Chest X-rays Flashcards
What features must be visible on chest X-ray for it to be diagnostic?
1st rib,
Lateral margins of ribs,
Costophrenic angle
What does the pneumonic RIPE stand for?
Rotation (seen in spine or clavicle most clearly),
Inspiration (should be able to see 5-7 ribs clearly), projection or penetration (AP or PA, how visible are the deeper structures?) and Exposure (how clear is the image, can the cardiophrenic angle be seen?)
What are the downsides of AP modality?
Heart seems enlarged so cannot comment on cardiothoracic ratio,
Often poorer exposure due to the use of mobile X-ray or inability of patient to inspire fully.
When is AP modality used?
If a patient is immobile or too acutely unwell to stand and oppose scapulae for PA X-ray
How can you tell the difference between AP and PA view?
PA - angle of the clavicle is often more bent, the scapulae are retracted laterally and not seen over the lungs, heart is normal in size and picture has better exposure.
What does a loss of the costophrenic angle suggest?
Hyper inflation and barrel chestedness (emphysema)
What artefacts commonly show up on chest x ray?
Clothes with buttons, hair, surgical lines, pacemakers, nipples (yes, really!)
What is to be noted about the hila of the lungs on chest X-ray?
The left Hillman anatomically sits higher than the right. If this is not the case, or hilar deviation occurs, it is a sign of pathology.
What is the carina?
What might cause it to splay?
A ridge at the base of the trachea that separated the openings of the right and left main bronchi.
May splay in left atrial hypertrophy.
When may fissures present pathologically on X-ray?
Pulled superiorly during lung collapse,
Fluid filling the fissures makes them more prominent on X-ray.
What is the importance of checking the costophrenic angles?
Effusions gather here first as it is the lowest point of the lung. May see fluid lines superior to this.
What is the function of the azygos vein?
Drains posterior chest and abdominal wall into the superior vena cava t
Which anatomical landmarks may be lost or obscured if a mass grows within close proximity to them?
Paratracheal stripe, aortic pulmonary window and paraspinal line.
What should we look for in the bones on a CXR?
fractures, sclerotic and lyric lesions, signs of metastasis.
What is the systemic ABCDE approach to CXR?
Patient demographic - check X-ray is right one.
Projection - AP or PA?
Adequacy - penetration artefacts and exposure.
Airway,
Breathing,
Circulation,
Diaphragm,
Everything else (eg bones and peripheries)
