Chest Flashcards
Larynx
C3 - C6
2” - 5cm long
Cartilagenous
9 cartilages
Thyroid Cartilage C5 largest
Cricoid cartilage - inferior margin of larynx - tracheotomies below this level
Epiglottis
Glottis - opening between folds of larynx - upper and lower folds - lower is true vocal cords
Trachea
C6 - T5
1” diameter
4” long
16 - 20 c-shaped rings of cartilage in front - muscular and fibrous connective tissue in back
Bronchi
Bronchus
Carina - where trachea bifurcates
Right main bronchus - wider, shorter, more vertical
3 secondary bronchi
Left main bronchus
2 secondary bronchi
Bronchioles
Terminal bronchioles - no longer contain cartilage
Bronchial tree has continual decrease in cartilage and increase in smooth muscle as it decreases in size
Alveoli
Alveolus
Functional unit of lung
Exchange gases
Thin-walled and near capillaries
Millions in each lung
Emphysema - lungs are over inflated - loss of elasticity and dyspnea
Costal surface
Rounded portion against ribs
Hilum
Hilus
Medial surface, lung root
Where structures enter lungs
No movement in this area during respiration
Costophrenic angles
Lateral lower aspect
Right hemidiaphragm higher to accommodate liver
Cardiac notch
Concavity where heart rests against lung
Lobes
Divided by fissures
Right - 3 lobes - Horizontal and Oblique fissures
Left - 2 lobes - oblique fissure
Each lobe divided into lobules
Pleura
Double fold of serous membrane
Visceral against lung
Parietal against thoracic wall
Pleural space - contains some serous fluid to eliminate friction
pneumothorax - collapsed lung with air in pleural space
hemothorax - blood in pleural cavity
pleurisy inflammation of pleura
pleural effusion - accumulation of fluid in a cavity
Parenchyma
Spongy, elastic tissue of lung
Allows for expansion and contraction during respiration
Mediastinum
Located between lungs
All structures of thorax except lungs:
- heart
- great vessels
- trachea
- esophagus
- miscellaneous
Thoracic skeletal landmarks
Jugular notch - manubrial notch / suprasternal notch
Vertebra prominens - C7
Xyphoid process
Progression of air through respiratory system
Nose and mouth
pharynx
Larynx
Trachea
Bronchi
Bronchioles
Alveoli
Lung capillaries
Respiration phases
Inspiration
Suspended
Expiration
Body habitus types
Asthenic
Hyposthenic
Sthenic
Hypersthenic
Sign of degree of sufficient inspiration for chest x-ray
10 ribs show
Bronchitis
Inflammation of lining of bronchial tubes
COPD
Chronic Obstructive Pulmonary Disease
Group of diseases that cause progressive airflow obstruction
Cystic Fibrosis
Affects cells that produce mucus, sweat, and digestive juices
Causes thick, sticky mucus that plugs up passageways
Dyspnea
Difficulty breathing
Shortness of breath
Emphysema
Definition, appearance on x-ray and technique
Alveoli become inflated, air does not expel
Barrel-chest, increased lung dimensions, flattened diaphragm obscures costophrenic angles, elongated heart shadow
— Significant decrease in exposure factors
Epiglottitis
Definition, appearance on radiograph, techinique
Children 2-5 most common
Narrowing of upper airway (edema or swelling of epiglottis)
Soft tissue lateral upper airway
Neoplasm
Abnormal mass of tissue
Caused by cells dividing more rapidly than they should or not dying when they should
Pleural effusion
Definition, 2 types, appearance, technique
Abnormal accumulation of fluid in pleural cavity
*Empyema - PUS - chest wounds, bronchial obstruction, ruptured lung abscess. May occur from pneumonia entering pleural space
*Hemothorax - BLOOD - left-sided is from trauma, pulmonary infarct, pancreatitis, subphrenic abscess.
Right-sided or bilateral from congestive heart failure,
Lateral decub with affected side down OR erect positioning
Pneumonia
4 types
Inflammation of lungs resulting in accumulation of fluid within certain sections of lungs creating increased radiodensities in these regions
*Aspiration pneumonia - aspiration into lungs irritating bronchi causing edema
*Bronchopneumonia - bronchitis of both lungs caused by Strep
*Lobar pneumonia - confined to one or two lobes
*Viral pneumonia - inflammation of alveoli and connecting structures appears radiodense at hila
Pneumothorax
Accumulation of air in pleural space causing partial or complete lung collapse
Immideiate severe shortness of breath and chest pain
Cased by trauma or pathologic condition causing rupture of weakened lung area
Appearance - lung displaced from chest wall. No lung markings in region of collapsed lung
Positioning - ERECT - if pt cannot, then lateral decub with affected side UP
Pulmonary edema
Excess fluid within the lung caused by backup in pulmonary circulation.
Appearance - Diffuse increase in radiodensity in hilar regions fading toward the periphery of the lung
Increased air-fluid levels
HORIZONTAL BEAM PROJECTIONS in more severe conditions
RDS
Respiratory Distress Syndrome
Adult Respiratory Distress Syndrome (adults) ARDS
Hyaline Membrane Disease (infants) HMD
Injury or infection of alveoli and capillaries of lung
Results in leakage of fluid and blood into the spaces between alveoli or into alveoli
Appearance - increased density throughout lungs with granular pattern
Tuberculosis
Contagious disease caused by airborne bacteria
Primary tuberculosis - first-timers. Pleural effusion, Hilar enlargement, mediastinal lymph node enlargement
Reactivation TB - adults. Appears bilaterally in upper lobes as calcifications that are mottled in appearance
AP LORDOTIC PROJECTIONS
Pneumoconiosis
3 types
Anthracosis - black lung pneumoconiosis - coal dust - radiographs as small opaque spots or masses
Asbestosis - pulmonary fibrosis - may turn into cancer
Silicosis - inhalation of silica (quartz) dust - makes pt susceptible to TB
Severe pulmonary edema technique
Higher kV
Severe emphysyma technique
Lower exposure factors
Pleural effusion technique
Higher kV
2 conditions to use a grid
Tissue thicker than 10cm
Using high kV
2 conditions for using a grid
Tissue thicker than 10cm
Using high kV
Pneumothorax positioning technique
Sitting/standing PA if possible
Lateral decub with affected side up
Hemothorax positioning technique
Upright PA if possible
Lateral decub affected side down
Exposure factors for chest X-ray
MAs
kVp
SID
110 - 125 kVp
8 mAs
72” SID
Grid
14 x 17 or 17 x 17 if possible
3 reasons for erect chest position
Allows diaphragm to move farther down
Demonstrates air-fluid levels
Prevents engorgement of pulmonary vessels
Routine chest positions
PA
Lateral
Special chest positions (5)
AP supine or semierect
Lateral decub
AP lordotic
Anterior obliuqe
Posterior oblique
Average distance from jugular notch for CR position in AP projection
3 - 4 inches below jugular notch
Average distance from vert prominens for CR position
7-8 inches
CR position for PA chest (vertebra)
T7
AP supine or semierect projection angle
~5 degrees caudal
Lateral Upper Airway
CR at which landmark
Breathing instructions
CR at C6-7
Slow, deep inspiration
AP Upper Airway
CR position
T1-2
Larynx is between which vertebra?
C3 - C6
Thyroid cartilage (adams apple) at which vertebral level?
C5
Trachea between which vertebral levels?
C6 - T5
