Chest Xrays Flashcards

1
Q

What is Density?

A

Often used interchangeably with opacity, density refers to an area on the X-ray that is brighter than expected. When X-rays are absorbed or blocked by something, such as the thick pus and mucous of a pneumonia, this shows up as a brighter spot on the lungs. Density or opacity are very nonspecific terms, and can represent a variety of lung pathologies.

Hyperechoic

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2
Q

What is Lucency?

A

Lucency is the exact opposite of density: more X-rays pass through less dense regions, such as air-filled lungs, resulting in darker areas on the image. On chest X-ray, lucency can be abnormal when there is too much of it (e.g. emphysema) or when present in an atypical location (e.g. pneumothorax).

Hypoechoic

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3
Q

What are Costophrenic Angles?

A

Where the diaphragm meets the ribs, blunting can be a sign of pleural effusion

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4
Q

Hemidiaphragm

A

Half the diaphragm is elevated: indicated abcess, hematoma, tumor, atelectasis, or rib fracture

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5
Q

Kerley Lines

A

Septal lines = fine thread-like lines produced by fluid or thickening of the septa between the lobules of the lung. Several different types of septal lines have been described1,2,4, but much the most common are those referred to as Kerley B lines.

Kerley B lines = fine horizontal lines approximately 1 cm long, situated perpendicular to the lateral pleural surface. They are most commonly seen just above the costophrenic angles on a frontal CXR

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6
Q

CXR orientations

A

Posterior anterior

Anterior Posterior

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7
Q

Posterior anterior

A
  • Patient standing up
  • beam passes through the patient from the back towards the front
  • From Posterior to Anterior

The Image is viewed as if looking at the patent face-to-face

Considered the “standard”

Think the direction the xray travels through the patient

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8
Q

Anterior Posterior

A
  • Patient unable to standing up (i.e. in bed)
  • beam passes through the patient from the front towards the back
  • From Anterior to Posterior
    The Image is viwed as if looking at the patent face-to-face

Used when a PA CXR is not atainable

Think the direction the xray travels through the patient

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9
Q

PA -vs- AP

A

AP is lower quality and the heart is magnified (being an anterior structure)
So check the orientation before assuming the heart is enlarged!

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10
Q

CXR: taken on inspiraiton or expiration?

A

inspiration

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11
Q

Why is it better to have deeper inspirations on a CXR?

A
  • shows more lung
  • better image results
  • less heart enlargement
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12
Q

What other qualities does a good CXR have?

A

centered image: shows the medial ends of the clavicle eqidistant from the midline

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13
Q

Pneumothorax: typical signs

A

Hyperinflated lung
deviated trachea

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14
Q

Pleural Effusion: typical signs

A

blunt costophrenic angles

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15
Q

What is a gastric bubble?

A

radiolucent rounded area under the left hemidiaphragm

represetns gas in the fundus of the stomach

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16
Q

NG on CXR: Where should it be?

A

midline down the thorax
in the gastric bubble

17
Q

COPD: typical signs

A

Hyperinflated

18
Q

CXR for central line placement verification

A
  • the tip should sit at the junction of the SVC and the RA
19
Q

Risks for misplaced Central line catheter?

A
  • Too High: increased risk of thrombus
  • Too Low: increase risk of arrythmia
20
Q

CXR also used in the verification of?

3

A
  1. Dual Chamber Pacemaker
  2. ICD
  3. Biventricular Pacemaker
21
Q

The ABCDE’s of CXR’s

A
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
22
Q

Airway

ETT verification

A
  • Start at the top
  • Find the midline
  • Identify trachea
  • Follow it down the carina
  • tip of the ETT ≈5cm above carina
  • Width 2/3 of trachea diameter
23
Q

Breathing

BANNNNN

A
  1. Both lungs expanded and similar volumes
  2. Apices, upper, middle, lower zones symmetrical
  3. Normal lateral margins
  4. Normal costophrenic angles
  5. Normal hemidiaphragms
  6. Normal cardiac borders
  7. Normal lung behind the heart
24
Q

Right Lower Lobe Atelectasis

3

A
  • right lower zone opacity
  • indistict right heart border
  • ipsilateral tracheal deviation
25
Q

Left Upper Lobe Atelectasis

3

A
  • ipsilateral tracheal deviation
  • veil-like opacity
  • obscure left upper heart border
26
Q

Right Upper Lobe Atelectasis

2

A
  • ipsilateral tracheal deviation
  • right upper zone opacity
27
Q

Right Lung Atelectasis

2

A
  • diffuse lung opacity
  • ipsilateral tracheal deviation
28
Q

Bilateral Lower Lobe Atelectasis

A

bilateral lower zone opacity

29
Q

Circulation

A

Assess mediastinum:
cardiac size, position, and look for aortic aneurysm

i.e. Cardiac Hypertrophy or an Ascending aortic aneurysm

30
Q

Disability

A

Looking for fractures or metastasis

31
Q

Exposure

A

Looking for everything else:
Subcutaneous emphysema
below the diaphragm
free air (subdiaphragmatic free gas)