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Respiratory System > 19) Chest X-Ray > Flashcards

19) Chest X-Ray Flashcards

1
Q

What is a radiograph?

A

Photographic image of internal composition of body, produced by X-rays being passed through the body part and being absorbed to different degrees by different tissues

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2
Q

How do more dense tissues appear on X-ray?

A

More white

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3
Q

In what projection are CXRs usually taken?

A

PA, X-ray source behind patient

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4
Q

Why is AP projection sometimes used?

A

Patient too unwell to stand

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5
Q

What are the problems with AP projection?

A

X-ray beams are diverted by heart, due to heart being closer to source
Means heart looks bigger

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6
Q

What does a chest X-ray need to include?

A

Region above 1st rib
Lateral margins of rib (incase of lateral nodules)
Costophrenic angles

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7
Q

How would you check the rotation of a CXR?

A

Look if spinous processes are in between medial ends of clavicle

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8
Q

What does the patient need to do when a CXR is taken and why?

A

Needs to breath in and hold breath

Allows ribs 5-7 are in line with MCL

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9
Q

What will be seen if incomplete inspiration?

A

Big heart and increased lung markings

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10
Q

What will be seen in exaggerated expansion (obstructive)?

A

Flattened diaphragm

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11
Q

How can you check for adequate penetration?

A

Vertebrae just visible through heart

Left hemi-diaphragm visible

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12
Q

What are the right and left borders of the heart?

A

Right - RA

Left - LV

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13
Q

Where should the trachea be positioned?

A

Centrally

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14
Q

Which side are the hila higher on?

A

Left

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15
Q

What side is the aortic knuckle on?

A

Left

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16
Q

What side can bowel gas been seen on?

A

Left

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17
Q

How should the costophrenic and cardiophrenic angles present?

A

Sharp and pointy

18
Q

How should you analyse an X-ray?

A 
Adequacy
A - airway 
B - breathing
C - circulation 
D - diaphragm and bones
19
Q

What is a silhouette sign?

A

Loss of crisp difference between adjacent structures with differing densities e.g. white heart next to black lung

20
Q

What causes a mediastinal shift?

A

Changes to volume and pressure on one side of the chest

21
Q

What is a pneumothorax?

A

Air trapped in pleural space causing uncoupling of lung from chest wall

22
Q

What can cause a pneumothorax?

A

Spontaneous (trauma, fractured rib lacerates VP)
Underlying lung disease
Marfan’s

23
Q

How is a large pneumothorax defined?

A

> 2cm from chest wall

24
Q

How would a tension pneumothorax present on CXR?

A

Tracheal and mediastinal shift away from pneumothorax

Depressed diaphragm

25
Q

How does a pleural effusion present on CXR?

A

Uniform white area due to liquid in pleural spaces
Obscures hemi-diaphragm and blunting of costophrenic angles
Meniscus at top
Mediastinal shift away

26
Q

If patient is supine what will a pleural effusion look like?

A

Hazy all over

27
Q

What is a lobar lung collapse and what can cause it?

A

Volume loss within lung lobe

Aspirated foreign material, mucus, carcinoma, compression by mass

28
Q

What are some general findings on X-ray for lobar lung collapse?

A

Elevation of hemi-diaphragm on same side
Crowding of ribs
Mediastinal shift towards collapse

29
Q

What specific findings are there for left lower lobe collapse?

A

Sail’s sigh - sharp line behind heart

30
Q

What specific findings are there for left upper lobe collapse?

A

Veil sign - hazy opacification

31
Q

What specific findings are there for right upper lobe collapse?

A

Horizontal fissure displaced up

32
Q

What specific findings are there for right middle lobe collapse?

A

Right border of heart not seen

33
Q

What specific findings are there for right lower lobe collapse?

A

Horizontal fissure displaced down

34
Q

What is consolidation?

Give some examples

A

Filling of small airways and alveoli with dense material

e.g. pus (pneumonia), blood, fluid (oedema), cells (cancer)

35
Q

How does a consolidation present on CXR?

A

Dense and white area

Air bronchogram

36
Q

What is an air bronchogram?

A

Air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white)

37
Q

What space occupying lesions can present on CXR?

A

Nodule < 3cm, Mass > 3cm

Malignant, inflammatory, bone lesion

38
Q

How do asbestos plaques present on CXR?

A

Calcified, irregular, well defined, multiple

39
Q

What is pneumoperitoneum?

A

Air under diaphragm due to bowel perforation

40
Q

How is the cardiothoracic ratio calculated and what is a normal result?

A

Widest part of heart divided by widest part of ribcage

Normal < 50^%

Respiratory System (4 decks)

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