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Principles of Anes II > Chest Xrays > Flashcards

Chest Xrays Flashcards

1
Q

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

A

mediastinum, interstitium, & center of lung

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2
Q

A normal CXRAY does not rule out _______

A

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

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3
Q

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

A
  • Physical exam
  • CXRAY
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4
Q

Overexposure will cause a film to be too _____

A

DARK

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5
Q

Underexposure will cause a film to be too ______

A

WHITE

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6
Q

Breast tissue will cause over or underexposure?

A

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

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7
Q

What is the major difference between male & female xray?

A

differences in amount of breast tissue

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8
Q

path of xray beam = ambulatory pts, chest up against the film holder, xray tube is behind the pt

A

PA (posterior-anterior) = beam passes form back & exits in front of chest

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9
Q

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

A

AP (anterior-posterior)

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10
Q

Which xray projection will make the heart look magnified?

A

AP = because heart is farther from the film & xray beam diverges as it goes father from tube

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11
Q

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

A

heart will be magnified on an AP xray

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12
Q

The amount of inspiration is greater if the patient is ______

A

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

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13
Q

When standing, most adults can easily take an inspiration that brings the diaphragmatic domes down to the level of what ribs? When sitting down?

A

10th posterior ribs = standing
8th & 10th ribs = sitting

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14
Q

What would indicated that the chest is hypoinflated?

A

if the domes of the diaphragm are at the 7th posterior ribs (caution in diagnosing basilar PNA or cardiomegaly)

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15
Q

Assess cxray in this order?

A

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

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16
Q

What is a deep sulcus sign?

A

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

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17
Q

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

A

posterior rib fractures

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18
Q

Generally, the heart should be no larger than _______

A

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

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19
Q

A lateral view CXRAY can help locate ______.

A

foreign bodies

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20
Q

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

A

sternum

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21
Q

The spine is usually covered by what structure?

A

mediastinum

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22
Q

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

A

10th or 11th ribs

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23
Q

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

A

liver on the left
spleen on the right

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24
Q

Is the pleura visible on cxray’s?

A

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

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25
Q

If there is a plural effusion, you will be unable to visualize what structure?

A

diaphragm

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26
Q

Displacement of _____ is an important clue to disease

A

mediastinum

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27
Q

Gastric bubble is usually located where?

A

on left side underneath the diaphragm

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28
Q

Which hemidiaphragm is higher and more likely to have air trapping?

A

RIGHT diaphragm

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29
Q

Poor inspiration results in _______

A

hypoinflated lungs, high diaphragms, & crowding of normal lung markings

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30
Q

Which lung has 3 lobes and which one has 2 lobes?

A

right lung = 3 lobes
left lung = 2 lobes

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31
Q

In the right lung, which lobe is typically the smallest and which is the largest?

A

smallest = right middle lobe
largest = right lower lobe

32
Q

The right lower lobe extends between which structures?

A

posteriorly/superiorly = T6
inferiorly to the diaphragm (as low as L2)

33
Q

Posteriorly, the RUL is adjacent to which ribs?

A

RUL = the first 3-5 ribs (adjacent to T6 posteriorly)

34
Q

Anteriorly, the RUL extends inferiorly as far as which rib?

A

RUL = 4th rib (anteriorly)

35
Q

The right lower lobe can extend as far down as?

A

L2, becoming superimposed/overlapping the upper poles of the kidneys

36
Q

The minor fissure separates which 2 lobes?

A

RUL & RML (situated flat line)

37
Q

What represents the visceral pleural surface of lung lobes?

A

interlobar fissures

38
Q

The major fissure separates which lobes?

A

RLL from the other 2 lobe (situated obliquely & extends posteriorly & superiorly to approx the 4th vertebral body

39
Q

What separates the 2 lobes in the left lung?

A

only 1 major fissure (identical to right side, but often slightly more inferior in location

40
Q

Not completely formed and in some individuals, there may be a complete absence on xray film unless fluid present in the pleural space.

A

Interolobar fissures

41
Q

A tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates is known as what sign?

A

air bronchogram sign – visualization of air in the intrapulmonary bronchi

42
Q

Why are the bronchi not visible on cxray?

A

because they are density structures surrounded by alveoli with are also air density

43
Q

What is a silhouette sign?

A

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

44
Q

Consolidation is a _______ process.

A

localized (liquid density – as alveolar space fills with inflammatory exudate – WBCs, bacteria, plasma, debris)

45
Q

Most common cause for lobar consolidation

A

Pneumococcal pneumonia

46
Q

Causes of increased air density?

A
  • localized airway obstruction
  • diffuse airway obstruction
    -emphysema
    -bulla
47
Q

Infiltrates, consolidation, cavitation, masses, pulmonary congestion, & atelectasis are classified as:

A

localized liquid density

48
Q

Term that means “loss of air”

A

Atelectasis

49
Q

Radiologic Criteria for ________:
- a density corresponding to a segment or lobe
- significant signs of loss of volume
- compensatory hyperinflation of normal lungs

A

OBSTRUCTIVE ATELECTASIS

50
Q

Stages of evaluating an abnormality:

A

1 - identify abnormal shadows
2 - anatomically localize lesion
3 - identify pathological process
4 - identify etiology

51
Q

Normally, which lung is larger?

A

RIGHT LUNG

52
Q

Normally, which hemidiaphragm is higher?

A

RIGHT diaphragm

53
Q

What is the normal size of the heart?

A

1/3 of your chest diameter

54
Q

What is the normal size & shape of aorta?

A

aortic root diameter < 2.1 cm

55
Q

Fluid shows up as white or dark?

A

WHITE

56
Q

Increased density/white area shows?

A

something is inflamed

57
Q

Gohn complex is a lesion associated with?

A

Tuberculosis – the lesions consist of calcified focus of infection/calcified lymph nodes

58
Q

Anterior mediastinal mass (wide mediastinum) can cause ______ after paralytics/NMBA given

A

mass may cause airway to obstruct once everything relaxes

59
Q

thin layer of air between heart & lung caused by airway trauma, tracheal or esophageal rupture, blunt trauma to chest…

A

pneumomediastinum

60
Q

What pathology correlates with the “bat wing” sign?

A

pulmonary edema –> intraop causes: large fluid volume resuscitation & negative pressure pulm edema
generally brought on by cardiac hx

61
Q

If one side of lung is completely whited out, what might be the cause of this?

A

patient has had a pneumonectomy

62
Q

What should you think of if a patient has a wide mediastinum?

A

aortic dissection or aneurysm

63
Q

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)

A

Chilaiditi Sign
– Chilaiditi syndrome when abdominal pain present & SOB d/t torsion of the bowel

64
Q
  • small lung fields with a large chest
  • wide mediastinum
  • air visible on each side of heart
    This may indicate:
A

esophageal rupture

65
Q

What would indicate a possible bowel perforation on xray?

A

free air under the diaphragm = serious condition, emergent surgical intervention

66
Q

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.

A

BL hilar adenopathy

67
Q

Tracheal/mediastinal deviation away from the pneumothorax is considered a:

A

tension pneumothorax

68
Q

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)

A

COPD pts

69
Q

5 key distinguishing features on a cxray of a heart failure patient (ABCDE):

A

A - alveolar edema (bat wing sign)
B - Kerley B lines
C - cardiomegaly (> 1/3 chest diameter)
D - dilated vessels
E - pleural effusion

70
Q

Unilateral lymphadenopathy is more closely associated with _____ or ______.

A

TB & malignancy

71
Q

Uniform/Bilateral lymphadenopathy more closely associated with ______ or _____.

A

sarcoidosis or viral infection

72
Q

What does the pneumonic RIPE stand for?

A
  • Rotation
  • Inspiration
  • Projection/penetration (assessed by identifying the outline of the thoracic vertebrae through the heart shadow)
  • Exposure
73
Q

Can use the pneumonic ABCDE for clinical findings:

A

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)

74
Q

Blunting of costophrenic angles could indicate:

A

fluid settled in this space (could be d/t hyperinflated lungs related to emphysema)

75
Q

Which rib should be seen penetrating “through” the diaphragm?

A

7th rib

76
Q

If the 7th rib is above the diaphragm, what could this suggest?

A

hyperinflation of the lungs (COPD, emphysema)

77
Q

The hila contains:

A

pulmonary vessels & lymph nodes
** may become more prominent in disease processes (TB, sarcoidosis, & lymphoma)

Principles of Anes II (3 decks)

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