Chest X-ray Flashcards
What are the first steps of interpreting a CXR?
Confirm patient identity
Check date and time
What is involved in the technical assessment of a CXR?
Check side markers
Projection
Rotation
Inspiration
Penetration
Describe CXR projection
PA - arms are raised to provide best view of lung fields
AP - unstable patient, humerus visible
Supine - very unwell patient
Lateral - rare
How do you determine the rotation of a CXR?
Heads of the clavicles should be equidistant from the spinous processes of the vertebral bodies
What is a well inspired CXR?
PA are taken in held deep inspiration - six anterior ribs or ten posterior ribs should be seen
What system can be used to work through a CXR?
Airway
Breathing
Cardio
Diaphragm
Delicates
What is assessed in airway?
Is the trachea central?
What makes up the breathing section?
Mediastinal borders
Hila
Zones
Name each of these borders
- Aorta
- Pulmonary artery
- Left auricle
- Left ventricle
- Right atrium
- Trachea
- Hemidiaphragm
- Stomach bubble
- Horizontal fissure
What are the lung hila?
Junctions between the heart and lungs where the pulmonary arteries and bronchi enter/pulmonary veins exit
What are the lung zones called?
Upper
Mid
Lower
Name the components of the cardio review
Cardiomegaly - heart shadow should be less than half the width of the chest cavity on PA
Heart borders
Cardiophrenic angle
Behind the heart
What is assessed when looking at the diaphragm?
Hemi-diaphragms
Costophrenic angles
What side is a gastric air bubble normal?
Left
Why is the right hemi-diaphragm higher?
Liver
What is classed as delicates?
Bone and soft tissue
Name the review areas
Apices
Hila
Behind the heart
Costophrenic angle
Around the pleura
Under the diaphragm
Left lower lobe collapse - sail sign, sharp at the same angle as the left heart border, elevation of the hemidiaphragm, left hilum displaced downwards
Heart Failure
Alveolar oedema (bat wing opacities and air bronchograms)
B lines (kerley) and (peribronchovascular cuffing)
Cardiomegaly
Dilated upper lobe vessels
Effusion (pleural)
Unliateral Pleural Effusion
What is the most likely cause of a unilateral pleural effusion?
More likely to be exudate (>30g/l protein, infection, PE, malignancy, autoimmune, pancreatitis, trauma)
Left upper lobe collapse - veil sign, elevation of the left hemidiaphragm, loss of clarity of the heart shadow and diffuse opacification of the left hemithorax
Right middle lobe collapse- loss of clarity of the right heart border, preservation of the hemi-diaphragmatic border
Right middle lobe consolidation - increased density in lower zone with loss of clarity of the right heart border but preservation of the right hemi-diaphragm. Hazy but no volume loss
Bilateral pleural effusion
What causes a bilateral pleural effusion?
More likely to be transudate (<30g/l protein, heart failure, protein loss, malnutrition, iatrogenic, hypothyroidism, liver failure)
Pneumoperitoneum
Perforation of a hollow viscus results in gas in the peritoneal cavity. Erect X-ray shows free air under the diaphragm seen as a black line between the diaphragm and sub-diaphragmatic structures.
Lingula infection - obscured left heart border
Left upper lobe consolidation - loss of clarity of upper mediastinum, volume preserved, air bronchograms (air still in bronchus and bronchioles but not in the surrounding lung)
Right lower lobe collapse- loss of clarity of the diaphragmatic border but the right heart border is preserved. Depression of the horizontal fissure.
Right upper lobe- hazy with raised horizontal fissure
