Chest x-ray Basics Flashcards
What is the 8-step approach to chest X-ray interpretation?
- Patient and Image Verification, 2. Airways, 3. Bones and Soft Tissues, 4. Cardiac Silhouette and Mediastinum, 5. Diaphragm, 6. Effusions, 7. Lung Fields, 8. Lines and Tubes.
What does the mnemonic ‘PA B-C-DE-L-T’ stand for?
P: Patient/Image Verification, A: Airways, B: Bones/Soft Tissues, C: Cardiac Silhouette, D: Diaphragm, E: Effusions, L: Lung Fields, T: Tubes and Lines.
Why is it important to verify patient identity and image quality when reading a chest X-ray?
To confirm you are evaluating the correct patient and ensure the image is of sufficient quality for accurate interpretation.
What are the key indicators of good image quality on a chest X-ray?
Good positioning, no rotation, full inspiration (8-10 posterior ribs), proper penetration (spine faintly visible through heart), and exposure.
What are you assessing when checking the airways on a chest X-ray?
Tracheal position, bronchial markings, and evidence of obstruction.
What could cause tracheal deviation on a chest X-ray?
Tracheal deviation can be caused by tension pneumothorax, atelectasis, or a large mass.
What bones should be evaluated on a chest X-ray?
Clavicles, ribs, scapulae, spine, and proximal humerus.
What are common causes of rib fractures visible on a chest X-ray?
Trauma, osteoporosis, or metastatic lesions can cause rib fractures.
What might soft tissue emphysema look like on a chest X-ray?
Soft tissue emphysema appears as streaky or bubbly black areas in the soft tissues.
What is the normal size of the heart silhouette on a PA chest X-ray?
The heart should be less than 50% of the thoracic diameter on a PA X-ray.
What are possible causes of an enlarged cardiac silhouette?
Causes include cardiomegaly, pericardial effusion, or heart failure.
What could a widened mediastinum indicate?
A widened mediastinum may indicate aortic dissection, lymphoma, or trauma.
What should the hemidiaphragms look like on a normal chest X-ray?
The right hemidiaphragm is usually slightly higher than the left, and the borders should be smooth.
What does free air under the diaphragm indicate?
Free air under the diaphragm indicates pneumoperitoneum (e.g., bowel perforation).
How do pleural effusions appear on a chest X-ray?
Pleural effusions appear as fluid in the dependent areas (e.g., meniscus sign or blunting of costophrenic angles).
What causes blunting of the costophrenic angles?
Blunting of the costophrenic angles is caused by pleural effusion or thickening.
What are the key zones to assess in the lung fields?
Upper, middle, and lower zones of both lungs.
What causes focal opacities in the lung fields?
Focal opacities can be caused by pneumonia, tumors, or pulmonary edema.
What is the difference between interstitial and alveolar opacities?
Interstitial opacities are thin, reticular markings; alveolar opacities appear dense and fluffy.
What are common causes of cavitation in the lungs?
Common causes include tuberculosis, abscess, or necrotizing pneumonia.
What is the correct position for an endotracheal (ET) tube on a chest X-ray?
The ET tube tip should be 2-5 cm above the carina.
Where should a nasogastric tube (NGT) tip be located on a chest X-ray?
The nasogastric tube tip should be located in the stomach, below the diaphragm.
How should a chest tube appear on a chest X-ray?
A chest tube should be in the pleural space, without kinking or malposition.
What are signs of a malpositioned central venous catheter on a chest X-ray?
Signs include catheter coiling, misplacement, or tip outside the superior vena cava.
How do pacemaker leads appear on a chest X-ray?
Pacemaker leads appear as thin, radiopaque wires leading to the heart chambers.
What does a ‘white’ appearance on a chest X-ray typically indicate?
A white appearance indicates fluid, soft tissue, bone, or metal.
What does a ‘black’ appearance on a chest X-ray represent?
A black appearance represents air (gas) in the lungs or pleural space.
What material causes a ‘metallic white’ appearance on a chest X-ray?
Surgical implants, pacemakers, or bullets can cause a metallic white appearance.
What are examples of pathological causes of increased lung opacity?
Pathological causes include pneumonia, pulmonary edema, tumors, or atelectasis.
What might cause a hyperlucent (extra black) area on a chest X-ray?
Hyperlucent areas can be caused by pneumothorax, emphysema, or over-inflation.
What abnormalities would you look for in the lung apices on a chest X-ray?
Lung apices are checked for Pancoast tumors, pneumothorax, or cavitary lesions.
What should you check in the retrocardiac area on a lateral chest X-ray?
The retrocardiac area is checked for consolidation, masses, or hernias.
How would a pneumothorax appear on a chest X-ray?
A pneumothorax appears as a sharp pleural line with no lung markings beyond it.
What are the radiological findings of a tension pneumothorax?
A tension pneumothorax shows tracheal deviation, mediastinal shift, and collapsed lung.
What does a consolidation look like on a chest X-ray, and what causes it?
Consolidation appears as a dense, white area with air bronchograms; causes include pneumonia, pulmonary hemorrhage, or ARDS.
