Chest X-Rays Flashcards
What is the mnemonic for interpreting chest x-rays?
ABCDEF
What are you looking for when checking the airway? (The “A” in ABCDEF)
Ensuring that the trachea and carina are in place. The trachea should be right in the mid-line.
What are you looking for when checking the bones and soft tissues (breast shadows)? (The “B” in ABCDEF)
Looking for fractures, osteoblastic/osteolytic clavicles, ribs, and the thoracic spine.
The presence of what bony landmark ensures that the x-ray is not over or under penetrating?
The spinous processes of the vertebrae. If they are visible it is a good x-ray. If not then it either didn’t penetrate enough (will be too radiopaque) or penetrated too much (too radiolucent)
What are you looking for when checking the heart (cardiac) and mediastinum? (The “C” in ABCDEF)
Heart size and heart borders (ventricles and atriums), the aorta (aortic knob), and any mediastinal widening.
What are you looking for when checking the diaphragm? (The “D” in ABCDEF)
Looking to see if the right hemi-diaphragm is higher than the left, and if the costophrenic angles are sharp or blunted. If it is an upright x-ray, check for free air under the diaphragm for possible intra-abdominal perforation (gas in the GI is normal though).
What are you looking for when checking the edges (pleura), any extra-thoracic structures, and effusion? (The “E” in ABCDEF)
Look at the edges for fibrosis, pneumothorax, pleural thickening, or plaques. If there are effusions check to see if fluid is tracking along the fissure (horizontal and oblique).
What are you looking for when checking the lung fields? (The “F” in ABCDEF)
Look for opacity (loss of heart borders or contour) and the pattern of opacity (Kerley B lines, ect).
What are the three common x-ray angles?
PA (posterior-anterior), AP (anterior-posterior), and lateral.
What will show up on an AP x-ray as opposed to a PA?
On anterior-posterior x-rays the heart will appear enlarged (due to the heart being anterior), and the lung bases will be indistinct.
What is the lateral decubitus position used for?
It is used to detect free fluid in the chest cavity which moves upon re-positioning of the patient.
What chest x-ray should be taken when a pleural effusion is suspected?
An upright x-ray should be taken, as this will show blunting of the lateral costophrenic angle if pleural effusion is present.
When during respiration should a chest x-ray be taken?
Upon full inspiration. Should be able to count 9-10 ribs.
What is a steeple sign?
A subglottic airway narrowing in the trachea.
Why is it important to check the breast shadow?
A mastectomy can cause the affected side to be more radiolucent due to the decreased tissue. This could be mistaken for a pathology. It is important to remember that an x-ray is the summation of everything that it passes though.
