Chest X-rays Flashcards
where is the left lingula?
which ribs do the lungs & pleura go down to
- on the mid clavicular line?
- on the mid axillary line?
- *lungs:**
- mid clavicular line: 6th rib
- mid axillary line: 8th rib
- *pleura:**
- mid clavicular line: 8th rib
- mid axillary line: 10th rib
where are the costophrenic and cardio-phrenic angles?
what is the neuronal control of breathing from?
central respiratory control: brainstem - pons & medulla
communicated to the thorax via the phrenic nerve (visceral c3-5) & intercostal nerves
what do dense substances appear as on the x-ray?
white :)
what is this?
costophrenic angle
what is this ?
cardio-phrenic angle
label this bestie xox
how you approach a chest x-ray? (explain 1 & 2)
- *1. Patient details: (normally in top corners)**
- name
- age / dob
- image type
- date
- previous imaging (for comparison)
- *RIPE**
- Rotation: the medial aspect of each clavicle should be equidistant from spinous process
- Inspiration: (patient should take deep breath in, you see:) 5-6 anterior ribs (or 8-10 posterior ribs), costo-phrenic angles and lateral rib edges should be present
- *- Projection:** AP or PA (standard)
- Exposure: (of the film). left hemi-diaphragm should be visible to the spine and verterbrae behind the heart
then,
how do u approach an x-ray? (overview)
- *1. Patient details: (normally in top corners)**
- name
- age / dob
- image type
- date
- previous imaging (for comparison)
- *RIPE**
- Rotation
- Inspiration
- Projection
- Exposure
- *ABCDE:
i) AIRWAY** - Trachea
- Carina
- Bronchi
- Hilar Structures
- *ii) BREATHING**
- Lung fields
- Pleural Space
- *iii) Circulation**
- Heart Size
- Heart Borders
- Mediastinum
- *iv) Diaphragm**
- Curvature
- Elevation
- Beneath diaphragm
- *v) Everythng else**
- Bones
- Soft tissue
- Other objects
what are the main things that could cause airways to not be correct? (4)
- non-central trachea
- airway obstructions
- foreign bodies
- englargement of hilar regions
how do you tell if an x-ray is PA or AP?
who is more likely to have an PA or AP x-ray?
- *PA**
- The standard / default
- Patient must be able to stand
- Can comment on cardiac size
- *AP**
- The ill / recumbent patient
- Scapulae in lung field
- anterior ribs more prominant
- Can’t comment on cardiac size
whats wrong here?
- tracheal deviation (to right)
whats up here?
hilum enlarged
what would you look for ABCDE BREATHING?
what look for that could go wrong? (3)
ii) BREATHING
- Lung fields
- Pleural Space
- *look for:
- opacification / whitening of lungs: infection :(
- collapse of lung
- air of fluid in pleural space**
whats wrong here?
whitening of the lung - in the right middle zone of the lung
whats wrong here?
how can you tell?
pneumothorax
- A pneumothorax is, when looked for, usually easily appreciated on erect chest radiographs. Typically they demonstrate:*
- visible visceral pleural edge is seen as a very thin, sharp white line*
- no lung markings are seen peripheral to this line*
- peripheral space is radiolucent compared to the adjacent lung*
- lung may completely collapse*
- mediastinum should not shift away from the pneumothorax unless a tension pneumothorax is present (discussed separately)*
- which areas do you look for with ABCDE CIRCULATION? (3)
- what things do you loo
ABCDE CIRCULATION:
- Heart size (width of the heart should be less than half the size of width of thorax)
- *- Heart borders
- Mediastinum**
Look for:
- Englarged heart - PA view only
- Loss of heart borders
what is a cardiomegaly?
- *normal**: width of the heart should be less than half the size of width of thorax
- *cardiomegaly:** width of the heart is more than half the size of width of thorax on PA film
whats wrong here?
loss of heart border !
what do you look for in ABCDE Diaphragm? (5)
things that might be wrong? (3)
- *Look for:**
- Curvature
- Elevation
- Beneath diaphragm
- Costophrenic and cardiophrenic angles
- *Wrong:**
- Blunted costophrenic and cardiophrenic angles
- Flattened diaphragm
- Sub-diaphragmatic air / gas (dont want !! )
whats wrong here?
blunted cardiophrenic and costophrenic angles
what do u look for ABCDE Everything else? (3)
what can go wrong?
v) Everythng else
- Bones
- Soft tissue
- Other objects
- *Wrong:**
- fractures
- discolations
- pacemakers
- inserted lines
whats this?
cardiopacemaker
whats wrong here?
air under the right diaphragm
what is dextrocardia?
condition in which the heart is pointed toward the right side of the chest.
whats up here? (2)
- trachea is non-central
- left lung is completely white (due to fluid build up)
whats up here xo
inhaled foreign bodies (dentures)
