CC 2 - Thoracic Anatomy (Radiologic Review of the Chest) Flashcards
Indicate what portions of the heart appear on the X-ray.
What color does soft tissue (e.g. fat, muscle) appear like on an X-ray?
Grey
What appears black on an X-ray?
Air
Can tissues of the same density be distinguished on an X-ray? Example?
NOPE
Liver and spleen
Mark the structures that can be seen on the X-ray.
What do the white lines in the lungs correspond to?
Blood vessels
What are the sharp angles on either side of the chest inferiorly on the X-ray? What does it mean when these angles are blunted?
Where the diaphragm meets the chest wall
Blunted angles could be indicative of pleural effusion or other fluids in the thorax
What does the gastric bubble correspond to on a chest X-ray?
Pocket of air in the stomach just underneath the diaphragm
Why are PA X-rays preferred to AP? Issue though?
- With the patient holding the plate in front of them, they roll their shoulders forward, getting the scapulae out of the way of the X-ray
- Puts heart closest to the plate so that it does NOT appear larger because the X-rays diverge as they come out (you want a better representation of the organ)
Issue: a lot of patients are bed ridden, so we need to use AP shot by putting a plate below the bed
How to describe subject placement in radiography?
First the side receiving the rays first
Then the side next to the film
What are the 2 types of X-ray positioning?
- AP = anterior posterior
- PA = posterior anterior
What is the preferred lateral chest X-ray? Why?
Right lateral chest X-ray so the heart is closest to the plate
Mark the structures that can be seen on the X-ray.
On the RL chest X-ray, why is the area toward top of spine white and then it gets darker?
Latissimus dorsi are responsible for the white and then there is less and less muscle
How to tell which is the right and left diaphragm on a RL chest X-ray? Which one is higher more often than not?
- Right diaphragm will extend from the back all the way to the front of the chest
- Left diaphragm will extend from the back and will disappear before reaching the front of the chest because the soft tissue heart above it makes the outline dissipate
Right diaphragm is OFTEN higher because the heart pushes down on the left (according to radiologists) or because the liver pushes up on the right (according to anatomists)
What is the carina of the trachea?
Ridge of cartilage in the trachea that occurs between the division of the two main bronchi
What is the aortic knob formed by on an X-ray?
Aortic arch + carina of the trachea
How to find the carina on a chest X-ray?
- Darker column coming superiorly from left chest and meeting the trachea
- Right under pulmonary artery and hilum
What are the 6 main veins used to insert tubes inside the chest?
- R/L subclavian veins
- R/L jugular veins
- R/L femoral veins
What is a pneumothorax?
Presence of air in pleural space
What is a tension pneumothorax?
Air in pleural space due to pneumothorax restricts inflation of the lungs => progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax => mediastinum obstructs venous return to the heart => may result in traumatic arrest
What is atelectasis? 2 types? Treatment for each?
Alveolar collapse
- Obstructive = something obstructs the lung and the air that remains in the alveoli is absorbed into the capillaries so the lung collapses (with tracheal deviation toward side of atelectasis) => bronchoscope
- Compressive = positive pressure outside the lung (e.g. tension pneumothorax) causes the alveoli to collapse (with tracheal deviation away from side of atelectasis) => chest tube
What’s the issue here?
Pneumothorax causing compressive atelactasis
What’s the issue here?
Pneumothorax due to tube inserted into bronchi instead of esophagus
What’s the issue here?
Right pneumothorax
What is a buffalo chest?
2 lungs in only 1 pleura
What’s the issue here?
Left tension pneumothorax with right tracheal and mediastinum deviation and left diaphragm is completed pushed into the pelvis
What’s the issue here?
Pleural effusion with white meniscus
How can a pleural effusion be confirmed by X-ray?
Make patient lie down during X-ray and see the fluid spread out
What’s the issue here?
Complete white out of the hemi-thorax caused by pleural effusion
What is pneumonia?
Fluid inside the lungs without any shifting of structures
3 potential causes of white out?
- Pleural effusion with shifting of mediastinum away from effusion
- Pneumonia
- Obstructive atelectasis with shifting of mediastinum towards obstruction
What’s the issue here?
Obstructive atelectasis with right tracheal deviation
What’s the issue here?
Obstructive atelectasis of left lung due to right main stem intubation
What’s the issue here?
Cannot see the left heart border => lingula which is in contact with it has pneumonia => left upper lobe pneumonia => left upper lobe atalectasis
What are the lobes of the lungs?
- Right lung: superior, middle, inferior
- Left lung: superior/anterior, inferior/posterior
What is the superior lobe of the left lung divided in?
- Upper division
- Lingula (lower division of superior lobe of left lung)
What’s the issue here?
Left upper lobe lung pneumonia
What’s the issue here?
Right heart border is obscured => right middle lobe pneumonia
What’s the issue here?
Obscured diaphragm and right border of the heart + shifting of heart to the right => right lung middle and inferior lobes obstructive atalectasis
What’s the issue here?
Abnormal lymphadenopathy of sarcoid
