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Respiratory Unit > 9.1 Radiology Of Chest 2 > Flashcards

9.1 Radiology Of Chest 2 Flashcards

1
Q

What details must you check before conducting a chest X-ray?

A

Patient details (name DOB Identification no.)
Date and time film was taken
Previous imaging (useful comparison)
Determine projection and adequacy of x-ray

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2
Q

What is the mnemonic RIPE used for?

A

To assess image quality

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3
Q

What does RIPE stand for?

A

Rotation
Inspiration
Projection
Exposure

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4
Q

How is rotation assessed in a chest x-ray?

A

The medial aspect of each clavicle should be equidistant from the spinous processes.

The spinous processes should also be in vertically orientated against the vertebral bodies.

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5
Q

How is inspiration assessed in a chest x-ray?

A

The 5-6 anterior ribs, including 1st rib

Lung apices, both costophrenic angles and the lateral rib margins should be visible.

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6
Q

How is projection assessed in a chest x-ray?

A

Note if the film is AP or PA: if there is no label, then assume it’s a PA film (if the scapulae are not projected within the chest, it’s PA).

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7
Q

How is exposure assessed in a chest x-ray?

A

The left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart.

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8
Q

What is the ABCDE approach when examining a chest x-ray

A 
Airway 
Breathing
Cardiac
Diaphragm
Everything else
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9
Q

Why is an AP chest x-ray not favourable?

A

As the heart silhouette is magnified, cannot accurately judge heart size
Scapula appear in the chest
Poor view of the lung bases due to magnified heart, can miss anthology there

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10
Q

How should lung volumes be when taking a chest x-ray?

A

Should be during inspiratory phase.

5th to 7th anterior ribs at Mid clavicular line.

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11
Q

How might lung volumes indicate pathology in an x-ray?

A

Incomplete inspiration = fewer the 6 anterior ribs visible at mid clavicular line. May be due to big heart, may show increased lung markings

Exaggerated expansion = greater amount of anterior ribs visible at the MCL. May be due to obstructive airways disease. Will also see flattening of the diaphragm

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12
Q

Why should a chest x-ray not be taken during expiration?

A

As fewer than 5 anterior ribs will be visible as lung volumes are reduced. Diaphragm raised. Less lung tissue visible

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13
Q

Which hilar point is higher?

A

The left hilar point appears higher than the right hilar point

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14
Q

What are lung zones?

A

3 divisions of the chest: upper, middle and lower.

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15
Q

Why is it important that costophrenic angles appear crisp and clear?

A

To ensure there is no fluid sat in the costophrenic recess, which happens in pleural effusion

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16
Q

What structures are assessed when considering airways?

A

trachea, carina, bronchi and hilar structures.

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17
Q

What structures are considered when assessing breathing?

A

lungs
Pleural spaces
Lung interfaces
(Compare and contrast against each side)

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18
Q

What structures are assessed when considering circulation?

A

heart size and borders
- right heart border (right atrium and middle lobe interface
- left heart border (left ventricle, lingula interface)
Mediastinum
Aortic arch
Pulmonary vessels (hila)

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19
Q

What structures are assessed when considering diaphragm?

A 
assessment of costophrenic angles and cardiophrenic angles 
Free gas under diaphragm 
Nodules
fracture/dislocation
Mass
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20
Q

What structures are assessed when we are considering ‘everything else’?

A

Areas where pathology in commonly missed.

Apices = pneumothorax
Thoracic inlet = mass
Paratracheal stripe = mass/lymph nodes in mediastinum 
AP window = mediastinal lymph nodes
Hila = mass/lymph nodes
Behind heart = mass 
Below diaphragm = pneumoperitoneum/ mass
Bones–allofthem! =Fracture/mass/missing 
Edge of films
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21
Q

If there is a space between the lung edge and the chest edge, what does that indicate?

A

Pneumothorax

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22
Q

What is a pancoast tumour?

A

A tumour of the pulmonary apex. Can spread to near by tissues such as ribs and vertebrae.

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23
Q

What is pneumoperitoneum?

A

Abnormal presence of air or other gas in the peritoneal cavity

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24
Q

What is a sarcoma?

A

A malignant tumour that starts in connective tissue such as in bone

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25
Q

What is the silhouette sign?

A

Crisp silhouette caused by structures of differing density lying next to each other. Lost if there is colsolidation or a mass

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26
Q

Loss of silhouette sign at the right heart border indicates?

A

Pathology of right middle lobe

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27
Q

Loss of silhouette sign at the left heart border indicates?

A

Pathology of the lingula

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28
Q

What is the lingula?

A

Downwards projection of the upper lobe of the left lung

29
Q

Loss of silhouette sign at the paratracheal stripe indicates?

A

Mediastinal disease

30
Q

Loss of silhouette sign at the chest wall indicates?

A

Pathology in the lung/pleura/rib

31
Q

Loss of silhouette sign at the aortic knuckle indicates?

A

Anterior mediastinum/ upper lobe pathology

32
Q

Loss of silhouette sign at the diaphragm indicates?

A

Lower lobe pathology

33
Q

Loss of silhouette sign at the horizontal fissure indicates?

A

Anterior segment upper lobe

34
Q

What do we need to assess when considering mediastinal shift?

A

Adequately centred image (rotation)

Look at trance and heart to see if it has been punched/ pulled by pathology

35
Q

What causes a mediastinal shift?

A 
Push  = increase volume or pressure 
Pull = decrease volume or pressure
36
Q

What might cause a pushed mediastinal shift?

A

Tension pneumothorax

Large pleural effusion

37
Q

How do you know if substance in an x-ray is a fluid?

A

Has a meniscus

38
Q

What might cause a pulled mediastinal shift?

A

Collapse of lung (white out with fluid and consolidation

Collapse of lobes

39
Q

What causes a bronchus cut off sign?

A

A tumour sat in the bronchus, obstructing the lung. Can cause collapse and effusion followed by mediastinum shift

40
Q

What words are used to describe a pathology of lung tissue

A

Shadowing
Opacification
Density

41
Q

What is a pneumothorax (primary/secondary)?

A

Air trapped in pleural space
Primary = spontaneous
Secondary = as a result of underlying lung disease

42
Q

What is the most common cause of pneumothorax?

A

Trauma with laceration of the visceral pleura by a fractured rib

43
Q

What is a large pneumothorax?

A

Lung edge measures more than 2 cm from the inner chest wallat the level of the hilum

44
Q

When is a pneumothorax said to be under tension?

A

Tracheal or mediastinal shift away from the pneumothorax and depressed hemidiaphragm

45
Q

What signs are seen on an X-ray of a pneumothorax?

A

Visible pleural edge

Lung markings not visible beyond this edge

46
Q

Why does a tension pneumothorax need to be urgently decompressed?

A

Needs aspiration. Massive pressure in thorax stops cardiac return. Stops blood circulation, cardiac arrest and death

47
Q

What is a pleural effusion?

A

Collection of fluid in pleural space

48
Q

How does a pleural effusion appear on a CXR?

A

Uniform white area
Loss of costophrenic angle
Hemidiaphragm obscured
Meniscus at upper border

49
Q

Why can a CXR of a pleural effusion very depending on position of patient

A

In emergency situation patient may be supine, fluid doesn’t layer to form layer. Pleural effusion would look larger and hazy

50
Q

What is lobar lung collapse?

A

Volume loss within lung

51
Q

What causes lobar lung collapse?

A

Luminal (aspirated foreign material, mucous plugging, iatrogenic)
Mural ( bronchogenic carcinoma )
Extrinsic ( compression by adjacent mass)

52
Q

What are the general findings on an CXR of a lobar lung collapse?

A

Elevation of ipsilateral hemidiaphragm
Crowding of ipsilateral ribs
Shift of mediastinum to the side of atelectasis
Crowding of pulmonary vessels

53
Q

What pathology is a sail sign on an x-ray associated with?

A

Left lower lobe collapse

54
Q

What signs are seen in left upper lobe collapse?

A

Preserved lung volume
Veiling opacity
Luftsichel sign

55
Q

What is consolidation?

A

Filling of small airways/alveoli with stuff other than air.

56
Q

What can cause consolidation?

A

Pus - pneumonia
Blood - haemorrhage
Fluid - oedema
Cells - cancer

57
Q

How does consolidation appear on a CXR

A

Dense opacification
Volume preserved (possibly increased)
Air bronchogram

58
Q

What are the different types of space occupying lesions?

A 
Nodule = less than 3cm
Mass = more than 3cm
59
Q

What do we need to consider when looking at space occupying lesions?

A

Size (nodule/mass)

Single vs multiple

60
Q

What may cause space occupying lesions?

A

Malignant - primary / metastasis

Benign mass lesion

Inflammatory

Congenital

Mimics - bone lesion, cutaneous lesion, nipple shadow

61
Q

What commonly cause cavitating lung lesions?

A

Malignancy
TB
Septic embolisms

62
Q

What are military nodules caused by?

A

TB

Metastatic malignancies

63
Q

What should the cardiac index be?

A

Less than 50% on a PA

Heart should occupy less than half of the thoracic cavity

64
Q

What are the advantages and disadvantages of CT scan?

A

Higher radiation dose than CXR

Clearer imaging as can use windows to view tissues of interest better

65
Q

why might give contrasts in CT scans?

A

To view PEs

66
Q

Why arent ultrasounds commonly used to image the lung?

A

As poor at looking at air

67
Q

When is USS used to image lungs

A

For guidance for draining pleural effusions

68
Q

Why are MRIs not used to image lungs?

A

As very time sensitive. Cant hold breath for long enough

69
Q

When would we worry about radiation exposure?

A

Pregnant patients/ breastfeeding - breast tissue is much more radiosensitive

Respiratory Unit (12 decks)

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