chest and abdomen Flashcards
how does artificial heart valves appear on xray
typically appear as ring-shaped structure
how does pacemaker appear on xray
radio-opaque disc or oval in infraclavicular region
common tubes / lines
nasogastric tube (NGT)
endotracheal tube (ETT)
central venous lines
chest drainage tubes
how should NGT placement be
CXR should include upper esophagus to below diaphragm
NGT should
- remain in the midline down to the level of the diaphragm
- bisect the carina
tip of NGT should be
- clearly visible and below the left hemidiaphragm
- approx 10cm beyond the gastro-esophageal junction
correct placement of ETT
tip should be in the trachea, 5cm above the carina
what is the CVC for
monitoring of central venous pressure
fluid administration
hemodialysis
correct placement of CVC
SVC or just above the level of carina
cavo-atrial junction
- long term chemotherapy - hemodialysis
common conditions and injuries of the chest
pulmonary consolidation
pneumomediastinum
pneumoperitoneum
flail chest
aortic dissection
pleural effusion
pneumothorax
atelectasis
what is pulmonary consolidation
loss of alveolar air by fluid, cells, pus or other materials
pneumonia is the most common cause of consolidation
radiological appearance of pulmonary consolidation
- patchy shadowing
- lobar density
- absent / ill-defined heart borders and hemidiaphragm
- air bronchogram
absent / ill-defined border of which region indicates pulmonary consolidation of which lobe
ill-defined —> location
right heart boarder —> middle lobe
left heart border —> left upper lobe
right hemidiaphragm —> right lower lobe
left hemidiaphragm —> left lower lobe
what is pneumomediastinum
- free air within the mediastium
causes and risk factor of pneumomediastinum
- forceful coughing
- excessive vomiting
- neck/chest injury
- rupture of trachea
- rupture of esophagus
radiological appearance of pneumomediastinum
- lucency surrounding mediastinal structures
- subcutaneous emphysema
- continuous diaphragm sign
causes of pneumoperitoneum
perforation of
- peptic ulcer
- bowel
- stomach
trauma
post surgery
what is flail chest
- 2 or more adjacent ribs fractured in more than one area (2 or more breaks in 1 or 2 ribs can present as flail chest)
what does flail segment affect
breathing mechanism
what is aortic dissection
- tear in the inner layer of the aorta
causes or risk factor of aortic dissection
- chronic hypertension
- trauma
how are aortic dissection classified
Stanford A (involving ascending aorta)
- DeBakey I
- DeBakey II
Stanford B (involving only descending aorta)
- DeBakey III
4 quadrants of an abdomen
RUQ
LUQ
RLQ
LLQ
9 regions of an abdomen
right hypochondrium
epigastic
left hypochondrium
right lumbar
umbilical
left lumbar
right iliac
suprapubic
left iliac
systematic approach in checking abdomen
ABDOX
Assessment of Air
Bowels
Density
Organs
External objects and artefacts
ABBDO
Air
Bowels
Bones
Densities
Organs
common pathological conditions of the abdomen
ascites
pneumoperitoneum
bowel dilation
sigmoid volvulus
inflammatory bowel disease
kidney calculi
gallbladder & bladder calculi
what is ascites
accumulation of fluid in the peritoneal cavity
radiological appearance of ascites
ground glass appearance
absent/ill-defined organs and soft tissue shadows
laterally displaced properitoneal fat stripe
centralised bowels
paucity of bowel gas
require >500ml of fluid to be detected on plain radiograph
what is pneumoperitoneum
free air in the peritoneal cavity
radiological appearance of pneumoperitoneum
chest xray:
rim of lucency under diaphragm
continuous diaphragm sign
abdomen xray:
rigler/double wall sign
football sign
falciform ligament sign
describe bowel dilation
3-6-9 rule: small bowel, large bowel, caecum
measured on supine abdomen radiograph
indicates bowel obstruction
position of dilated small bowels
central
wall pattern of dilated large bowels
haustral folds
position of dilated large bowels
circumferential
wall pattern of dilated small bowels
valvulae conniventes
what is sigmoid volvulus
twisting of the bowel on its mesentery, the sigmoid mesocolon
can cause partial or complete bowel obstruction
radiological appearance of sigmoid volvulus
coffee bean sign
loss of haustra pattern
possible distention of the proximal portion of the colon
what is inflammatory bowel disease
unknown cause; could be due to bacteria, virus or an autoimmune response
what are some types of IBD
Crohn’s disease
Ulcerative colitis
describe Crohn’s disease
- can occur anywhere along the GIT
- common sites are terminal ileum and proximal colon
describe Ulcerative colitis
- usually occur in the colon and rectum
radiological appearance of IBD
mucosal thickening of the bowel resulted in
- increased distance between the bowel loops
- thick haustral folds which form the thumbprinting sign
what is the lead pipe sign in IBD
a lack of haustral markings in the descending colon has resulted in a smooth cylindrical appearance termed the lead pipe sign
how does gallbladder calculi appear to be
different shapes and sizes:
- polygonal shaped, radiopaque outline with lucent center or concentric rings
- often rounded and cluster together
common sites for CVC insertion
- subclavian vein
- internal jugular vein
- peripherally inserted central catheter
what happens if CVC is inserted into the brachiocephalic veins
increased risk of line infection and thrombosis
when does lobar and segmental bronchi become visible
- asthma (thick walled)
- bronchiectasis (dilated)
- distorted (lung fibrosis)
systematic approach for chest
Airway
Breathing
Circulation
Diaphragm
Everything else
what to look out for when checking for airway
trachea
carina
bronchi
hilar structures
what to look out for when checking for circulation
cardiac size
mediastinal contours
great vessels
hilar assessment
which pathology affects the anatomic outlook of the diaphragm
pleural effusion
pneumoperitoneum
phrenic nerve palsy
zones of the lung
upper
mid
lower (including behind the diaphragm)
do not correspond to the lobes
lobes of the right lung
upper
middle
lower
lobes of the left lung
upper lower
fissures of the right lung
oblique
horizontal
fissures of the left lung
oblique
where can azygos lobr be found
medial right upper lung
how are fissures seen in radiographs
right oblique - partly visible on the lateral CXR
horizontal - visible as a thin white line in the right midzone on the frontal CXR
right upper lobe can be further divide into
3 segments:
anterior
posterior
apical
right middle lobe can be further divided into
2 segments:
medial
lateral
right lower lobe can be further divided into
5 segments:
superior
posterobasal
laterobasal
antero basal
medial basal
left upper lobe can be further divided into
4 segments:
superior and inferior lingular segments
anterior and apicoposterior
left lower lobe can be further divided into
4 segments
superior
posterior
lateral
anteromedial
how is cardiothoracic ratio calculated
horizontal diameter of the heart divided by widest internal diameter of thoracic cage
what is a normal CTR
<50%
what is the degree of cardiomegaly
mild 50-55%
moderate 55-60%
severe >60%
what structure is checked to confirm a situs inversus
aortic knuckle on the right and
liver density below the left diaphragm
examples of radiolucent kidney stones
- uric stones
- pure matrix stones
