chest and abdomen Flashcards
what does CXR, ACS, MI, SOB AND SOBOE stand for
- chest xray
- acute coronary syndrom
- myocardial infarction
- shortness of breath
- shortness of breath on exertion
what does SATS, AE, AF, LVF, PPM, TAVI stand for
- oxygen saturation
- air entry
- air fibrillation
- left ventricular failure
- permanent pace maker
- transcatheter aortic valve implantation
what does CABG, PTX, (P)TB, PE, CAD, CAP/HAP, COPD stand for
- coronary artery bypass graft
- pneumothorax
- pulmonary tuberculosis
- pulmonary embolism
- coronary artery disease
- community/hospital acquired pneumonia
- chronic obstructive pulmonary disease
what structures are part of the respiratory thoracic content
- pharynx
- trachea
- bronchi/bronchioles
- lungs
what structures are part of the mediastinum thoracic content
- heart
- great vessels
- trachea
- oesophagus
- thymus
- lymphatics
- nerves
- fibrous tissue
- fat
what structures are part of the bony thoracic content
- ribs
- thoracic spine
- sternum
why is a PA CXR preferred over AP
PA = heart is closer to the detector so there is less magnification
how can you check for rotation in a chest xray
- medial ends of clavicle equidistant from spinous process
what is the main way in which rotation will affect a chest xray
- it will make the costaphrenic angle appear blunt due to additional overlying breast tissue which can mimic pathology
how is the heart affected if the patient is rotated to the left or right on a chest xray
- if left side is rotated AWAY from IR, heart size is EXAGGERATED
- if right side is rotated away from IR, heart size is UNDERESTIMATED
How can you tell if there is adequate respiration on a chest xray
- you can see 6-7 anterior ribs OR
- 9-10 posterior ribs
how can poor inspiration affect a chest xray
- inaccurate projection of heart size (cardiac outline) and increase radio-density of lung fields
- can cause misdiagnosis
how can you tell if you have applied the correct exposure for a chest xray
- you should see the mid thoracic vertebral bodies through/behind the heart
- the dome of diaphragm should be clearly seen to the spine
should a chest xray be taken on full inspiration or expiration
inspiration
what should be seen on a chest xray
- apices of lung
- costaphrenic angles
- lung margins
what is the ABCDE method for analysing chest xrays
- airways
- breathing (lungs and pleural space)
- circulation (cardiomediastinal contour)
- disability (bones/fractures)
- everything else e.g pneumoperitoneum
what is pneumoperitoneum
the presence of air or gas in the abdominal (peritoneal) cavity.
define consolidation
infections resulting in lobar, diffuse or multifocal ill-defined opacities
define interstitial shadowing
involvement of supporting tissue of the lung parenchyma resulting in fine or coarse reticular opacities or small nodules
define nodule/mass
any space occupying lesion ether solitary or multiple
define atelectasis
collapse of part of lung due to decrease in amount of air in alveoli resulting in volume loss and increased density
to which side of the aorta should the trachea sit
- central or slightly off right passing the aorta
what might it mean if the trachea is not seen sitting central/right to the aorta
rotation or pathology
how do you check that there is adequate breathing
- both lungs expanded and similar in volume
- apices, upper, middle and lower zones symmetrical
- normal lateral margins
- normal costaphrenic and cardiaphrenic angles
- normal hemidiaphragms
- normal cardiac borders
- normal lung behind heart
how may lobes should be seen on a lateral chest on either side
right side = 3 lobes, RUL, RML, RLL
left side = 2 lobes, LUL, LLL
How do you assess circulation on chest xray
- asses position of heart (is heart on left and apex pointing left)
- heart size ( for PA it should be less then 50% of chest diameter )
- aortic knuckle should be on left
how do you check for disability (bones) on chest xray
- check rib to rib
- clavicles
- proximal humerus
- scapula
- vertebral body
for fractures of pathology e.g metastasis
what is everything else checked on a chest xray
- apices (above clavicles)
- behind heart, altered density in retro-cardiac region
- diaphragmatic contour is dome of diaphragm (lungs extend posteriorly below diaphragms)
- surrounding soft tissue
why must the diaphragmatic contour / dome of diagram be checked
- as the lung extend posteriorly below the diaphragms, there can be mass lesions below the diaphragm
what is a pleural effusion
abnormal accumulation of fluid in the pleural space
what are some radiographic features of a pleural effusion
- blunting of costophrenic angles
- blunting of cardio-phrenic angles
- fluid within horizontal/oblique fissures
- eventually meniscus seen on frontal films seen laterally and gently sloping medially
what is pneumonia
infection within the lung due to infectious material filling the alveoli
what are radiographic features of pneumonia
- airspace consolidation (cloudy)
what is pneumothorax
air gets into space between chest wall and lung (pleural space)
what is a radiographic feature of pneumothorax
- pressure of air causes lung collapse
- lung may fully collapse but most often only part of it collapses
what organs are in the abdominal cavity
- stomach
- small/large intestine
- gallbladder
- spleen
- pancreas
- liver
- kidneys
what organs are in the pelvic cavity
- rectum
- sigmoid
- urinary bladder
- reproductive organs
name and label the 9 regions of the abdoment
going from left to right, top to bottom
- right hypochondriac
- epigastric
- left hypochondriac
- right lumbar
- umbilical region
- left lumbar
- right illiac
- hypogastric region
- left iliac
what organs are found in each of the 9 regions of the abdomen
RH = liver, gallbladder, right kidney, small intestine
EG = stomach, liver, pancreas, duodenum, spleen, adrenal glands
LH = spleen, colon, left kidney, pancreas
RL = gallbladder, liver, right colon
UR = navel, part of small intestine, dudenum
LL = descending colon, left kidney
RL = appendix, cecum
HR= bladder, sigmoid, female reproductive organs
LL = descending colon, sigmoid
what is the area of interest on abdomen xray
- symphysis pubis
- diaphragms
- abdominal margins
how can you tell if the abdomen xray is rotated
- symmetry in ribs and pelvis (obturator foramen and iliac crest)
- pedicles equidistant from spinous process
- sacroiliac joints equidistant from midline
what are some regular gas patterns found in the stomach, small intestine and large intestine
stomach = always gas in stomach (gastric bubble)
SI = usually small amount of air in 2/3 loops
LI = almost always air in sigmoid and rectum, varying amounts of gas in rest of large bowel
what are radiographic features of small bowel obstruction
- ’ valvulae conniventes ‘
- piles of pennies are visible confirming small bowel
- centrally located multiple dilated lops of mass filed bowel
what are radiographic features of large bowel obstruction
- colonic distension (> 6cm)
- sigmoid distension (>9cm)
- small bowel dilation depending on duration and location of obstruction
- incompetence of illeocaecal valve
what are radiographic features of pneumoperitoneum
- riglers sign (double-wall sign, air on both sides of intestines)
- football sign (cases of massive peritoneum, abdominal cavity is outlined by gas from perforated viscus)
free-air can be seen beneath the diaphragm during pneumoperitoneum
what should be done before taking an xray for a patient with suspected pneumoperitoneum
sat erect for at least 10 min so gas travels up beneath diaphragm
when would a cross-kidney view be needed
- used as additional view when diaphragm isnt included in initial AP view
when would an ap axial bladder xray be taken
- if the pubic symphysis is missing from initial AP image
where do u centre for an ap cross kidney and ap bladder view
kidney = lower costal margins L1/2
bladder = centre of ASIS
how is contrast affected if there is high kVP and low mAs. What pro is there to this
- low contrast (flat grey image)
- useful for lines and tubes but difficult to differentiate soft tissue
- low patient dose
how is the contrast affected if theres low KVP but high mAs. what con is ther
- high contrast
- better definition between tissue and densities on image
- high patient dose
where is the centering point for a cross-kidney view
- lower costal margin
L1/2/3
why would an ap axial bladder view be needed
- if the pubis symphysis is missing from initial AP image
where is the centering point for an AP axial bladder
- midway between ASIS
in special circumstance where lateral decubitus (patient lying on side for an AP abdomen view), which side is it best to lie on and why
- left lateral decubitus is preferred as any free intraperitoneal gas will be contrasted by the liver
how can you tell if an pelvic or abdominal xray has (retrograde) ureteric stents?
- you can see 2 j shaped stands (curled at the end), one anchored in renal pelvis and the other inside the bladder
what is the difference between retrograde and antegrade
- retrograde = directed or moving backwards
- antegrade = in normal order or sequence
