Chest Xrays Flashcards
Lesions located in what 3 locations are rarely picked up by physical exam?
mediastinum, interstitium, & center of lung
A normal CXRAY does not rule out _______
pulmonary problems (ex: asthmatics can have a normal cxray)
_______ is better for acute illness, while ______ is better for chronic illness.
- Physical exam
- CXRAY
Overexposure will cause a film to be too _____
DARK
Underexposure will cause a film to be too ______
WHITE
Breast tissue will cause over or underexposure?
UNDER-exposure (breast tissue absorbs some of the xray beam)
What is the major difference between male & female xray?
differences in amount of breast tissue
path of xray beam = ambulatory pts, chest up against the film holder, xray tube is behind the pt
PA (posterior-anterior) = beam passes form back & exits in front of chest
If a patient is lying down, what is the standard practice for xray projection?
AP (anterior-posterior)
Which xray projection will make the heart look magnified?
AP = because heart is farther from the film & xray beam diverges as it goes father from tube
The main difference between a PA & AP projection image is ______
heart will be magnified on an AP xray
The amount of inspiration is greater if the patient is ______
upright = allows spreading of the pulm vessels and allows clearer visualization
When standing, most adults can easily take an inspiration that brings the diaphragmatic domes down to the level of what ribs? When sitting down?
10th posterior ribs = standing
8th & 10th ribs = sitting
What would indicated that the chest is hypoinflated?
if the domes of the diaphragm are at the 7th posterior ribs (caution in diagnosing basilar PNA or cardiomegaly)
Assess cxray in this order?
Are There Many Lung Lesions = abdomen, thorax, mediastinum, lungs, bilateral lungs
What is a deep sulcus sign?
pneumothorax or increased intrathoracic pressure will push the diaphragm down and flatten out the domes
Since anterior & posterior ribs show up a little differently, what can be difficult to detect?
posterior rib fractures
Generally, the heart should be no larger than _______
1/3 of your chest diameter (if larger = active CV disease)
A lateral view CXRAY can help locate ______.
foreign bodies
When assessing ribs, start at the ____ & follow them to posterior side
sternum
The spine is usually covered by what structure?
mediastinum
In a normal adult, the diaphragm should overly the posterior aspect of ______
10th or 11th ribs
Diaphragmatic images in the lung bases are dense, radiopaque shadows made primarily by what 2 structures?
liver on the left
spleen on the right
Is the pleura visible on cxray’s?
normal pleura not not visible expect where 2 layers come together to form interlobar fissures
If there is a plural effusion, you will be unable to visualize what structure?
diaphragm
Displacement of _____ is an important clue to disease
mediastinum
Gastric bubble is usually located where?
on left side underneath the diaphragm
Which hemidiaphragm is higher and more likely to have air trapping?
RIGHT diaphragm
Poor inspiration results in _______
hypoinflated lungs, high diaphragms, & crowding of normal lung markings
Which lung has 3 lobes and which one has 2 lobes?
right lung = 3 lobes
left lung = 2 lobes
In the right lung, which lobe is typically the smallest and which is the largest?
smallest = right middle lobe
largest = right lower lobe
The right lower lobe extends between which structures?
posteriorly/superiorly = T6
inferiorly to the diaphragm (as low as L2)
Posteriorly, the RUL is adjacent to which ribs?
RUL = the first 3-5 ribs (adjacent to T6 posteriorly)
Anteriorly, the RUL extends inferiorly as far as which rib?
RUL = 4th rib (anteriorly)
The right lower lobe can extend as far down as?
L2, becoming superimposed/overlapping the upper poles of the kidneys
The minor fissure separates which 2 lobes?
RUL & RML (situated flat line)
What represents the visceral pleural surface of lung lobes?
interlobar fissures
The major fissure separates which lobes?
RLL from the other 2 lobe (situated obliquely & extends posteriorly & superiorly to approx the 4th vertebral body
What separates the 2 lobes in the left lung?
only 1 major fissure (identical to right side, but often slightly more inferior in location
Not completely formed and in some individuals, there may be a complete absence on xray film unless fluid present in the pleural space.
Interolobar fissures
A tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates is known as what sign?
air bronchogram sign – visualization of air in the intrapulmonary bronchi
Why are the bronchi not visible on cxray?
because they are density structures surrounded by alveoli with are also air density
What is a silhouette sign?
Refers to the loss of normal borders between thoracic structures, usually caused by an intrathoracic radiopaque mass that touches the border of the heart or aorta
Consolidation is a _______ process.
localized (liquid density – as alveolar space fills with inflammatory exudate – WBCs, bacteria, plasma, debris)
Most common cause for lobar consolidation
Pneumococcal pneumonia
Causes of increased air density?
- localized airway obstruction
- diffuse airway obstruction
-emphysema
-bulla
Infiltrates, consolidation, cavitation, masses, pulmonary congestion, & atelectasis are classified as:
localized liquid density
Term that means “loss of air”
Atelectasis
Radiologic Criteria for ________:
- a density corresponding to a segment or lobe
- significant signs of loss of volume
- compensatory hyperinflation of normal lungs
OBSTRUCTIVE ATELECTASIS
Stages of evaluating an abnormality:
1 - identify abnormal shadows
2 - anatomically localize lesion
3 - identify pathological process
4 - identify etiology
Normally, which lung is larger?
RIGHT LUNG
Normally, which hemidiaphragm is higher?
RIGHT diaphragm
What is the normal size of the heart?
1/3 of your chest diameter
What is the normal size & shape of aorta?
aortic root diameter < 2.1 cm
Fluid shows up as white or dark?
WHITE
Increased density/white area shows?
something is inflamed
Gohn complex is a lesion associated with?
Tuberculosis – the lesions consist of calcified focus of infection/calcified lymph nodes
Anterior mediastinal mass (wide mediastinum) can cause ______ after paralytics/NMBA given
mass may cause airway to obstruct once everything relaxes
thin layer of air between heart & lung caused by airway trauma, tracheal or esophageal rupture, blunt trauma to chest…
pneumomediastinum
What pathology correlates with the “bat wing” sign?
pulmonary edema –> intraop causes: large fluid volume resuscitation & negative pressure pulm edema
generally brought on by cardiac hx
If one side of lung is completely whited out, what might be the cause of this?
patient has had a pneumonectomy
What should you think of if a patient has a wide mediastinum?
aortic dissection or aneurysm
a rare condition when pain occurs due to transposition/bowel torsion of a loop of large intestines in between the diaphragm & liver
- visible on plain abdominal xray or cxray
- normally this causes no symptoms
- anatomical variant can be sometimes mistaken for a more serious condition (free air under diaphragm = bowel perf)
Chilaiditi Sign
– Chilaiditi syndrome when abdominal pain present & SOB d/t torsion of the bowel
- small lung fields with a large chest
- wide mediastinum
- air visible on each side of heart
This may indicate:
esophageal rupture
What would indicate a possible bowel perforation on xray?
free air under the diaphragm = serious condition, emergent surgical intervention
a bilateral enlargement of the lymph nodes of pulmonary hila.
- It is a radiographic term for the enlargement of mediastinal lymph nodes and is most commonly identified by a chest x-ray.
BL hilar adenopathy
Tracheal/mediastinal deviation away from the pneumothorax is considered a:
tension pneumothorax
Key reliable findings on a CXRAY of these types of pts ______:
- flattened diaphragm d/t hyper expansion of chest & overinflation of lungs (air trapping)
- will visualize more anterior ribs than normal
- may see floating heart sign (can see inferior border of heart)
- bullae (widespread patchy changes)
COPD pts
5 key distinguishing features on a cxray of a heart failure patient (ABCDE):
A - alveolar edema (bat wing sign)
B - Kerley B lines
C - cardiomegaly (> 1/3 chest diameter)
D - dilated vessels
E - pleural effusion
Unilateral lymphadenopathy is more closely associated with _____ or ______.
TB & malignancy
Uniform/Bilateral lymphadenopathy more closely associated with ______ or _____.
sarcoidosis or viral infection
What does the pneumonic RIPE stand for?
- Rotation
- Inspiration
- Projection/penetration (assessed by identifying the outline of the thoracic vertebrae through the heart shadow)
- Exposure
Can use the pneumonic ABCDE for clinical findings:
A - airway (is trachea visible and central, carina, bronchi, hilar region)
B - breathing (lungs, lobes/zones, pleura should not normally be visible)
C - cardiac/circulation (AP exaggerate size of heart, SVC/IVC, aorta, RA, LV, pulm trunk)
D - diaphragm (right higher, acute/sharp costophrenic angles, fundal gas bubble)
E - everything else (ribs and bony structures, soft tissue damage, foreign objects, lines/tubes)
Blunting of costophrenic angles could indicate:
fluid settled in this space (could be d/t hyperinflated lungs related to emphysema)
Which rib should be seen penetrating “through” the diaphragm?
7th rib
If the 7th rib is above the diaphragm, what could this suggest?
hyperinflation of the lungs (COPD, emphysema)
The hila contains:
pulmonary vessels & lymph nodes
** may become more prominent in disease processes (TB, sarcoidosis, & lymphoma)
