Chest Xray

Question 1

what dz causes airpsace dz

Answer 1

pneumonia 
pulmonary alveolar edema 
hemorrhage
aspiration 
near-drowning

Question 2

What dz cause interstitial dz

Answer 2

pulmonary interstitial edema
interstitial pneumonia
scleroderma
sarcoid

Question 3

describe characteristics of airspace dz

• opacites?
• margins?
• signs that can be present too

Answer 3

• fluffy, cloudlike or hazy opacities
• Margins: indistinct–difficult to identify a clear demarcation b/w dz and normal lung
• confluent opacities: blend into one another with imperceptible margins

*localized as in segmental or lobar pneumonia
OR
*distributed thorughought the lung–pulmonary edema

• air bronchograms
• silhouette sign

Question 4

air bronchograms are assoc with which type of dz

Answer 4

airspace

**pneumonia

Question 5

define air bronchograms

Answer 5

visibility of air in bronchus bc of surrounding airspace dz

• *bronchi normally not visible bc walls are very thin and contain air and surrounded by air
• when somehting other than air fills the space around the bronchus—fluid or soft tissue–inside of the bronchus becomes visible—looks like black branching tubular structures

Question 6

what can fill in airspaces besides air?

Answer 6

• fluid: pulm edema
• blood
• gastric juices (aspiration)
• inflammatory exudate (pnma)
• water (near drownings)

Question 7

Silhouette sign can be seen with?

Answer 7

airspace dz

Question 8

patchy, segmental or lobar airspace dz

Answer 8

pneumonia

Question 9

bilateral, perihilar airspace dz

Answer 9

pulmonary alveolar edeam

Question 10

bat-wing sign or angel wing confirmation

Answer 10

pulm alveolar edema (airspace)

Question 11

do you see air bronchograms with pulm alveolar edema?

Answer 11

no because the fluids fill airspacs and the bronchi

Question 12

for bedridden patients, where does aspiration usully occur

Answer 12

lower lobes or posterior portions of upper lobes

Question 13

reasons why trachea would not be midline

Answer 13

1. deviated towards dz side
   - -lung collapse aka atelectasis
   - -pneumonectomy or lobectomy
2. deviated away from side of dz
   - -tension pneumo
   - -massive effusion

Question 14

if u cannot see the right heart border– where is the opacification?

Answer 14

RML

Question 15

if u cannot see the left heart border– where is the opacification?

Answer 15

Lingula of LUL

Question 16

if u cannot see the right hemidiaphgram border– where is the opacification?

Answer 16

RLL

Question 17

if u cannot see the left hemidiaphgram border– where is the opacification?

Answer 17

LLL

Question 18

MCC of kerley B lines

Answer 18

interstitial pulmonary edema (like from HF or PHTN)

Question 19

where do u see kerley B lines

Answer 19

periphery of the lungs—extend inwards from pleural surface
*become visible when thickened with fluid tumor or fibrosis

Question 20

how do Kerley B lines (aka??) develop

Answer 20

septal lines caused by engorgement of pulmonary interlobular septal lymphatics by fluid, tumor or fibrosis

Question 21

define cardiomegaly on CXR

Answer 21

when the width of heart is more than half the total width of thorax

Question 22

which view can u measure heart

Answer 22

PA

NOT AP or supine

Question 23

which hemi-dia is usually higher?

Answer 23

right is higher

BC of the heart’s position

Question 24

lungs interstitium consists of?

Answer 24

CT 
lymphatics 
BVs 
bronchi 
***these surround and support airspaces

Question 25

characteristics of interstitial lung dz

Answer 25

1. Reticular Interstitial dz—-network of lines
2. Nodular–assortment of dots
3. Reticulonodular–both lines and dots

**packets or particles of interstitial dz are separated from each other by visible areas of normal aerated lung–inhomogenous

**margins are sharper

Question 26

homogenous vs inhomogenous (what goes with which type of lung dz)

Answer 26

homogenous–airspace/alveolar

inhomogenous–interstitial/infiltrative

Question 27

list the predominantly reticular interstitial lung dz

Answer 27

pulmonary interstitial edema

Question 28

list the four radiologic findings for interstitial pulmonary edema

Answer 28

1. fluid in fissures (major and minor)
2. peribronchial cuffing (fluid in the walls of bronchioles)
3. pleural effusions
4. Kerley B lines

Question 29

how many posterior ribs visible for a good inspiration XRay

Answer 29

10

Question 30

in hospitizd pt, how many post ribs makes adequate inspiration

Answer 30

8-9

Question 31

what is a downfall to severe roation

Answer 31

pulmonary arteries appear larger on the side father from the film

Question 32

in a ___ film, the heart is closer to the film and appears less magnified

Answer 32

PA

Question 33

in an ____ film, the heart is farther from the film and is more magnified

Answer 33

AP

Question 34

list causes that would lack full inspiration on CXR

Answer 34

• Obesity
• Acute abdomen or recent surgery (voluntary restriction)
• CHF
• Chronic restrictive lung disease
• Scarring and loss of compliance in the lung tissues
• Referred to as
• “shallow lung volumes” and “poor inspiratory film”
• Good inspiratory effort
• Low lung volumes

Question 35

why would we get an expiratory film (5)

Answer 35

• Suspected foreign body in a bronchus
• Suspected pneumothorax.
• If the patient cannot cooperate
• Toddler or a sedated patient
• Decubitus views

Question 36

what is dressler’s syndrome

Answer 36

also called Post pericardiotomy/Postmyocardial infarction syndrome

+pleural effusion with compressive atelectasis
+patient is usally s/p recent cardiac surgery with a pacemaker placed in