Chest X-ray Flashcards
Normal CXR
What is a general principle for interpreting a CXR?
Have a systematic approach.
How should a CXR be interpreted?
In conjunction with the clinical findings.
What should you do if a previous CXR is available?
Always compare with previous CXR to assess for change.
What are the components of a systematic approach to CXR interpretation?
- Name/marker/rotation/penetration,
- lines/metal work,
- heart,
- mediastinum,
- lungs, zones (upper/middle/lower),
- bones,
- diaphragm,
- soft tissues.
What does the systematic approach include regarding clavicles?
Clavicles equidistant from spinous processes of thoracic spine.
What should be visible in the lower CXR?
Can just see lower thoracic spine.
What should you look for in lines/metal work?
Sternal wires (implies previous thoracic surgery) and tip of endotracheal tube (2cm above carina).
Where should the tip of central venous lines be located?
At the origin of the superior vena cava.
What percentage of the maximum internal thoracic diameter does the heart occupy on a standard PA erect view?
Up to 50%.
Can you comment on heart size on an AP view?
No, because of magnification of the heart.
What should be observed in the mediastinum?
- Hilar vascular structures should be crisply defined,
- no widening of mediastinum,
- and trachea should be central.
What should you compare in the lungs?
Upper, mid, and lower zones.
What should you look for between ribs in the lungs?
Lung detail.
What should you remember to look for in relation to the heart?
Look ‘behind’ the heart.
What bones should be examined in a systematic approach?
- Look at each rib in turn,
- clavicles,
- scapulae and
- humeri if visible,
- lower cervical and
- thoracic spine.
What should be noted about the diaphragm in a systematic approach?
Both diaphragms should form a sharp margin with the lateral chest wall.
Both diaphragm contours should be clearly visible medially to the spine.
What is in this red arrow?
position of stomach gas bubble, usually right here but not present in this CXR
What soft tissues should be examined?
Supraclavicular fossae (enlarged nodes), lateral chest wall (surgical emphysema), under diaphragm (pneumoperitoneum).
How would you summarize the chest X-Ray?
- This is an erect chest X-Ray of an adult male.
- The heart is not enlarged,
- the mediastinal contours are normal
- the lungs are clear.
Where is the ETT in this CXR?
what happend here?
Right mainstem
Pleural effusion (fluid in pleural space)
Atelectasis
Tumor
Pneumonia
pneumoperitoneum
ARDS
Correct placement of RIJ
subclavian
central line (prob PICC)
is too deep into RA
R pneumothorax
NG TUBE
What happen to this NGT?
It is in the lung, right mainstem
Where did this NGT go?
went to the left lung
proper placement of NGT
NGT went to the right lung
