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Respiratory > Chest Radiology > Flashcards

Chest Radiology Flashcards

1
Q

What are the four main radiographic densities?

A

Soft tissue (water)
Fat
Air
Bone

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2
Q

Dense object appear what color on x-ray? Why?

A

White d/t absorption of more photons

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3
Q

Object that are not dense appear what color on x-ray? Why?

A

Black

lower absorption of photons

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4
Q

Should CXR be performed with full inspiration or expiration?

A

Inspiration

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5
Q

The midpoint of the hemidiaphragm should be at what posterior rib level?

A

9th or 10th

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6
Q

True or false: on a PA view of the chest, the thoracic spine should be visible through the heart, with bony details well seen

A

False-should be visible, but fine detail is not usually seen

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7
Q

How do you determine if there is adequate x-ray penetration with a lateral CXR?

A
  • The spine should darken as you move caudally
  • the sternum should be on edge
  • posteriorly should be 2 sets of ribs
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8
Q

true or false: on a normal lateral CXR, the ribs should align

A

false–rarely do they align

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9
Q

what identifies an under penetrated film?

A

inability to make out any of the vertebral bodies

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10
Q

What identifies an over-penetrated CXR?

A

Clear vertebrae, but inability to make out lung structures

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11
Q

What should happen to the spine on a lateral CXR as you move inferiorly?

A

Should get darker

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12
Q

How do you determine rotation for a CXR?

A

Assess the clavicular heads–should be equidistant from the spinous processes of the vertebral bodies

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13
Q

What are the three major determinants of an adequate CXR?

A

Good inspiration
Adequate penetration
No rotation

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14
Q

How do you differentiate the anterior and posterior ribs on a CXR?

A 
Posterior = horizontally oriented
Anterior = vertically oriented
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15
Q

What is the right paratracheal stripe?

A

Border of the right bronchus on CXR

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16
Q

What is the normal size of the right paratracheal stripe?

A

No more than 5 mm in diameter

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17
Q

The right heart border is formed by which structure of the heart?

A

Right atrium

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18
Q

The left heart border is formed by which structure of the heart?

A

Left ventricle

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19
Q

Where is the ascending aorta seen on a CXR?

A

Right side of the chest, (second bump after the RA bump)

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20
Q

Where is the SVC seen on a CXR?

A

just above the ascending aorta

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21
Q

Where is the right brachiocephalic vein seen on a CXR?

A

Just above the SVC

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22
Q

What is the order of vascular structures on the left side of a CXR going from superior to inferior?

A 
Left brachicephalic
Aortic arch
AP window
Descending thoracic aorta
LV
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23
Q

What is the AP window on a CXR?

A

Space between the undersurface of the aortic arch and the superior surface of the left pulmonary artery

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24
Q

What is responsible for the delineation of the vascular structures of the chest?

A

Difference in density of the lungs vs the vascular structures

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25
Q

True or false: in order to see a structure on CXR, the XR beam must pass parallel or tangential to the structure

A

True (cannot by perpendicular)

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26
Q

Where does the left brachiocephalic vein lay in relation to the right brachiocephalic artery?

A

Anterior to the artery

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27
Q

What is the vascular structure that sits to the right of the ascending aortic arch on a transverse section of a CT?

A

SVC

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28
Q

What structures bound the LV?

A

lingula and the LLL

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29
Q

What structures bound the right atrium?

A

RLL

RML

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30
Q

What structures bound the SVC?

A

RUL

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31
Q

What structures bound the aortic arch?

A

LUL

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32
Q

What are the lung fissures, generally?

A

The space between the lobes where the visceral pleural surfaces touch

33
Q

What are the two fissures of the right lung?

A

horizontal and oblique

34
Q

What is the fissure that divides the left lung?

A

Oblique fissure

35
Q

What is the pleural space?

A

Potential space between the visceral and parietal pleura

36
Q

Which sits anterior: the right middle lobe or the right lower lobe?

A

Right middle lobe

37
Q

The lung fissure are only visible when the x-rays are in what relation to the fissures?

A

Only if they are parallel–cannot be perpendicular or oblique

38
Q

The major fissures will be best seen on which views? Minor fissures?

A 
Major = lateral view
Minor = PA or lateral
39
Q

On a lateral CXR, how does the major fissure of the left lung relate to the right lung?

A

Left is posterior to the right

40
Q

How does the right upper lobe bronchus appear on a lateral CXR?

A

Area of radiolucency in the trachea

41
Q

Radiolucent areas in the bronchi on a lateral CXR mean are what?

A

branching bronchi

42
Q

True or false: you cannot really appreciate much of the aorta on a lateral CXR unless the pt has COPD

A

True

43
Q

How does the left pulmonary artery appear on a lateral CXR?

A

Comma shaped opacity that sits over the continuum of the left bronchus

44
Q

What is the radiodense structure that sits anterior to the pulmonary bronchus on a lateral CXR?

A

Right pulmonary artery and the right superior pulmonary vein

45
Q

What obscures the superior margin of the aortic arch on CXR?

A

Great vessels or axillary folds

46
Q

What is contained within the aortic-pulmonic window?

A

Lymph nodes
Left recurrent laryngeal nerve
Fat

47
Q

How do you identify the aortic-pulmonic window on CXR?

A

It is the crescent shaped lucency between the inferior border of the aortic arch, and the superior border of the left pulmonary artery

48
Q

Why are the right ribs magnified with a lateral CXR?

A

Because the left side is adjacent to the detector

49
Q

The left hemidiaphragm is obscured by what structure anteriorly?

A

the heart

50
Q

How do you identify the right hemidiaphragm from the left?

A

Left should go to non magnified ribs, and never goes to the anterior chest

Right should follow magnified ribs

51
Q

What are the two structures of the heart the comprise the posterior wall of the heart?

A

LA

LV

52
Q

Where is the pulmonary outflow tract on a lateral CXR?

A

anterior-superior part of the heart

53
Q

Where is the posterior border of the IVC on a lateral CXR?

A

Just below the left ventricle

54
Q

What are the three clear spaces seen on a CXR?

A

Retrosternal
Retrotracheal
Retrocardial

55
Q

What does a retrosternal clear space indicate? (5 T’s)

A 
Terrible lymphoma
Thymoma
Teratoma
Thyroid
Thoracic AA
56
Q

What are the pathologies that correlate to a retrotracheal clear space? (3)

A

Vascular abnormalities
Esophageal disease
Lung CA

57
Q

What are the diseases that can present in the retrocardiac clear space? (4)

A

Hiatal hernias
Esophageal disease
LV enlargement
Pneumonia

58
Q

On a lateral CXR, what are the black spaces between the vertebrae?

A

Neural foramen

59
Q

Which are magnified on a lateral CXR, the right or left ribs?

A

Right

60
Q

What are the four major structures that reside in the anterior mediastinal space?

A

Thymus
Lymph nodes
Fat
Internal mammary vessels

61
Q

True or false: if something crosses the midline of the chest, it is likely a lung pathology

A

False– lungs do not communicate with one another, so not likely

62
Q

How can you differentiate anterior vs posterior masses in the chest?

A

Anterior ones will still show the descending aorta well since it is still bounded by air

63
Q

What is contained within the middle mediastinum?

A

Heart/pericardium
Ascending aorta and arch
SVC/IVC

64
Q

Which part of the mediastinum houses the AP window?

A

Middle

65
Q

How do you identify the AP window on a chest x-ray?

A

Concavity on the left side beneath the aorta and above the pulmonary artery

66
Q

What is the right paratracheal stripe? What is the normal thickness of this?

A

The interface between the right lateral wall of the trachea and the RUL

Normal thickness is less than 5 mm

67
Q

What are the 4 major structures in the posterior mediastinum?

A

Esophagus
Descending aorta
Azygous and hemiazygous veins
Thoracic duct

68
Q

What is the normal cardio:thoracic ratio?

A

Less than 0.5

69
Q

When is the cardiothoracic ratio only valid?

A

If the CXR is a PA

70
Q

What is the spatial relationship between the left hilar structures compared to the right?

A

Left are usually higher (97% of cases, other 3% same level)

71
Q

What is the spatial relationship between the left hemidiaphragm compared to the right?

A

The right hemidiaphragm is normally slightly higher than the left d/t liver

72
Q

What is the very first step in evaluating a CXR?

A

“administrative work” (pt, time, type)

73
Q

What is the second step in evaluating a CXR?

A

Ensure adequate penetration, rotation, inspiration vs expiration

74
Q

True or false: by definition, you cannot do a supine PA chest

A

True

75
Q

A ring in the heart = ?

A

Prosthetic valve

76
Q

Line that enters the heart = ?

A

Swan-Ganz catheter

77
Q

Air beneath the right hemidiaphragm = ?

A

Pneumoperitoneum

78
Q

Curving of the costophrenic angle = ?

A

Pleural effusion

Respiratory (34 decks)

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