Chest x-rays Flashcards
Position
supine vs erect
widening of mediastinum
increased heart size
elevated hemi-diaphragms
AP vs PA
portable
heart size
scapula over lung fields
Exposure
Different tissues absorb X rays to varying degrees
Air – low absorption (black)
Bone – High absorption (white)
Tissues- Middle absorption (grey)
Rotation
space between medial clavicle and margin of adjacent vertebrae should be equal to each other
systemic approach
ABCDEFG
Airways bones cardiac diaphragm effusions Fields/ fissures and foreign bodies gastric bubble
Airways
Check the position of the trachea and the carina
Is there any evidence of shifting the structures
If there is an ETT in place, where does it rest
Bones
look out for fractures, osteoporosis and scoliosis
Cardiac
check heart borders
check ratio of heart size: mediastinal space size
cant judge cardiomegaly accurately on an AP film
Diaphragm
Check the position of the right and left hemi diaphragm (right hemi diaphragm should be higher than the left)
Check cardio phrenic and cost phrenic angles for blunting
Check if there is any flattening of the diaphragm
Effusions
accumulation of fluid in an anatomical space
fields fissures and foreign bodies
Check the lung fields: compare right to left lung as an overall? Is there equal lung volume? Are there any masses? Can you see an air bronchogram?
Evaluate fissures for thickening, fluid or change of position
Any foreign bodies
consolidation
Accumulation of solid or liquid material (infiltrates) in the air spaces and lung parenchyma
Positive silhouette sign (loss of normal boarders between thoracic structures)
Increased opacity
Air bronchogram (air filled bronchi being made visible by the opacification of surrounding alveoli in which something other that air fills the alveoli)
collapse
Increased opacity
Positive silhouette sign
No air bronchogram
Shift in hila, fissures
Gastric bubble
in 70% of chest x-rays
under the hemidiaphragm representing gas in the fundus of the stomach
