Abnormal Chest X-rays Flashcards
What can increased translucency be due to?
- Air (gas)
- Loss of tissue density
What can too white or white in the wrong place be due to?
- Fluid
- Increased tissue e.g lymphadenopathy
What devices could appear as very white or very radio opaque on a CXR?
- Pacemaker
- ETT
- NG tube
- Sternal wiring
- Prosthetic heart valves
- CVP line
- Chest drain
What does a chest x-ray that is too white with the trachea pushed away indicate?
Pleural effusion
What ‘too white’ conditions can pull the mediastinum towards the pathology?
- Collapse/atelectasis
- Fibrosis
What 4 things should you consider on clinical examination?
- Inspection
- Palpatation
- Percussion
- Auscultation
What differentiates a tension pneumothorax from a simple?
Tension have mediastinal shift
What conditions cause a deviated trachea away from the pathology?
- Tension pneumothorax
- Massive pleural effusion, or any mass effect
What conditions cause mediastinal shift towards the pathology?
- Pneumonectomy / lobectomy
- Lobar collapse atelectasis
What is a pneumonectomy?
surgical removal of a lung or part of a lung.
What does blurring of the heart shadow indicate?
Opacification is in lingula
What 5 substances and subsequent conditions can cause consolidation?
- Pus - pneumonia
- Blood - pulmonary haemorrhage
- Fluid - pulmonary oedema
- Cells - lung cancer
- Protein - alveolar proteinosis
What is an air bronchogram?
- Large airways are spared so become visible (black) against a white background
- Like branches of tree with snow
- Pus blood or oedema fluid sit in alveoli
- No loss of volume
What condition is there a loss of volume atelectasis or consolidation?
Atelectasis
What differentiates pleural effusion from pulmonary consolidation upon clinical examination?
Increased vocal resonance in consolidation decreased in pleural effusion.
What is atelectasis caused by?
When a main bronchus has been blocked
What is the normal level of the horizontal fissure?
Anterior 4th rib
What is atelectasis?
Reduction in inflation of all or part of the lung
What would you see on an X-ray if an individual has an atelectasis?
- Volume loss
- Displacement of trachea
- Displacement of diaphragm
- Displacement of lung fissures
- Compensatory over inflation of non collapsed lung
- Crowding of vessels & bronchi
- Loss of cardio mediastinal contour
- “Veil like” opacification of left lung field
What is seen on an x-ray with pleural effusion?
- Trachea is pushed away
- Uniformly white
- Concave upper border (meniscus)
What is pleural effusion?
Fluid collecting within the pleural cavity
What does a large (50% of hemithorax), unilateral pleural effusion usually indicate?
Lung cancer
What is the cause of an exudate pleural effusion?
- Malignancy
- Infection
- Rheumatoid
What is usually the cause of a transudate pleural effusion?
Congestive Heart Failure
What does asbestos exposure look like on a CXR?
- Can see pleura
- Holly leaf?
- Whispy calcified white
- If malignant (mesothelioma)
unilateral fluffy opacification
What are the signs of acute pulmonary oedema from congestive heart failure on a CXR?
- A: batwing shadowing - alveolar oedema coming out from the hilum
- B: Kerley B lines - little straight lines perpendicular to the thorax interstitial septa
- C: cardiomegaly
- D: upper lobe diversion
- E: pleural effusion - blunting of costophrenic angles
What does sternal wiring indicate?
Sternotomy for cardiac surgery
What can free gas under the diaphragm indicate?
- Laperoscopy (from up to 2 weeks)
- Post abdominal surgery (from up to 2 weeks)
- Perforated abdominal viscus most likely
What can a bright white structure in the trachea be?
Tracheostomy tube
What can the hidden areas be?
- Neck
- Apices
- Mediastinum
- Behind the heart
- Costophrenic angles
- Behind / below diaphragm
- Soft tissues
- Bones
What can bilateral hilar lymphadenopathy indicate?
- Lymphoma (hodgkins)
- Sarcoid
What can unilateral lymphadenopathy be?
- TB
- Metastic spread
