Chest Xrays Flashcards
11 steps to analyzing chest xrays
- Is it PA or AP?
- Is it over or underexposed?
- Is it satisfactory inspiration
- Is the patient rotated?
- Is the heart enlarged?
- Are both domes of diaphragms clearly seen and well defined? (silhouette signs)
- What is the position of the mediastinum?
- Landmarks in mediastinum
- Are hila and fissures normal?
- are bones normal? (look for fractures)
- Clinical reasoning
Is PA or AP standard for chest xrays?
PA
When would an AP xray be used
done on bedside
How will an overexposed xray appear
totally black
What is satisfactory inspiration
9 ribs posteriorly
6 rips anteriorly above the dome of the left diaphragm
How do you determine if the Pt is rotated? How do you determine which side they are rotated to?
Draw vertical line from T1-4 and measure line to medial end of clavicle (rotated towards side w/ larger space
How do you determine if the heart is enlarged
look at A/B ratio: A= width of heart B= width of inside of lung cavity; should not be over 50%
What are 3 silhouette signs? What do they indicate
costophrenic angles, costocardiac angles, and Dome of diaphragm
- indicates what lobe the pathology is in
How do you determine if there is a tracheal shift?
What is the shifting rule?
should be in line with the T1-4 vertebrae
SHIFTING RULE= shift away from increased volume, shift towards decreased volume
What is the desired mediastinum position
2:1 R:L
what are 2 landmarks in the mediastinum you would look for?
look for pulmonary artery, look at cobweb appearance of blood vessels
What are normal hila?
Are seeing fissures normal?
- want hila to be the same height or within 1-2 levels of each other, close to bronchi bifurcation
- fissures are seen only in about 50% of x-rays
Signs of an atelectasis on a chest xray
- will usually result in shifting of the landmarks
- silhouette signs
- lobar collapse can be white because no air is in it, full of secretions
Signs of consolidation or pleural effusion on a chest xray
- lung fields will be opaque
- usually will have signs of atelectasis with consolidation as well
- pleural effusion may have blunting of the costophrenic angle
- Sometimes mediastinal shifts to opposite side
Signs of pneumothorax on a chest xray
- dark area because of air
- absence of lung markings
- Fine line showing outline of the collapsed lung
