Chest xray Flashcards
Give a systematic approach to interpreting a CXR
- Name, DOB, CHI, date of CXR
- Technically adequate? projection, inspiration, rotation, penetration
- Cardiothoracic ratio
- Contours
- Lung zones and lobes
- Bones
- Diaphragm
- Lines and tubes
- Pleura
How does the heart appear in an AP projection
Larger than it actually is
Which projection is better, AP or PA?
PA
What is a normal cardiothoracic ratio?
1:2
What contours should you look for
trachea, aortic knuckle, LV, RA, hemidiaphragms, stomach bubble
Which is higher, the left or right pulmonary hilum
Left is higher
What causes lobar collapse/atelectasis
bronchial obstruction e.g. tumour
poor ventilation of the lung causes it to collapse and deflate like a balloon
What is a typical feature of lobar collapse
Loss of lung volume on affected side
hyperdensity
fissure has been pulled out of place
What is consolidation and how does it differ from atelectasis
When the alveoli are filled with dense material such as inflammatory fluid, blood, pus
it not a ventilatory problem like atelectasis
What is a characteristic sign of consolidation
Air bronchogram - black lines indicating larger airways are spared of consolidation
What features are characteristic of pleural effusion
costophrenic blunting
meniscus sign
fluid goes to the area of most dependence ie bottom of thorax
What are findings of a pneumothorax
black spaces with ABSENT lung markings
air moves to areas of least dependence ie apices
Signs of heart failure
ABCDE
Alveolar oedema - batwings sign B - Kerley B lines (septal lines) Cardiomegaly Dilatation of upper lobe vessels E - pleural effusion
At what level is the carina found
T5-7
Where should an ET tube be found
5cm above the carina
What is the correct placement of NG tube
passes the carina and descends in the midline
should be subdiaphragmatic
the tip should be visualised and be seen at least 10cm, away from the GOJ
What are the consequences of a misplaced NG tube
aspiration pneumonia if misplaced in the lung tissue
What are CVC and where should they be placed
Central venous catheters detect central venous pressure
should be found on right 2nd intercostal space
What does PICC stand for
Peripherally inserted central catheter
What size is a miliary nodule
<2mm
Size of pulmonary micronodule
2-7mm
Size of pulmonary nodule
7-30mm
Size of pulmonary mass
> 3cm/30mm
common locations for lung tumour to metastasise to
more lung, brain, liver, adrenal glands, bone
What is different about liver metastases on contrast enhanced scans
They appear hypoattenuated because they generate their own blood supply
What imaging is needed for suspected pneumoperitoneum
Erect CXR
Supine AXR
on a CXR, what is the difference between pulmonary collapse and consolidation
collapse - loss of volume, hyperdense, fissure out of place
consolidation - hyperdense, preserved lung volume, air bronchograms
why do you see air bronchograms in lung consolidation
bronchi are filled with air
lung tissue is filled with consolidation and inflammation
