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Respiratory > Chest X-ray > Flashcards

Chest X-ray Flashcards

1
Q

Systematic approach to the chest X-ray

A

D- Details ( Name, DOB, type of Film)
R- RIP (Image quality) : Rotation, Inspiration, Penetration
S- Soft tissues and bones
A- Airway – is the trachea normal? Deviated? To which side? Is the patient incubated?
B- Breathing – are both lungs normal? Is there effusion or consolidation? Lesions? Fluffy looking areas? Any evidence of collapse
C- Circulation – Is the silhouette sign present? What is the cardiac thoracic ratio? Heart position, size and shape? Are there any lines in?
D- Diaphragm – Costophrenic angles? Is the diaphragm in its usual location/ position?
E- Everything else- anything else relevant, ECG leads, pacemaker, NG tube

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2
Q

Types of X-ray

A

PA

  • x-rays from the posterior to the anterior of the patient
  • image is viewed as if looking at the patient face-face

AP

  • xrays pass from the anterior to posterior of the patient
  • image still viewed as if the patient is face to face
  • usually unwell patients
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3
Q

Consolidation definition

A

alveolar air replaced with fluid/pus extra

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4
Q

Lobes and fissures of the lung

A
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5
Q

Right upper lobe collapse

A

Horizontal fissure separates RU for ML

Collapse fissure moves upwards and medially

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6
Q

Right middle lobe collapse

A

Horizontal and oblique fissures collapse up against the heart

Loss of right cardiact sillohette and haze!! with diaphragm maintained

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7
Q

Right lower lobe collapse

A

The Right Lower lobe is a posterior structure

lower lobe collapses medially against the diaphragm (loss of diaphragm) with maintained right heart border

Sharp edge

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8
Q

Which type of collapse is shown

A

Right lower lobe collapse

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9
Q

Left upper lobe collapse

A

Oblique fissure separates the two structures

  • Left upper lobe collapses forward
  • densely collapsed upper lobe
  • Aortic arch is aeriated (heart is anterior)
  • haze!!
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10
Q

What type of collapse is this?

A

Right upper lobe collapse

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11
Q

What does this radiograph show?

A

Complete collapse of the lung

white out!

heart moves towards where it has collapsed

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12
Q

What does this radiograph show?

A

Pneumonectomy

  • lung is removed
  • heart moves over
  • pleura not removed “heart weeps for his missing buddy” causes an effusion
  • fluid is dense and therefore WHITE
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13
Q

How to tell the difference between pneumonectomy and complete collapse

A

Look at the ribs

2-5 ribs are cut out in pneumonectomy !!!

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14
Q

Consolidation vs collapse

A

AIR BRONCHOGRAMS IN CONSOLIDATION

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15
Q

What is another name for collapse

A

Atelectasis

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16
Q

Review areas

A
  • apex - often obscure underlying lung
  • cardiac shadow- hiding a considerable amount fo lung posteriorly
  • hilar vessels - obscuring lung anteriorly and posteriorly
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17
Q

Abnormal masses by site of origin

A
  • within the lung
  • arising from the mediastinum
  • within the plerual space
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18
Q

Most common cause of multiple intrapulmonary nodules

A

Metastases or septic emboli

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19
Q

Causes of cavitating masses

A

tumours have air inside them! hollow cavity

  • abscess - most common
  • necrotic tumours
20
Q

Solitary masses causes

A

Malignancy

  • primary
  • secondary

Infection

TB

21
Q

Causes of pulmonary massess

A

Bronchial carcinoma - can arise in any bronchus

  • peripheral- distal bronchioles
  • central

Other pulmonary masses

  • benign pulmonary masses
  • non neoplastic pulmonary masses

Tuberculosis

22
Q

Periperal tumour

A
  • 40-60% patients have a peripherally located mass
  • round or oval
  • edge is usually spiculated- term corona radiata is sometimes used

size position shape margin

23
Q

Central tumour

A
  • unilaterlal hilar enlargement
  • and/or unilateral dense hilum
  • mass in, or superimposed on the hilum +/- hilar lymph nodes
  • obstruction of a major bronchus leads to atalectasis (reduced ventilation of affected lung) or consoldation (failure to evacuate secretions)
24
Q

If no airbronchograms + collapse whats the diagnosis

A
  • foregin body
  • most COMMON CAUSE CENTRAL LUNG CANCER
25
Q

Hilar masses causes

A

Hilar and paratracheal lymph nodes

  • spread from bronchial carcinoma
  • spread from other tumours
  • lymphoma
  • sarcoid
  • TB
26
Q

Mediastinal masses causes

A

Rule of T’s

  • Thyroid
  • thymus
  • teratoma
  • tortous aorta
27
Q

Pleural lesion causes

A

Pleural plaques

  • due to asbestos exposure
  • pleural plaques that are calcified
28
Q

Cystic spaces causes

A
  • normal lung tissue destroyed
  • air filled cystic spaces
  • emphysema/ COPD
29
Q

TB is also known as

A

the great mimicker

30
Q

Pneumonia definition

A

An inflammatiory reaction in the lungs, occurs either as primary infection of the lungs or secondary to bronchial obsrtuction

31
Q

Chest- xray signs of pneumonia

A

CONSOLIDATION

32
Q

Pleural effusion

A

A flud collection in the space between the parietal and visceral layers of the pleura usually contains serous fluid but may have different contents

haemothorax- Blood, following trauma

Empyema - Puruelnt fluid from extension of pneumonia

hydropneumothorax- fluid and air

33
Q

Pleural effusion CXR features

A

Pleural fluid in the erect position, gravitates to the lower-most part of the thorax

  • opacity with sharp border
  • loss of diaphragm sillouehette
  • miniscus
34
Q

Main causes of pleural effusion

A
  • heart failure
  • infection (in TB)
  • malignancy (mesothelioma)
  • pulmonary embolism
35
Q

Pneumothorax

A

occurs when air enters the pleural cavity via a tear in either the parietal or visceral pleura, the lung subsequently relaxs and retracts to a varying extent towards the hilum

36
Q

tension pneumothorax

A

A tear in the visceral pleura may act as a ball valve allowing air to enter the pleural cavity during each inspiration and none to escappe during expiration

37
Q

Idopathic pulmonary fibrosis radiological features

A
  • fine nodular and streaky linear shadowing (reticulonodular shadowing) start at bases
  • honeycomb pattern- with small cystic spaces and coarse reticulodnodular shadwng
  • reduction in lumb volme
  • poor cardiac outline
  • dilation of pulmonary vessles
38
Q

Lung abscess appearance

A

starts as area of pneumonic consolidation with subsequent development of cavitation

39
Q

Types of tubes and lines

A
  • NG tube
  • ET tube
  • Central line
40
Q

Use of Nasogastric tubing

A
  • feeding
    • stroke
    • dysphagia
    • patient on ventilator
  • gastric decompression
    • bowel obstruction
  • administration of medicines
41
Q

NGT passage

A
  • clearest nostril
  • nasopharynx
  • patient to swallow if gag reflex
  • oesophagus
  • tip in the stomach
  • confirm position
42
Q

How to confirm the position of an NG tube

A
  • aspirate content if <5.5 tip is in the stomach
  • if not adequate sample request CXR
  • it is mandatory to incude epigastric region in the view
43
Q

NGT consequences of incorrect position

A
  • intrapulmonary feedig
  • aspiration pneumonia
44
Q

Problems with NG tubing

A
  • Impaired gag reflex (stroke, pt under GA )
  • Neck/mediastinum pathology –goitre, lymphadenopathy
  • Thorax deformity – kyphosis
  • Hiatus hernia
45
Q
A

Respiratory (18 decks)

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