CXR Interpretation Flashcards
What do each letter stand for when reading and CXR?
ABCDEFGH
-Assessment of the patient and detailed history
-Bones
-Cardiac silhouette and size
-Diaphragm
-Effusion and Equipment
-Fields of the lungs
-Great vessels and Gastric
-Helium
ASSESSMENT-Three steps to check for good quality image on CXR
- NO excess rotation of patient by checking that the medial ends of spinal processes are equality distanced from the vertebral body
- Good inspiration should show 6-8 anterior ribs or 8-10 posterior ribs
- Proper exposure by making sure you can see fine lung markings
-Don’t forget the need to assess the patient and take detailed history
What are four abnormal (bad) findings on CXR where air shouldn’t be ?
- Pneumothorax
- Pnemomediastinum
- Pneumoperitoneum (air in the peritoneum, sign of perforation)
- Subcutaneous emphysema
BONES-Explain how you look at the bones on CXR
- Look at both clavicles and shoulder joint
- All 12 pair of ribs
- Make sure you look at soft tissue outside of chest for swelling and masses or air
CARDIAC SILHOUETTE AND SIZE-What are the three markers you look at for a cardiac silhouette?
- Atrial appendage
- Right atrium
- Left ventricle
What is normal measure of the heart on CXR?
-Less than 50% of diameter of the rib cage
-Transcardiac diameter should be less than half of transthoracic diameter
DIAPHRAGMS-When does it look normal on CXR?
-Not too flat and fairly symmetric
-Right hemidiaphragm slightly higher than the L (room for heart)
EQUIPMENT-Where should a correctly positioned ET tube be on CXR?
-Middle of the trachea
-The tip of ET tube should be > 2 cm from trachea bifurcation or carina
-Carina is typically located at T4-T5
EFFUSION-What is pleural effusion?
-Pleural effusion is fluid that gets collected at the costophrenic angle
-Meniscus sign: loss of the sharp costophrenic angle on CXR
FIELDS-What does a normal lung field look like on CXR?
-Symmetric, no haziness, no white spots or blotches
-Look for abnormalities: infiltrates or densities, air bronchogram, masses, lobar collapse, Kerley B lines
GREAT VESSELS- What vessels does it include on CXR?
-SVC
-IVC
-Ascending aorta
-Aortic arch
-Pulmonary artery
-Descending aorta
-Deviation of heart blood vessels may indicate congenital or abnormality of the heart
What are some indications of of ordering CXR?
-Shortness of breath
-Chest pain
-Persistent cough
-Hemoptysis
-Fever of unknown origin
-Hypoxemia
-Abnormal respiratory exam
-Chest trauma
-Suspicion of foreign body
-Confirm of device placement
What are the three fissures and between what lung lobes?
-Horizontal fissure (major fissure): RUL and RML
-Oblique fissure (minor fissure): RML and RLL
-Oblique fissures (major fissure): LUL and LLL
What are three views of CXR?
- PA Posterior anterior view “routine”
- AP Anteroposterior view portable
- Lateral view, not done portable
What is the adjacent structure of RUL?
Ascending aorta
What is the adjacent structure of RLL?
Right diaphragm
What is the adjacent structure of LUL?
Aortic knob
What is the adjacent structure of LLL?
Left diaphragm and descending aorta
When would you perform a lateral decubitus view ?
-To measure amount of pleural effusion, 1 ml of thickness of pleural fluid in the lateral decubitus is approx. 20 ml of pleural fluid
What is hilum?
-A landmark where the bronchi, arteries, veins and nerves enter and exit the lung
What is bilateral hilar lymphadenopathy ?
-Enlargements of the lymph nodes in the hilar regions of the lungs
-Can indicate infection, TB, cancer, sarcoidosis
What are the clinical/physical and CXR findings of Asthma?
-Clinical/physical findings: wheezing, chest tightness, cough, shortness of breath, worsens at night, triggers to allergens or exercise
-CXR: generally normal in asthma but in severe asthma attack may show hyperinflation, increased lung markings and some atelectasis
What does air bronchogram look on CXR?
What does it indicate?
-Air filled bronchi within affected lung area, these air filled bronchi appear as dark branching structures on CXR
-Indicates consolidation, pulmonary edema, non-obstructive atelectasis, pulmonary infarction
What is the clinical/physical and CXR of findings of COPD?
-Clinical/physical findings: chronic cough, shortness of breath, sputum production, wheezing, barrel chest, history of smoking or exposure
-CXR: hyper inflated lungs, flat diaphragm, increased retrosternal space
-Pulmonary functions tests
What is the clinical/physical and CXR findings of pneumonia and consolidation?
-Clinical/physical findings: sudden onset of fever, productive cough with purulent sputum, dyspnea, chest pain, crackles, increase tactile remits, dullness on percussion over affected areas
-CXR: change of density due to tissue more permeable inviting fluid there
-Consider aspiration pneumonia for older or stroke patients
What is the clinical/physical and CXR findings of Atelectasis?
-Clinical/physical findings: gradual or sudden dyspnea, decrease breath sounds, may be associated with post operative or tumour or mucus plug, dullness to percussion over affected areas
-CXR: opacification or collapse of a portion of lung, affected lung may appear denser, mediastinal structure may shift in severe atelectasis, elevation of hemidiaphragm on contralateral side, silhouette sign with air bronchogram
What is the clinical/physical and CXR findings of CHF/Pulmonary edema?
-Clinical/physical findings: orthopnea, paroxysmal nocturnal dyspnea, cough with pink frothy sputum, crackles, increased JVP, possible peripheral edema
-CXR: increased vascular markings, cephalization of vessels (engorged blood vessels in upper lung fields due to increase in pulmonary vessels), Kerley B lines (linear opacities, fluid in connective tissue of lung), alveolar edema leading to bat’s wing, increase cardiothoracic ratio
What are three stages of heart failure?
- Redistribution
- Interstitial edema
- Alveolar edema
What is the clinical/physical and CXR findings of pneumothorax?
-Clinical/physical findings: sudden onset of sharp chest pain, dyspnea, decrease breath sound to one side, trauma or spontaneous, hyper resonance to percussion, possible tracheal deviation in tension pneumothorax
-CXR: dark area at the lung periphery, collapse lung, mediastinum shift towards the unaffected side
What is the clinical/physical and CXR findings of subcutaneous emphysema?
-Clinical/physical findings: presence of air in soft tissue, palpable sensation of crepitus, clinical sign of pneumothorax, air leak, COPD
-CXR: dark area (air) outside of the lung