basic radiographic diagnostics Flashcards
consolidation
region of compressible lung tissue filled with liquid
atelectasis
collapse or incomplete expansion of the lung or part of the lung (snapping sound when opening)
complications for atelectasis
cystic fibrosis inhaled foreign objects lung tumors fluid in the lung respiratory weakness chest injuries
AP view
x-ray picture beam pass from front to back (anteroposterior)
PA view
standard chest x-ray (posterioranterior) and lateral chest x-ray
PA scapula and clavicles
scapula seen in periphery of thorax
clavicles project over lung fields
AP scapula and clavicles
scapula seen over lung fields
clavicles above the apex of lung fields
why get the lateral view
PA view
The triangular shape below the left ventricle will hide a lot of “bad things” and a lateral view is the only way to see it. It is blocked by the heart
chest x-ray for decubitus
helpful in assessing the volume of pleural effusion and demonstrate whether a pleural effusion is mobile or loculated
kerley lines
thin linear pulmonary opacities caused by fluid or cellular infiltration into the interstitium of the lungs
sarcoid
sarcoidosis - disease involving abnormal collections of inflammatory cells forming granulomas aka: nodules
labs that aid in sarcoid dx
elevated serum Ca
normal parathyroid hormone
elevated serum ACE level
DX: should be one of exclusion
lofgren syndrome
type of acute sarcoidosis
lofgren syndrome s/sx
fever, large lymph nodes, arthritis and rash (erythema nodosum)
additionally patients may present with wheezing, cough, SOB and chest pain
so if patient comes in for flu and you see erythema nodosum - get a picture
erythema nodosum
inflammatorycondition
aka: sub-acute migratory panniculitis of vilanova and pinol
characterized by inflammation of the fat cells under the skin, resulting in tender red nodules or lumps.
causes of erythema nodosum
It can be caused by a variety of conditions such as IBD, Strep, TB, Cat Scratch Fever, and Sarcoid
air bronchogram
refers to the phenomenon of air filled bronchi (dark) being made visible by the opacification of the surrounding alveoli
basically large airway becomes more visible
causes of air bronchogram
lung consolidation pulmonary edema nonobstructive pulmonary atelectasis severe interstitial disease neoplasm normal expiration
interstitial
anatomy relating to or situated in the small narrow spaces between tissues or parts of an organ
interstitial cells
interstitial fluid
pleural or pulmonary effusion
buildup of fluid in pleural space
-area between the layers of tissue that line the lungs of the chest cavity
two types of pleural effusions
transudative
exudative
transudative pleural effusion
fluid leaking into the pleural space from increased pressure in the blood vessels or a low blood protein count.
Think in terms of fluid overload
exudative pleural effusion
blocked blood vessels or lymph vessels
Inflammation
lung injury
tumors.
pneumothorax
air in the cavity between the lungs and chest wall causing a collapse of the lung
closed pneumothorax
air in the pleural space
can be spontaneous
open pneumothorax
guns knife ect
tension pneumothorax
air in pleural cavity and is trapped during expiration
air pressure within the thorax mounts higher atmospheric pressure and compressing the lung
displace the mediastinum and its structures towards the opposite
hemothorax
blood in the pleural space
solitary pulmonary nodule
SPN aka coin lesion
mass in lung usually smaller than 3 cm in diameter
10-20% of patients with granulomas are diagnosed with lung cancer
color of images
black-air
gray- muscle, fat, fluid
white- bone, metal, contrast media
limitations of chest x -ray
- show only conditions that change the side of tissue in the chest or how the tissue absorbs radiation
- limited to two dimension pictures
- very small areas of cancer and blood clots in the lungs usually not visible
many reasons to get a chest x-ray but dr hatch specifically mentioned
post tube and line insertions
approach to imaging steps 1-4
- check patient details (name DOB)
- check film orientation (L&R is view AP or PA)
- check additional info (enough inspiration expansion or expiration compression)
- check rotation (measure distance from medial end of each clavicle to the spinous process of the vertebra at the same level- SHOULD BE THE SAME)
approach to imaging steps 5-7
- check for adequacy of inspiration (9 pairs of ribs)
- check penetration (thoracic vertebra should be visible behind heart)
- check exposure (ID both costophrenic angles and lung apices)
ABCDEFGHI of chest x -ray
Assessment of quality Bones and soft tissues Cardiac Diaphragm Effusions Fields and Fissures Great Vessels Hilum / mediastinum Impression
cardiac on chest x-ray
heart should be 50% of the chest diameter on PA films
diaphragm on chest x-ray
check hemi-diaphragms for position and shape (right is slightly higher than left) (may be flat in asthma and COPD)
-look below the diaphragm for free air (gastro perforation)
pleural effusions on chest x-ray
- Pleural effusions may be large and obvious or small and subtle.
- Always check the costophrenic angles for sharpness (blunted angles may indicate small effusions).
- Check a lateral film for small posterior effusions
epidural
pt fine for a few minutes then progressively worse
above the dura
looks like a lemon
subdural
under the dura
progressive unconscious
looks like a banana
kids suspect pneumonia but CXR is negative
admit and hydrate and then re-film in the morning
