CXR Flashcards
What is the disadvantage of an AP CXR?
It makes the heart look larger
Approaching a CXR
- Patient details and projection
- AP vs PA
- Technical factors
- Rotation
- Inspiration
- Exposure/penetration
- Lines and metalwork
- ABCDE
- Airway
- Breathing
- Circulation
- Diaphragm
- Everything else
- Review areas
- Lung apices
- Costophrnic angels
- Behind the heart
- Behind and below the diaphragm
- Soft tissue and bone
How to assess rotation?
Spinous processes lie in the middle of the medial heads of the clavicles.
How to assess inspiration?
Adequate inspiration:
5-7 anterior ribs
10 posterior ribs
How to assess exposure?
Can see vertebrae and intervertebral disc space
Four steps to assessing NG tube position
- Midline
- Crosses the carina or left main bronchus
- Tip lies below the left hemi diaphragm
- Tip lies 10cm distal to the GOJ
Endotracheal tube correct position
5 +/- 2cm above carina
Loss of lung volume features
- Opacity
- Tracheal shift towards side of lung volume loss
- Hemidiaphragm shift
Features which you would see in lung collapse and not in consolidation:
- Well demarcated
- Dense
- Homogenous
- No air bronchograms
Causes of lobar collapse
- Luminal
- Foreign body
- Mucouus plugging
- Malignancy
- Mural
- Malignancy
- Extrinsic
- Malignancy
Causes of loss of lung volume
- Collapse
- Pneumonectomy/lobectomy
How to recognise cardiomegaly
>0.5 thoracic width
Normal
Correctly placed NG tube
Incorrectly placed NG tube
Unilateral pleural effusion
Right pneumonectomy (there are clips)
Without clips it would be right lung collapse
Right lower lobe collapse
Cardiomegaly
Heart failure
Alveolar oedema
Cardiomegaly (although AP so can’t assess properly)
Dilated upper lobe vessels
Pleuarl effusion
Left sided pneumothorax
Pneumoperitoneum
Heart failure
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Right lower lobectomy
Bilateral pleural effusion
Right upper lobe consolidation
Right lower lobe consolidation
Normal
ET tube correctly placed
Tension pneumothorax
