CXR Flashcards
What is normal on CXR
Air pocket on L side above diaphragm
What causes a cavitating lesion [6]
Abscess TB SCC PE RA Fungal
What causes lobar collapse [3]
Cancer
Asthma
Foreign body
What are signs of lobar collapse
Tracheal deviation to affected side
Mediastinal shift to affected side
Elevation of hemidiaphragm
Other areas of lung hyper lucent
What metastasis to lung
Breast Colorectal Renal Bladder Prostate
Where is NG tube positioned
Below diaphragm in stomach If pH <5.5 = safe to feed If >5.5 = check position with a CXR Should go down straight If wrong = pneumonia
What causes mediastinal widening [6]
Patient position: rotation Goitre Lymphoma Thymus tumour Teratoma Thoracic AA
What does pulmonary oedema look like [7]
Intersitital edema Bat wing Upper lobe diversion due to increased flow to superior parts of lung Kerley A / B lines Pleural effusion Cardiomegaly if cardiac cause Fluid in horizontal fissure
What causes a white lung shadow [6]
Consolidation Pleural effusion Pneumonectomy Collapse Oedema Lesion e.g. tumour
If there is a white out what do you do
Assess trachea position
What does trachea going towards white shadow suggest [3]
Pneumonectomy
Complete collapse
Pulmonary hypoplasia
What does central trachea suggest [3]
Consolidation
Oedema
Mesothelioma
What does trachea going away suggest
Pleural effusion
Diaphragmatic hernia
Large mass
Pneumothorax
Loss of lung markings due to collapsed lung
White rim around
Hilar lymphadenopathy
Patchy round the lung
What causes hilar lymphadenopathy [7]
Infection Malignancy Silicosis Sarcoid Pulmonary HTN Pulmonary artery aneurysm Bronchogenic cyst
Abnormalities deviating trachea away from affected site [3]
Pneumothorax
Pleural effusion
Large mass
Abnormalities deviating trachea towards affected side [4]
Marked atelectasis/collapsed lung
Lobectomy/pneumonectomy
Pleural fibrosis
Pulmonary fibrosis
What is the steeple sign on CXR when looking at the trachea
Subglottic airway narrowing
Dx: croup, tracheal stenosis
Malignancies causing hilar lymphadenopathy [3]
Infections causing hilar lymphadenopathy [4]
Primary lung cancer
Lymphoma
Mets disease
Infections:
- TB
- EBV
- Histoplasmosis
- Tularemia
Causes of elevated hemidiaphragm [5]
§ Diminished lung volume eg in atelectasis § Phrenic nerve paralysis § Eventration of diaphragm § Subphrenic abscess Hepatomegaly or splenomegaly
Pneumothorax CXR [4]
How to determine size [3]
Trachea deviates away
Lung markings stop at periphery
Rim of air around lung
Deep sulcus sign
Size of pneumothorax based on thickness of rim of air around lung at level of hilum
- <2cm-small
- > 2cm - large
Hyperinflation on CXR
- Characteristics [3]
- Causes [2]
§ Number of ribs seen § Flattening of diaphragm § Diffusely increased lucency § Causes § COPD Asthma
Pulmonary edema:
- Cardiogenic pulmonary edema
- Non-cardiogenic pulmonary edema [2]
Features of CXR that can differentiate between the two [5]
Acute lung injury
ARDS
CXR
- Cardiac size
- Pattern of opacities
- Air bronchograms
- Peribronchial cuffing
- Kerley B lines
Kerley A [4]
Diagonal unbranching lines
Extending from hilum
2-6cm
Represent channels between peripheral and central lymphatics
Kerley B lines [4]
Faint thin horizontal lines
At lung periphery, usually at bases
1-2cm
Represent interlobular septa
What are air bronchograms?
What is Peribronchial cuffing?
Bronchi arent usually visible on x-ray so opacification of alveoli next to a bronchi > dark air-filled bronchi being seen
Interstitial edema can accumulate around bronchi
Causes bronchial wall thickening
Alveolar opacities vs interstitial opacities
Alveolar opacity caused by cardiac pulmonary edema
Interstitial opacities - interstitial lung disease e.g. IPF, CTD, Sarcoidosis
- Don’t have air bronchograms
