Chest Xrays Flashcards by Kayla Dewberry

Lesions located in what 3 locations are rarely picked up by physical exam?

mediastinum, interstitium, & center of lung

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A normal CXRAY does not rule out _______

pulmonary problems (ex: asthmatics can have a normal cxray)

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_______ is better for acute illness, while ______ is better for chronic illness.

Physical exam
CXRAY

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Overexposure will cause a film to be too _____

DARK

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Underexposure will cause a film to be too ______

WHITE

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Breast tissue will cause over or underexposure?

UNDER-exposure (breast tissue absorbs some of the xray beam)

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What is the major difference between male & female xray?

differences in amount of breast tissue

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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

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If a patient is lying down, what is the standard practice for xray projection?

AP (anterior-posterior)

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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

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The main difference between a PA & AP projection image is ______

heart will be magnified on an AP xray

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The amount of inspiration is greater if the patient is ______

upright = allows spreading of the pulm vessels and allows clearer visualization

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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

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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)

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Assess cxray in this order?

Are There Many Lung Lesions = abdomen, thorax, mediastinum, lungs, bilateral lungs

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What is a deep sulcus sign?

pneumothorax or increased intrathoracic pressure will push the diaphragm down and flatten out the domes

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Since anterior & posterior ribs show up a little differently, what can be difficult to detect?

posterior rib fractures

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Generally, the heart should be no larger than _______

1/3 of your chest diameter (if larger = active CV disease)

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A lateral view CXRAY can help locate ______.

foreign bodies

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When assessing ribs, start at the ____ & follow them to posterior side

sternum

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The spine is usually covered by what structure?

mediastinum

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In a normal adult, the diaphragm should overly the posterior aspect of ______

10th or 11th ribs

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Diaphragmatic images in the lung bases are dense, radiopaque shadows made primarily by what 2 structures?

liver on the left
spleen on the right

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Is the pleura visible on cxray’s?

normal pleura not not visible expect where 2 layers come together to form interlobar fissures

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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)