Chest XR pt2 Exam1 Flashcards
Label 1
- Oblique Fissure
Label 2
- Horizontal Fissure
Label 3
- Thoracic spine/ Retrocardial space
Label 4
- Retrosternal space
What will cause a Silhouette Sign on a CXR?
- Lungs making contact with the heart or any structure (tumor, mass, lesion) that may obscure the border of a CXR.
Visualization of air in the intrapulmonary bronchi on a CXR is called a ________ sign.
- Bronchogram
- 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.
1/3rd of the heart sides on ______ side
2/3rd of the heart sides on the ______ side.
- right side
- left side
Lung injury or pathological states can be either a ________ or _______ process.
- generalized
- localized
What can cause generalized liquid density in a lung? (3)
- Diffused alveolar
- Diffused interstitial
- Mixed/Vascular
What can cause localized liquid density in a lung? (6)
- Infiltrate
- Consolidation
- Cavitation
- Mass
- Congestion
- Atelectasis
What can cause increased air density in the lungs? (4)
- Localized airway obstruction
- Diffuse airway obstruction
- Emphysema
- Bulla
What is consolidation on a CXR?
- Alveolar space filled with inflammatory exudate (bacteria/WBC/plasma/debris).
- With consolidation, architecture remains the same and the airway is patent
What is obstructive atelectasis on a CXR?
- No ventilation to the lobe beyond the obstruction (ie: mucous plug, right main stem intubation)
What are the stages of evaluating a CXR abnormality?
- ID abnormal shadows
- Anatomically localize lesion
- ID pathological process
- ID etiology
- Confirm clinical suspicion (contrast, CT, MRI)
What are the two arrows pointing at?
What does the “^” indicate?
- ETT
- Carina
central line passing by
What does this CXR show?
- Right mainstem intubation
radiopaque line in ETT directed down right mainstem
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.
What is this CXR showing?
- Right pleural effusion
- Notice the loss of the costophrenic angle and leveling of fluid
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.
What is this CXR showing?
- RUL pneumonia
What is this CXR showing?
- RLL pneumonia
What is this CXR showing?
- Free air under the diaphragm
What are the four arrows pointing at?
- Cavitary Infiltrate
A lesion seen in the lung that is caused by tuberculosis.
- Ghon’s Complex
- The lesions consist of a calcified focus of infection and an associated lymph node.
- Very hard to detect.
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.
What are the arrows pointing to in this CXR?
- LUL Mass
What is this CXR showing?
- Pulmonary Metastasis (Cancer)
- The white circular object on the patient’s right lung is a medication port.
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
What is this CXR showing?
- Left Pneumothorax
- Notice the air trapping on the patient’s left lung
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.
What is the red arrow indicating?
- Deep Sulcus Sign
- This is an indirect indicator of a pneumothorax.
If a child swallows a large coin, is it more likely to go down the esophagus or trachea?
- Esophagus
What is this CXR showing?
- Pulmonary Fibrosis
What is this CXR showing?
- Diffuse Pulmonary Edema
What is the classic sign on a CXR of pulmonary edema secondary to CHF?
- Bat Wing Pattern
- Enlarged Heart
What is this CXR showing?
- Post-op Left Pneumonectomy
- There is no left lung
What is this CXR showing?
- Transverse Aortic Arch Aneurysm
What is this CXR showing?
- Cardiomegaly
What is this CXR showing?
- Aortic Dissection
- Notice the wide mediastinum and deviation of the heart to the patient’s left side
What sign is present when a large loop of the intestine gets shoved between the diaphragm and the liver?
- Chilaiditi Sign
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
What is hilar adenopathy?
- Hilar adenopathy is the enlargement of lymph nodes in the hilum.
- It can be caused by conditions such as tuberculosis, sarcoidosis, drug reactions, infections, or cancer.
What is this CXR showing?
- Bilateral Hilar Adenopathy
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).
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
Case Study: 30yo female with 1 week of fever and cough
- Right Middle Lobe Pneumonia
- Left Upper Lobe Pneumonia
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.
What are the two arrows indicating in this CXR?
- Tuberculosis (stretched out cotton ball appearance)
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.
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.
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.
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.
What is the CXR showing?
- Chest wall lesion: arising off the chest wall and not the lung
What is the CXR showing?
- Pleural effusion: Note loss of left hemidiaphragm.
- Fluid drained via thoracentesis
What is the CXR showing?
- Lung Mass
What is the CXR showing?
- Small Pneumothorax: LUL
- Notice that thin white line, that is the lung being shoved down by the pneumothorax
What is the CXR showing?
- Right Middle Lobe Pneumothorax: complete lobar collapse and deep sulcus
What is the CXR showing?
- Metastatic Lung Cancer: Multiple nodules seen
What is the CXR showing?
- RUL pulmonary nodule
What is the CXR showing?
- TB
What is the CXR showing?
- Perihilar mass
- Hodgkin’s disease
What is the CXR showing?
- Widened Mediastinum
- Aortic Dissection
What is the CXR showing?
- Pulmonary artery stenosis with cardiomegaly likely secondary to stenosis.
