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Respiratory > Chest X-Rays > Flashcards

Chest X-Rays Flashcards

0
Q

Which view is the standard one?

A

PA

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1
Q

In which view does the heart appear larger?

A

AP

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2
Q

How do you know if the exposure is normal?

A

Can just see the vertebrae through the heart

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3
Q

What is the alphabet approach for looking for things on a CXR?

A 
A - airway
B - bones
C - circulation
D - diaphragm
E - extra-thoracic
F - fields
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4
Q

What do you look for in A?

A 
Airways
Is the trachea central?
Can it be seen all the way down?
Look at bronchi and left and right hilar
Left is normally higher than right.
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5
Q

What do you look for in B?

A

Bones

  • fractures
  • notches
  • dislocations
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6
Q

What do you look for in C?

A

Circulation

  • cardio thoracic ratio
  • aortic arch - location, aortic-pulmonary window (aortic knob)
  • pulmonary vessels and hila
  • right heart border (right atrium), left heart border (left ventricle)
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7
Q

What do you look for in D?

A

Diaphragm

  • air underneath it?
  • raised?
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8
Q

What do you look for in E?

A

Extrathoracic

  • shoulder joints
  • air under skin
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9
Q

What do you look for in F?

A

Fields of lungs

  • equal on both sides?
  • any masses?
  • consolidation?
  • vascular markings?
  • collapse?
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10
Q

From where should vascular markings not be visible?

A

Should not be visible in the lateral third

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11
Q

Which bronchus do inhaled objects usually go down?

A

The right

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12
Q

When are lung fissures seen more clearly?

A

If there is fluid eg pleural effusion

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13
Q

What are a few extra points you should look for?

A

Lung fissures
Rotation
Silhouette sign

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14
Q

How do you check for rotation?

A

Look at difference between central end of clavicle and centre of trachea. Should be equal on both sides

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15
Q

What is the silhouette sign?

A

When adjacent structures of different density form a crisp silhouette. Loss of the contour can locate a pathology.

16
Q

What are the borders that can be lost and what does this mean?

A

Right heart border - right middle lobe affected
Left heart border - lingula
Paratracheal stripe - mediastinal disease
Chest wall - lung/pleura/rib affected
Aortic knuckle - anterior mediastinum or upper lobe
Diaphragm - lower lobe
Horizontal fissure - anterior segment of upper lobe

17
Q

What is the lingula?

A

Part of the left lower lobe which wraps itself over the left ventricle

18
Q

What is a pleural effusion?

A

Collection of fluid in the pleural space

19
Q

What is seen in a pleural effusion on a CXR?

A

White area and loss of costophrenic angle
Hemidiaphragm can be obscured
Get a meniscus of the upper border
Difficult to pick up in a supine CXR

20
Q

What is a pneumothorax?

A

Presence of air/gas in the pleural space, causing lung collapse

21
Q

Features of a pneumothorax on a CXR?

A

‘Large’ if lung is more than 2cm away from inner chest wall
Mediastinal shift away from the affected lung
Depressed hemidiaphragm
Visible pleural edge, lung markings not visible beyond this edge

22
Q

Common causes of a pneumothorax?

A

Trauma with laceration of the visceral pleura by a fractured rib

23
Q

What is consolidation?

A

Filling of the alveoli/small airways with anything that isn’t air eg

  • pus (pneumonia)
  • blood (haemorrhage)
  • fluid (oedema)
  • cells (cancer)
24
Q

What is a space-occupying legion?

A

A mass in the lung

-nodule if 3cm

25
Q

Causes of lesions in the lung?

A

Malignancies (primary or metastasis)
Benign mass lesion
Inflammatory
Congenital

26
Q

What can lesions mimic?

A

A bone lesion
Cutaneous lesion
Nipple shadow

27
Q

What is lobar collapse? Causes?

A

Loss of volume within a lung lobe.
Luminal - aspirated foreign material, mucous plugging, iatrogenic
Mural - bronchogenic carcinoma
Extrinsic - compression by adjacent mass

28
Q

How does a collapsed lung appear on a CXR?

A

Squashed blob around the hilum - dense whiteness

Tissue has collapsed so now has the density of normal tissue

29
Q

What other features are there on a CXR that indicate lung/lobar collapse?

A

Mediastinal shift towards the collapse
Elevation of hemidiaphragm
Crowding of pulmonary vessels

Respiratory (17 decks)

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