Chest X ray

Question 1

If there is a single mass in the lung what is it most likely to be?

Answer 1

•Malignant tumour: lung cancer or carcinoid or lymphoma

Question 2

What is the most likely benign tumour if there is a single mass in the lung?

Answer 2

Haratoma

Question 3

If there are multiple masses in the lung what are the most likely causes?

Answer 3

• Metastases

* Infection

Question 4

What are the symptoms of abscess/tb?

Answer 4

• Fever
• Cough
• Spit
• Night sweats

Question 5

Post-primary TB

Answer 5

• Cavitating lesions

* Mainly upper zone of the lung

Question 6

Miliary TB

Answer 6

Lots of dots on the lung

Question 7

Chronic TB imaging

Answer 7

• Calcified lungs and nodes
• Lots of scarring
• especially in the upper zones

Question 8

What is consolidation?

Answer 8

•Alveoli become packed with blood or pus or fluid or cells

Question 9

What is air bronchogram?

Answer 9

Air in the bronchi are black overlying white, packed alveoli

Question 10

What is the silhouette sign?

Answer 10

• Loss of definition of structures due to a lack of contrast
• Due to consolidation
• E.g. may not be able to see the diaphragm or the heart border

Question 11

If the consolidation area is defined by a sharp line what does this mean?

Answer 11

The consolidation is being confined to a lobe

Question 12

How many lobes does the right lung have? Name them and the fissures

Answer 12

3: upper, middle, lower with a horizontal and oblique tissue

Question 13

How many lobes does the left lobe have? Name them and the fissures

Answer 13

2 lobes: upper and lower, oblique fissure

Question 14

What are the cause of a collapsed lung?

Answer 14

It deflates due to a blockage in the airway, this can be caused by:
•Mucus plug
•Foreign body
•Tumour

Question 15

Appearance of a right upper lobe collapse

Answer 15

Horizontal fissure will have moved up from its usual position (as the other lobes hyper-inflate)

Question 16

Appearance of a right lower lobe collapse

Answer 16

You won’t be able to see a right semi-diaphragm clearly

Question 17

Right middle lobe collapse

Answer 17

you won’t be able to see the right heart border clearly

Question 18

Left upper lobe collapse

Answer 18

Veil like opacity, you won’t be able to see the left heart border clearly

Question 19

Left low lobe collapse

Answer 19

Triangular opacity behind the left heart border (sail sign)

Question 20

What is a pneumothorax?

Answer 20

Lung gets punctured and shrivels up, the air leaks in to the pleural space

Question 21

What is a tension pneumothorax?

Answer 21

• Air leaks into the pleural space
• Eventually there is so much air that it pushes the mediastinum and trachea away and the diaphragm is pushed down
• Pressure is so high it could result in circulatory collapse

Question 22

How can you tell from an X ray if the patient was rotated?

Answer 22

Check the spinal processes are in between the two clavicles

Question 23

Cardiomegaly on cXR

Answer 23

The heart is less than half the width of the thoracic cavity (only in PA)

Question 24

How can you check to see if a patient is well inspired?

Answer 24

6 anterior ribs