32. Chest x-rays Flashcards
What does the following show on a chest x-ray?
Black Dark grey Light grey White Bright white
Black - air Dark grey - fat Light grey - soft tissues White - bone/fluid Bright white - metal
LOOK AT THIS AND RECOGNISE FROM AN IMAGE
How do the anterior and posterior ribs appear on a chest x-ray?
The posterior ribs are the ones that are attached to the sternum
These then follow the lungs around towards the front and these (anteriorly) are the anterior ribs
Which rib dissects the diaphragm?
The seventh rib (check)
What are the first things you should look for on a chest x-ray?
Patient details i.e. name and DOB
Date/time of the CXR
What is the difference between a PA and AP chest x-ray and why might each be used?
PA - this is the most common CXR
This is preferred
Can accurately comment on the size of the heart
Ask the patient to hug a block and the clavicles and the sternum are moved out of the way and do not obscure the x-ray
AP - This will be used for a patient who may be bed-bound in hospital and cannot stand up for a PA view
The heart appears larger in this
The scapular is visible over the lung field
The clavicles are horizontal and are not moved out of the way
How can you recognise a PA x-ray from an AP x-ray?
NB. look at the label !!
OR
See if the scapula is present over the lung fields
See if the clavicles are present horizontally
Give a pneumonic of things to look for in a chest x-ray
Airways Breathing Circulation Diaphragm Everything else
What should you look for on a CXR regarding the airways?
Trachea - is it deviated? (Will be pulled to the same side of a collapsed lung and pushed to the opposite side in a pneumothorax)
Left and right main bronchi - is the lumen clear?
Are there any masses present?
Any reduced lung volume?
Any consolidation?
What should you look for on a CXR regarding breathing?
Compare the lung zones on both sides - upper, middle and lower
See any pleural effusion? Consolidation? - small airways will fill with dense white material
How can a pneumothorax be recognised in a chest x-ray?
Asymmetrical zones of the lung
There is a lack of lung markings to the edge of the lung field
How can a pleural effusion be recognised on a chest x-ray?
This is a collection of fluid in the pleural space
Fluid gathers in the lowest part of the chest (according to the patient’s position)
Will appear white (fluid)
There will be a meniscus at the top
GOOD IMAGE ON SLIDE 31
What should you look for on a CXR regarding circulation?
Cardiothoracic ratio (length of the lungs to the lenght of the heart) - 50% is considered normal
Mediastinum - the aortic knuckle should be present, should not be widened
Heart contours should be visible
What should you look for on a CXR regarding the diaphragm?
Should be dome shaped
The right hand side should be higher than the left hand side - to the top of the 5th intercostal space compared to the bottom of the 5th intercostal space
Have a look - is there any air under the diaphragm?
What is under the diaphragm on the left and right hand side respectively?
Left hand side - bowel
Right hand side - liver
What should you look for on a CXR regarding ‘everything else’?
Bones - are there any fractures?
Soft tissues - are there any swellings? any breast shadows?
Lines - ECG, endotracheal tubes, pacemakers, chest drains
