19 Radiology 2 Flashcards
What do you need for a chest x-ray to be adequate?
- 1st rib
- Lateral margin of ribs
- Costophrenic angle
What indicates cardiomegaly on a chest x ray?
- Over 50% cardiac thoracic ratio
- Only on PA film
- Think about situs invertus
What are the A and B of the ABCDE approach of looking at a CXR?
A: airway for central trachea and hila
B: breathing: lungs, pleural spaces, lung interfaces (silhouette sign)
What are the C and D of the ABCD approach of looking at a CXR?
C: circulation: mediastinum, aortic arch, pulmonary vessels, borders of the heart
D: diaphragm/dem bones: free gas under diaphragm, nodules, fractures, mass
Where are some of the important review areas on a CXR and what pathology might we be looking for?
What is the silhouette sign?
Structures of differing density eg heart muscle and air in lung form a crisp silhouette so when this is lost there is pathology in an area
How can you tell on a CXR if there is mediastinal shift?
- Check the trachea and the cardiac shadow
- Pushed if there is an increase in volume or pressure (pleural effusion)
- Pulled if decrease (consolidation with lung collapse)
What are some causes of costophrenic blunting on a CXR? (3)
- Consolidation
- Fluid
- Hyperinflation of lung
How do you identify a pneumothorax on a CXR?
- Lung edge more than 2cm from chest wall
- Tracheal or mediastinal shift away from pneumothorax is tension
- Visible pleural edge
-No lung markings beyond this point. Side effected is blacker
How do you identify a pleural effusion on a CXR?
- Collection of fluid so uniform white area
- Loss of costophrenic angle
- Hemidiaphragm obscured
- Meniscus at upper border (not when supine)
How does a lobar lung collapse look on a CXR?
- Elevation of ipsilateral hemidiaphragm
- Crowding of ipsilateral ribs
- Crowding of pulmonary vessels
- Shift of mediastinum towards atelectasis
What are some things that can cause consolidation on a CXR?
Always reassess in 6 weeks to think about cancer
How do you spot consolidation on a CXR?
- Increased opacity
- Air bronchograms (pattern of air-filled bronchi on a background of airless lung)
What is being shown on this CXR? What could have caused the pathology?
Cavitation
Which could be due to infarction, abscess, TB, malignancy, septic microthrombi
What are some causes of a space occupying lesion on a CXR?
Vertebral body height is about 3cm (use as reference)