CXR Flashcards
What is shown on the following cxr?
Pleural effusion (w loss of cardiac silhouette sign)
What is shown on the following cxr?
Infiltrate in R middle lobe (w loss of cardiac silhouette sign)
What is shown on the following cxr?
Normal bowel gas in LUQ
What lung lobes are shown?
Right upper lobes
What lung lobes are shown?
Right lower lobes
What lung lobes are shown?
Right middle lobes
What lung lobes are shown?
Left upper lobes
What lung segments are shown?
Superior lingular segments of LUL
What lung segments are shown?
Inferior lingular segments of LUL
What lung lobes are shown?
Left lower lobes
Pleural markings should extend all the way to where?
Chest wall (more prominent lower and centrally within the lung fields)
What makes up the left and right heart contour?
Left heart contour = left lateral border of left ventricle and left atrium
Right heart contour = right lateral border of right atrium
What is shown in the following cxr?
Aortic knob
(represents left lateral edge of the aorta as it arches backwards over the left main bronchus and pulmonary vessels)
The following cxr is consistent with what condition?
COPD
The following cxr is consistent with what condition?
Bullous emphysema and fibrosis (large bullae)
What does the following cxr show?
Pneumothorax
What does the following cxr show?
Left upper pneumothorax
What does the following cxr show?
Left tension pneumothorax
What does the following cxr show?
Subcutaneous emphysema
(air leak from lung into subcutaneous tissue, dark lines following muscle and tissue planes)
What does the following cxr show?
Pneumoperitoneum
(radiolucent area noted below the diaphragm across the abdomen)
What does the following cxr show?
Right pleural effusion
What does the following cxr show?
RUL pneumonia with minor fissure outline
What does the following cxr show?
RLL infiltrate
What does the following cxr show?
Kerley B lines (suggestive of CHF)
What does the following cxr show?
Air bronchograms
(seen with pneumonia or CHF but NOT effusion)
What does the following cxr show?
Butterfly or bat-wing sign (CHF)
What does the following cxr show?
Bilateral lower lobe atelectasis
What does the following cxr show?
Pulmonary malignancy
What does the following cxr show?
Pulmonary metastases
What does the following cxr show?
Pulmonary abscess
What does the following cxr show?
Mediastinal mass consistent with lymphoma
What does the following cxr show?
Mediastinal mass
What does the following cxr show?
Thoracic aortic aneurysm
What does the following cxr show?
Anterior mediastinal mass (thymoma)
What does the following cxr show?
Chest trauma- rib fractures
What is the following cxr concerning for?
Child abuse (chest trauma/ acute clavicle fracture/ healed rib fractures)
What does the following cxr show?
NG tube
Is an AP or PA view preferred and why?
PA, projection of the mass of the heart is more accurate (heart and mediastinum project a larger “shadow” with AP)
What does a silhouette sign indicated?
Where materials of the same radiographic density meet there is no border
What does a border, inerface, or line indicate?
Meeting point of materials of different radiographic densities
Marked differences in densities lead to what kind of borders?
Sharp
Minor differences in densities lead to what kind of borders?
Fuzzy
Visualiziation of 8-10 ribs posteriorly and 5-7 ribs anteriorly indicates what?
Good inspiration
In a non-rotated pt, the clavicles will to be located where w/ respect to the spinous processes?
Equidistant
If CXR is captured while pt is sitting, what bone structure will you be able to visualize?
Scapula
What side of the diaphragm will naturally sit higher? Why?
Right side b/c of liver
What should you be concerned about if you notice blunting of the diagphragm?
Scarring or fluid
What should you check for below the diaphragm?
Gas pattern and free air
Paralysis from nerve damage, trauma, or loss of lung volume on 1 side due to atelectasis pr pneumothorax will be evident via what on cxr?
Unilateral high diaphragm
What might a low, flat diaphrgam suggest?
COPD
What is the ABCDEFGHI systematic approach?
A= assessment of quality/ airway | B = bones | C= cardiac | D= diaphragm | E= effusions/ extrathoracid soft tissue | F= fields, fissues, foreign bodies | G= great vessels/ gastric bubble | H= hila and mediastinum | I= impression
Which hilum is typically higher, left or right?
Left
What makes up the hila?
Main pulmonary arteries and major bronchi
What are the potential spaces around the mediastinum? (3)
In front of the heart (anterior mediastinum), being the heart (posterior mediastinum), above the heart (superior mediastinum)
A cardio throracic ratio > 1:2 (50%) is normal or abnormal?
Abnormal
Under what conditions might underlying structures such as the lung markings be obscured?
Thick soft tissue due to obesity
On a CXR what shouyld you look for to indicate adequate penetration?
Able to see disk spaces, but not bony details of spine
On CXR of COPD pt, what would you expect to see? (3)
hyperlucency, flattened diaphragms, hyperinflation/”barrel chest” (increased rib sapce and rib angle)
What is defined as a shift of intrathoracic structures and tracheal deviation?
Tension pneumothorax
A tall pt in his 20s presents w acute dyspnea and chest pain. You suspect pneumothorax due to what?
Primary cause (bleb)
An older pt presents with acute dyspnea and chest pain. You suspect pneumothorax due to what?
Secondary cause (underlying lung disease)
Why is an expiratory CXR used in pt’s with a suspected small pneumothorax?
B/c volume of the PTX will remain the same, but lung volume shrinks, making the PTX more obvious
What additional imaging study can you order for definitive dx of PTX?
CT
What is the gold standard for DX penumomediastinum?
CT
Leakage of air into mediastinum primarily seen in the young adult male population that presents with acute chest pain that can radiate anterior, posterior and/or superior to the jaw is concerning for what?
Pneumomediastinum
If pneumomediastinum is noted on cxr, what condition is it important to r/o?
Esophageal perforation
Crackly, “rice-crispy” sound (like popping bubble wrap) with palpation is concerning for what?
Subcutaneous emphysema (air from pneumo-mediastinum that dissected up to the neck)
The following history/ signs/ sxs are associated w what? Recent abd/ pelvic surgery, trauma, PUD/ duodenal ulcer, malignancy (bowel cancer), IBD, and acute onset abd pain that may radiate to shoulders will likely show what on cxr?
Subdiaphragmatic air
What is the most common cause of pneumoperitoneum?
Disruption of the wall of a hollow viscus
On LLD CXR for pt w/ suspected pleural effusion, what would you expect to see?
Layering of pleural fluid
What is defined as pulmonary parenchymal process due to presence of blood, pus, protein, interstitial fluid within the lung tissue (not pleural space)?
Infiltrate (infectious process)
Fluid in the pleural space is what?
Pleural effusion
Air in the pleural space is what?
Pneumothorax
Fluid in the lungs is what?
Infiltrate
Can infiltrate and effusion occur together?
Yes
Kerley-B lines and “butteryfly”/”bat wing” patten on CXR is suggestive of what disease process?
CHF (fluid filled alveoli)
What is defined as collapse or incomplete expansion of pulmonary parenchyma?
Atelectasis
Increased lung density, displacement of interlobal fissures, crowding of pulmonary vessels, shift of mobile structures of the thorax, overinflatioin of the unaffected ipsilateral lobes or the contralateral lung, +/- air bronchograms and elevated hemidiaphragm are all signs of what?
Atelectasis
Structural shifts (fissues, trachea, heart, diaphragm elevation) are suggestive of infiltrate or atelectasis?
Atelectasis
What typically appear as peripheral, rounded nodules of variable size, scattered throughout both lungs?
Pulmonary metastases
What is the most common etiology of atelectasis?
Bronchial obstruction (neoplasm, mucus plugging, FB aspiration)
Breast, head and neck SCC, colorectal, renal cell, and uterine CAs are the most common primary cancers to result in what?
Pulmonary metastases
What are the characteristics of malignant lesions? (4)
Large nodule size (>15mm), irregular, homogeneous density, spiculated margins
What are the characteristics of a benign lesion? (4)
Smooth, well-defined margins, homogeneous density, calficifcations
Traumatic aortic injury, vascular anomalies, pulmonary masses, mediastinal lymphadenopathy, enlarged pulmonary arteries, mediastinal mass, or thymus can all be causes of what?
Mediastinal widening
