Chest X Rays Flashcards
What mnemonic is used for assess the image quality of a chest X ray
RIPE
Rotation
Inspiration
Projection
Exposure
How do you assess the image quality of a chest X ray?
RIPE
- Rotation: medial aspect of clavicle should be equidistant from spinous processes (which should be vertically orientated)
- Inspiration: posterior ribs 8-10 lung apices, both costophernic angles + lateral rib edges should be visible
- Projection: AP or PA? (If scapulae is not projected within the chest it’s PA)
- Exposure: left hemidiaphragm should be visible to the spine + vertebra should be visible behind the heart
What is the ABCDEF approach on a chest X ray?
Airways
Bones
Cardiac contour
Diaphragm
Effusion
Fields
Normal position of the trachea on a chest X ray
Centrally or very slightly to the right
What could a deviated trachea be due to?
- large pleural effusion or tension pneumothorax if pushed
- lobar collapse if pulled
What is a true vs apparent tracheal deviation on a chest X ray?
- True means the trachea is actually deviated
- Apparent is when there is the appearance of deviation due to the rotation of the patient (inspect clavicles to see if rotated)
Which main bronchus are inhales forgein objects are more likely to be lodge in and why?
- right
- right main bronchus is wider, shorter + more vertical
Normal cardiothoracic ratio
0.4 - 0.55
Why should you not draw any conclusion about heart size from a AP film?
AP films exaggerate heart size
Reasons for doing a chest X-ray
Evaluating:
- symptoms
- signs
- lines, tube + pacemakers
- effects of treatment
What must be seen for the inspiration of a chest x ray to be adequate?
Must be able to count 8-10 posterior ribs
(More horizontal)
Differentiate between anterior and posterior ribs on a chest x ray
Posterior are more horizontal
Anterior angled down
What is the cardiac contour made from?
The borders of the heart:
Right atrium
Left ventricle
What is the lung hilum formed from?
What shape is it?
Superior pulmonary vein
Inferior pulmonary artery
Concave
What is the aorto-pulmonary window?
A space between the arch of the aorta + pulmonary arteries
What is the paratracheal stripe?
There should be nothing next to the trachea on the right side
What is looked for under the diaphragm on a chest x ray?
- Gastric air bubble (normal) under the left hemidiaphragm (location of the stomach)
- the diaphragm should be indistinguishable from the underling liver
- accumulation of free gases (from bowel perforation) under the diaphragm causes it to lift + visibly separate from the liver
- If air is in incorrect place, indicative of pathology
What are the fissures of the lungs?
Oblique (both)
Horizontal (right)
Why must lung markings be seen until the edge in a chest x ray?
Lost in pleural effusion + pneumothorax
What is seen on a chest x ray in a lower lobe collapse?
Obscured hemidiaphragm on affected side
What is seen on a chest x ray in a upper lobe collapse?
Both hemidiaphragm seen
Affect lung is more hazy + smaller
Affected side of heart border is gone
e.g. left ULC: left lung smaller +hazy with left heart border gone
What is seen on a chest x ray in a right middle lobe consolidation?
- both hemidiaphragms seen
- right heart border obscured
What is seen on a chest x ray with military nodules + paraspinal mass?
- multiple small dots
- FINISH CHECK ***
What is seen in a chest x ray of a patient with bilateral hilar lymphadenopathy?
Hilar angle is obliterate (not concave)
What is seen on a chest x ray of a patient with a pleural effusion?
- blunting of costophernic angle
- dense opacities (higher on lateral sign)
- meniscus sign (concave line)
What is the bats wing appearance on a chest x ray?
Bilateral fluffy appearance around hilum
Due to pulmonary oedema
>\???
What is seen on a chest x ray in a patient with pneumothorax?
Lung markings don’t go to the edge of the lungs
What is the unfolding of the aorta?
Not pathological - age related
Aorta looks larger
Compare with previous x rays to see if the same
What makes up the right heart border?
Right atrium
What makes up the left heart border?
Left ventricle
What is reduced definition of the right heart border typically associated with?
Right middle lobe consolidation
Normal position of the right and left hemidiaphragm
The right hemidiaphragm is normally higher than the left due to the presence of the liver
How can air accumulate under the diaphragm?
From a bowel perforation
What are the costophernic angles formed from?
Dome of each hemidiaphragm + lateral chest wall
What is blunting of the costophrenic angles indicative of?
Presence of fluid or consolidation
What is dextrocardia?
Heart is positioned on right side of chest instead of left
Aortic arch on right ride instead of left
