Chest X-ray Flashcards
What does the DRSABCDE of the CXR stand for?
Details RIPE (rotation, inspiration, picture, exposure) Soft tissue and bone Airways and mediastinum Breathing Circulation Diaphragm Extras
How many ribs should be visible in full inspiration on CXR?
5-6.5 anterior ribs
8-10 posterior ribs
How can you tell if the film is appropriately exposed?
- spinous processes to ~T4
- L hemi-diaphragm visible through cardiac shadow
What should be noted when looking at the soft tissue?
Is there any:
- swelling
- subcut air
- symmetry
- masses
What should be noted when looking at bone?
- fractures
- dislocations
- hyperdensities
- lytic lesions
- symmetry
At what level does the trachea bifurcate?
T4-5 (starts at C6)
At what level are the hilums?
T6-7 intravertebral disc (left hilum is 2cm higher than the right)
Is the hilum higher on the left or right?
Left by ~2cm
What should be looked for in the lung fields?
- vascularity
- pneumothorax
- lung field outlines
- R lung horizontal fissure
- pulmonary infiltrates
- coin lesions
- cavitary lesions
What is normal vascularity of the lungs?
- vessels to 2cm of pleural surface (3cm in apices)
- vessels in bases > apices when erect
Describe the normal heart position?
1/3 to the right, 2/3 to the left
normal cardiothoracic ratio?
<0.5 on PA film
What extras may be seen on CXR?
- metal work
- pacemaker
- central venous catheter
- nasogastric tube
- chest drain
- endotracheal tube
What are 3 causes of small lung volumes (ant ribs <5)?
- pulmonary fibrosis
- kyphosis
- atelectasis
What is a major cause of large lung volume (ant ribs >7)?
COPD
What makes the heart appear larger on CXR?
- supine (heart rotates to the left)
- AP projection
- if supine and AP -> adds 20% diameter
- poor inspiration
What are some issues with the supine film?
- heart appears larger
- lungs appear small and congested due to the dependent posterior veins
What are 5 causes of increased opacity in the lung fields?
- pleural fluid
- atelectasis
- fluid or cells in the airspaces
- fluid or cells in the lung interstitium
- tumours or other masses in the lung
What are 4 causes of increased lucency in the lung fields?
- pneumothorax
- bullous emphysema
- lobar collapse
- PE
What is the correct position of the central venous catheter (CVC)?
tip should be at about the level of the carina
What is the correct position of the endotracheal tube? and what is the issue if its too far down?
- 5cm above the carina (up to 2cm)
- if its too close to the carina it runs the risk of slipping into one bronchus and overventilating one lung whilst underventilating the other
What is the correct position of the nasogastric tube?
- inferior to the diaphragm
