). One horizontal line is drawn connecting the internal aspect of thoracic ribs at the level of maximum transverse dimension (C). CTR is obtained by the formula: C divided by A + B.
Fig. 2
Fig. 2
Types of gastric fundic bubble based on morphology and gas pattern. Type I: Gastric fundic bubble demonstrating only gas, Type II: Gastric fundic bubble demonstrating air fluid level.
Fig. 3
Fig. 3
Types of diaphragm depending on visible angle between right dome of diaphragm and right cardiac border: (a) Type I: the diaphragm has an acute angle with the right cardiac border. The dome of diaphragm is clearly visible; (b) Type II: the diaphragm joins the right cardiac border almost at a right angle; (c) Type III: the diaphragm joins the right cardiac border at an obtuse angle. Please note that the diaphragmatic slope is steep and there is no discernible dome in this type of diaphragm.
Fig. 4
Fig. 4
Method of measuring difference in diaphragmatic dome level. A horizontal line is drawn tangential to the highest dome of right (AB) as well as left (CD) hemi-diaphragms. Distance (E) between these two lines (AB and CD) represents the difference in diaphragmatic dome level.
Fig. 5
Fig. 5
Relationship of maximum transverse cardiac diameter (in mm, Y axis) and degree of inspiration at various rib levels (X axis).
Fig. 6
Fig. 6
Relationship of maximum internal thoracic diameter (in mm, Y axis) and degree of inspiration at various rib levels (X axis).
Fig. 7
Fig. 7
Relationship of cardiothoracic ratio (CT ratio) (Y axis) and degree of inspiration at various rib levels (X axis).
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