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Clinical Laboratory Medicine > Chest X-Ray > Flashcards

Chest X-Ray Flashcards

1
Q

Why are PA CXRs more accurate than AP views?

A

AP = enlarged heart/mediastinal shadow

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2
Q

What is it called when materials of the same radiographic density meet, resulting in a lack of border?

A

silhouette sign

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3
Q

What are two examples of silhouette sign?

A

heart + pleural effusion

heart + infiltrate

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4
Q

When reviewing a film, when should you examine the part of the chest you are most interested in?

A

last

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5
Q

What are 4 Rs to consider before reviewing a film?

A

Right patient, right date, right study, right side?

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6
Q

How do you assess for rotation of a patient on a CXR?

A

Clavicles equidistant from spinous proceses

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7
Q

On inspiration CXR, how many posterior and anterior ribs should sit above the diaphragm?

A

8-10 posterior

5-7 anterior

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8
Q

Regardless of PA or AP view, how does the reader view a film?

A

as if they are facing reader

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9
Q

What is ABCDEFGHI for CXR Interpretation?

A 
Airway/Assess quality
Bones
Cardiac
Diaphragm
Effusion/Extrathoracic soft tissue
Fields/fissures/foreign bodies
Great vessels/Gastric Bubble
Hila & mediastinum
Impression
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10
Q

How can you identify the first rib/T1?

A

T1 has upward angled spinous process

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11
Q

When reviewing the diaphragm/abdomen on CXR, is the right or left side of the diaphragm usually higher?

A

right side

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12
Q

Blunting of the diaphragm on CXR indicates…

A

scarring/fluid

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13
Q

What should you assess for when looking just below the diaphragm?

A

air/gas: pneumoperitoneum

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14
Q

A low-flat diaphragm is suggestive of…

A

COPD

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15
Q

Paralysis/nerve damage, trauma, or loss of lung volume due to atelectasis/PNA would cause what radiographic finding of the diaphragm?

A

unilateral high diaphragm

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16
Q

A healthy costophrenic angle should have what appearance?

A

sharply pointed acute angles

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17
Q

bubbling below the left diaphragm in the LUQ is a normal/abnormal finding…

A

normal (bowel gas)

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18
Q

On supine or AP CXR, the mediastinum will appear…

A

wider

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19
Q

Which hilum typically sites higher?

A

Left higher

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20
Q

The hila are made up of what structures?

A

main pulmonary arteries and major bronchi

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21
Q

A bump off the left side of the mediastinum around the 2nd or 3rd rib is the…

A

aortic knob

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22
Q

On a lateral view, the upper and middle lobes are separated by the…

A

minor fissure (horizontal)

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23
Q

On a lateral view, the upper/middle lobes are separated from the lower lobe by the…

A

major fissure (oblique line)

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24
Q

The right lung has how which fissures and how many lobes?

A

3 lobes, horizontal and oblique fissures

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25
The left lung has which fissures and how many lobes?
oblique fissure, 2 lobes (no middle)
26
What are two unique features to the left lung?
lingula (superior/inferior) and cardiac notch
27
Where are vascular markings more prominent in lung fields?
lower and central
28
Pleural/vascular markings should extend where?
to the chest wall
29
What structures are in the middle mediastinaum?
heart and great vessels
30
On PA view, the right heart contour is the border of what heart structure?
the right atrium
31
On PA view, the left heart contour represents the border of what two heart structures?
left atrial border (superior) | left ventricle border (inferior)
32
The aortic knob arched backwards over what two structures?
the left main bronchus and pulmonary vessels
33
A chest to thoracic ratio (CTR) greater than what is considered abnormal?
> 1:2
34
It is important to examine soft tissue around what three structures when reviewing a CXR?
neck, thoracic wall, breasts
35
What is an indication of a good inspiratory effort for a CXR
8+ posterior ribs above diaphragm
36
disk spaces seen, but bony details of spine not seen indicates good or bad penetration/exposure?
good
37
What finding on CXR can be an indication of the below 4 conditions? COPD, PTX, Pneumomediastinum, SubQ Emphysema
Air densities
38
COPD on CXR can show what 3 abnormalities?
hyperlucency, flattened diaphragms, hyperinflation
39
large bullae evident on CXR can indicate...
bullous emphysema and fibrosis
40
If there is a shift of intrathroacic structures and/or tracheal deviation, what condition should you consider?
tension PTX
41
the following presentation is concerning for... 20s & Tall Pleuritic chest pain Acute dyspnea
PTX
42
What are two findings on CXR that may indicate PTX?
Hyperlucency | absent vascular markings
43
With PTX, the lung collapses toward the...
mediastinum
44
What type of film can identify a small PTX?
expiratory CXR
45
What additional imaging study can be definitive in identifying PTX?
CT
46
Why is PTX more visible on expiratory CXR?
lung volume shrinks, but PTX remains same size
47
"tunnels" of hyperlucency can indicate...
pneumomediastinum
48
What is the cause of pneumomediastinum?
air leakage into mediastinum
49
A young adult male patient presents with acute CP that radiates to areas above, below, and behind the jaw...
pneumomediastinum
50
What is gold standard for identifying pneumomediastinum?
CT
51
What must be ruled out when assessing a possible pneumomediastinum?
esophageal perforation
52
On CXR, you notice dark lines in lateral soft tissue. What is this?
subq emphysema
53
The below are common causes of what CXR finding? - Recent surgery - trauma - peptic ulcer disease/duodenal ulcer - malignancy - IBD
subdiaphragmatic air
54
Acute onset of abd. pain that radiates to shoulders can indicate...
subdiaphragmatic air
55
A radiolucent area noted below the diaphragm and across the abdomen is indicative of...
pneumoperitoneum
56
disruption of the wall of a hollow viscus via mechanical ventilation or post-op intraperitoneal gas is a common cause of...
pneumoperitoneum
57
What are three causes of abnormal fluid collection?
pleural effusion, infiltrates, HF
58
A patient presenting with the following is concerning for... - rheum disease - malignancy - recent illness - fever/dyspnea/sob - fever - recent travel/surgery
pulmonary effusion
59
On a lateral decubitus film, an effusion would be evident via...
layering of pleural fluid
60
A patient with the following S/S would be concerning for... - cough - fever - SOB - DOE - CP
infiltrate
61
to properly identify the location of infiltrates, what two views are necessary
lateral and PA
62
What radiologic findings should you look for on a patient with suspected CHF?
kerley b lines air bronchograms butterfly/bat-wing sign
63
Interstitial edema shows on CXR as kerley-b lines. How do these appear on the film?
blurred edges of blood vessels
64
Butterfly/bat-wing infiltrates are present in what area on CXR?
perihilar infiltrate
65
are air bronchograms seen in effusion?
no
66
This condition is the collapse or incomplete expansion of pulmonary parenchyma
Atelectasis
67
the following findings on CXR are indicative of? - increased opacity/lung density - displaced fissures - crowded pulmonary vessels - shifted thoracic structures - elevated hemidiaphragm - overinflation
atelectasis
68
What is the most common etiology of atelectasis?
bronchial obstruction (neoplasm, mucus, foreign body)
69
What is a key way to differentiate infiltrate vs atelectasis?
structural shifts
70
What are the 5 MC primary malignancies to have mets to lungs?
breast, colorectal, renal, uterine, head/neck SCC
71
4 characteristics of benign lesions?
smooth, well defined margin, homogenous density, calcifications
72
4 characteristics of malignant lesions?
large (1.5 cm) irregular non-homogenous density spiculated
73
An abscess will be indicated by the presence of what in the lesion?
air/fluid level
74
What are three major causes for mediastinal widening?
trauma, pulm masses, thymus/thymoma

Clinical Laboratory Medicine (9 decks)

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