Chest Radiology Flashcards
assessing inspiration in CXR?
> 6 ribs visible
assessing rotation in CXR
medial ends of clavicle should be equidistant from spinous processes
what projection should a CXR be in generally and why is this best
standing PA
allows measurement of CTR and prevents unwanted enlargement of organs due to xray beam projection
what lung hila sits higher
left generally
what hemidiaphragm sits higher
right
review areas for CXR?
apices
retrocardiac
beneath diaphragm
edges of radiograph
what possible missed findings may be seen at lung apices
pancoast tumour
PTX
what possible missed findings may be seen at edges of radiograph and others
fracture
subcut emphysema
soft tissue injury
past surgery
what possible missed findings may be seen behind heart
consolidation
hiatus hernia
mass
what possible missed findings may be seen beneath diaphragm
pneumoperitoneum
NG placement
bowel obstruction
cause of lung lobe collapse
tumour
aspiration
mucus impaction
foreign body
features of LL lobe collapse
increased density in retrocardiac region
loss of clarity of left medial hemidiaphragm
left hila displaced down
triangle of opacity
features of LU lobe collapse
elevation of left hemidiaphragm
veil like opacity with difficulty finding left heart border
features of RU lobe collapse
increased density in upper zone of right lung with demarcation by horizontal fissure
volume loss
golden S sign
density in RU zone and elevated horizontal fissure
features of RM lobe collapse
loss of right heart border
visible right hemidiaphragm
right lower zone density
features of RL lobe collapse
sparing of right heart border but loss of right hemidiaphragm
increased lower zone density
features of RM and RL lobe collapse
volume loss and loss of right heart border and hemidiaphragm
depression of horizontal and oblique fissure
describe why collapse of RM and RL lobe commonly occur together
obstruction of the middle and lower bronchi is possible more commonly due to blockage of bronchus intermedius
how can consolidation be differentiated from collapse
generally not as much volume loss
what does consolidation of the lingula lead to radiologically
loss of left heart border
what is an air bronchogram
bronchus contains air but lung does not
where would you be likely to find a small PTX
lung apex
escess fluid in the pleural space may be seen by what radiologically?
blunting of costophrenic angles
ABCDE features of heart failure on CXR
Alveolar oedema - bat wing Kerley B lines Cardiomegaly Dilated upper lobe vessels Pleural Effusion
normal placement features of ETT
5cm above carina
2/3rd tracheal diameter
cuff not expanding trachea
normal placement features of NG tube
subdiaphragmatic, overlying gastric bubble and should pass about 10cm past gastro-oesophageal junction
possible areas of malposition of ETT
extension past carina
extension to right main bronchus
oesophagus
possible areas of malposition of NG tube
coiled in upper airway
stuck in oesophagus
trachea or R/L main bronchus
Intracranial
where are central venous catheters inserted and what is their correct placement?
subclavian or internal jugular
cavoatrial junction, roughly anterior end of right 2nd rib
possible areas of malpiosition of central line
tip too high in prox SVC
tip too low in RA/RV
displacement into another vein
how may a mass appear on CXR
discrete mass/masses or secondary features like collapse
use of contrast CT in masses?
tumour size
biopsy
metastasis
use of FDG-PET CT in masses
nodal, distant mets or finding mass in an area of collapse
what may be the cause of pneumoperitoneum
perforation of stomach, colon, duodenum, small intestine
features of PE on CXR
normal/non specific
usually to exclude other causes
gold standard for PE
CTPA
Indication for V/Q scan?
defects caused by clot
very mild ambulatory pt
pt not suited to CTPA
