CHEST Flashcards
What is below aortic knob and splits after carina of trachea?
Bronchus in hilar region
Smaller bronchi are INVISIBLE bc filled with air, so all looks black on NORMAL film
Where are vessles seen commonly?
lung bases d/t gravity
taper as they move peripherally
What structures should be noted when viewing?
BE aware of scapula border, humerus, nipple shadow, breast tissue
How should the spine be viewed laterally?
lucent/dark-Moving superior to inferior should opaque to more dark
Retrosternal should ALWAYS BE Lucent/CLEAR
WHAT is systematic approach for viewing xray?
Name date-M, F Large abnormality- WHITE STUFF which lobe Technique- PA, AP, Lateral, Upright, Lateral decubitus RIPMA Full view- costorphrenic, apices Bones Soft tissue- trachea, mediastina, vascu Heart Pleura and fissures Lungs Diaphragm Lines Stomach bubble Free stuff- 7th cervicle spine rib, Air fluid level
What determines rotation adequacy?
SP equal btwn clavicle. Whatever clavicle is opened more that side is rotated away
Bad outcomes- heart size, vessels hila diaphragm distorted
What determines inspiration adequacy?
See at-least 8-9 post ribs, Count 1-3 closely
Bad outcomes- lungs compressed, may look like LL PNA
What determines penetration adequacy
Should see spine through heart. Lateral- R diaphragm behind heart, pulm vessels 1/3 of lung periphery
BAD- OVER-lungs look like emphysema (dark). UNDER (opaque) penetration creates false PNA inLL
What determines magnification adequacy
AP films enlarge heart. AP do apical lordoctic position
What determines angulation adequacy
Clavicle should be S shaped. Medial ends superimposed on 3-4ribs.
Sometimes can see UL better bc apex w/in mid 1/3 of clavicle
BAD- if clavicle highset, apical lordotic heart is large
What are reasons for LLD position?
Air fluid level
Pleural effusion layers out >75ml
Loculated effusion
*Expiratory films needed for…
Small pneumothorax
Can CXR diagnosis Cancer?
NO
Highly suspicious
What is fluid (pus, blood, gastric, water) filled space around bronchi, which makes bronchi more visible?
Air bronchograms
Finding in Air space DZ/Alveolar Dz
Air space
Peribronchial- same, but on end
What would opacities look like with alveolar dz?
Confluent merged Poor defined borders Consolidation and Lobar stays in lung section Hazy fluffy Bat wing w/in lobes \+Silhouette sign
The minor and major fissure are located where?
R lobe
Minor- upper horizontal R lobe
Major- lower lateral to medial diagonal R Lobe
L lobe
ONLY one Major lower, obliquely
Which condition can be segmental, interstitial, streaky, round and cavitary, overlap?
Pneumonia- Strep Pneumonia MC
Round- H.flu, strep, no SS
Segmental- multi lobar staph, pseudo, few bronchograms
TB
ARDS
List the DDX Airspace and key findings?
Pneumonia- lobar UPPER mostly
Aspiration- bronchi opaque, then bc lucent, lower lobes
Pulmonary edema-CHF late, drown, drugs
TB
Hemorrhage
ARDS- BIL infiltrate acute/adult resp. distress syndrome.
Chronic alveolar DZ- Emphysema
What are the DDX cavity lesions/ REACTIVATION TB? *
Cavitary lesion have cleared center, discreet border
- TB
- Staph
- Strep
- Klebsiella
- Coccidiomycosis
Is TB always in upper lobes?
NO
Primary- ANYWHERE (CT) ipsilateral hilar adenopathy
Reactivation TB- cavitation anywhere, MC UL w/ effusion
Miliary TB- starry night CT everywhere. Pillets on CXR
What disease has the following white line, netlike dots mass, nodules, honeycomb NO AIR BRONCHOGRAMS NO LOBAR focal and diffuse
Interstitial DZ
Systemic and Bilateral
What are characteristic findings of CHF?
Interstital DZ- EARLY CHF
Alveolar - LATE CHF
This DDX are common in what kind of locale DZ:
- Atypical PNA- viral, myoc, fungal, miliary TB, varicella, PCP
- Mass, nodules, tumor
- BiL hialar adenopathy-sacroid, restricts
- RA
- Pulmonary fibrosis
- Silicosis, asbestosis etc
- Early CHF, non cardiac
INTERSTIAL DZ
XRAY show dark, white fluffy patches, denser white area. Describe each.
LUCENCY- darker, absent. Bulla, PNeumothorax, cycst
OPAGUE- white less dense, fluid mass
CONSOLIDATION- dense white
Mr. Chain c/c of SOB, cough, and shoulder pain? What is DDX based on CXR?
Apical mass- apex
Shoulder pain
Smoker
Elderly
What enlarges the mediastinum other then the heart?
Torturous aorta lymph nodes Mediastinal masses Aortic AA Pericardial effusion- fluid around heart Bony abnormalities
CXR it noted that this mass is what based off the findings below?what is plan? <30yo <3cm Round, well defined edges NO growth for 2y Central calcification
BENIGN mass
Repeat CXR Q3MO FOR 1Y
2YR- REPEAT every 6MO
CXR it noted that this mass is what based off the findings below?what is plan? >30yo >3cm Irregula, poor defined edges Growth Asym calcification Cavitary
SUSPICIOUS OF MALIGNANCY
w/u CT
Biopsy-dx
PET- stage dx
What causes pleural space to appear opacified on CXR?
Pleural effusion- blunt costophrenic angle
Concave meniscus
Loculated effusion- thick viscous
Fissures opacified, effusion
If the ascending aorta is no longer seen, where is the consolidation?
Silhouette sign
Blurred ascending aorta means RUL consolidation
If the R heart border is no longer seen, where is the consolidation?
Blurred R heart border means RML consolidation
If the R hemidiaphragm is no longer seen, where is the consolidation?
Blurred R hemidiaphragm means RLL consolidation
If the descending aorta is no longer seen, where is the consolidation?
Blurred decending aorta means LUL or LLL consolidation
If the L heart border is no longer seen, where is the consolidation?
Blurred L heart border means LINGULA or LUL consolidation
If the L hemidiaphragm is no longer seen, where is the consolidation?
Blurred L hemidiaphragm means LLL consolidation
What do straight line indicate on CXR?
Not normal Lobar PNA Atelectasis Kerby B lines Air Fluid
What can be seen on Lateral view if the infiltate is on the spine?
SPINE usually superior white/opaque-lower spine dark/lucent
+ Spine sign- infiltrate is posterior to heart in spine
HIGH density in LLL
How far should endotracheal tube go?
3-5cm ABOVE carina
Radiopaque tube- black btwn two opague tracks
Where should central venous catheter?
Runs superior to SVC and R atrium
What is difference in Child CXR vs Adult?
Child Thymus make wide mediastinum
Heart is 65% of width. TOF
Croup- viral infx=Narrow Trachea- “Steeple sign”
The coin is en face on PA, where is it located?
Esophagus
The coin is on edge on PA, where is it located?
Trachea
For foreign bodies, what must be of concern?
Radioopague
Evaluate for Atelectasis
When should a CT for chest be ordered?
Details of size, extent, lesion Systemic lung dz Nodules and masses follow/up Staging Pleural effusion >75ml Pulmonary embolus Aorta and medstinal structures Trauma
