Chest Flashcards
Is the heart larger on an AP or PA CXR?
AP CXR
This is due to the heart lying more anteriorly within the chest.
What width of a PA CXR should be taken up by the heart?
Less than, or equal to 50%.
Can inspiration/expiration affect a CXR?
Yes, can mimic pathology.
Counter this by asking patient to take a deep breath and hold.
What are the hila?
The junctions found between the lungs and the heart.
The left hilum is slightly higher.
Which diaphragm is higher?
The right diaphragm lies slightly higher than the left.
What areas should be given special attention when reviewing a CXR?
Lung apices
Above/Behind the clavicles
Behind the heart
Below the diaphragms
How many lobes are there in the right lung?
3
How many lobes are there in the left lung?
2
What causes lobar collapse?
Bronchial obstruction
Can be a foreign body, compacted mucus or tumour.
How does a left lower lobe collapse appear on CXR?
White triangle muffles the left heart border.
Hilum not visible on this side.
How does left upper lobe collapse appear on CXR?
Tricky to see, left heart border appears to have disappeared.
Described as a veil-like opacity.
Left diaphragm may become higher than the right.
How does right upper lobe collapse present?
Clearly visible horizontal fissure - white tissue will border black tissue below the fissure.
Does the right middle lobe collapse alone?
Very rarely seen without a right lower lobe collapse too - this is because both lobes share a bronchus intermedius.
If only a right middle lobe collapse is seen, how does this present?
Lost right heart border only.
If only a right lower lobe collapse is seen, how does this present?
Lost diaphragm contour only.
If both right middle and right lower lobes collapse, how does this present?
Loss of the right heart border AND diaphragmatic contour.
Right lung will be clearly smaller.
Which lung has a lingula?
The left lung.
How does infection of the lingula affect a CXR?
Obscures the left heart border.
How does the presence of fluid in the pleural space initially present?
Blunting of the costophrenic angles.
How is a small pneumothorax seen on a CXR?
A dark crescent sign without lung markers, often seen at the lung apices.
Can be subtle.
How is a large pneumothorax seen on CXR?
There will be no lung markings.
What is the ‘ABCDE’ of heart failure?
Alveolar oedema Kerley B lines Cardiomegaly Dilated upper lobe vessels Pleural effusion
Where are Kerley B lines seen?
In the lower zones at the edges.
What is ‘batwing’ oedema characteristic of?
Heart failure
Where should an endotracheal tube be observed on CXR?
5cm above the carina.
What is the carina of the lungs?
The point at which the bronchus splits.
Where are CVC lines most commonly inserted?
The right internal jugular vein
Where are PICC lines inserted?
Usually in the cephalic vein, basilic vein or brachial vein.
A line placed too high risks what?
Thrombosis
A line placed too low risks what?
Arrhythmia (can enter the right atrium)
Where should be checked for metastasis in lung cancer?
Brain
Liver
Adrenal glands
Bones
What are sites of perforation associated with pneumoperitoneum?
Stomach
Diaphragm
Small bowel
Large bowel
Can pneumoperitoneum be diagnosed on a supine CXR?
No, as the air will not rise to the top of the abdominal cavity - will need to be a erect CXR.
What is gold standard for diagnosis of a pulmonary embolism?
CT-pa
