Common CXR Findings, Investigations, Management, Complications Flashcards
Pneumonia findings
Air bronchograms - alveoli filled with pus, bronchioles filled with air
-can see dark bronchiolar outline surrounded by consolidation
No CXR or blood test findings but patient still unwell?
PE!
AXR - differentiating between large and small bowel
Most common causes of BO
How to identify the source of volvuli
LB - -haustra (not transverse) -peripheral SM -valvular convenientes (transverse) -central
Volvulus - cecal (haustra visible, R =>L) and sigmoid (coffee bean, L=>R)
Introduction when presenting
I would like to present the CXR of (patient, DOB) who presented to (location) with (PC).
I would like to confirm when this CXR was taken and ask if there is any previous imaging for comparison
I would like to take you through my findings
Assessing the adequacy of the film
This is an (insert view here) Rotation -Is the spine central between the 2 clavicles? Inspiration -10 post ribs Penetration and exposure -Can you see the spine behind the heart I believe this is an adequate/inadequate film
Assessing airways
Trachea - deviated to which side?
Carina - visible?
Hila - enlarged or displaced?
-L higher than R
Assessing breathing
Compare lung zones for opacification
- consolidation (cloudy) - airways filled
- interstitial (liney)
- nodule/masses
- atlectasis - lobe collapse
Number
Unilateral/bilateral
Diffuse/well demarcated
Location
Assessing cardiac
Cardiac shadow
-aortic knuckle, LV, RA
Cardiac size
-U1/2 of chest width of PA
Assessing diaphragm
2 hemidiaphragms
R higher than L
Costophrenic and cardiophrenic angles visible? - usually very sharp
Assessing everything else
Bones - any fractures? scoliosis?
Gadgets - lines, drains, ECG leads
Pulmonary edema
- possible findings
- presentation and signs
- investigations
- management
Alveolar edema - batwing B lines Cardiomegaly Dilated upper lobe vessels Pleural effusion
Acute SOB
Orthopnea, PND
Most likely from acute HF
- MI
- arrythmia/valve/muscle issue
- HTN
12 and 3 lead ECG - arrythmias, recent MIs Bloods -FBC, U&E, LFT - baseline, infection -TnT - recent MI -BNP - HF -ABG - assess oxygenation and pH -TFT - hyperthyroid related arrythmias Imaging -echo - valve issues
Management - treat underlying cause
Acute - GTN, sit up, O2, loop, fluid balance monitoring, CPAP/BIPAP if needed
Chronic - ACEi/ARB + Bb + diuretics
- add aldosterone
- specialist input - sacubatril valsartan/ivabradine/digoxin/hydralazine
Pneumonia
- possible findings
- presentation and signs
- investigations
- management
Consolidation - may be limited to lobe or whole lung
Presentation
- SOB, productive cough, pleuritic pain
- fever, fatigue
Signs
- dull percussion, increased tactile fremitus
- crackles, decreased breath sounds, wheeze
Investigations CURB65, vital signs -FBC, CRP - confirm infection -U&E - U above 7 -blood, sputum culture, urinary antigen test
Management guided by CURB65 0-1 - home, PO amox 2 - consider hospital, PO amox+claryth 3+ - admit, IV coamox+claryth O2, fluids, analgesia
Complications
- sepsis
- effusion
- ARDS
Pleural effusion
- possible findings
- presentation and signs
- Investigations
- management
Tracheal and mediastinal deviation away from effusion if large
Blunted CPA, fluid line with meniscus
Presentation
SOB, cough, pleuritic
Signs Reduced expansion Stony dull percussion Increased tactile fremitus Reduced breath sounds
Investigations - find cause FBC, CRP - inflammation LFT, U&E - liver, kidney failure RF, CCP - RA ECG, BNP, echo - heart failure Blood, sputum culture CT chest - further assess effusion Pleural tap and analysis
Management - depends on cause
Therapeutic aspiration/drain
If frequent - pleurodesis
Complications
- resp compromise
- empyema, sepsis
- PT
Common causes for pulmonary edema
Heart failure from
- valve problems
- arrythmias
- HTN
Liver failure
Common causes for pleural effusion
-transudate
-exudate
How would you differentiate between transudate and exudate
Transudate
- heart failure
- liver failure, cirrhosis
- PE
Exudate - inflammation, infection, malignancy
- RA, SLE, sarcoid
- pneumonia, TB
- cancer
Pleural tap results Transudate -high pH, glucose -low protein, LDH Exudate -low pH, glucose -high protein, LDH -may have cells
Lights criteria for exudate
- pleural protein : serum protein 1/2+
- pleural LDH : serum LDH 2/3+
- pleural LDH greater than 2/3 of upper limit of normal serum value
