Chest xrays Flashcards
Systematic review of chest xrays
DCBA (LAMDA) Documentation Chest (Lungs, Airways, Mediastinum, Diaphragm, And pleura) Bones and soft tissues Abdomen And review Areas
Important factors to assess in “Documentation” when assessing chest xray
Patient details
Radiograph details (projection, side markings, position of patient)
Quality of film
How to assess quality of chest xray film
Rotation
Inspiratory effort
Exposure
How to assess rotation of Chest xray
Spinous process should be central between clavicles
How to assess inflation of chest xray
6-7 ANTERIOR ribs above the diaphragm in adult. 5-6 in child
Diaphragm dome >1cm above costo-cardiac line
How to assess exposure in chest xray (3)
- Thoracic spinal discs should be just visible through the heart (not under exposed)
- Pulmonary vasculature should be visible to lung periphery (not overexposed)
- Air outside patient should be black
Areas to assess in “chest” section of interpretation of chest xray
Lungs Airways Mediastinum Diaphragm And pleura
Assessing “lungs” in chest xray
Compare opacity side to side using diamond shapes between ribs, then up and down.
?Opacities/lucencies
Describe lesions
If diffuse disease note pattern (interstitial v alveolar) and location (upper v middle v lower zone)
Causes of interstitial pattern of diffuse lung disease
Pus (pneumonia) Blood (haemorrhage) Water (interstitial oedema) Fibrosis Malignant cells
Appearance of interstitial disease on chest xray
White linear pattern
Appearance of alveolar disease on chest xray
White, tiny dots which may coalesce
Causes of upper zone fibrosis of lungs (7)
Silicosis Tuberculosis Allergic alveolitis Ankylosing spondylitis Wegener's syndrome Sarcoidosis Coal-worker's lung/pneumoconiosis
Describing lesions on xrays
Seven Ss Site Size Shape Surface (distinct v regular) Substance Single (or multiple) Solid (or cystic)
Areas and what to assess when looking at airways on chest xray
Trachea position - central or slightly to right in normal
Main bronchi - left should be long and narrow, right short and wide
- left hilum (thus bronchus) higher than right
Peripheral bronchi
- not usually visible
- bronchiectasis = dilated, thick walls, “tram tracks”
- Air bronchograms = air filled bronchi surrounded by fluid-filled alveoli
Structures of mediastinum (from 12 o’clock clockwise)
Aortic arch Pulmonary artery Left ventricle Right ventricle - touches diaphragm Right atrium - touches diaphragm Left atrium (only if enlarged) - does not touch diaphragm
Identifying and normal hilar points on CXR
<> shapes, lateral to mediastinum. Left usually slightly higher than right
Causes of abnormal height of hilar points
Elevation or depression:
- collapse of lobe
- fibrotic tethering
Causes of hilar lymphadenopathy (4)
Lymphoma (large, knobbly node)
Tuberculosis
Sarcoidosis (most likely to be bilateral)
Metastatic disease
Definition and causes of flat diaphragm
<1cm “dome”
due to hyperinflation of lungs, usually COPD
Causes of raised hemidiaphragm
Poor patient compliance/positioning
Damage to phrenic nerve (may be associated with Pancoast tumour)
Volume loss (collapsed lobe, fibrous tethering)
Congenital causes (hernia)
Pushed from below (e.g. dilated stomach)
Trauma to diaphragm (e.g. rupture with bowel herniation)
Features to look for when assessing pleura on CXR
Effusions
Pneumothorax
Pleural based lesions
Pleural calcifications
Appearance and cause of hydropneumothorax on CXR
HORIZONTAL meniscus of effusion, due to air AND fluid in pleural space, often occurs post drainage of effusion
Cause of a horizontal meniscus of pleural effusion
hydropneumothorax often post drainage of effusion
Appearance of pleural based lesions
Obtuse angle of pleura to lesion, “ball-under-carpet” sign, v pulmonary mass touching pleura (acute angle, “ball-on-carpet”)
