Chest Flashcards
x-ray air
black
X-ray fat
grey
x-ray soft tissue/muscle
grey/white
x-ray bone
white
x-ray metal
bright white
how does x-ray make an image
compares densities - more dense = darker, less dense = lighter
what to look at to tell if x-ray is technically accurate
projection
inspiration (anterior ends of at least 6 ribs should be visible eg. diaphragm should be low)
rotation
penetration (is there enough radiation)
how is the cardiothoracic radio measures
PA x-ray
not AP as objects close to the X-ray tube are enlarged so heart looks bigger
what is the air underneath the diaphragm on the left
stomach bubble (gastric bubble)
what are the lung hila
junctions between heart and lungs where pulmonary arteries and bronchi enter and the pulmonary veins exit the lungs
which hilum sits higher than the other
left bc left pulmonary artery comes out over the top of the bronchus and right goes underneath
which side of the diaphragm sits higher and why
right because it sits above the liver
what is the upper zone of lungs
up to second ribs anteriorly
curvy ribs are anterior and straight ribs are posterior
what areas need reviewed
Apices (pan coast tumour, pneumothorax)
Behind the heart
Below the diaphragm
Bones and soft tissues
what is lobar collapse
when there is obstruction of a lobar bronchus so that lobe os no longer ventilated
looses volume, collapses like balloon
become collapse down and is more dense so is no longer black, is now more white
which lung has 3 lobes
right
which lung has a lingula
left lower lobe - separates from upper lobe
sign of a lower lobe
sale sign
triangle sale shape coming down from centre
sign of a left lower lobe collapse
sail sign
triangle sale shape coming down from centre
what does a left upper lobe collapse look like
can no longer see the border of the left side of the heart
volume loss - left lung smaller
diaphragm gone up
veil like capacity??
what happens when the right upper lobe collapses
right horizontal fissure is pulled up the way
clarity losses in the superior aspect of the right side of the mediastinum
what happens when the middle lobe collapses
loss of clarity of the right heart border but preservation of the hemidiaphragm
why do right middle and lower lobe often collapse together
because they are supplied by the same part of the bronchus
loss of right heart border clarity PLUS loss of clarity of hemidiaphragm
what is pulmonary consolidation
follows same pattern as collapse without the volume loss
obstructs the same parts and the lobe collapses do making them cloudy
what are some pleural space abnormalities
pleural effusion
when is the pleural cavity visible
only if there’s something wrong - pathological
what is pleural effusion
fluid in the pleural space
often collects at the bottom of the chest
meniscus sign visible - fluid is collecting the the costophrenic angle
tend to be all the same colour of white
what is a pneumothorax
air in the pleural space
air tends to rise up towards the apexes
black crescent overlying edge of the lung that has no lung markings
can see the lung edge - the pleural space is black and the lung has the lung markings
in normal cxr lung marking should go right to the edge
what is a tension pneumothorax
when the pneumothorax is so big is squashes the lungs so that the patient cannot ventilate
pushes everything over to other side on a CXR
what does heart failure look like on CXR
Pleural Effusion
dilation of the upper lobe vessels/cardiomegaly
interstitial opacities airspace opacification -fluid overspilling into interdiction -lots of lines in lungs -looks like cotton wool once it gets into the alvioli
pleural effusion
signs of heart failure ABCDE
A -alveolar oedema B- Kelley b lines C- cardiomegaly D- dilated upper lobe vessels E - pleural effusion
normal endotracheal tubes
5 cm above the carina
width - 2/3 of tracheal diameter
cuff should not expand the trachea
malposition of endotracheal tubes
Tip may pass the carina (were main bronchus splits)
tip may be in the right main bronchus (will ventilate right lung but occlude left causing complete collapse)
may have entered….
where should nasogastric tubes be placed
sit beneath the diaphragm overlying the gastric bubble
should be 10cm below gastro-oesophageal junction
u know its in the oesophagus if it is passed the carina
where should central venous catheters be
can be inserted via right and left internal jugular or subclavian veins
tip MUST ALWAYS BE ON RIGHT SIDE OF PATIENT (SVC is always on right side)
tip should be around the 2nd intercostal space anteriorly
should be at the cavoatrial junction
what are miliary nodules
tiny ones, heavily calcified, stable?
<2mm
what size is a pulmonary mass
>30 mm solitary soft tissue density new haemoptysis
what is a pulmonary nodule
7-30mm
soft tissue density
more towards the base of the lungs
most common place for a primary lung cancer
apical - in smokers as smoke rises up
how is lung cancer staged
TNM
tumour size
nodes
metastasis
what imaging is used to show tumour size and metastasis
contrast enhanced CT
what is used to look at smaller metastasis
FDG-PET CT shows distant nodal metastasis
what is pneumoperitoneum
perforation of a hollow viscus (stomach, duodenum, small or large bowel) resulting in gas in the peritoneal cavity
what does pneumoperitoneum look like on CXR
gas interposed between the diaphragm and the liver
thin black line of air
what imaging is done for PE
CXR
CTPA
V/Q scan
what does PE look like on CTPA
dilated right heart
heart septum moves towards left
large clot stops blood flowing through the pulmonary veins
what does PE look like on V/Q
mismatch of ventilation and perfusion
