Chest Comp Flashcards
PA chests are good for visualizing?
- pneumothorax
- pleural effusions
- atelectasis
- signs of infection
Why is erect chest better than supine?
- diaphragm allowed to move farther down (gravity)
- air fluid levels visualized
- engorgement and hyperemia of pulmonary vessels (distended and swollen with fluid) may be prevented
What is a lateral chest good for visualizing?
-pathologies situated posterior to the heart ,great vessels, and sternum
How much rotation is acceptable on a lateral chest?
1/4 to 1/2”
How do you identify the left hemidiaphragm from the right?
The gastric air bubble and inferior border of the heart shadow
What is better about a right lateral compared to a left?
Increased radiographic detail in the right lung because is it placed closer to the IR
What is best seen on a supine chest?
-pathologies including the lungs, diaphragm, and mediastinum
Why do we do a PA expiration chest?
- foreign bodies
- pneumothorax
How many ribs are seen on a PA expiration chest?
8 or fewer
What do we do to our technique for an PA expiration chest?
Increase mAs, lungs more dense without air
Why do we do a lateral decubitus?
-better detects small amounts of fluid in the pleural space
How do we position for fluid vs. air on a lateral decubitus?
Fluid: affected side down
Air: affected side up
3 parts of the chest
- bony thorax
- respiratory system proper
- mediastinum
What is the bony thorax?
Provides protective framework for the parts of the chest involved with breathing and blood circulation (thoracic visera)
Parts of the sternum (breast bone)
- manubrium
- body
- xiphoid process
Parts of the bony thorax?
- sternum
- clavicles
- scapulae
- ribs
- thoracic vertebrae
Positioning landmarks and their vertebral levels?
- Vertebral prominens C7
- Jugular notch T3
- xiphoid process T9/T10, T11/T12 on inspiration (approx level of anterior diaphragm which separates the chest and abdominal cavity
4 divisions of the respiratory system?
- larynx
- trachea
- bronchi
- lungs
What is the diaphragm for?
Primary muscle of inspiration
How does the diaphragm affect chest volume and thoracic pressure?
Diaphragm down (inspiration) = decreased thoracic pressure = increased chest volume = sucking action
What does the esophagus connect?
The pharynx to the stomach (laryngeopharynx down)
Where is the larynx (voice box) located?
C3/C6, suspended from hyoid bone
What does the larynx consist of?
- thyroid cartilage (laryngeal prominence and cricoid cartilage)
- vocal cords
- epiglottis
What vertebral level is the trachea at?
C6-T4/5
Where is the thyroid gland located?
Anterior and inferior to larynx,
Stored and releases hormones
Where are the parathyroid glands located?
Posterior/lateral lobes of the thyroid gland
Store and release hormones for maintenance of blood calcium levels
Where is the thymus gland located?
Inferior to thyroid gland
Right bronchi?
- wider and shorter, more vertical than left
- 25 deg angle
- things more likely to go down here***
- divides into 3 secondary bronchi
Left bronchi?
- smaller, longer than right
- divides into 2 secondary bronchi
What is the carina?
Where the right and left mainstem bronchi split off from the trachea, left of the midline
Branches off of the mainstem bronchi?
Mainstem bronchi-secondary bronchi-bronchioles-alveoli
How many lobes/fissures does the right lung have?
- 3 lobes (superior, middle, inferior)
- 2 fissures (horizontal (s and m) , oblique (m and i)
- 1” shorter than left lung because of the liver
How many lobes/fissures does the left lung have?
- 2 lobes (superior and inferior)
- 1 fissure (oblique)
What are the lungs composed of?
Parenchyma that allows for the breathing mechanism of expansion and contraction
What are the lungs contained in?
Pleura
- parietal
- visceral (close to lung) (aka pulmonary pleura)
Where is the apex located?
Above the clavicles (T1)
What are the costophrenic angles?
Extreme outermost lower corners of lungs
What is the hilum?
Central area of lungs where bronchi, blood vessel, lymph vessels, and nerves enter and exit the lungs
What projection are the hemidiaphragms seen?
Lateral
Parts of the mediastinum?
- thymus gland
- heart
- great vessels
- trachea
- esophagus
What does the thymus gland do?
Prominent in infancy, reaches max size at puberty, shrinks into adulthood
-aids with immune system and helps body resist disease, helps body produce antobodies
The heart and great vessels are enclosed in?
The pericardial sac
Where are the heart and great vessels located?
Posterior to body of sternum, anterior to T5-T8
2/3rds of heart to the left of the median plane
Esophagus sits between?
Anterior to descending aorta and posterior to trachea
Body habitus and thorax/lung size
Hypersthenic: broad and deep thorax, shallow vertically
Asthenic: narrow and long thorax, long vertically
Breathing movements, inspiration changes?
- vertical diameter (downward movement of diaphragm)
- transverse diameter (ribs outward and upward)
- anteroposterior diameter (raising of ribs especially 2-6)
Technique for chests?
Long scale contrast, more greys
-110-125 kVp
Special considerations for older patients??
-have less inhalation capability which results in more shallow lung fields and high CR location
What is aspiration?
- foreign object swallowed
- soft tissue technique
What is atelectasis?
- collapse of portion of lung, region appears more radiodense
- increase technique
What is bronchiectasis?
Irreversable dilation or widening of the bronchi or bronchioles, walls destroyed, chronically inflammed, increase mucous, chronic cough
-common in lower lobes, regional radiodensity
What is bronchitis?
Acute/chronic excessive mucous secreted into bronchi
- common in lower lobes
- hyperinflation and more dominant lung markings
What is COPD-chronic obstructive pulmonary disease
-persistent obstruction of airways
-emphysema or chronic bronchitis
-asthma
(Blunted bases)
What is cystic fibrosis?
- inherited
- heavy mucous causes clogging of bronchi and bronchioles
- hyperinflation and increased radiodensities
- increase technique with sever condition
What is dyspnea?
- shortness of breath, difficulty breathing
- most common in older people
What is emphysema?
Irreversible chronic lung disease
- alveolar wall destruction, loss of elasticity, air not expelled during expiration (increased lung dimensions)
- flat diaphragm (blunted bases), radiolucent lungs
- decrease technique
90% of cancers start where?
Bronchi
What is epiglottitis?
- inflammation of the epiglottis
- life threatening, rapid
- most common in children aged 2-5
- soft tissue lateral technique
What is hamartoma?
- most common benign pulmonary mass, peripheral regions of lung
- small, radiodense, sharp outlines
What is a pleural effusion? (Hydrothorax)
- accumulation of fluid is the pleural cavity
- increase technique
- lateral decubitus affected side down or erect
What is empyema?
Pus in the pleural space, can develop from pneumonia
What is a hemothorax?
Blood in the pleural space
What is pleurisy?
Inflammation of the pleura
Causes rubbing of pleura
What is pneumonia?
- inflammation of lungs resulting in accumulation of fluid in certain sections of the lungs
- increased lung markings
Types of pneumonia?
- aspiration
- bronchopneumonia
- lobar
- viral (interstitial)
What is aspiration pneumonia?
Aspiration resulting in edema
What is bronchopneumonia?
Bronchitis of both lungs
What is lobar pneumonia?
Pneumonia confined to 1 or 2 lobes of the lungs
What is viral (interstitial pneumonia)?
Pneumonia in the alveoli and connecting structures
What is a pneumothorax?
- air in the pleural space
- no lung markings
- best seen in the apex on expiration
- erect or lateral decub, affected side up
What is pulmonary edema?
- excess fluid within the lung “bat sign”
- most commonly caused by CHF or coronary artery disease
- increased radiodensity in hilar region
- increase technique in severe cases
What is RDS/hyaline membrane disease/ARDS?
- HMD: infants: decreased surfactant, alveoli stick together
- ARDS: adults
- air bronchogram sign
- increase technique
Types of TB?
Primary
Secondary
What is primary TB?
- never had disease before
- small lesions found in lungs and unilateral pleural effusion
What is secondary TB?
- adults, upper lobes
- upward retraction of the hila
- calcifications
- increase technique
When is TB best seen?
On AP lordotic so clavicles are above the apices
-if supine, angle 15-20 deg cephalad
Types of occupational lung disease?
- Anthracosis
- Asebestosis
- Silicosis
What is anthracosis?
-deposits of coal dust, small opaque spots
Black lung pnuemoconosis
What is asbestosis?
-inhalation of asbestosis that results in pulmonary fibrosis
What is silicosis?
- permanent condition
- inhalation of silica (quartz dust)
- nodules and scarring
- 3x more likely to develop TB
What is subcutaneous emphysema?
Cracking skin
-air in subcutaneous
Anterior oblique chests best demonstrate?
- pathology involving the lung fields, trachea, and mediastinal structures
- determine the size and contours of the heart
Oblique lungs: degree of rotation to see the heart?
60 LAO
Do lung fields appear shorter on anterior or posterior obliques? Why
They appear shorter on posterior obliques because of increased magnification of the anterior diaphragm
Do the heart and great vessels appear larger on anterior or posterior obliques?
Posterior obliques, farther from the IR
Which side is best demonstrated on an anterior oblique?
PA away (side away from the IR)
Costochondral joint calssification?
-synarthrodial, no movement
Sternoclavicular joint classification?
- diarthrodial, synovial
- double plane/gliding
Sternocostal- rib 1 joint classification?
- synarthrodial
- cartilagenous, synchondrosis type
Sternoconstal rib 2-7 joint classification?
- diarthrodial, synovial
- plane/gliding
Interchondral joints?
- diarthrodial, synovial
- plane/gliding
Costovertebral joint classification?
- diarthrodial, synovial
- plane/gliding
Costotransverse ribs 1-10 joint classification?
- diarthrodial, synovial
- plane/gliding
Tracheostomy
- opening into the trachea to provide an airway
- distal end at 1-2” above carina
Endotracheal tube?
- nose/mouth to trachea, for ventilation and sucking
- distal end 1/2” above carina
- infants between thoracic inlet and carina (T4)
Pleural drainage tube?
- remove fluid/air from pleural space
- fluid: laterally in pleural space at 5-6th intercostal space
- air: anterior in pleural space at midclavicle
Central venous catheter?
- infusion of toxic substances
- subclavian or jugular veins, extends to SVC, 2.5cm above right atrial junction
Umbilical artery catheter?
- measures oxygen saturation
- T6-T9 or below levels of renal arteries L1/L2
Pulmonary arterial catheter (swan-ganz)
- measures atrial pressures, pulmonary artery pressures, cardiac output
- subclavian, internal/external jugular, or femoral vein
- advances through right atrium into pulmonary artery
Umbilical vein catheter?
- deliver fluids/meds
- junction of right atrium and IVC
- anterior and superior to heart
Pacemaker?
- regulates heart rate by supplying electrical stimulation
- in subcutaneous fat in anterior chest wall
- catheter tips directed to right atrium or right ventricle
Automatic implantable cardioverter defibrillator (ICD)
- anterior chest wall
- catheter tips directed to the right atrium or right ventricle
- detects heart arrythmias and then delivers and electrical shock
- seen laterally on PA chest
What is the sail boat sign?
Thymus gland
Inspiration/expiration views done for?
- pneumothorax
- foreign body
- moving diaphragm
- ? Opacity on lung vs rib
Where does the mediastinum shift for atelectasis?
To affected side
RDS
Alveoli are injured causing fluid to leak in/around them
Increase technique
How is TB transmitted?
Airbourne
Image taken for croup?
Ap soft tissue
Croup?
Narrowing of subglottic portion
Gothic arch sign
What is congenital goiter?
Enlarged thyroid
Dextracardia?
Heart is on right side
Congential
Situs inversus?
Major vessels or organs are on the opposite sides from where they would normally be
Open cones to see?
Croup
Diaphragmatic hernia
How do you see a foreign body if it is radiolucent
Forced expiration
Cretinism?
Hypothyroid in children
Jaundice and decreased growth
Long bones and skull
Airborne precautions?
- Sars
- Small pox
- TB
- Varicella (chicken pox)
- Rubeola (red measles)
Droplet size for airborne precautions?
5 micrometers or smaller
Droplet precautions?
- Influenza
- Rubella (german measles)
- Mumps
- Pertussis (Whooping cough)
- Most pneumonias
- Diphtheria
- Pharyngitis
- Scarlet fever
- Meningococcal meningitis
Contact precautions?
- Hepatitis
- Herpes simplex and zoster
- Impetigo
- Scabies
- MRSA
- VRE
- Ebola
- Varicella
- Norwalk
- Lice
Droplet size for droplet precautions?
Greater than 5 micrometers
Contract drug resistant?
- C.Difficile
- E.Coli
- Rotavirus
- Shigella
Airborne and Contact?
- Varicella
- SARS
- Herpes zoster
Droplet and Contact
-Diphtheria
3 main functions of NG tubes?
- Feeding
- Decompression
- Radiographic examination
Types of NG tubes?
- Dobbhoff (most common for feeding)
- Levin (one lumen with holes)
- Salem-sump (one lumen)
3 main functions of NE tubes?
- Feeding
- Decompression
- Radiographic examination
Types of NE tubes?
- Miller-abbott (2 lumen, drainage, balloon)
- Harris (1 lumen)
- Cantor (1 lumen)
Another name for NE tubes?
NI (nasointestinal)
Why NE instead of NG tube?
- decrease or absence of peristalsis in the stomach, but not intestines
- delayed gastric emptying
- patient has had a gastric resection
CVCs are for?
- administration of chemo/long term drugs
- total parenteral nutrition
- dialysis
- blood transfusions
- blood drawing
- allows venous pressure monitoring
Types of CVCs
- Hickman (long term, meds, venous pressure, withdraw blood)
- Groshong (1 or 2 lumen, meds, fluid, withdraw blood)
- Raaf (2 lumen, dialysis)
- Port-a-cath (infusion, venous access)
- PICC (short/long term)
What is a swan ganz catheter also known as?
A pulmonary artery catheter
Purpose of a swan ganz?
- cardiac output
- heart pressures
- right and left ventricular failure
- monitor meds
- measure core temps
- oxygen in blood
Grid ratio formula?
h/D (interspace width)
Contrast improvement factors?
No grid: 1
5: 1 : 2
8: 1 : 4
12: 1 : 5
16: 1 : 6
Types of grids?
- Parallel
- Crossed
- Focused
- Moving
Grid problems?
- Off-level
- Off-center
- Off-focus
- Upside down
Is high kVp and high ratio grid better than low kVp and low ratio grid?
Yes
Which grid problem occurs with parallel, crossed, and focused grids?
Off level
