CHEST XRAYS Flashcards
what is the approach to CXrays? (6)
- projection
- patient details
- technical quality - RIP
- obvious abnormalities
- Systemic review of the film - ABCDE approach
- summary
What is the standard projection?
PA
When is an AP projection film carried out?
sick patients
How do you know if a film is in PA? (2)
- arms are raised up
2. scapulae are pulled out almost fully out of lung fields
How can you tell if a film is in AP? (2)
- humerus is down
2. scapulae in lung fields
How do you check technical quality of the film? (3)
- look for lung apices
- look for lateral sides of the ribcage
- look for both costophrenic angles on the film
In assessing technical quality of the film what do you look for in Rotation?
- the heads/medial ends of the clavicles are equidistant from the spinous processes of the vertebral bodies
In assessing technical quality of the film what do you look for in Inspiration? (2)
- PA films are held on deep inspiration
2. Count ribs - 6 anterior ribs and 10 posterior ribs
In assessing technical quality of the film what do you look for in Penetration?
- you can the vertebral bodies behind the heart
What do you look for in obvious abnormalities and how do you describe them? (5)
- which lung
- which zone
- size
- shape
- density/texture
What do you look for in airways?
- tracheal deviation
What do you look for in breathing? (3)
- start at apices down to costophrenic angles
- inspect apices, hila, mediastinum and costophrenic angles
- edge of lung fields - pneumothoraces
In breathing - when you are looking at the hila which hila should be higher and when is this an exception, and what densities should they be in comparison to each other?
- left hilum should NOT be lower than the right
- exception - dextrocardia
- both same density
What do you loo for in circulation/cardio?
- cardiomegaly
- heart borders
- cardiophrenic angles
- behind the heart
How do you know if there is cardiomegaly?
the heart shadow is more than half the width of the chest cavity on PA film
What do you look for in regards to the heart borders? (3)
- if the left or right heart borders are not clearly visible
- consolidation
- collapse
What do you look for behind the heart?
- any lung masses
What you do you look for in diaphragm? (4)
- both hemi-diaphragms are visible and NOT flattened
- costophrenic angles
- right hemi-diaphragms
- air under the diaphragm
- left = gastric bubble
What do you look for in the costrophrenic angles? (2)
- whether they are clearly demarcated
2. do they have fluid?
Which hemi-diaphragm should be higher and why?
- right - due to liver
What do you look for in exposure? (1 (3))
- bones
- fractures
- rib space narrowing = COLLAPSE
- gas in soft tissues = black areas = SURGICAL EMPHYSEMA
What do you say in a summary?
- summarise
2. provisional diagnosis and differentials
What to look for in review? (8)
- apices
- hila
- behind the heart
- costophrenic angles
5, around pleura
- edge of lung fields - pnemothoraces
- pleural thickening
- under diaphraghm
What is seen in a pneumonia? (4)
- dense or patchy consolidation - usually unilateral
- air bronchograms
- lower zones - may be difficult to distinguish from effusions
- need to know which lobes touch which heart and diaphragmatic borders - tells you which lobe is affected
Which lung lobes touch the diaphragm?
- left and right lower lobes
Which lung lobe touches the right heart border?
- right middle lobe
Which lung lobe touches the left heart border?
- lingula
what should you refer to the lobes as?
zones
What is seen in a pleural effusion?
- loss of costophrenic angles
- homogenous opacification
- fluid level - meniscus
Are transudate effusions bilateral or unilateral?
- more likely to be bilateral
Are exudate effusions likely to bilateral or unilateral?
- unilateral
What criteria is used to assess pleural effusion fluid?
- light’s criteria
How do you assess heart failure? (5)
- A - alveolar (interstitial) shadowing
- B - Kerley B lines
- C - cardiomegaly
- cardiothoracic ratio is greater than 50% on PA film - D - prominent upper lobe vasculature
- due to upper lobe blood diversion - E - effusions and fluid in horizonatl fissures
What are Kerley B lines?
- little white horizontal lines in the lateral lower edges
What would be seen in pneumothorax? (3)
- loss of lung markings in the peripheral lung field
- a discrete lung edge
- tracheal deviation in tension pneumothorax
how would you identify a lobar collapse?
- loss of volume
- narrowing of the space between ribs compared to the other side
- look for tracheal and mediastinal drift
What is veil sign in lobar collapse? (2)
- happens in the left upper lobe
- whole lung field looks like it is covered by a veil
What is the sail sign in lobar collapse? (2)
- happens in the left lower lobe
- sharp line like the edge of a sail at the same angle as the left heart border
What can be seen in the RUL of the lung is lobar collapse? (3)
- hazy
- raised horizontal fissure
- abnormality well demarcated by the fissure
What happens to the right middle lobe in lobar collapse? (2)
- loss of right heart border
- can be difficult to differentiate from consolidation
What happens to the right lower lobe in lobar collapse? (2)
- complete loss of diaphragmatic border
- hard to differentiate from effusion
How do you describe demarcated lesions (single or multiple)?
- round opacities
