Chest Radiology Flashcards
What are the initial steps to assessing a chest radiograph?
- Check name & CHI no. - Establish side/view - Is it technically adequate - projection, inspiration, rotation, penetration?
What is meant by the projection?
AP or PA
Is a PA or AP chest radiograph preferable and why?
PA as doesn’t over-magnify the heart
Cardio-thoracic ratio should only be done on…
PA radiograph
What is the correct inspiration for a chest radiograph?
At least 6 ribs should be visible
What is a normal cardiothoracic ratio?
< 0.5
How can you establish if the rotation of a chest radiograph is correct?
medial ends of the clavicles should be equidistant from the spinous processes of the upper thoracic vertebrae
Which structure does 1 correspond to?
Aorta
Which structure does 2 correspond to?
Pulmonary artery
Which structure does 6 correspond to?
Trachea
Which structure does 9 correspond to?
Horizontal fissure
Which structures are contained in the hila?
Pulmonary artery, vein, bronchi & nodes
Are the hila at the same level?
No, left hilum usually lies higher
Where does the diaphragm lie on each side?
Right around 1.5cm higher than left
When reporting chest radiographs, how can you describe the area of a lung field defect?
Upper, mid or lower zones
Where roughly is referred to as the upper zone?
Apex to rib 2
Where roughly is referred to as the mid zone?
Rib 2 to 5
Where roughly is referred to as the lower zone?
Rib 5 to base
What is meant by ‘review areas’?
Areas which are commonly missed
What are the review areas on a chest radiograph?
Lung apices
Below the diaphragm
Behind the heart
Bones & soft tissues
Which lobes are seen from the front of the patient?
Right upper & middle lobes
Left upper lobe (including lingula)
Which lobes are seen from the back of the patient?
Right lower lobe
Left lower lobe
When does lobar collapse occur?
Obstruction of a bronchus
What pathology is shown here?
Left lower lobe collapse - sail sign
What is the classic sign of left lower lobe collapse?
Sail sign
What is the classic sign of right upper lobe collapse?
Veil-like opacity
What pathology is shown here?
Left upper lobe collapse
Which pathology is shown?
Right upper lobe collapse
Which classical sign is seen in right middle lobe collapse?
Obscures right heart border
Which pathology is seen?
Right middle lobe collapse
Which pathology is seen?
Right lower lobe collapse
Which lobes tend to collapse together?
Right lower & middle lobes
Which pathology is shown?
Right middle & lower lobe collapse
Why do the right middle and lower lobes tend to collapse together?
Have same bronchus of origin - bronchus intermedius
Which pathology is shown?
Right middle lobe consolidation
Which pathology is shown?
Right upper lobe consolidation
Which pathology is shown?
Right lower lobe consolidation
Which pathology is seen here?
Lingular consolidation
Which pathology is seen here?
Left upper lobe consolidation
The lingula is part of the…
Left upper lobe
Where is the pleural space?
between visceral & parietal pleura
Which radiological feature suggests pleural effusion?
Meniscus sign - blunting of the costophrenic angle on erect CXR
A pneumothorax occurs due to rupture of…
Visceral pleura
What is the sign of a pneumothorax on CXR?
dark crescent without lung markings bounded medially by the lung edge
Which pathology is seen here?
Left sided pleural effusion
Which pathology is seen here?
Small left-sided pneumothorax
Which pathology is shown here?
Right-sided tension pneumothorax
What is usually the first sign of pulmonary oedema?
Dilation of upper lobe vessels/cardiomegaly
What are the radiological signs of heart failure?
ABCDE
A - alveolar oedema (bat wing opacities)
B - Kerley B lines
C - cardiomegaly
D - dilated upper lobe vessels
E - pleural effusion
Chest x-rays are used to ensure that which tubes are correctly placed?
Endotracheal (ET) tubes
Nasogastric tubes
Central venous lines
Where is the normal placement of an endotracheal tube?
tip 5 cm above carina
width 2/3 tracheal diameter
cuff should not expand the trachea
Where is an endotracheal tube commonly misplaced?
Inserted into right main bronchus - should not extend past carina
What is the correct positioning of a nasogastric tube?
Inserted in the mid-line beyond the carina, below the diaphragm and ideally, 10cm beyond the gastro-oesophageal junction
Where should central venous catheters be inserted?
right and left internal jugular or subclavian veins
Where should Peripherally inserted central catheters (PICC) be inserted?
via cephalic, basilic or brachial veins
Where should the tip of a CVC be seen radiologically?
2nd intercostal space
How big is a pulmonary mass?
> 30mm
What density masses are most suspicious of malignancy on CXR?
Soft tissue density masses
Where do metastases in the lungs tend to be found?
At the bases
Where do primary lung cancers tend to be?
Apical
Which imaging would be preferred in suspected lung cancer?
Contrast-enhanced CT
What is pneumoperitoneum?
Perforation of stomach, duodenum, small or large bowel resulting in gas in the peritoneum
How would pneumoperitoneum be visualised?
Erect x-ray - seen as a thin black line between the diaphragm and subdiaphragmatic structures
Which pathology is seen here?
Pneumoperitoneum
When should D-dimers be used in work up of PE?
Only in low risk groups to exclude diagnosis
What kinds of imaging may be used in PE?
CXR
CTPA
V/Q scan
What finding on V/Q scanning suggests PE?
Mismatch perfusion defect
What is shown on the CT?
Pulmonary fibrosis
What is shown on the CT?
Bronchiectasis
