Clinical Imaging: Thorax

Question 1

Where is the focus of a thoracic X-ray?

Answer 1

T5

Question 2

Why are thoracic x-rays taken in PA aspect?

Answer 2

So the heart does not appear amplified and prevent diagnosis

Question 3

What needs to be observed in a thoracic x-ray?

Answer 3

Is spine in midline?
Is trachea in midline?
Are clavicles on the same level?
Is the x-ray intensity correct?
Was image taken at full inspiration?
9 posterior and 6 anterior ribs visible? (in PA)
Heart - Shape, size, margins sharp
Costophrenic angles

Question 4

What is the ABCDE of thoracic x-rays?

Answer 4

Airways
Bones
Cardiac shadow
Diaphragm
Everything else

Question 5

What are Ultrasounds used for mainly in thoracic imaging?

Answer 5

Cardiac issues - valve function can be observed through oesophageal wall

Question 6

What are CT scans used for?

Answer 6

Mainly PE diagnosis - pulmonary angiogram

Also to look at air pockets/fibrosis in honeycomb lung conditions

Question 7

What are MRI scans used for?

Answer 7

Growths/tumours
Damaged blood vessels
MI
Muscles, tendons + ligaments

Question 8

What are V:Q scans used for?

Answer 8

To identify areas of poor perfusion or ventilation
pale = bad
T99 used

Question 9

What are endoscopies used for?

Answer 9

Viewing the trachea and other respiratory tracts

Question 10

What do the different opacities mean?

Answer 10

Consolidation - alveoli filled with fluid
Interstitial - Supporting tissue affected
Masses - Lesion/tumour
Atelectasis - Collapse of lung

Question 11

What would you expect to find in a respiratory examination for Pneumothorax?

Answer 11

Inspection - Breathless, hyper-inflation on one side, dyspnoea
Palpation - Deviated trachea towards opposite side
Percussion - hollow on affected side
Auscultation - Decreased breath sounds on affected side

Question 12

What would you expect to find in a respiratory examination for consolidation?

Answer 12

Inspection - Increased vibration over affected lobe
Percussion - Dull note over affected area
Ausculation - Bronchial breath sounds over affected lobe

Question 13

What would you expect to find in a respiratory examination for pneumonia?

Answer 13

Inspection - Fever, breathless, Increased resp rate
Percussion - Dull note over affected area
Auscultation - Bronchial breath sounds

Question 14

What would you expect to find in a respiratory examination for COPD?

Answer 14

Inspection - Hyperinflation, decreased expansion (sometimes)
Percussion - Hyper-resonant
Ausculation - Decreased breath sounds, wheezes, Lung bases crackles