Chest Xrays Flashcards
Radiopaque (pack)
Dense substances appear white or light
Ex. Bone
What color do underexposed images appear?
More white
Radiolucent
Low density substances appear dark/ black
Ex. air filled lung tissue
What do overexposed images look like?
Black
Is it okay to delay treatment while images are being produced and/or interpreted?
False
When should you take an xray?
Max inhalation or expiration?
Inhalation: so you can see as much as possible
What is the most common view of xrays?
PA view
In a PA view is the xray infront or behind the patient?
Behind, and chest is against plate
How many feet away does the patient stand from the machine in a PA ?
6 ft
What type of imaging do we use commonly for ICU patients?
AP view
How is the xray positioned for AP view?
Film plate is placed under patients back and xray is placed above
What two views is the heart closer to the film?
Lateral view and PA view
What special CXR view do we use to identify if pleural fluid is present?
Lateral decubitus
“Air rises, water falls”
What special CXR view do we use to look closer at the middle lobe or the top (apical) regions of the lungs?
Apical Lordotic
When do you take a CXR on exhalation?
To identify a small pnemo
What are the two systemic approach acronym?
PIE
ABCDEF
What does PIE stand for in regards to CXR interpretation?
Position, Inspiration, Exposure
What does ABCDEF stand for in regards to xray interpretation?
Airway
Bones
Cardiac and Costophrenic
Diaphragm and Devices
Edges and Extrathorasic
Fields
If you cannot see the heart silhouette the infiltrates are located where?
In the middle lobe
If you can see the heart silhouette where are the infiltrates located?
In the lower lobe
What would you see on a CXR for an air bronchogram ?
Visible bronchi when surrounded by consolidated alveoli
Two types of ATX?
Compressive and Obstructive
If my patient has a pleural effusion, PNX, hemothorax, or any space occupying lesion that caused ATX what type is it?
Compressive (because those things all apply pressure to the lung)
If my patient has a tumor, aspirated foreign body, or mucus plugging that caused ATX what type is it?
Obstructive (because its obstructing the ventilation of the airway)
What are signs of hyperinflation? and who do we see this in?
Increased AP diameter
Large retrosternal space
Flattening of diaphragm
Seen in CFCBABE’s
Where are most ILD diseases contained too?
Interstitium
What would you see on a CXR that indicated sarcoidosis?
large hilar and paratracheal lymph nodes
What would you see on a CXR that indicated asbestosis?
calcified pleural or diaphragmatic nodules
What would you see on a CXR that indicated end stage pulmonary fibrosis?
honey comb size cavities
Signs of CHF on CXR?
Engorgement of upper lobe vessels
Increased cardiothoracic ratio (>0.5)
Kerley B lines
What are two signs of pulmonary edema?
Bat wings or butterfly pattern
What are the two types of pulmonary edema?
Cardiogenic and Noncardiogenic
What would you see on a CXR for cardiogenic pulmonary edema?
Heart englargement, increased vasularity, and kerly B lines
Seen in CHF patients
What would you see on a CXR for noncardiogenic pulmonary edema?
normal heart size, normal vasculatity, and no kerly B lines
Diffuse patchy infilitrates
Seen in ARDS, inhalation of toxic agents, chlorine, ammonia, and allergic reaction to drugs
How much fluid does the pleural space contain normally on each side?
appox. 30 mL
How much fluid must be present before it can be seen on a CXR?
100 mL
Blunting of the costophrenic angle
Small meniscus sign
Partially obscured and elevated diaphragm
Are all signs of what pleural effusion on a CXR?
Small volume pleural effusion
Complete or nearly complete whiteout
Complete obscuring of the hemidiaphragm
Are signs of what type of pleural effusion on a CXR?
Large volume effusion
What is a pleural effusion an imbalance of?
formation of pleural fluid and rate of absorption by lymphatic system
What is a deep sulcus sign?
radiolucency below the costophrenic angle seen in the presence of a pneumothorax
What kind of pressure builds in a tension pneumothorax?
Typically negative, but becomes positive
What is the most common cause of lung consolidation?
Bacterial pneumonia
Do the lungs collapse with lung consolidation?
No
What are signs of consolidation on a CXR?
Minimal loss of volume
Lobar or segmental distribution
Homogenous density
Air bronchogram is the airway leading to the consolidated area is
open
Ground glass appearance on a CXR indicates what?
ARDS
Where should the central venous pressure be placed? (CVP)
Right or left subclavian vein or jugular vein
Where should the pulmonary artery catheter be placed?
tip at the right midlung near the hilum
accidental rupture of balloon may rupture artery
Where should NG feeding tubes be placed?
at the stomach or small bowel
When do we use a CT?
Occupational lung diseases
PNA
Bronchiectasis
COPD
What is fluoroscopy?
Projects a continuous xray beam through the patient allowing visualization of live action
When do we use Fluoroscopy?
Cardiac catheterization, bronchs, etc
