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Year 3 - Preparation for Clinical Practise > Chest X ray Interpretation > Flashcards

Chest X ray Interpretation Flashcards

1
Q

What is an X ray

A

= describe radiation which is part of the spectrum which includes visible light, gammons rays and cosmic radiation

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2
Q

What are the benefits of X ray

A
  • easily available
  • non-invasive
  • relatively inexpensive
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3
Q 
What colour is 
- gas
- fat 
- water 
- bone 
- metal and contrast 
in an X ray
A
  • gas = appears black
  • fat = dark grey
  • water = grey
  • bone = white
  • metal and contrast = white
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4
Q

In what position does the heart appear enlarged AP or PA

A

AP - heart is a greater distance from the film, it appears more magnified than in a PA

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5
Q

Where is the scapulae visible in a Chest X ray

A

AP

- scapulae are usually visible in the lung fields as they are not rotated out of view as they are in a PA

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6
Q

How do you take a lateral position of the X ray

A
  • patient stands upright with the left side of the chest against the film and arms raised over the head
  • allows the viewer to see behind the heart an diaphragmatic dome
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7
Q

What is a lateral decubitus view of the x ray

A
  • patient lies on either the right or left side than in the standing position as with a regular lateral radiography
  • radiograph is labelled according to the side that is placed down
  • often useful in revealing a pleural effusion that cannot be observed in a upright view since the effusion will collect in the dependent position
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8
Q

What does a normal rotation look like

A
  • can be assessed by observing the clavicular heads and determining whether they are equal distance from the spinous processes of the thoracic vertebral bodies
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9
Q

how many ribs should be visible on a chest x ray

A
  • 8-10 posterior ribs should be visible and 5-6 anterior ribs
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10
Q

do you take an chest x ray in expiration or inspiration

A

inspiration

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11
Q

How exposed should a chest x ray be

A
  • the lower thoracic vertebrae should be visible through the heart
  • the bronchovascular structures should be seen behind the heart - trachea, aortic arch, pulmonary arteries should be seen
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12
Q

what pushes away the trachea

A
  • large pleural effusion
  • large simple pneumothorax
  • tension pneumothorax
  • aortic aneurysm
  • mediastinal mass
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13
Q

What pulls the trachea towards

A
  • extensive collapse
  • consolidation
  • pulmonary fibrosis
  • lobectomy
  • pneumonectomy
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14
Q

describe the first rib

A
  • most curved and the shortest of all ribs
  • broad and salt
  • surfaces looking upward and downward
  • borders inward and outward
  • head is small, rounded, and possess only a single articular facet for articulation with the body of the first thoracic vertebra
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15
Q

describe the right hemidiaphrgam

A
  • right is higher than left by 1-3cm
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16
Q

what causes both hemidiaphrgams to become flat

A
  • chronic obstructive limitation disease such as emphysema
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17
Q

describe the mediastinum

A
  • width <8cm on a PA CVR

Associated with

  • AP CXR view which magnifies the heart and mediastinal structures
  • unfolded aortic arch or a thoracic aortic aneurysm
  • mediastinal lymphadenopathy, retrosternal thyroid, thymoma, paravertebral mass, oesophageal dilatation, ruptured aorta
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18
Q

what bones are visible in the chest radiograph

A
  • ribs = posterior aspects of the 10th rib
  • clavicles
  • scapulae
  • vertebrae
  • proximal humeri
19
Q

What structure is in contact with the right upper lobe

A
  • ascending aorta
20
Q

What structure is in contact with the right middle lobe

A
  • right heart border
21
Q

What structure is in contact with the left upper lobe

A
  • upper left heart border

- aortic knuckle

22
Q

what structure is in contact with lingual of the left lung

A
  • left heart border
23
Q

What structure is in contact with the lower lobes (anterior)

A
  • anterior hemidiaphragms
24
Q

What conditions are air bronchograms seen in

A
  • lung consoldiation
  • pulmonary edema
  • non obstructive pulmonary atelectasis
  • interstitial disease
  • neoplasm
25
Q

What might consolidation contain

A
  • Pus (pneumonia)
  • fluid (pulmonary edema)
  • blood (pulmonary haemorrhage)
  • cells (cancer)
26
Q

What does atelectasis mean

A
  • this means loss of air
27
Q

What happens in absorptive atelectasis

A
  • there is an obstructive lesion on the broncus
  • there is no ventilation to the lobe beyond the obstruction
  • gradually the air gets absorbed by pulmonary circulation
  • the involved lobe eventually is devoid of air and becomes atelectatic
28
Q

What is pneumonia

A
  • air space disease and consolidation
29
Q

What is the typical findings of pneumonia on a chest radiograph

A
  • airspace opacity
  • lobar consolidation
  • interstitial opacities
30
Q

what are the two types of pulmonary oedema

A
  • cariogenic pulmonary oedema

- non cardiogenic pulmonary oedema

31
Q

what is cardiogenic pulmonary oedema

A
  • caused by increased hydrostatic pulmonary capillary pressu
32
Q

What is non cardiogenic pulmonary oedema

A
  • caused by either altered capillary membrane permeability or decreased plasma oncotic pressure
33
Q

How does a lung mass present

A
  • lesion with shape margins and a homogenous appearance in contrast to the diffuse appearance in contrast to the diffuse appearance of an infiltrated
34
Q

What are the signs of congestive heart failure on a chest X ray

A
  • alveolar oedema is often present in a classic perihilar bat wing pattern of density
  • Kerley B lines - interstital oedmea
  • cardiomegaly
  • dilated and cephalisation of the pulmonary vessels
  • pleural effusion
35
Q

how should you interpret the chest X ray

A
  • details- patient name, type of film, date and time of study
  • RIP - rotation, inspiration, penetration and exposure
  • Soft tissue
  • airway and mediastinum
  • Bones
  • Cardiac silhouette
  • Diaphragm
  • edge of heart border
  • lung fields and pleura
  • gastric bubble
  • hila
  • instruments
36
Q

what are the chest x ray findings of extrinsic allergic alveolitis

A
  • small bilateral pulmonary nodules

- hilar lymphadenopathy - rare

37
Q

what are the 5 stages of sarcoid

A
  • stage 0 - normal chest radiography
  • Stage 1 - bilateral Hilar lymph node enlargement
  • stage 2 - bilateral hilar lymph node enlargement and parenchymal disease
  • stage 3 - bilateral pulmonary infiltrates
  • stage 4 - fibrotic change +/- cystic and bullous changes
38
Q

How do you diagnose sarcoidosis

A
  • diagnosis based on a characteristic clinical picture an histological evidence of non-caveating granulomata
  • bronchoscopy with trans bronchial or endobronchial biopsy may not be necessary and a clinical diagnosis may be sufficient if there is good enough evidence clinically and radiologically that sarcoid is the correct diagnosis
39
Q

what can be used to monitor sarcoid

A
  • Serum angiotensin converting enzyme is helpful in monitoring the activity of the disease
40
Q

how many patients with sarcoid have Hypercalcaemia

A
  • 30% of patients

- not related to the activity of the disease

41
Q

What other organs can be affected by sarcoid

A
  • respiratory system
  • liver
  • skin
  • eye
  • cardiac
  • renal involvement
  • CNS
42
Q

what are the steps to managing a pleural effusion

A
  • perform a pleural aspiration to discover whether it is a simple or complicated parapneumonic effusion or an empyema
  • send pleural fluid for microbiology, cytology, protein, lactate dehydrogenase, glucose and pH
  • insert a chest drain - if complicated
43
Q

What does collapse of the right middle lobe look like

A
  • horizontal fissure and lower half of the oblique fissure move towards one another
  • looks like a triangle coming out from the heart

Year 3 - Preparation for Clinical Practise (33 decks)

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