7a. Trauma Evaluation - Chest Flashcards
how many anterior ribs is good inspiration for PA chest
5 ant ribs
what shows good positioning for PA chest in terms of rotation
medial clavicles equidistant to spinous processes
what shows good positioning for PA chest in terms of lordosis/kyphosis
clavicles should be projected over the 3/4th post ribs
what are the 5 common densities on a CXR
bone soft tissue fat air iatrogenic
what does iatrogenic
placed in by doctor
what are the 4 locations of interest for evaluation in a CXR
mediastinum
lungs
pleura
chest wall
what 4 things create densities
water
pus
blood
cells
what creates lucencies
air
what are 2 common pathologies of the lung
consolidation
tumors
what are 2 common pathologies of the pleura
pleural effusion
pneumothorax
what are 2 common pathologies of the mediastinum
enlarged heart
mediastinal nodes
what are 2 common lung densities
consolidations and masses/nodes
what is an example of what a consolidation can be in the chest
infection
what is an example of what masses and nodes can be in the chest
cancer
what is a silhouette sign
loss of normal borders between 2 adjacent soft tissue structures (eg losing the heart border)
what is the silhouette sign used for
locating area of consolidation
if there is a right paratracheal stripe in the xray which lobe of the lung is the consolidation in
right upper lobe
if the right heart border is obscured in the xray which lobe of the lung is the consolidation in
right middle lobe
if the right hemi diaphragm is obscured in the xray which lobe of the lung is the consolidation in
right lower lobe
if the aortic knuckle is obscured in the xray which lobe of the lung is the consolidation in
left upper lobe
if the left heart border is obscured in the xray which lobe of the lung is the consolidation in
lingula segments of the left upper lobe
if the left hemi diaphragm or descending is obscured in the xray which lobe of the lung is the consolidation in
left lower lobe
can you tell the difference on images between blood, pus, water and tumor cells from an xray
no you need clinical history
what is the air bronchogram sign
air filled bronchi remain patent and visible on image as there is contrast between the air in the bronchi and the fluid in the alveoli
sign of bronchi that are not filled with fluid and are filled with air and run through infection
what is the air bronchogram used for
occur with conditions such as cancers but are most commonly associated with infective consolidations such as pneumonia
shows its not a solid mass so likely to be a infection
what is the bulging lobar margin sign due to
formation of large amounts of inflammatory exudate (pus/fluid) results in local expansion of lung
what does bulging lobar margin indicate
infection or inflammation
what are 2 common mediastinal pathologies
enlarged glands and heart
what is the definition of an enlarged heart
heart size is usually less than 50% of the thoracic diameter
when does upper lobe diversion happen
early heart failure
what is upper lobe blood diversion
incompetence of heart forces blood to go to upper lobes
what does the batwing presentation indicate
cardiac infarct
what does the batwing presentation look like
edges/corners of lung near diaphragm are blackened
what is a pleural effusion
fluid in pleural cavity
what is pneumothorax
air in the pleural cavity
what does the deep sulcus sign indicate
supine pneumothorax
besides all normal chest checks what are the 4 things needed to be checked
deep sulcus sign
pneumothorax on patient with shoulder and rib #
check for other bony #
widened mediastinum
in a supine patient with normal lungs the distribtution of blood would be
equal throughout the lungs due to gravity
what is a flail chest
2 or more ribs fractured in 2 or more places
in the normal chest the left hilum lies where relative to the right hilum
1-2cm above the right
the medial ends of the clavicles should be equidistant to what in an unrotated image
spinous proceses of the vertebra
a good inspiration should have how many anterior ribs
5-6
what does the silhouette sign indicate
loss of normal borders between 2 adjacent structures because of consolidation in the lung which appears white
the whiter lung area alongside the white solid organ outline means that the borders cannot be distinguished
what is the apical zone
above the clavicles
what is the upper zone
below the clavicles and above the cardiac silhouette
what is the mid zone
level of hilar structures
what is the lower zone
bases of the lung
what is the air bronchogram sign
fluid/consolidation present in air spaces/alveoli, it appears white on radiograph, any fluid in alveoli appears white on radiograph
bronchi is visible in abnormal case as branching black lines the air filled bronchi remain patent and visible as there is contrast between the air in the bronchi and the fluid in the alveoli
what are air bronchograms most commonly associated with
infective consolidations such as pneumonia
what are the 2 types of pneumonia
bronchopneumonia and lobar pneumonia
what is bronchopneumonia
initially inflammation of the bronchioles and bronchi later affecting the alveoli resulting in a more patchy appearance
what is lobar pneumonia
a part or whole of one lobe is affected
what are the 2 types of lung cancers
metastases or primaries
what is the most common type of lung cancer
metastatic
what are the 2 main types of primary lung cancers
small cell
non small cell
what are the 3 most common non small cell primary lung cancers
adenocarcinomas
squamous cell carcinomas
large cell carcinomas
what are the 4 things to look for in terms of lung nodules and masses
tracheal shift
smooth outlines
popcorn lesions
lack of air bronchograms
what is tracheal shift in context of nodules and masses
trachea is often pushed or pulled by a neoplasm usually a primary lesion
what happens with mild pulmonary edema
upper lobe blood diversion
what 4 things happens with moderate pulmonary edema
upper lobe blood diversion
bronchial wall thickening
blurring of bronchovascular densities due to fluid in supporting tissues
blunting of costophrenic angles
what happens with severe pulmonary edema
edema fills alveoli and results in air space opacification
what is interstitial edema
increased interstitial densities including septal lines/interlobular septa are visible
what is the batwing distribution indicate and what part of the lung is not affected
severe pulmonary edema - myocardial infarct
outer 3rd of lungs commonly spared
