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Cardiology Secrets > CHEST X-RAY > Flashcards

CHEST X-RAY Flashcards

1
Q

What is the first step in a systematic approach to interpreting a chest radiograph?

A

Begin with general characteristics such as the age, gender, size, and position of the patient.

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2
Q

What should be examined in the periphery of a chest radiograph?

A

Bones, soft tissue, and pleura including rib fractures, rib notching, bony metastases, shoulder dislocation, soft tissue masses, and pleural thickening.

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3
Q

What is evaluated in the lung on a chest radiograph?

A

Infiltrates, pulmonary nodules, and pleural effusions.

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4
Q

What cardiovascular structures form the silhouette of the mediastinum on the right side?

A
  • Ascending aorta
  • Right pulmonary artery
  • Right atrium
  • Right ventricle (RV)
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5
Q

What cardiovascular structures form the silhouette of the mediastinum on the left side?

A
  • Aortic knob
  • Left pulmonary artery
  • Left atrial (LA) appendage
  • Left ventricle (LV)
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6
Q

What is the most anterior cardiac structure on the lateral chest x-ray?

A

Right ventricle (RV).

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7
Q

How is heart size measured on a chest radiograph?

A

If the heart size is equal to or greater than twice the size of the hemithorax, it is considered enlarged.

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8
Q

What factors can affect heart size on a chest radiograph?

A
  • Size of the patient
  • Degree of inspiration
  • Emphysema
  • Contractility
  • Chest configuration
  • Patient positioning
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9
Q

Which items should be reviewed on ICU chest radiographs?

A
  • Placement of the endotracheal tube
  • Central lines
  • Pulmonary arterial catheter
  • Pacing wires
  • Defibrillator pads
  • Intraaortic balloon pump
  • Feeding tubes
  • Chest tubes
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10
Q

How can one determine which cardiac chambers are enlarged?

A
  • Ventricular enlargement displaces the lower heart border
  • LA enlargement creates a convexity between the left pulmonary artery and LV
  • Right atrial enlargement bulges the lower right heart border
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11
Q

What are some common causes of chest pain identifiable on a chest radiograph?

A
  • Aortic dissection
  • Pneumonia
  • Pneumothorax
  • Pulmonary embolism
  • Subcutaneous emphysema
  • Pericarditis
  • Esophageal rupture
  • Hiatal hernia
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12
Q

What are the causes of a widened mediastinum?

A
  • Aortic dissection/rupture
  • Mediastinal bleeding from trauma or misplaced central venous catheters
  • Thoracic lipomatosis
  • Tumors such as germ cell tumors, lymphoma, and thymomas
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13
Q

What are common radiographic signs of heart failure?

A
  • Enlarged cardiac silhouette
  • LA enlargement
  • Hilar fullness
  • Vascular redistribution
  • Linear interstitial opacities (Kerley’s lines)
  • Bilateral alveolar infiltrates
  • Pleural effusions (right greater than left)
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14
Q

What is vascular redistribution and when does it occur in heart failure?

A

Vascular redistribution occurs when upper-lobe vessels become larger than lower-lobe vessels, typically at pulmonary capillary occlusion pressures of 12 to 19 mm Hg.

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15
Q

How does LV dysfunction lead to pleural effusions?

A

LV dysfunction causes increased hydrostatic pressures, leading to interstitial edema and pleural effusions.

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16
Q

How helpful is the chest radiograph in identifying and characterizing a pericardial effusion?

A

The CXR is not sensitive for detection of pericardial effusion and may not help determine extent, but a large cardiac silhouette may suggest it.

17
Q

What are the characteristic radiographic findings of significant pulmonary hypertension?

A
  • Enlargement of central pulmonary arteries
  • Rapid tapering of vessels
  • Cardiac enlargement (particularly RV)
  • Calcification of pulmonary arteries
18
Q

What is Westermark’s sign?

A

An area of oligemia beyond an occluded pulmonary vessel seen in pulmonary embolism.

19
Q

What is rib notching?

A

Erosion of the inferior aspects of the ribs seen in patients with coarctation of the aorta.

20
Q

What does pericardial calcification suggest?

A

It suggests diseases affecting the pericardium, such as tuberculosis, and is highly indicative of constrictive pericarditis.

21
Q

What is subcutaneous emphysema?

A

Accumulation of air in the subcutaneous tissue, often tracking along tissue plains.

22
Q

What is pneumopericardium?

A

Air in the pericardial space, which is extremely rare.

23
Q

What is subcutaneous emphysema?

A

The finding of subcutaneous emphysema is almost always associated with a serious medical condition or complication.

Subcutaneous emphysema refers to the presence of air in the subcutaneous tissue, often indicating significant underlying issues.

24
Q

What is pneumopericardium?

A

Pneumopericardium is air in the pericardial space and is extremely rare.

Causes include blunt trauma, penetrating injury, infectious pericarditis, fistula between the pericardium and adjacent air-containing structure, and iatrogenic complication.

25
Q

What are the common causes of pneumopericardium?

A
  • Blunt trauma
  • Penetrating injury
  • Infectious pericarditis with a gas-forming organism
  • Fistula between pericardium and adjacent air-containing structure
  • Iatrogenic complication

Pneumopericardium can arise from various medical scenarios, including trauma and infections.

26
Q

What is a pericardial cyst?

A

A pericardial cyst is a fluid filled structure that can be either congenital or acquired.

Pericardial cysts are usually found incidentally and are most commonly located at the right cardiodiaphragmatic angle.

27
Q

Where are pericardial cysts most commonly located?

A
  • Right cardiodiaphragmatic angle
  • Left cardiodiaphragmatic angle
  • More superiorly

The location of the cyst can vary, and they are often detected through imaging techniques.

28
Q

How is the diagnosis of a pericardial cyst most often confirmed?

A

Diagnosis is most often confirmed by chest CT.

Imaging techniques like chest X-ray or echocardiography may initially suggest the presence of a cyst.

29
Q

What does calcification of a pericardial cyst suggest?

A

Calcification of a cyst suggests a bronchogenic cyst, teratoma, or echinococcal cyst.

The characteristics of the cyst can provide insight into its nature and potential origins.

Cardiology Secrets (26 decks)

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