Chest X-Ray Flashcards
Why are PA CXRs more accurate than AP views?
AP = enlarged heart/mediastinal shadow
What is it called when materials of the same radiographic density meet, resulting in a lack of border?
silhouette sign
What are two examples of silhouette sign?
heart + pleural effusion
heart + infiltrate
When reviewing a film, when should you examine the part of the chest you are most interested in?
last
What are 4 Rs to consider before reviewing a film?
Right patient, right date, right study, right side?
How do you assess for rotation of a patient on a CXR?
Clavicles equidistant from spinous proceses
On inspiration CXR, how many posterior and anterior ribs should sit above the diaphragm?
8-10 posterior
5-7 anterior
Regardless of PA or AP view, how does the reader view a film?
as if they are facing reader
What is ABCDEFGHI for CXR Interpretation?
Airway/Assess quality Bones Cardiac Diaphragm Effusion/Extrathoracic soft tissue Fields/fissures/foreign bodies Great vessels/Gastric Bubble Hila & mediastinum Impression
How can you identify the first rib/T1?
T1 has upward angled spinous process
When reviewing the diaphragm/abdomen on CXR, is the right or left side of the diaphragm usually higher?
right side
Blunting of the diaphragm on CXR indicates…
scarring/fluid
What should you assess for when looking just below the diaphragm?
air/gas: pneumoperitoneum
A low-flat diaphragm is suggestive of…
COPD
Paralysis/nerve damage, trauma, or loss of lung volume due to atelectasis/PNA would cause what radiographic finding of the diaphragm?
unilateral high diaphragm
A healthy costophrenic angle should have what appearance?
sharply pointed acute angles
bubbling below the left diaphragm in the LUQ is a normal/abnormal finding…
normal (bowel gas)
On supine or AP CXR, the mediastinum will appear…
wider
Which hilum typically sites higher?
Left higher
The hila are made up of what structures?
main pulmonary arteries and major bronchi
A bump off the left side of the mediastinum around the 2nd or 3rd rib is the…
aortic knob
On a lateral view, the upper and middle lobes are separated by the…
minor fissure (horizontal)
On a lateral view, the upper/middle lobes are separated from the lower lobe by the…
major fissure (oblique line)
The right lung has how which fissures and how many lobes?
3 lobes, horizontal and oblique fissures
The left lung has which fissures and how many lobes?
oblique fissure, 2 lobes (no middle)
What are two unique features to the left lung?
lingula (superior/inferior) and cardiac notch
Where are vascular markings more prominent in lung fields?
lower and central
Pleural/vascular markings should extend where?
to the chest wall
What structures are in the middle mediastinaum?
heart and great vessels
On PA view, the right heart contour is the border of what heart structure?
the right atrium
On PA view, the left heart contour represents the border of what two heart structures?
left atrial border (superior)
left ventricle border (inferior)
The aortic knob arched backwards over what two structures?
the left main bronchus and pulmonary vessels
A chest to thoracic ratio (CTR) greater than what is considered abnormal?
> 1:2
It is important to examine soft tissue around what three structures when reviewing a CXR?
neck, thoracic wall, breasts
What is an indication of a good inspiratory effort for a CXR
8+ posterior ribs above diaphragm
disk spaces seen, but bony details of spine not seen indicates good or bad penetration/exposure?
good
What finding on CXR can be an indication of the below 4 conditions?
COPD, PTX, Pneumomediastinum, SubQ Emphysema
Air densities
COPD on CXR can show what 3 abnormalities?
hyperlucency, flattened diaphragms, hyperinflation
large bullae evident on CXR can indicate…
bullous emphysema and fibrosis
If there is a shift of intrathroacic structures and/or tracheal deviation, what condition should you consider?
tension PTX
the following presentation is concerning for…
20s & Tall
Pleuritic chest pain
Acute dyspnea
PTX
What are two findings on CXR that may indicate PTX?
Hyperlucency
absent vascular markings
With PTX, the lung collapses toward the…
mediastinum
What type of film can identify a small PTX?
expiratory CXR
What additional imaging study can be definitive in identifying PTX?
CT
Why is PTX more visible on expiratory CXR?
lung volume shrinks, but PTX remains same size
“tunnels” of hyperlucency can indicate…
pneumomediastinum
What is the cause of pneumomediastinum?
air leakage into mediastinum
A young adult male patient presents with acute CP that radiates to areas above, below, and behind the jaw…
pneumomediastinum
What is gold standard for identifying pneumomediastinum?
CT
What must be ruled out when assessing a possible pneumomediastinum?
esophageal perforation
On CXR, you notice dark lines in lateral soft tissue. What is this?
subq emphysema
The below are common causes of what CXR finding?
- Recent surgery
- trauma
- peptic ulcer disease/duodenal ulcer
- malignancy
- IBD
subdiaphragmatic air
Acute onset of abd. pain that radiates to shoulders can indicate…
subdiaphragmatic air
A radiolucent area noted below the diaphragm and across the abdomen is indicative of…
pneumoperitoneum
disruption of the wall of a hollow viscus via mechanical ventilation or post-op intraperitoneal gas is a common cause of…
pneumoperitoneum
What are three causes of abnormal fluid collection?
pleural effusion, infiltrates, HF
A patient presenting with the following is concerning for…
- rheum disease
- malignancy
- recent illness
- fever/dyspnea/sob
- fever
- recent travel/surgery
pulmonary effusion
On a lateral decubitus film, an effusion would be evident via…
layering of pleural fluid
A patient with the following S/S would be concerning for…
- cough
- fever
- SOB
- DOE
- CP
infiltrate
to properly identify the location of infiltrates, what two views are necessary
lateral and PA
What radiologic findings should you look for on a patient with suspected CHF?
kerley b lines
air bronchograms
butterfly/bat-wing sign
Interstitial edema shows on CXR as kerley-b lines. How do these appear on the film?
blurred edges of blood vessels
Butterfly/bat-wing infiltrates are present in what area on CXR?
perihilar infiltrate
are air bronchograms seen in effusion?
no
This condition is the collapse or incomplete expansion of pulmonary parenchyma
Atelectasis
the following findings on CXR are indicative of?
- increased opacity/lung density
- displaced fissures
- crowded pulmonary vessels
- shifted thoracic structures
- elevated hemidiaphragm
- overinflation
atelectasis
What is the most common etiology of atelectasis?
bronchial obstruction (neoplasm, mucus, foreign body)
What is a key way to differentiate infiltrate vs atelectasis?
structural shifts
What are the 5 MC primary malignancies to have mets to lungs?
breast, colorectal, renal, uterine, head/neck SCC
4 characteristics of benign lesions?
smooth, well defined margin, homogenous density, calcifications
4 characteristics of malignant lesions?
large (1.5 cm)
irregular
non-homogenous density
spiculated
An abscess will be indicated by the presence of what in the lesion?
air/fluid level
What are three major causes for mediastinal widening?
trauma, pulm masses, thymus/thymoma