Chest X Rays Flashcards
Radiodensity and different structures
Less dense tissue such as air or air filled structure are referred to as radiolucent (black)
More dense structures are referred to as radiopaque (white)
Gas= black eg air filled lungs
Fat= grey
Soft tissue= grey, heart, blood vessels and muscle
Bone or metal= white eg ribs and sternum
What are the preliminary checks to take before?
Name and date Ap or pa Exposure Position Inspiration
What is the A-G system
A- Alighnment- look at clavicles in relation to the spinous processes
B- Bones- are they all there, intact and in a normal position?
C= Cardiac/ mediastinum - Is there a clear heart border? Is it a normal size (around 1/3 of the chest diameter) ? Is there anything else of note in the mediastinum? Any evidence of shifting of structures?
D- Diaphragms- are both hemidiaphragms clearly visible? What about the angles, cardiophrenic and costophrenic?
E- Expansion - how well expanded is the chest? The 10th rib posteriorly should bisect the right hemidiaphragms at mid clavicular line and it’s the 6th rib anteriorly
F- Fields- are the lung fields clear? Are there any areas where the density increases or decreases? Can you see a lung edge? Can you see a fluid level? With a collapse and consolidation you will see increased opacity but with collapse you can see shifting of structures or crowding of lung markings
G- gadgets- what drips, drains, tubes, lines and other gadgets are visible?
What is consolidation and how does it appear on an x ray?
A condition in which lung tissue becomes firm and solid rather than elastic and air filled because it has accumulated fluids and tissue debris
CXR- white/ grey shadow, no loss of volume
Auscultation- increased breath sounds, or decreased with or without crackles or wheezes dependent on the stage of consolidation
Main causes-
Pneumonia
Chest infection
Trauma
What is atelectasis/collapse?
An airless state of the lung tissue which may involve all or part of the lung - ie anything from a few alveoli to the whole lung.
CXR- white/grey shadow, with loss of volume and shifting of structures. A total collapse may displace the mediastinum towards the affected side.
Auscultation- quiet breath sounds of occluded bronchus or bronchial breath sounds if patent bronchus, fine end expiratory crackles with smaller atelectasis.
Main causes- shallow breathing Bronchial obstruction Absorption of trapped gas Surfactant depletion Abdominal or cardio thoracic surgery
What is a pleural effusion?
Excess fluid in the pleural cavity (usually less than 20ml of fluid is present in normal lungs)
CXR- fluid is white on a CXR. A small amount of fluid (at least 500mls) will result in loss of the costs- phrenic angle. As the amount increases a fluid line may be visible with tracking up the pleura laterally. Large amounts of fluid will displace (push) the mediastinum towards the non- affected side.
Auscultation- quiet breath sounds over the pleural effusion with bronchial breathing just above the top of the fluid level.
Main causes- malignancy Heart, kidney or liver failure Abdominal or cardio thoracic surgery Pneumonia T.B
What is a pneumothorax?
Air in pleural space secondary to a rupture in either pleural layer. Lung squashed towards the hilum in proportion to the amount of pleural air.
Clinical features on CXR and auscultation:
CXR- air in pleural space is very black as there are no lung markings. With significant pneumothorax the lung is squashed and appears as a white density towards the hilum. The mediastinum may be displaced to the non affected side.
Auscultation- quiet over the area of pneumothorax
Main causes- fast growth particularly in young men
Smoking
Trauma such as rib fracture, surgery, insertion of a line
Barotrauma with high pressure positive pressure devices
What is a pulmonary oedema?
It is extra vascular water in the lungs- interstitial and alveoli
CXR- bilateral fleecy opacities spreading from the hila known as bats- wing or butterfly-wing shadows. Depending on the cause there may also be an enlarged heart
AUSCULTATION- crackles that are more evident in dependent regions, sometimes fine, sometimes bubbly noise.
Main causes- fluid overload
- back pressure from a failing left heart
- increased capillary permeability
What is the pump handle movement?
Elevation of the ribs leads to an increase in Antero-Posterior diameter of thoracic cavity
What is the bucket handle movement?
Elevation of the ribs leads to an increase in lateral diameter of the thoracic cavity
What causes the costophrenic angle?
The costophrenic angles are formed by the points at which the chest wall and diaphragm meet.
Blunting of the costophrenic angles is usually caused by pleural effusion, lung disease in the costophrenic angle or lung hyper expansion
What is the cardiophrenic angle and what causes it
The cardiophrenic angle is the angle between the heart and the diaphragm
What is bronchial breathing
Increased breath sounds
Why do you hear increased breath sounds with a sputum related problem?
Air is a poor conductor of sound and sputum is a better conductor of sound so it produces increased breath sounds
What could potentially cause shadowing the in the lungs
Consolidation
Pulmonary oedema
Collapse/ atelectasis
Pleural effusion
