Abnormal Chest X-Rays

Question 1

Before you start looking at clinical features what should you do when interpreting a chest X-ray

Answer 1

• Correct patient - Correct date of radiograph, - AP or PA - Orientated correctly? - Exposure - Is there any rotation

Question 2

Describe the appearance of translucency and opacification and what this could be?

Answer 2

Translucency (too black) - Air or loss of Opacification (too white) - Fluid or increased tissue

Question 3

What could cause the trachea to be pushed away from the midline?

Answer 3

Pneumothorax (too black). Massive pleural effusion (too white)

Question 4

What could cause the trachea to be pulled towards from the midline?

Answer 4

Atelectasis or fibrosis

Question 5

What does calcification look like and how can you tell if it is the left upper lobe or left lower lobe?

Answer 5

It an area of increased opacification. If it is in the lower lobe then there will be a will differentiated boarder between the heart and lung. If it was blurred with the heart shadow then it is likely to be upper load.

Question 6

Try and draw where the different lung lobes are

Answer 6

Add photo

Question 7

What is consolidation?

Answer 7

Replacement of normal air space gas with fluid or solid material.

Question 8

What is atelectasis?

Answer 8

Reduction in inflation of all or part of the lung.

Question 9

When should you suspect atelectasis on an X-ray?

Answer 9

• Volume loss, - Displacement of trachea, - Displacement of diaphragm, - Displacement of lung fissures, - Compensatory over inflation of non-collapsed lung, - Crowding of vessels and bronchi.

Question 10

Describe the appearance of an left upper lobe atelectasis?

Answer 10

“veil like” opacification, elevated hemi diaphragm and loss of cardio mediastinal contour.

Question 11

Describe the appearance of COVID on an X-ray?

Answer 11

Patchy opacification, bilateral, peripheral distribution and its more towards the base of the lungs.

Question 12

Describe the appearance of pleural effusion on a chest X ray?

Answer 12

Very white rather than patchy

Question 13

What is exudate?

Answer 13

High protein (malignancy, infection or rheumatoid)

Question 14

What is transudate?

Answer 14

Low protein (CSF)

Question 15

What is shown on this xray

Answer 15

Asbestos (add photo)

Question 16

Describe how you examine the heart on a PA chest xray?

Answer 16

A - alveolar oedema (Bat wing shadowing), B - Kerley B lines (oedema in the interstium) C - Cardiomegaly (enlarged heart) D - Upper lobe diversion (dilation of pulmonary veins, looks like stag antlers) E - Pleural effusion

Question 17

What does this x-ray indicate?

Answer 17

Bilateral hilar lymphadenopathy which could be lymphoma or sarcoid. If unilateral then it could be TB or metastatic spread.