Chest X-Rays (Cornelius) Exam 1 Flashcards
In the U.S., CXR is routinely obtained for hospitalized adults. In other countries, due to cost, providers rely on physical examination. Physical examination has inherent limitations and difficulty identifying lesions in the following structures:
Select 3
a) pleural space
b) mediastinum
c) diaphragm
d) interstitium
e) middle of lung
f) trachea
g) center of lung
b) mediastinum,
d) interstitium
g) center of lung
Slide 3
What pathologies can be present even with a normal chest X-ray?
a) pleura, diaphragm, and bronchi
b) interstitial, airway, and pulmonary vascular systems
c) pulmonary vascular systems, intersitial, and ribs
d) airway, diaphragm, and pleural space
b) interstitial, airway, and pulmonary vascular systems
Interstitial, airway and pulmonary vascular disease in certain cases cannot be recognized by chest x-ray while it is easily evident on physical exam, e.g. asthmatics
Slide 3
True or False
Physical exam in general is good for acute illness, while chest x-ray is better for chronic illness markers.
True
Physical exam and chest x-ray provide compliment
Slide 3
Overexposure will cause a film to be too _______.
a) Light
b) Blurry
c) Dark
d) Grainy
c) Dark
Slide 4
Which structures are well seen on an overexposed chest X-ray? (Select 4)
a) Thoracic spine
b) Mediastinal structures
c) Retrocardiac areas
d) Small lung nodules
e) Fine lung structures
f) Ribs
g) Diaphragm
a) Thoracic spine
b) Mediastinal structures
c) Retrocardiac areas
f) Ribs
Slide 4
Which structures are difficult to see on an overexposed chest X-ray? (Select 2)
a) Small nodules
b) Ribs
c) Thoracic spine
d) Mediastinal structures
e) Fine lung structures
a) Small nodules
e) Fine lung structures
Slide 4
Underexposure will cause a film to be too _______.
a) Bright
b) Blurry
c) Dark
d) Grainy
a) Bright - White
Slide 4
Which structures are well seen on an underexposed chest X-ray?
a) Small pulmonary blood vessels
b) Thoracic spine
c) Mediastinal structures
d) Retrocardiac areas
a) Small pulmonary blood vessels
* Small pulmonary blood vessels will appear prominent and may lead you to think that there are generalized infiltrates when none is really present.
Slide 4
How does breast tissue or excessive body fat affect a chest X-ray image?
a) It causes overexposure of the entire image.
b) It causes underexposure of the tissue in the path
c) It enhances the exposure of the tissue in the path
d) It has no effect on the quality of the image.
Correct Answer: b) It causes underexposure of the tissue in the path of the X-ray beam.
Breast tissue and large amounts of fat tissue can absorb X-ray beams which causes underexposure of the tissue in the path.
Male/Female - Depends on body habitus and positioning
Hard to look under the diaphragm
Slide 4
How are chest X-rays on outpatient or ambulatory patients routinely performed while standing?
a) AP projection (anterior to posterior)
b) PA projection (posterior to anterior)
c) Lateral projection
d) Supine position
b) PA projection (posterior to anterior)
- Patient’s chest is up and against the firm holder.
- The X-ray passes from the back and exits in front to the chest.
silde 5
If the patient is lying down, what will be the typical orientation of the X-ray projection?
a) PA Projection (posterior to anterior)
b) Lateral Projection
c) AP Projection (anterior to posterior)
d) Oblique Projection
c) AP Projection (anterior to posterior)
Portable X-ray
Slide 5
For interpretative purposes, what is the main difference between an AP and PA chest X-ray projection?
a) The heart will appear smaller on an AP projection.
b) The heart will be magnified on an AP projection.
c) The lungs will appear clearer on an AP projection.
d) The diaphragm will be higher on a PA projection.
b) The heart will be magnified on an AP projection.
- The X-ray beam diverges/spreads out as it goes farther from the X-ray tube.
- A patient lying down is unable to take a full inspiration; the liver and abdominal contents are pushing up on the lungs and heart, and the result is that the pulmonary vessels are crowded and make the heart appear large.
- Prefered to have the patient in the seated position if they can’t stand
Slide 5
Why do X-ray technicians instruct patients to take a deep breath and hold it before capturing a chest X-ray?
a) To inflate the patient like a balloon for better contrast.
b) To increase lung density for better visualization.
c) To see if the patient can hold their breath longer than the technician.
d) To allow for the spreading of the pulmonary vessels and clearer visualization.
d) Inspiration allows for the spreading of the pulmonary vessels and clearer visualization.
Slide 5
Why is an upright chest X-ray preferred over a supine chest X-ray? (Select 2)
a) Patients can achieve a greater inspiration.
b) The diaphragm appears lower.
c) Lung markings are better visualized.
d) Pleural effusions are less noticeable.
e) The lungs appear more compressed.
a) Patients can achieve a greater inspiration.
c) Lung markings are better visualized.
A pleural effusion will been seen better since it will run into the normally deep costophrenic angle due to gravity.
Slide 5
True or False
The quality of the image is dependent on a good x-ray tech
True
Don’t let them rush, watch them and give them guidance to get a better image
slide 6
When standing, most adults can take an inspiration that brings the domes of the hemidiaphragm down to which rib number?
a) Rib 6
b) Rib 8
c) Rib 10
d) Rib 12
c) Rib 10
Slide 6
When seated, most adults can take an inspiration that brings the domes of the hemidiaphragm to which rib number?
a) Rib 6 to Rib 8
b) Rib 7 to Rib 9
c) Rib 8 to Rib 10
d) Rib 9 to Rib 11
c) Anywhere from Rib 8 to Rib 10
slide 6
If the lungs are hypoinflated, the diaphragm on a chest X-ray will typically be seen at which rib level?
a) Rib 5
b) Rib 6
c) Rib 7
d) Rib 8
c) Rib 7
Slide 6
When doing a quick scan at a CXR, we start at the area of least importance to most importance. What will this order be?
- Abdomen (first) - free fluid, abdominal distention, gastric bubble (puking)
- Thorax
- Mediastinum - great vessels and heart
- Individual Lungs
- Bilateral Lung (last)
ATMIB
“Always Think More In Breath.”
Slide 7
While scanning in a back and forth pattern what will you be looking for in an abdomen xray?
a) Liver shadow and spleen
b) Gastric bubble and esophagus
c) Diaphragmatic outlines and psoas muscles
d) Gastric bubble and hemidiaphragms
d) Gastric bubble and hemidiaphragms
Google: A hemidiaphragm is half of the diaphragm, each with its own apex, or cupula. The right hemidiaphragm is usually higher than the left and is protected by the liver, making it stronger. The left hemidiaphragm is more likely to rupture or herniate than the right.
slide 10
True or False
A gastric bubble is a normal finding on a CXR and should be below the hemidiaphragm.
True
A gastric bubble is a normal finding on a CXR and should be below the hemidiaphragm.
Google:A gastric bubble is a round, radiolucent area on a chest x-ray that’s usually located under the left hemidiaphragm and represents gas in the stomach
Slide 10
What does the deep sulcus sign on a chest X-ray indicate?
a) Pleural effusion
b) Atelectasis
c) Pneumothorax
d) Pulmonary edema
c) Pneumothorax
Due to the collection of air in the pleural space pushing down on the lung, causing the hemidiaphragm to appear lower and the lateral costophrenic sulcus to appear more pronounced than normal.
Slide 10
Pattern of how you will scan the thorax of a CXR? (pic)
Slide 12
When scanning the thorax on a chest X-ray, which of the following structures should be evaluated for continuity and malformation, such as fractures? Select 3
a) Spine
b) Ribs
c) Jaw
d) Clavicles
e) Scapula
f) Mediastinum
Bony structures
b) Ribs - small can be hard to detect (better on CT). Likely to have more than 1 fracture, so look for the other one
d) Clavicles
e) Scapula
Slide 13
True or False**
Air will conform to the surrounding structures, while fluid, such as in a hemothorax, will settle dependently due to its higher density. As fluid accumulates, it blunts the costophrenic angles by filling in the lower recesses of the pleural cavity.
True
Air will conform to the surrounding structures, while fluid, such as in a hemothorax, will settle dependently due to its higher density. As fluid accumulates, it blunts the costophrenic angles by filling in the lower recesses of the pleural cavity.
Slide 13
When counting ribs on a chest X-ray, where do you typically start?
a) Posterior side and bottom
b) Anterior side and top
c) Lateral side and middle
d) Posterior side and top
b) Anterior side and top
1st rib is superior to clavicle it may be impossible to see because the 1st and 2nd rib are on top of each other
Slide 14
Which type of rib fracture is harder to detect on a CXR (Posterior or Anterior Ribs)?
- Posterior Rib fractures are harder to detect.
Slide 14
The pattern of how you will scan the mediastinum and heart of a CXR. (pic)
Slide 17
Which four structures in the mediastinum should be centrally located during a routine chest X-ray?
a) Lungs, diaphragm, aorta, and esophagus
b) Heart, sternum, esophagus, and greater vessels
c) Diaphragm, bronchi, esophagus, and ribs
d) Heart, sternum, trachea, and greater vessels
d) Heart, sternum, trachea, and greater vessels
Many times these structures will be overlying each other. You can invert the colors/contrast of the x-ray, this can make the air filled structures stand out more
Slide 17
Cardiomegaly is considered present if the cardiac silhouette is larger than what fraction of the thoracic distance?
a) One-third
b) One-half to two-thirds
c) Three-quarters
d) One-quarter to one-third
b) One-half to two-thirds
slide 17
The pattern of how you will scan each lung on a CXR. (pic)
Slide 19
We don’t get a lot of lateral views, rarely will you get them through ER. Will get them on outpatients and pulmonary workups. (pic)
Slide 20
Which of the following is not part of the systematic approach for viewing a chest X-ray?
a) Bony fragments/framework
b) Soft tissues
c) Sinuses and nasal cavity
d) Diaphragm and pleural space
e) Mediastinum and heart
f) Abdomen and neck
g) Lung fields and hila
c) Sinuses and nasal cavity
Slide 21
What bony fragments can be viewed on a chest X-ray? (Select 5)
a) Ribs
b) Pelvis
c) Sternum
d) Spine
e) Shoulder girdle
f) Clavicles
g) Femur
h) Skull
a) Ribs
c) Sternum
d) Spine
e) Shoulder girdle
f) Clavicles
- Ribs - count them, start at sternum and trace posteriorly
- Sternum - look for continuity - hard to see or if underdeveloped.
- Spine - **best view on lateral image **
- Shoulder girdle - look for displacement
- Clavicles - look for symmetry
Slide 22
Which soft tissues are inspected on a chest X-ray? (Select 4)
a) Breast shadows
b) Supraclavicular areas
c) Subclavicular areas
d) Tissues under the breasts
e) Tissues along the sides of the breasts
f) Axillae
a) Breast shadows
b) Supraclavicular areas
e) Tissues along the sides of the breasts
f) Axillae
- Breast tissue - breast tissue can hide diaphragmatic problems and costophrenic angles, fluid accumulation, free air
Slide 23
How does blood and air typically accumulate in the upright versus the supine patient on a chest X-ray?
a) In an upright patient, blood pools down and air accumulates up; in a supine patient, blood is usually detected on one side and air may only be seen at the lateral edges.
b) In an upright patient, blood pools up and air accumulates down; in a supine patient, both blood and air are easy to detect.
c) In an upright patient, air pools down and blood accumulates in the middle; in a supine patient, blood accumulates on both sides and air is centrally located.
d) In an upright patient, air and blood accumulate in the same location; in a supine patient, blood accumulates in the middle and air at the top.
a) In an upright patient, blood pools down and air accumulates up; in a supine patient, blood is usually detected on one side and air may only be seen at the lateral edges.
Slide 23
What structures can be viewed in the hilum on a chest X-ray?
a) Bronchi and trachea
b) Pulmonary arteries and pulmonary veins
c) Diaphragm and heart
d) Ribs and clavicles
b) Pulmonary arteries and pulmonary veins
“The hilum is the shadow of pulmonary artery and vein adjacent the heart shadow.”
If you follow the arteries and veins from the heart all the way out, also known as ‘lung markings’, you can see to the edge or lateral parts of the lung fields. They can help you point out pneumothorax
slide 24
What is another name for the hilum on a chest X-ray?
a) Lung apex
b) Pulmonary base
c) Lung root
d) Pleural node
c) Lung root
Slide 24
What normal lung makers should be seen in a healthy adult’s chest X-ray?
a) Linear and large areas of shadow of consolidation
b) Air-fluid levels throughout both lungs
c) Linear and fine nodular shadows of pulmonary vessels
d) Complete absence of any lung markings
c) Linear and fine nodular shadows of pulmonary vessels
Slide 24
How are abnormal lung markings seen in a sick adult’s chest X-ray?
a) Excessive radiolucency, normal radiopacity, or opacified areas.
b) Excessive radiolucency, excessive radiopacity, or opacified areas.
c) Abnormal lung markings are seen as excess radiopacity or opacified areas
d) Abnormal lung markings are seen as faint shadows with no clear pattern.
b) Abnormal lung markings present as excessive radiolucency, excessive radiopacity, or opacified areas.
Slide 24
What percent of the lung field and hila will typically be obscured by tissue on a chest X-ray?
a) 20%
b) 30%
c) 40%
d) 50%
c) 40%
Slide 24
What kind of shape should the diaphragm form on a normal chest X-ray?
a) Flat shape with costophrenic angle
b) Dome shape with a costophrenic angle
c) Irregular shape with sharp edges
d) Dome shape with costodiaphragmatic angle
b) Dome shape with a costophrenic angle
Costophrenic angle circled in red
Slide 25
True or False
You should not be able to see the pleural in a normal CXR, except where two layers come together to form the interlobar fissures
- True
- On an abnormal CXR you can see the pleural when air is trapping between the chest wall or the mediastinum and lungs.
Slide 25
On a Posterior-Anterior (PA) chest X-ray, the normal right heart and mediastinal border are made up of which four structures, listed from bottom to top?
a) Right Atrium, Inferior Vena Cava, Aortic Arch, Superior Vena Cava
b) Inferior Vena Cava, Right Atrium, Ascending Aorta, Superior Vena Cava
c) Right Ventricle, Pulmonary Artery, Ascending Aorta, Superior Vena Cava
d) Inferior Vena Cava, Left Atrium, Descending Aorta, Right Pulmonary Artery
b) Inferior Vena Cava, Right Atrium, Ascending Aorta, Superior Vena Cava
slide 26
On a Posterior-Anterior (PA) chest X-ray, the normal left heart and mediastinal border are made up of which five structures, listed from bottom to top?
a) Left Atrium, Left Ventricle, Pulmonary Artery, Aortic Arch, Subclavian Artery/Vein
b) Aortic Arch, Pulmonary Artery, Left Ventricle, Left Atrium, Subclavian Artery/Vein
c) Left Ventricle, Pulmonary Artery, Aortic Arch, Subclavian Artery/Vein, Left Atrium
d) Left Ventricle, Left Atrium, Pulmonary Artery, Aortic Arch, Subclavian Artery/Vein
d) Left Ventricle, Left Atrium, Pulmonary Artery, Aortic Arch, Subclavian Artery/Vein
Cornelius big take aways, be able to see the aortic arch “knob” and cardiac silhouette
Slide 27
On which side is the gastric bubble usually seen on a chest X-ray?
a) Right
b) Left
c) Laterally
d) It is not typically visible
b) Left
slide 28
When assessing the abdomen on a chest X-ray, which of the following should be evaluated?
a) Free air under diaphragm and gastric bubble
b) Kidney shadows and liver density
c) Proximal intestinal loops and gastric bubble
d) Free air under diaphragm and spleen position
a) Gastric bubble and free air under the diaphragm
Free air under diaphragm is = perforated ulcers (most common)
Slide 28
What is assessed in the neck area on a chest X-ray?
(Select 3)
a) Soft tissue mass
b) Thyroid size
c) Lymph node enlargement
d) Air trapping Thyroid size
e) Vertebral alignment
f) Tracheal deviation
a) Soft tissue mass
d) Air trapping (air bronchogram)
f) Tracheal deviation
Slide 28
True or False
You tell the content of a fluid by looking at a X-ray
False
* You can tell that the substance is a fluid, but not what it is made up of (blood, mucous, pulmonary edema).
slide 29
Match the substance with its appearance on a CXR
Air = b) Black, representing areas of low density or no density
Water = d) Solid white, indicating fluid accumulation or dense structures
Bone = a) Translucent white, denser than soft tissue but not completely opaque
Tissue = c) More solid white than fluid, denser than air but less than bone
slide 29
Which factors can lead to misinterpretation of a chest X-ray? (Select all that apply)
A) Proper lung inflation
B) Poor inspiration
C) Under penetration
D) Rotation of the patient
E) Forgetting the path of the X-ray beamWhat factors can result in a poor quality x-ray film?
B) Poor inspiration
C) Under penetration
and over penetration
D) Rotation of the patient
E) Forgetting the path of the X-ray beam
Slide 30
On a properly penetrated posterior-anterior CXR, what anatomical structures should be visible overlying the image of the heart?
A) The thoracic vertebrae
B) The clavicles
C) The diaphragm
D) The scapulae
A) The thoracic vertebrae
Slide 30
Which of the following is a method to check that patient is not rotated on a chest radiograph?
A) Ensure the diaphragm is visible
B) Confirm the lungs are fully inflated
C) Measure the distance from the vertebral spines to the medial ends of the clavicles
D) Look for visible rib fractures
C) Measure the distance from the vertebral spines to the medial ends of the clavicles
Slide 30
If the carina is not visible on a chest radiograph, where is it typically located?
A) Level with the diaphragm
B) 2-3 cm below the clavicles
C) 2-3 cm above the clavicles
D) At the midline of the sternum
B) 2-3 cm below the clavicles
Slide 31
Which of the following lobes are found in the right lung?
A) Superior lobe
B) Middle lobe
C) Inferior lobe
D) All of the above
D) All of the above
3 lobes on the right lung
Slide 31
Which of the following lobes are found in the left lung?
A) Superior lobe
B) Middle lobe
C) Inferior lobe
D) Both A and C
E) Both B and C
F) Both A and B
D) Both A and C
2 lobes on the left lung: Superior and Inferior
Slide 31
Which chest X-ray (CXR) projection/orientation is most likely to show extensive lung overlap?
A) AP view
B) Lateral view
C) PA view
D) Oblique view
C) PA view
Posterior-anterior X-ray projection will show the lower lobes extending high over the lung field.
Slide 33
True or False
The lateral view of a chest X-ray provides a better visualization of the extent of the lower lobes compared to the PA view.
True
The lateral view of a chest X-ray provides a better visualization of the extent of the lower lobes
Slide 33
What portion of the right lung is occupied by the right upper lobe (RUL)?
A) Lower one-third
B) Middle one-third
C) Upper one-third
D) Entire lung
C) Upper one-third
Slide 34
Which ribs are adjacent to the right upper lobe (RUL) posteriorly?
A) First three to five ribs
B) Sixth to eighth ribs
C) Ninth to twelfth ribs
D) All ribs
A) First three to five ribs
Slide 34
How far does the right upper lobe (RUL) extend inferiorly on the anterior chest?
A) As far as the 6th rib
B) As far as the 2nd rib
C) As far as the 4th rib
D) As far as the 5th rib
C) As far as the 4th rib
Slide 34
Which of the following are characteristics of the right middle lobe? (Select all that apply)
A) It is the largest lobe in the right lung
B) It has a triangular shape
C) It is typically the smallest of the three lobes in the right lung
D) It is narrowest near the hilum
E) It extends down to the diaphragm
B) It has a triangular shape
C) It is typically the smallest of the three lobes in the right lung
D) It is narrowest near the hilum
Slide 35
Which of the following statements are true about the right lower lobe (RLL)? (Select all that apply)
A) The RLL is the largest lobe of the right lung
B) The RLL is the most common site for pneumonia
C) The RLL is easier to see in patients with poor inspiration
D) The RLL can be harder to see in patients with poor inspiration
E) The RLL is the smallest lobe of the right lung
A) The RLL is the largest lobe of the right lung
B) The RLL is the most common site for pneumonia
D) The RLL can be harder to see in patients with poor inspiration
Slide 36
How far superiorly does the right lower lobe (RLL) extend posteriorly?
A) To the 4th thoracic vertebral body
B) To the 6th thoracic vertebral body
C) To the 8th thoracic vertebral body
D) To the 10th thoracic vertebral body
B) To the 6th thoracic vertebral body
extends inferiorly to the diaphragm.
Review of the lateral plain film surprisingly shows the superior extent of the RLL.
Slide 36
Which fissures separate the lobes of the right lung?
A) Horizontal and Vertical fissures
B) Anterior and Posterior fissures
C) Minor and Major fissures
D) Superior and Inferior fissures
C) Minor and Major fissures
- Minor Fissure - separates RUL and RML
- Major Fissure - separates the RUL/RML from the RLL
Slide 37
Which lobe covers most of the anterior portion of the left lung?
A) Left lower lobe (LLL)
B) Right upper lobe (RUL)
C) Left upper lobe (LUL)
D) Right middle lobe (RML)
C) Left upper lobe (LUL)
*On Lateral view, it is divided pretty evenly between the upper and lower *
Slide 38
Which lobe covers most of the posterior portion of the left lung?
A) Left upper lobe (LUL)
B) Right upper lobe (RUL)
C) Left lower lobe (LLL)
D) Right middle lobe (RML)
C) Left lower lobe (LLL)
Slide 38
What separates the left upper lobe (LUL) from the left lower lobe (LLL)?
A) Minor fissure
B) Oblique fissure
C) Horizontal fissure
D) Major fissure
D) Major fissure
Slide 40
Label 1
- Aortic Arch
Slide 41
Label 2
- Pulmonary Trunk
Slide 41
Label 3
- Left atrial appendage
Slide 41
Label 4
- Left Ventricle
Slide 41
Label 5
- Right Ventricle
Slide 41
Label 6
- Superior Vena Cava
Slide 41
Label 7
- Right hemidiaphragm
Slide 41
Label 8
- Left hemidiaphragm
Slide 41
Label 9
- Horizontal fissure
Slide 41
Label 1
- Oblique Fissure
Slide 42
Label 2
- Horizontal Fissure
Slide 42
Label 3
- Thoracic spine/ Retrocardial space
Slide 42
Label 4
- Retrosternal space
Slide 42
Which of the following can cause a silhouette sign on a chest X-ray? (Select all that apply)
A) Lungs making contact with the heart
B) Presence of a tumor
C) Presence of a mass or lesion
D) Normal clear borders between lung fields and structuresWhat will cause a Silhouette Sign on a CXR?
A) Lungs making contact with the heart
B) Presence of a tumor
C) Presence of a mass or lesion
Lungs making contact with the heart or any structure (tumor, mass, lesion) that may obscure the border of a CXR
Slide 43
What is the visualization of air in the intrapulmonary bronchi on a chest X-ray called?
A) Silhouette sign
B) Pneumothorax
C) Air bronchogram sign
D) Pleural effusion
C) Air bronchogram sign
In the lungs the bronchi are not visible because they are air density surrounded by alveoli which are air density.
Bronchogram sign indicates an abnormal lung (consolidation).
With consolidation, pulmonary vessels are no longer visualized b/c they are surrounded by other soft tissue density material.
Slide 44
1/3rd of the heart sides on (right/left) side
2/3rd of the heart sides on the (right/left) side.
1/3rd of the heart sides on right side
2/3rd of the heart sides on the left side
Slide 46
Which of the following statements are true regarding pathological changes in the lungs? (Select all that apply)
A) Most disease states replace air with a pathological process
B) Each tissue reacts to injury in an unpredictable fashion
C) Lung injury or pathological states can be either generalized or localized
D) Most disease states involve fluid replacement instead of air replacement
E) Tissue reactions to injury follow a predictable pattern
A) Most disease states replace air with a pathological process
C) Lung injury or pathological states can be either generalized or localized
E) Tissue reactions to injury follow a predictable pattern
Slide 47
Which of the following can cause generalized liquid density in the lungs? (Select all that apply)
A) Diffused alveolar
B) Localized airway obstruction
C) Diffused interstitial
D) Emphysema
E) Mixed/Vascular
A) Diffused alveolar
C) Diffused interstitial
E) Mixed/Vascular
Slide 48
Which of the following can cause localized liquid density in a lung? (Select all that apply)
A) Infiltrate
B) Consolidation
C) Cavitation
D) Mass
E) Congestion
F) Atelectasis
A) Infiltrate
B) Consolidation
C) Cavitation
D) Mass
E) Congestion
F) Atelectasis
Slide 48
Which of the following can cause increased air density in the lungs? (Select all that apply)
A) Localized airway obstruction
B) Diffuse airway obstruction
C) Emphysema
D) Cavitation
E) Bulla
A) Localized airway obstruction,
B) Diffuse airway obstruction
C) Emphysema
E) Bulla
Slide 48
What is consolidation on a CXR?What is lobar consolidation characterized by?
A) Alveolar space filled with air
B) Alveolar space filled with inflammatory exudate
C) Clear lung fields with no fluid or exudate
D) Collapse of the entire lung
B) Alveolar space filled with inflammatory exudate (WBC, bacteria, plasma, and debris).
- With consolidation, architecture remains the same and the airway is patent
Slide 49
What characterizes obstructive atelectasis?
A) Overinflation of the lung
B) Loss of ventilation to the lobe beyond the obstruction
C) Fluid accumulation in the pleural space
D) Increased air density in the lung
B) Loss of ventilation to the lobe beyond the obstruction
(ie: mucous plug, right main stem intubation)
Radiologic criteria for absorptive Atelectasis is
1. a density corresponding to a segment or lobe,
2. significant signs of loss of volume, and
3. compensatory hyperinflation of normal lungs (maybe on one side)
Slide 50
Match the stages of evaluating a CXR abnormality:
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
A. Identification of etiology
B. Identification of abnormal shadows
C. Identification of pathological process
D. Confirmation of clinical suspension
E. Localization of lesion
Stage 1- Identification of abnormal shadows (B)
Stage 2 - Localization of lesion (E)
Stage 3 - Identification of pathological process (C)
Stage 4 - Identification of etiology (A)
Stage 5 - Confirmation of clinical suspension (D)
Slide 51
Which of the following imaging techniques can be used to evaluate complex problems after a chest X-ray? (Select all that apply)
A) CT chest
B) MRI scan
C) Introduction of contrast medium
D) Blood tests
E) Electrocardiogram (ECG)
A) CT chest
B) MRI scan
C) Introduction of contrast medium
Slide 51
What are the two arrows pointing at?
What does the “^” indicate?
- ETT
- Central Line
Slide 54
What does this CXR show?
- Right mainstem intubation
Slide 55
Is this a proper placement of a central line?
- No, the tip (smaller red arrow) is within the right ventricle. Pt will probably experience PVCs.
- The catheter tip should lie between the most proximal venous valves of the subclavian or jugular veins and the right atrium.
Slide 57
What is this CXR showing?
- Right pleural effusion
- Notice the loss of the costophrenic angle
Slide 59
What is this CXR showing?
- RML pneumonia
- You can rule out RLL pneumonia because there is no accumulation at the base of the lung.
- A lateral CXR will have the best view for confirmation.
Slide 60-62
What is this CXR showing?
- RUL pneumonia
Slide 63
What is this CXR showing?
- RLL pneumonia
Slide 64
What is this CXR showing?
- Free air under the diaphragm
Slide 66
What are the four arrows pointing at?
- Cavitary Infiltrate
Slide 67
What is the name of the lesion seen in the lung that is caused by tuberculosis?
A) Bulla
B) Cavitation
C) Ghon’s complex
D) Pleural effusion
C) Ghon’s complex
- The lesions consist of a calcified focus of infection and an associated lymph node.
- Very hard to detect.
Slide 68
What are the arrows pointing to in this CXR?
- Anterior Mediastinal Mass
- Need lateral CXR to confirm. It’s hard to see the mass in AP view.
Slide 69
What are the arrows pointing to in this CXR?
- LUL Mass
Slide 70-71
What is this CXR showing?
- Pulmonary Metastasis (Cancer)
- The white circular object on the patient’s right lung is a medication port.
Slide 72-73
What are the two arrows on this CXR indicating?
- Pneumomediastinum
- There should never be that much air between the heart and lungs.
- This can be caused by airway trauma, tracheal or esophageal rupture
Slide 76
What is this CXR showing?
- Left Pneumothorax
- Notice the air trapping on the patient’s left lung
Slide 77
What is this CXR showing?
- Subcutaneous Emphysema
- Notice the intermittent areas of radiolucency, often representing a fluffy appearance on the exterior borders of the thorax.
Slide 79
What is the red arrow indicating?
- Deep Sulcus Sign
- This is an indirect indicator of a pneumothorax.
Slide 80
If a child swallows a large coin, is it more likely to go down the esophagus or trachea?
- Esophagus
Slide 84-86
What is this CXR showing?
- Pulmonary Fibrosis
Slide 87
What is this CXR showing?
- Diffused Pulmonary Edema
Slide 89
What is the classic chest X-ray sign of pulmonary edema secondary to congestive heart failure (CHF)?
A) Honeycomb pattern
B) Bat wing pattern
C) Ground-glass opacity
D) Pleural thickening
B) Bat wing pattern
* Enlarged Heart
Slide 90
What is this CXR showing?
- Post-op Left Pneumonectomy
- There is no left lung
Slide 91-93
What is this CXR showing?
- Transverse Aortic Arch Aneurysm
Slide 94
What is this CXR showing?
- Cardiomegaly
Slide 95
What is this CXR showing?
- Aortic Dissection
- Notice the wide mediastinum and deviation of the heat to the patient’s left side
Slide 97
What sign is present when a large loop of the intestine gets shoved between the diaphragm and the liver?
- Chilaiditi Sign
Slide 98
What is this CXR showing?
- Esophageal Rupture (Boerhaave’s Syndrome)
- Notice small bilateral lung field and infiltrates
- Wide mediastinum pattern
- Air visible on bilateral sides of the heart
Slide 99-100
What does hilar adenopathy refer to?
A) Enlargement of the alveoli
B) Enlargement of lymph nodes in the hilum
C) Enlargement of the pulmonary arteries
D) Enlargement of the bronchioles
B) Enlargement of lymph nodes in the hilum
- It can be caused by conditions such as tuberculosis, sarcoidosis, drug reactions, infections, or cancer.
Slide 101
What is this CXR showing?
- Bilateral Hilar Adenopathy
Slide 101
Case Study: 35 y/o male with dyspnea, unplanned weight loss over 3 months.
- Pulmonary lesion on patient’s left lung
- Thin-walled cavity is noted in the left midlung. Most likely cancerous.
- This finding is most typical of squamous cell carcinoma (SCC).
Slide 104-105
Case Study: 65y/o with a month worth of dyspnea, occasional productive cough, and fever
- LUL Atelectasis: Loss of heart borders/silhouetting.
- Notice over inflation on unaffected lung
- Inflammatory process or pneumonia in the LUL
Slide 107-108
Case Study: 30yo female with 1 week of fever and cough
- Right Middle Lobe Pneumonia
- Left Upper Lobe Pneumonia
Slide 110-111
Case Study: 28y/o inmate for CT-guided drainage
- Cavitation: cystic changes in the area of consolidation due to the bacterial destruction of lung tissue.
- Pleural Effusion in RML
- Notice air-fluid level.
Slide 113-115
What are the two arrows indicating in this CXR?
- Tuberculosis (stretched out cotton ball appearance)
Slide 117
What is this CXR showing?
- COPD: increase in heart diameter, flattening of the diaphragm, and increase in the size of the retrosternal air space.
- In addition, the upper lobes will become hyperlucent due to the destruction of the lung tissue.
Slide 119-120
What is this CXR showing?
- Pseudotumor: fluid has filled the minor fissure creating a density that resembles a tumor (arrow). Recall that fluid and soft tissue are indistinguishable on plain film.
- Further analysis, however, reveals a classic pleural effusion in the right pleura.
- Note the right lateral gutter is blunted and the right diaphram is obscurred.
Slide 123-124
What is this CXR showing?
- Pneumonia: a large pneumonia consolidation in the right lower lobe.
- Knowledge of lobar and segmental anatomy is important in identifying the location of the infection.
Slide 126-127
What is this CXR showing?
- Pulmonary Edema secondary to CHF
- A great deal of accentuated interstitial markings, curly lines, and an enlarged heart.
- Normally indistinct upper lobe vessels are prominent but are also masked by interstitial edema.
Slide 129-130
What is the CXR showing?
- Chest wall lesion: arising off the chest wall and not the lung
Slide 133-134
What is the CXR showing?
- Pleural effusion: Note loss of left hemidiaphragm.
- Fluid drained via thoracentesis
Slide 136-137
What is the CXR showing?
- Lung Mass
Slide 139-140
What is the CXR showing?
- Small Pneumothorax: LUL
- Notice that thin white line, that is the lung being shoved down by the pneumothorax
Slide 142-143
What is the CXR showing?
- Right Middle Lobe Pneumothorax: complete lobar collapse and deep sulcus
Slide 145-147
What is the CXR showing?
- Metastatic Lung Cancer: Multiple nodules seen
Slide 149-150
What is the CXR showing?
- RUL pulmonary nodule
Slide 152-153
What is the CXR showing?
- TB
Slide 155-156
What is the CXR showing?
- Perihilar mass
- Hodgkin’s disease
Slide 158-159
What is the CXR showing?
- Widened Mediastinum
- Aortic Dissection
Slide 161-162
What is the CXR showing?
- Pulmonary artery stenosis with cardiomegaly likely secondary to stenosis.
Slide 164-166
