Chest X-ray Flashcards
Normal chest X-ray
PA and lateral
Note: in the hospital, because the patients are often bedridden an AP and lateral X- rays are taken.
Four standard x-ray views
- PosteriorAnterior (PA)
- AnteriorPosterior (AP)
- Lateral (Lat)
- Oblique
Abdominal X- rays
typical abdominal X-rays are:
Flat and upright
Typical extremity X-rays
Extremity X-rays are generally:
PA/AP, lateral, and oblique
Four shades:
- air - dark b/c the more x-ray that hits the film, the darker the image.
- fat
- water
- bone - light b/c the less of the X-ray that hits the film, the lighter the image.
Radiopaque
does not permit the passage of s-rays, so the film will be white
Radiolucent
Radiolucent permits the passage of x-rays, so the film will be dark.
Have a process:
Check: Name Date Look at the entire film every time If x-ray isn't done well, repeat it. If jewelry or anything metal shows up, repeat it.
Then: Check bones Check soft tissue Check organs Check for extra things
Compare previous films to current films
Bones should be …
Smooth, if not smooth, then it is fractured.
Views, have at least
Two views, to account for the fact that the body is 3 dimensional.
Chest X-rays:
PA and Lateral, unless patient is bedridden,
then … AP and lateral
In AP, the heart will appear larger than in a PA.
Normal Chest X-ray findings …
- Right hemi-diaphragm s/b 1 - 2 cm higher than left
- Diaphragm should never be paper thin, this indicates free air in the peritoneum.
- Costophrenic angles should be sharp and clear
- Gastric air bubble
Normal Chest X-ray, findings, bones …
Are the clavicles symmetrical?
Count the ribs
— Anterior ribs
— Posterior ribs
— Rib spaces - 8 - 10 with normal expansion, 10 + with hyperinflation
Posterior ribs are straight and attach to the vertebral body.
Anterior ribs angle; many attach to the sternum
Normal Chest x-ray, findings, cardiac
Cardiac silhouette diameter is less than 1/2 of the intrathoracic diameter.
Atelectasis
Atelectasis is the collapse of a portion or entire lung with the re-absorption of air from the alveoli.
Bleb and Bullae
Portion of the lung in which there is an air space without alveoli. Bleb is small, bullae is larger than 1 cm.
Infiltrate
Alveolar space is filled with pus, fluid, or blood.
Pneumonia, Signs on chest x-ray …
Look for infiltrates
Look for loss of sharp cardiac borders.
Patient must always return for test of cure x-ray to prove infiltrates are clear and to be sure that the infiltrate was not the result of something else, or was not hiding something else.
Right Lower Lobe Pneumonia ….
Infiltrates will appear posterior to the heart, obscuring the T-spine.
Right Upper Lobe Pneumonia …
Heart border disappears with lateral view, as the infiltrate will be anterior to the heart.
Left Lung landmarks
Upper lobe is anterior of the heart
Lower lobe is posterior of the heart.
Pleural Effusion
Fluid layering in pleural cavity.
If seen on upright x-ray, effusion is at least 100 cc.
Most seen in dependent portions of pleural spaces.
Blunting of costophrenic angles.
Larger effusions compress lung tissue.
CHF
CHF usually looks like a big heart with fuzzy borders. Order an echocardiogram.
Blunting of costophrenic angles results from pleural effusions.
Central blood vessels become hazy d/t infiltrates.
Kerley B lines visible on periphery.
Kerley B lines
Associated with CHF. Always located inside the ribs. Horizontal lines, no longer than 2 cm. Located in peripheral 1/4 of lung. Imply destruction of lymphatics. Mostly visible in costophrenic angles.
Rarely seen, really a “lucky finding” but somehow a frequent test question.
To distinguish between blood vessels, Kerley B lines are seen on the periphery, blood vessels are seen centrally. Kerley B lines are horizontal. Blood vessels aren’t.
