CXR Flashcards
What are the broad steps of assessing an X-ray?
Confirm patient details (Name, DOB, unique ID number)
Assess quality of image (RIPE)
Structured interpretation of CXR (ABCDE)
What does RIPE stand for?
Rotation: spinous process should be betwen medial ends of both the clavicles
Inspiration: should see at least 7 anterior or 9 posterior ribs
Projection: AP or PA?
Exposure: Vert should be visible behind the heart and left hemidiaphragm should be visibile to the edge of the spine
What considerations needed for AP CXR? [1]
Heart size is magnified in AP view - can’t tell if that is pathological or due to XR
Indiviudally what do the ABCDE stand for?
Airway
Breathing
Circulation
Diaphragm
Everything else
When investigating abnormalites in airways on a CXR, what would you look out for? [3]
Tracheal deviation
Obstruction/inhaled foreign bodies
Hilum abnormalities
What pathology would be indicated by trachea being pushed to R/L?
Trachea push indicates pneumothorax due to increase in volume forcing the trachea in opposite direction
Tension pneumothorax is a medical emergency
What pathology would be indicated by trachea being pulled to R/L?
Trachea push indicates pneumothorax due to decrease in volume (and pressure) forcing the trachea in opposite direction
E..g Lobar collapse;
Lobectomy
Inhaled foreign objects are more likely to be lodged into which bronchus? [1]
Right bronchus
What pathology would be indicated by englarged hilum?
Asymmetry/enlargement raises suspicion of pathology e.g:
* Lymphadenopathy and tumours
* Pulmonary venous hypertension
* Pulmonary arterial hypertension
What are common CXR presentations for breathing dificulties? [6]
Common presentations
Consolidation
Lung mass
Pulmonary oedema
Pneumothorax
Pleural effusion
How does consolidation appear on a CXR?
What is consolidation commonly caused by? [3]
Consolidation: opacification
Mostly due to pneumonoia BUT also due to malignancy / PE
(would repeat CXR to see if DD)
What can cause a lung mass on CXR? [4]
- Lung cancer
- Abscess
- Infection
- Granuloma
What does pulmonary oedema look like on CXR? What markers do you look for?
Pulmonary oedema:
- Fluid in alveolar and interstitial space
- Kerley B linees
- Batwing opacities
What does pleural effusion look like on CXR? What markers do you look for?
Fluid in the pleural space:
- Blunting of the costrophrenic and cardiophrenic angles
What is pneumothorax caused by?
What does it look like on a CXR?
Pneumothorax: Air within the pleural space
/ a collapsed lung
What 3 things are you looking for when assessing cardiac pathology in CXR? [3]
- Heart size: Normal cardiothoracic ratio ≤ 0.5
- Heart borders
- Mediastinal contours
What can cardiomegaly be caused by? [4]
Commonly due to heart failure with a long list of possible causes…
* Hypertension
* Valvular heart disease
* Cardiomyopathy
* Myocardial infarction
What causes indistinguishable heart borders on a CXR?
Pathology of overlying tissue (e.g infection)
Which diaphragm is more raised in a CXR?
Right > left
What 4 things are you looking for when assessing diaphragm pathology in CXR? [4]
- Hemidiaphragm levels- R>L
- Shape
- Costophrenic and cardiophrenic angles
- Air beneath diaphragm: pneumoperitoneum
Pneumoperitoneum is
commonly caused by? [1]
Pneumoperitoneum (air under diaphragm) is
commonly caused by perforation of the bowel
How can you ID hyperinflated lungs on a CXR? [3]
- Marked hyperinflation
- Flattened diaphragm
- Can see 10 anterior ribs- much more than normal
What would hyperinflated lungs most commonly be caused bY?
Seen most commonly in COPD
What could cause diaphragm elevation? [1]
phrenic nerve palsy [1]
What should you look for in everything else on CXR? [6]
- Bones
- Soft tissues
- NG tubes
- Pacemakers
- Lines
- Artificial heart valves
What does this CXR indicate?
- Pneumoperitoneum
- Pneumothorax
- Pulmonary oedema
- Consolidation
- Pleural effusion
What does this CXR indicate?
- Pneumoperitoneum
- Pneumothorax
- Pulmonary oedema
- Consolidation
- Pleural effusion
What does this CXR indicate?
- Pneumoperitoneum
- Pneumothorax
- Pulmonary oedema
- Consolidation
- Pleural effusion
What does this CXR indicate?
- Pneumoperitoneum
- Pneumothorax
- Pulmonary oedema
- Consolidation
Pleural effusion: blunted costophrenic edges
What does this CXR indicate?
- Pneumoperitoneum
- Pneumothorax
- Pulmonary oedema
- Consolidation
- Pleural effusion
What does this CXR indicate?
- Pneumoperitoneum
- Pneumothorax
- Pulmonary oedema
- Consolidation
- Pleural effusion
What does this CXR indicate?
- Pneumoperitoneum
- Pneumothorax
- Pulmonary oedema
- Consolidation
- Pleural effusion
What does this CXR indicate?
- Pneumoperitoneum : Gas is beneath both hemidiaphragms, more prominent on the right, in keeping with a pneumoperitoneum. Sternotomy wires
- Pneumothorax
- Pulmonary oedema
- Consolidation
- Pleural effusion
What does this CXR indicate?
- Pneumoperitoneum
- Pneumothorax
- Pulmonary oedema
- Consolidation
- Pleural effusion
What does this CXR indicate?
Pneumoperitoneum
Pneumothorax
Pulmonary oedema
Consolidation
Pleural effusion
In the context of acute pulmonary oedema, alveolar oedema radiates symmetrically from the hilar regions in a ‘bat’s wing’ distribution of airspace shadowing
Note the enlarged heart (CTR 60%) and the cardiac surgery artifact – sternal wires and metallic heart valve
Blunting of the costophrenic angles is due to pleural effusions – interstitial fluid has leaked into the pleural cavity
Which of the following is NOT a sign of acute pulmonary oedema?
Bat wing appearance
Kerley B lines
Upper Lobe division
Costrophrenic blunting
Which of the following is NOT a sign of acute pulmonary oedema?
Bat wing appearance
Kerley B lines
Upper Lobe division
Costrophrenic blunting
Which of the following is NOT a sign of acute pulmonary oedema?
Bat wing appearance
Kerley B lines
Upper Lobe division
Costrophrenic blunting
Which of the following is NOT a sign of acute pulmonary oedema?
Bat wing appearance
Kerley B lines
Upper Lobe division
Costrophrenic blunting
What pathology is depicted in this CXR? [1]
right sided pneumonia [1]
What pathology is indicated in this CXR? [1]
Right sided pneumothorax? [1]
What pathology the most likely cause of this CXR? [1]
Hyperinflation: most comonly caused by COPD
Name the CXR finding in this CXR [1]
diaphragm elevation
What has happened here?
Pneumothorax
Mass growth
Haemothorax
Malignant effusion
What has happened here?
Pneumothorax
Mass growth
Haemothorax
Malignant effusion
Which pathology is shown here?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
Pleural effusion
Pulmonary oedema
Cardiomegaly
Normal CXR
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
There is bilateral patchy opacification of the lung fields, which would be in keeping with pulmonary oedema.
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
There is a moderate right-sided pleural effusion. There is a meniscus and opacification clearly visible into the midzone of the right lung.
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
