CXR Interpretation - Exam 1 Flashcards
on an Xray, what color is dense tissue? What color is air?
dense (bone) is lighter and air is black
Which view (AP/PA) will the heart look larger? Which view is standard?
heart will look larger in AP view
PA view is standard
What are the standard 2 CXR views?
PA and lateral
What is the correct pt positioning for PA and lateral?
PA - performed with the chest against the detector
Lateral - performed with the left side of the body against the detector
When would you order a lateral decubitus chest xray?
pleural effusions vs consolidation
loculated effusions vs free pleural fluid
evaluate for small pneumothorax
What is the positioning for a pleural effusion? pneuomothorax?
pleural effusions - the side of interest should be down (because fluid will draw down away from the sterum so you can see it around the lateral chest wall)
pneumothorax - the side of interest should be up (because air rises and want to see the around NOT around the sterum)
expiratory view, foreign body with air trapping, what side will appear larger?
affected side will appear larger
What is a lordotic view? Why would you order one?
shoot xray at an upward angle.
evaluation of the lung apices that appear obscured on the PA/AP
When would you order an AP CXR? How is it performed?
reserved for patients who cannot stand erect
performed supine or sitting
How can you tell if an xray is PA or AP?
What is the way to remember how we know the CXR image is of good quality?
PAIR
Penetration
Artifact
Inclusion
Rotation
_______ is the degree to which X-rays have passed through the body. How can you tell?
penetration
Vertebrae are slightly visible behind the heart
Left hemidiaphragm should be visible to the edge of the spine
Is this image under or over pentrated?
under penetrated
Is this image over or under penetrated?
over penetrated
What are 3 radiologic artifacts?
Abnormal rotation of patient
Incomplete inspiration
Incorrect penetration
What are 6 patient artifacts?
Poor cooperation of patient
Movement
Clothing, hair, jewelry
Metal or implants in the body
Skin folds
Adipose or breast tissue
What are 4 things to look for when making comments about an image’s inclusion?
5-7 Anterior Ribs : angled (PA)
10 Posterior Ribs: horizontal (PA)
Costophrenic Angles
Lateral edges of Ribs
How do you determine if an image has rotation present?
Spinous processes of the thoracic vertebrae should be at the midline of the posterior chest
The medial ends of the clavicles should form a vertical line and should be equidistant from the midline
What is the pneumonic to interpreting a chest xray?
A-B-C-D-EF-G-H
Airway: Trachae/Bronchi
Bones
Circulation: Heart size/mediastinum
Diaphragm
Extra Features:
Gastric air/ free air
Hilium
In a good chest xray: Trachea should be _____, straight and branches off to R/L mainstem bronchus at the ______
mideline
carina
How many lobes does the left lung have? Right? What are the fissures called for each?
Draw and label the right lung from a lateral view with the different lobes and fissures clearly labeled.
In a good quality CXR, how many anterior ribs should be seen? posterior?
anterior: 5-7
posterior: 10
cardiothoracic ratio (CTR) should only be assessed confidently if a ____ view was acquired. What is considered abnormal?
PA
Cardiac width > 50% of the total thoracic width is abnormal
mediastinal contours and compartments include the borders of the ______ as well as the spaces in front and behind the _____. Borders should be _____
heart and great vessels
heart
sharp
Label this entire picture
What are the sub divisions of the mediastinum relative to the heart?
A transverse plane passing through the sternal angle to the junction of vertebrae T4/T5 separates superior from inferior mediastinum Or think of superior mediastinum as above Heart. Space in front of heart is anterior mediastinum. Space behind heart is posterior mediastinum. Region of heart is the middle mediastinum.
What does a normal diaphragm look like? Is it normal for one side to be higher than the other? Why?
rounded, domed structure with a crisp white edge contrasted against the adjacent dark lung
often the right diaphragm will be slightly higher than the left because the liver sits on the right side
Point out the right and left hemidiaphragm.
Blue= right: will be seen up to the anterior chest wall
red= left: blends with the heart
What forms the costophrenic angle? What is a normal measurement in degrees? What is abnormal?
Formed by the hemidiaphragms and the chest wall
CPA should be < 30°
Costophrenic “blunting” is used to refer to CPA > 30°
What angle is represented by the red stars?
cardiophrenic angle
_____ should not be visualized unless pathology is present. Lung markings should reach the ____
Pleura
thoracic wall
Give some examples of normal extra feature findings
Breast - symmetry
Nipple markings
Pseudo-blunting of CPA’s due to rotation or large pendulous breast
What does free air under the diaphragm indicate?
indicative of perforated intestinal
organ
black arrow is free air
red arrow is gastric air bubble
hilar structures contains major ______ and ______. ____ hilum is often higher than the _____
bronchi and pulmonary vessels
left hilum is often higher than the right
What is a consolidation?
a solidification of lung tissue with liquid or solid material that normally contains gas (air)
What is hyperexpansion? What will also be seen along side it?
an excessive amount of gas trapped in the alveoli of the lungs over a long period of time
lungs appear elongated and diaphragm is flattened
What is the pathophys behind hyperexpansion? What is the MC cause?
loss of elasticity preventing expulsion of air
COPD
What is the MC etiology of costophrenic angle blunting?
pleural effusion
What is pulmonary edema? What is the MC cause?
a collection of fluid in the alveoli of the lungs preventing adequate air exchange
Cardiogenic pulmonary edema
Name some additional causes of pulmonary edema.
Acute respiratory distress syndrome (ARDS): chest wall trauma, sepsis, pneumonias
Neurogenic pulmonary edema (NPE): head trauma, seizure, Subarachnoid hemorrhage (SAH)
Adverse drug reaction
Pulmonary embolism
Viral infections
Lung injury
What is air bronchogram?
a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates
aka can see the tree like/root like image on the chest xray
What is happening during a pneumothorax? Name some causes
occurs when air leaks into the pleural space
idiopathic
chest wall trauma
lung disease
ruptured blebs (cyst like things inside lungs)
mechanical ventilation
What is pleural effusion? What are some common etiologies?
Excess fluid builds in the pleural space
CHF, kidney failure, infection, malignancy, PE
What are septal “Kerley” lines?
Lung markings seen on imaging that represent thickened interlobular septa in the pulmonary interstitium
Describe Kerley A lines. B
Kerley A lines - 2-6 cm oblique lines that course toward the hila
Kerley B lines - 1-2 cm horizontal seen in the periphery of the lungs (perpendicular to the pleural surface)
Describe Kerley C lines. D.
Kerley C lines - same as Kerley B but coursing ventrally
Kerley D lines - same as Kerley B but seen on the lateral CXR in the retrosternal air space
What are some causes of Kerley lines?
pulmonary edema, malignant lymphoma, viral/mycoplasmal pneumonia, pulmonary fibrosis, pneumoconiosis, sarcoidosis
What am I?
mediastinal mass
What am I?
left pneumothorax
What am I?
right consolidation
What am I?
pulmonary edema with flat diaphragm
What am I? What position?
poor quality image, possible mediastinal widening with blunted costophrenic angles
AP view because clavicles are horizontal
What am I?
Kerley lines with possible right lower lobe consolidation, some flattened diaphragm, COPD barrel chest
