Chest X-ray

Question 1

*Image quality (RIPE)

Answer 1

• R - Rotation: 3 spinal processes (until between clavicles)
• I - Inspiration: Able to see 10 dorsal ribs
• P - Projection: In AP heart seems bigger
• E - Exposure: Good is to see the spinal process behind the heart.

Question 2

*Interpretations (ABCDE)

Answer 2

• A - Airway:
  
  • Trachea: Central or slightly to the right ->Normal
• B - Breathing:
  
  • Lungs: Compare zones of lungs are symmetrical.
  • Borders of lungs: Ensure lung markings extend all the way to the edges.
  • Vascular markings
  • Fluid or blood
• C - Cardiac
  
  • Heart size: in PA < 50%
  • Heart borders: Should be clear.
    
    • If fuzziness of the R heart border ->R middle lobe pneumonia.
    • If fuzziness of the L border ->L upper lobe pneumonia
• D - Diaphragm:
  
  • R hemi-diaphragm: Higher than L ->Normal
  • Costophrenic angles: Should be clear. Loss -> Consolidation or fluid.
    
    • If the R diaphragmatic border not clear -> R lower lobe pneumonia
    • If the L diaphragmatic border not clear -> L lower lobe pneumonia
• E - Everything else:
  
  • Mediastinal contours (i.e. widening->disection!!!)
  • Bones, soft tissues, tubes/valves/pacemakers.

Question 3

Common cases for NAC OSCE

Answer 3

• Congestive heart failure:
  
  • Costofrenic angle blunted
• Aortic dissection (tearing chest pain irradiating to the back):
  
  • Widening of the mediastinum
• Pneumothorax (px with trauma/car accident)
  
  • Lungs borders do not go to the edges
• COPD
  
  • Barril chest
• Hemothorax
• Pneumonia