Chest x-rays Flashcards
what is this likely to be?
peripheral lung cancer
the large mass appears to be cavitating - a lot of fluid
describe this are and how it should look
- Hilar vascular structures should be crisply defined
- No widening of the mediastinum
- Trachea should be central
in a systematic review what should you be looking for in the chest xray
•Name/marker/rotation/ penetration •Lines/metal work •Heart •Mediastinum •Lungs •Zones (upper/middle/lower) •Bones •Diaphragm •Soft Tissues
what is this likely to be ( a few things)
and how to decide upon it
central lung cancer complete whiteout of left hemithorax
number of things can cause this - pleural effusion
- complete collapse of lung -if patient has had mini ectomy
to differentiate - volume of mediastinal shift to one side or other
pleural effision - shift away from side of effusion by fluid
lung collapse - loss of volume on the side of white-out - similar to mini ectomy
what is this likely to be? which ___ is affected
right upper lobe collapse
horizontal fissure and right hilum pulled up + right hemidiaphragm
•BEWARE THE LOBAR COLLAPSE WHICH FAILS TO RESOLVE IN 2 TO 3 WEEKS IN A SMOKER OF AGE>45
each lobe has its own characteristics
more than one lobe can collapse
where on a chest x-ray should you be mindful of? what are more subtle?
- lesions more subtle
beware lesions behind the heart and hila below the hemidiaphragm
compare with previous films
always look at review areas
e.g. Pancoast tumor is a tumor of the apex of the lung. could hide up on apices of lung
normally what is higher in a chest xray and why? (H__)
Hilum on left is higher than right because the left main pulmonary artery arches over the left main bronchus
can be horizontal BUT
the right should NEVER be higher than the left
what are the abnormalities here?
Left hilar mass
the left hilum is clearer and denser than right
what are the abnormalities here?
right hilar mass
increased density and bulges out appearance comparing to left.
what is abnormal here?
mass behind the heart increased
density
what is abnormal here?
cotophrenic angle - compare with previous and think further imaging
what is abnormal here?
right pancost tumour
what is abormal?
this is a breast implant.
always compare previous imaging and sides- if you pay attention to breast shape on right side, it is missing on left and the white is an implant
this is a clear chest xray otherwise
what is a pulmonary module?
opacity in lung up to 3cm wide with no mediastinal adenopathy or atelectasis
adenopathy - swelling of the glands, swollen lymph nodes
atelectasis - complete or partial collapse of the entire lung or area (lobe) of the lung
what is a pulmonary mass?
opacity in lung over 3cm with no mediastinal adenopathy or atelectasis
enopathy - swelling of the glands, swollen lymph nodes
atelectasis - complete or partial collapse of the entire lung or area (lobe) of the lung
what should we remember to compare?
previous films
recent haemoptysis - history of tb as a child
abnormality both apices (left more) with linear, denser areas
recent left void - history previous tb - had cavitating illness - complication of fungal hole is aspergilloma within cavity common present with haemoptysis
after x-ray, what is useful to characterise findings
Ct useful in characterising
with history - what is an abnormality and what to consider?
matches in both lungs
pulmonary arteriovenous malformation (AVM) common for TIA
debri that usually would be stuck in pulmonary circulation cross to left side of circulation systemic circulation and can cause paradoxical emboli - with stroke and tia
CT confirms these (circled)
what is key to staging lung cancer?
CT
- need clinical history/exam
- performance status
- pulmonary function
- TNM international stating.
briefly describe TNM staging for lung Cancer
(T) - how big it is and how far it has spread/ size and position of the tumour
(N) - whether cells have spread into lymph nodes
(M) whether the tumour has spread anywhere else in the body - metastases
