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2.3.4. Respiratory System > CXR > Flashcards

CXR Flashcards

1
Q

What is an x-ray?

A

Electromagnetic wave of high energy and very short wavelength – able to pass through many materials

X-rays being absorbed to diff degrees

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2
Q

What x-ray dose is given?

A

0.02mSv (milli severt)

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3
Q

What are the projections we can do with a CXR?

A

AP = anterior posterior (heart closer to the front, will appear magnified), more diff to interpret, performed in unwell pts, cant put x-ray machine behind them

PA = posterior anterior

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4
Q

A good x-ray needs to include what?

A

1st rib

Lateral margin of ribs

Costophrenic angle

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5
Q

How is rotation assessed on a CXR?

A

Alignment of spinous and clavicles

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6
Q

How is lung volume assessed on a CXR?

A

Expect to see anterior ribs 5-7 at the diaphragm

Pt takes deep breath and holds

Flattened hemidiaphragm

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7
Q

Where is the costophrenic angle/recess seen?

A

Angle in the lower corner of the diaphragm

Important when looking for effusions – is the recess filled?

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8
Q

When are flat diaphragms seen?

A

Emphysema

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9
Q

How do we know we have an adequate levels of penetration?

A

Vertebrae just visible through heart

Complete L hemidiaphragm is visible

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10
Q

What is an artifact on the x-ray?

A

External/iatrogenic material which obstructs

Buttons

Hair

Surgical/vascular lines

Pacemaker

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11
Q

What anatomy should be seen on a normal CXR?

A

Trachea

Hilum of lungs (R/L hilar point)

Lungs

Diaphragm

Heart

Aortic knuckle

Ribs

Scapulae

Breasts

Bowel gas

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12
Q

How is the lung divided in a CXR?

A

Upper zone

Middle zone

Lower zone

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13
Q

Sometimes a darkened area is seen below the L diaphragm, what is this?

A

Stomach bubble

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14
Q

Describe the cardiac contours

A

L contour = LV

R contour = RA

Aortic knuckle

Pts with lymphoma have lymph node in aorto-pulmonary window

Para-tracheal stripe should be thin, if not suggestive of pleural abnormality

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15
Q

What approach is taken to evaluate a CXR?

A

Pt demographics

Projection

Adequacy

Airway = trachea, bronchi, hilar point

Breathing = lungs, pleural spaces, lung interfaces

Circulation = aortic arch, pulmonary vessels, R heart border, L heart border

Diaphragm/Dem bones = free has, nodules, fracture, dislocation, mass

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16
Q

What is CXR adequacy and how is it assessed?

A

R = rotation

I = inspiration

P = penetration

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17
Q

Pathology in the apices could be what?

A

Pneumothorax

18
Q

Pathology in the thoracic inlet could be what?

A

Mass

19
Q

Pathology in the paratracheal stripe could be what?

A

Mass

Lymph nodes

20
Q

Pathology in the AP window could be what?

A

Lymph nodes

21
Q

Pathology in the hila could be what?

A

Mass

Collapse

22
Q

Pathology behind the heart could be what?

A

Mass

23
Q

Pathology in below the diaphragm could be what?

A

Pneumoperitoneum – pt must be erect to visualise

Mass

24
Q

Pathology in the bones could be what?

A

Fracture

Mass

Missing

25
Q

What is the silhouette sign?

A

Adjacent structure of diff density form a crisp silhouette

Loss of this contour can locate pathology

26
Q

If the R heart border is lost what does this indicate?

A

Pathology in the R middle lobe

27
Q

If the L heart border is lost what does this indicate?

A

Pathology in the lingula

28
Q

If the paratracheal strip is lost what does this indicate?

A

Mediastinal disease

29
Q

If the chest wall silhouette is lost what does this indicate?

A

Lung disease

Pleural disease

Rib pathology

30
Q

If the aortic knuckle is lost what does this indicate?

A

Anterior mediastinum pathology

Upper lobe disease

31
Q

If the diaphragm silhouette is lost what does this indicate?

A

Lower lobe pathology

32
Q

If the horizontal fissure cant be seen what does this indicate?

A

Pathology in the anterior segment of the upper lobe

33
Q

What causes mediastinal shift?

A

Push = increased volume/pressure

Pull = decreased vol/pressure

34
Q

What descriptive terms can be used to describe a CXR?

A

Size = large, small varied

Side = R/L, unilateral/bilateral

Number = single, multiple

Distribution = focal, widespread

Position = anterior, posterior, lung zones

Shape = round, crescentic

Edge = smooth, irregular, spiculated

Pattern = nodular, reticular

Density = air, fat, soft-tissue, calcium, metal

35
Q

Describe a pleural effusion and how it appears on a CXR

A

Collection of fluid in the pleural space

Appearance = uniform white area, loss of costophrenic angle, hemidiaphragm obscured, meniscus at upper border

Pt needs to the erect for fluid to collect at the bases – beware supine CXR

36
Q

Describe a pneumothorax and how it appears on CXR

A

Air trapped in pleural space

Appearance = visible pleural edge, lung markings not visible beyond this edge

Primary = spontaneous

Secondary = as a result of underlying lung disease

37
Q

What is a hydropneumothorax?

A

Fluid and gas in the pleural cavity

38
Q

Describe consolidation and how it appears on CXR

A

Filling of small airway/alveoli with pus, blood, fluid, cells.

Dense opacification

39
Q

Describe cavitation and how it appears on CXR?

A

Area of central lucency = cavitation

Commonly seen in TB, lung infarcts

40
Q

Describe what a space occupying lesion is and how it appears on CXR

A

Nodule = <3cm

Mass = >3cm

Causes = malignant, benign, inflam, congenital

Appearance = white shadow can be localised or disseminated

41
Q

Describe lung/lobar collapse and how it appears on CXR

A

Volume loss within the lung

Causes = 1) luminal: aspiration, mucous plug, iatrogenic. 2) mural: brochogenic carcinoma. 3) extrinsic: compression by mass

Appearance = elevation of ipsilateral hemidiaphragm, crowding of ipsilateral ribs (lung vol declines), shift of mediastinum towards side of atelectasis, crowding of pulmonary vessels, second heart border

42
Q

What is cardiac index and how is it calculated?

A

Ratio of heart size to horizontal thoracic size

Normal = <50%

MUST be a PA image

2.3.4. Respiratory System (19 decks)

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