Chest X-Rays Flashcards
What are the two types of CXR projections
PA projection
AP projection
What conditions must be met for the CXR to be adequate
Must see 1st rib, lateral margin of ribs and costophrenic angle
Must have no/little rotation - check alignment of spinous processes and position of clavicles
5th-7th ribs at MCL - patient must take deep breath and hold
Pentration to be adequate - vertebrae visible through heart and complete left hemidiaphragm visible
Name some sources of artefact
Clothing - e.g. buttons
Hair - should be tied back
Surgical/vascular lines/medical equipment
Pacemaker
Name the features that can be found on a normal CXR
Costophrenic angle and recesses
Aorto-pulmonary window (AP window)
Hila - left and right. Left should sit higher
Aortic knuckle/notch
Horizontal fissure
Name the review areas of the lungs and what can be found in the areas
Apices - pneumothorax
Thoracic inlet - masses
Paratracheal stripe - masses, lymph nodes
AP window - lymph nodes
Hila - masses or collapse of hila
Behind heart - masses
Below diaphragm - pneumoperitoneum, masses
Bones - #s, masses, missing bones
What sign are we looking for between two structures of differing densities and at which places do we normally see this sign
Silhouette sign
Seen at:
- Right heart border
- Left heart border (lingula)
- Paratracheal stripe
- Chest wall
- Aortic knuckle
- Diaphragm
- Horizontal fissure
How is mediastinal shift caused and give some examples of things that cause mediastinal shift
Mediastinum push by increased pressure or volume. E.g. pleural effision, tension pneumothorax
Mediastinum pulled by decreased pressure or volume. E.g. lung collapse
What signs are seen on a CXR in pleural effusion
Meniscus at upper border
Uniform white area of opacification
Loss of costophrenic angle - if patient in orthostatic/standing position
Hemidiaphragm obscured
What features would be seen on a CXR if a patient has a lobar lung collapse
Elevated ipsilateral hemidiaphragm
Crowding of ipsilateral ribs
Shift of mediastinum towards side of atelectasis
Crowding of pulmonary vessels
What is a cavitating lung lesion and where is it seen
Cavitating lung lesion is where there is air within a space occupying lesion
Will have black/dark part in the centre fo white consolidation
Seen in TB, cavitating tumours, abscess, thromboemboli
Name the features of this CXR
What condition does this patient have
Pneumothorax
What does this patient have
Pneumothorax with mediastinal shift right
What does this patient have
Pleural effusion
What does this patient have
Tension pneumothorax
What does this patient have
Pneumothorax - small
A patient comes in with a 2 day history of fever. He has a productive cough of green sputum. This is his CXR, what is the most likely diagnosis
Pneumonia
A patient comes in with a history of chronic cough and fever. He has lost weight over the past few months. He also has night sweats. This is his CXR. What is his most likely diagnosis.
TB
A patient comes in with a history of chronic breathlessness. He has a history of 5-pack year smoking. Here is his CXR. What is his most likely diagnosis
COPD
A patient comes in with increasing breathlessness on walking and has become breathless on minimal exertion recently. He has been waking up at night with breathlessness. This is his CXR. What is his most likely diagnosis
Heart Failre
