Abnormal Chest X-Rays Flashcards
What is increased translucency a sign of?
- air (gas)
- loss of tissue density
What is increased opacification a sign of?
- fluid
- increased tissue eg. lymphadenopathy
What is really white a sign of?
- hardware
- pacemaker (just underneath left clavicle)
- ETT (just under trachea)
- NG tube
- sternal wiring
- prosthetic heart valves
- CVP line
- chest drain
What would you use an X-ray to check with an NG tube?
- that it isn’t too close to the carina (and therefore would need withdrawn)
- would be in danger of entering right main bronchus
What would shift the trachea from the midline?
Pushed away from pathology:
- too black: pneumothorax (look for visceral pleural line)
- too white: pleural effusion
Pulled towards pathology:
- too white: atelectasis (lobar collapse)/fibrosis
What would you expect to find on clinical examination of a patient with a pneumothorax?
- inspection: can be cyanosed and will have a high resp rate
- palpation: will have decreased expansion on side of pneumothorax and may have deviation of the apex
- percussion: hyper resonant sounds on side of pneumothorax
- auscultation: decreased or absent breath sounds over area of pneumothorax
How would you describe lung consolidation on an X-ray?
- wedge shaped area of opacification
- whether it blurs the heart shadow or not
- where it narrows
- what zone and lobe it is at
What is consolidation and the causes of it?
- replacement of normal air space gas with fluid or solid material
5 causes:
- pus (infection- pneumonia)
- blood (haemorrhage)
- fluid (oedema)
- cells (cancer)
- protein (alveolar proteinosis)
What are the clinical signs of consolidation?
- percussion: dull
- increased vocal resonance
- auscultation: bronchial breath sounds
What does consolidation look like on an air bronchogram?
tree in winter with snow on the branches
What is the normal level of the horizontal fissure?
anterior 4th rib
What is atelectasis (lobar collapse)
reduction in inflation of all or part of the lung
What signs on an X-ray would raise suspicion of atelectasis?
- volume loss
- displacement of trachea
- displacement of diaphragm
- displacement of lung fissures
- compensatory over inflation of non-collapsed lung
- crowding of vessels and bronchi
What would left upper lobe atelectasis look like?
- veil like opacification of left lung field (compare with right)
- elevated hemi-diaphragm
- loss of cardio-mediastinal contour
What would covid look like on an X-ray?
- patchy opacification
- bilateral
- distribution to the base and periphery of the lungs
What does pleural effusion look like on an X-ray?
- area uniformly white
- concave upper border (meniscus)
How would you go about determining what type of fluid is present in effusion?
- review patient history and clinical examination
- is it visible on both lung fields? (systemic?)
- or is it large and unilateral? (cancer?)
- sample the effusion (use ultrasound) then determine if:
- exudate: high protein, malignancy, infection, rheumatoid
- transudate: low protein, CCF
What does asbestos exposure look like on an X-ray?
- pleural plaques
- calcified
- covers pleural wall and diaphragm
- can cause mesothelioma
What are the ABDCE signs of heart failure on a chest X-ray?
- A: alveolar oedema, bat winged shadowing from heart, opacification
- B: Kerley B lines, oedema in interstitium, lines coming out perpendicular from thoracic wall
- C: cardiomegaly, englarged heart
- D: upper lobe deviation, vessels going to top of lung gets fattier
- E: pleural effusion, blunting of costophrenic angles
How would you differentiate a pacemaker from an implantable defibrillator?
an implantable defibrillator has thickened bits of wiring
What is gas in the diaphragm a sign of?
surgery or perforation of abdominal viscus
What is translucency of soft tissue a sign of?
surgical emphysema
What are the hidden areas?
- neck
- apices
- mediastinum
- behind the heart
- costophrenic angles
- behind/below diaphragm
- soft tissues
- bones
What is bilateral/unilateral hilar lymphadenopathy a sign of?
bilateral:
- hodgkins lymphoma
- sarcoid
unilateral/asymmetrical:
- TB
- metastatic spread
