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Pulmonary: Clin Med II B > CXR interpretations > Flashcards

CXR interpretations Flashcards

1
Q

what type of tissue does not allow as much radiation to pass through resulting a lighter reflected image and vise versa

A

deep tissue
This also results in absorption of the radiation by the anatomical structure

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2
Q

structures the x-ray beam hits first will look like how ?

A

magnified in relation to those which are closer tot he detector

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3
Q

indications for CXR

A
  1. Persistent cough
  2. SOB
  3. Wheezing
  4. Chest pain/injury
  5. Fever (unexplained)
  6. Monitoring of disease resolution or progression
  7. Lymphadenopathy (unexplained)
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4
Q

what must be asked/done for female pts before obtaining a CXR

A

LMP/pregnancy test

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5
Q

CXR views

A
  1. Posterior-Anterior (PA)
  2. Lateral
  3. Lateral Decubitus
  4. Expiratory
    5.Lordotic
  5. Anterior-Posterior (AP)
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6
Q

what CXR views are standard since they provide the most accurate reproduction of the anatomical structures

A

PA and lateral

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7
Q

this CXR view is performed with the chest against the detector

A

PA

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8
Q

this CXR view is performed with the left side of the body against the detector

A

lateral

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9
Q

what is this CXR view

A

PA

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10
Q

what is this CXR view

A

lateral

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11
Q

indications to order lateral decubitus CXR

A
  1. pleural effusions vs consolidation
  2. loculated effusions vs free pleural fluid
  3. evaluate for small pneumothorax
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12
Q

how do you position a pt for CXR with pleural effusions

A

the side of interest should be down

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13
Q

how do you position a pt for CXR with pneumothorax

A

the side of interest should be up

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14
Q

what is the expiratory view CXR for?

A

FB with air trapping
affected side will appear larger
Small pneumothoraces may be more pronounced

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15
Q

what is the Lordotic CXR view for?

A

evaluation of the lung apices that appear obscured on the PA/AP

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16
Q

what is the AP CXR for?

A

performed supine or sitting
reserved for patients who cannot stand erect

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17
Q

differences you’ll see between PA vs AP CXRs

A
  1. PA
    - clavicle in lung field
    - ribs slanted
    - scapula outward of lung
    - heart shadow is smaller
  2. AP
    - clavicle at top of lung
    - ribs horizontal
    - scapula in lung field
    - heart shadow is larger
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18
Q

what is the systemic approach to interpreting a CXR

A
  1. Image quality: Penetration, Artifact, Inclusion, Rotation (PAIR)
  2. CXR Interpretation
    - Air: Central airways, lung parenchyma
    - Bones: Ribs, clavicles, spine, shoulder, scapulae
    - Circulation: Heart, blood vessels and mediastinum
    - Diaphragm and pleura
    - Extra features: medical interventions, soft tissues
    - Gastric Bubble/Free air
    - Hilum
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19
Q

The degree to which X-rays have passed through the body

A

Penetration

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20
Q

what makes an Adequately penetrated image

A
  1. Vertebrae are slightly visible behind the heart
  2. Left hemidiaphragm should be visible to the edge of the spine
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21
Q

what are radiologic artifacts

A

Abnormal rotation of patient
Incomplete inspiration
Incorrect penetration

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22
Q

what are Patient Artifacts

A

Poor cooperation of patient
Movement
Clothing, hair, jewelry
Metal or implants in the body
Skin folds
Adipose or breast tissue

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23
Q

what does a rotation CXR look like?

A
  1. Spinous processes of the thoracic vertebrae should be at the midline of the posterior chest
  2. The medial ends of the clavicles should form a vertical line and should be equidistant from the midline
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23
Q

what would you see in an inclusion PA view CXR

A
  1. 5-7 Anterior Ribs - angled (PA)
  2. 10 Posterior Ribs - horizontal (PA)
  3. Costophrenic Angles
  4. Lateral edges of Ribs
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24
Q

what does the trachea/bronchi look like in CXR

A
  1. Visible in most good quality x-rays
  2. Contains air so lower density than surrounding structures resulting in a darker gray structure
  3. Trachea should be midline, straight and branches off to R/L mainstem bronchus at the carina
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25
Q

how to inspect the Lung Zones

A
  1. should be in a right-to-left pattern moving from the apex to the lung bases
  2. Always compare R/L and zone to zone
  3. Note any asymmetries and determine which is normal
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26
Q

which lung has 2 lobes (Upper and Lower) and which one has 3 (upper, middle, lower)

A

left
right

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27
Q

pleural covering separating the lower lobe from the upper lobe(s) in both lungs

A

Oblique (Major) Fissure

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28
Q

separates the R middle from upper lobe

A

Horizontal Fissure

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29
Q

what bones are visible on CXR

A
  1. Clavicles
  2. Ribs - pathology affects adequacy of inspiration
    - anterior and posterior ribs are visualized
  3. Scapulae
  4. Proximal humerus
  5. Vertebra
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30
Q

what diseases are you looking for in bones with CXR

A

fracture
arthritic changes
dislocation
metastatic pathology

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31
Q

How many ribs are seen anteriorly and posteriorly in the lung field ?

A

10 posterior
9 anterior

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32
Q

what part of the circulation is determined in relation to the total thoracic width

A

heart size

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33
Q

what is the Cardiothoracic ratio (CTR)

A

Cardiac Width : Thoracic width

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34
Q

CTR should only be assessed confidently if ?

A

“PA” view was acquired

35
Q

what is an abnormal cardiac width

A

> 50% of total thoracic width

36
Q

includes the borders of the heart and great vessels, as well as the spaces in front and behind the heart

A

contours

37
Q

how should the contours of the mediastinum look like

A

borders should be sharp

38
Q

what helps knowing these divisions allow us to make a more narrow differential diagnosis when there is a mediastinal mass

A

compartments/spaces of mediastinum
there is no tissue plane separating these compartments

39
Q

what is the space in thoracic cavity between lungs?
what are its boundaries?

A

mediastinum

Posteriorly: thoracic spine
Anteriorly: sternum and costal cartilages
Laterally: mediastinal pleura
Superiorly: thoracic inlet
Inferiorly: diaphragm

40
Q

Separates the thoracic cavity from the abdominal cavity

A

diaphragm

41
Q

how should the diaphragm look like on a CXR

A

rounded, domed structure with a crisp white edge contrasted against the adjacent dark lung
often the R diaphragm will be slightly higher than L

42
Q

what structures are almost superimposed on a lateral view.

A

The left and right hemidiaphragms

43
Q

which hemidiaphragm blends with the heart and becomes indistinct

A

left

44
Q

which hemidiaphragm can e seen up to the anterior chest wall

A

right

45
Q

what should you compare when looking at diaphragm abnormalities

A

lateral and PA CXR

46
Q

Formed by the hemidiaphragms and the chest wall
PA view should show sharp angles
what structures are being described

A

Costophrenic Recesses & Angles

47
Q

what angle should the CPA be?

A

<30 degrees

48
Q

what is Costophrenic “blunting”

A

CPA >30 degrees

49
Q

Not visualized unless pathology is present
Lung markings should reach the thoracic wall
what is describing

A

diaphragm: pleural spaces

50
Q

what extra features could be seen in CXR

A
  1. medical equipment
  2. soft tissues
    - Breast - symmetry
    - Nipple markings
    - Pseudo-blunting of CPA’s due to rotation or large pendulous breast
51
Q

Free air under diaphragm is indicative of?

A

perforated intestinal organ

52
Q

Contains major bronchi and pulmonary vessels
what is this structure?

A

hilum
Hilar structures should be of same size, density, and position

53
Q

which hilum is often higher than the other due to the anatomy

A

left hilum > right

54
Q

a solidification of lung tissue with liquid or solid material that normally contains gas (air)

A

Consolidation

55
Q

causes of Consolidation

A
  1. atelectasis
  2. infection/exudate
  3. pulmonary edema
  4. inflammatory
  5. exudate
  6. inhaled water
  7. blood
  8. tumor
56
Q

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 this condition

A

Hyperexpansion

57
Q

cause of Hyperexpansion

A

loss of elasticity preventing expulsion of air
MC cause COPD

58
Q

causes of Costophrenic Angle Blunting

A
  1. pleural effusion - MC
  2. pleural abscess
  3. hemothorax
  4. pulmonary embolism
  5. other lung disease in the lateral base of the lung
59
Q

a collection of fluid in the alveoli of the lungs preventing adequate air exchange

A

Pulmonary Edema

60
Q

causes of Pulmonary Edema

A
  1. Cardiogenic pulmonary edema - MC
    - CAD, cardiomyopathy, valvular disease, HTN, CHF
  2. Acute respiratory distress syndrome (ARDS)
    - chest wall trauma, sepsis, pneumonias
  3. Neurogenic pulmonary edema (NPE)
    - head trauma, seizure, Subarachnoid hemorrhage (SAH)
  4. Adverse drug reaction
  5. Pulmonary embolism
  6. Viral infections
  7. Lung injury
    - pneumothorax, near drowning, smoke/toxin inhalation,
61
Q

a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates

A

Air Bronchogram

62
Q

causes of Air Bronchogram

A
  1. lung consolidation
  2. pulmonary edema
  3. non-obstructive pulmonary atelectasis
  4. severe interstitial disease
  5. neoplasm
  6. normal expiration
63
Q

collapsed lung
occurs when air leaks into the pleural space
what is this condition called?

A

pneumothorax

64
Q

causes of pneumothorax

A

idiopathic
chest wall trauma
lung disease
ruptured blebs
mechanical ventilation

65
Q

Excess fluid builds in the pleural space

A

Pleural Effusion

66
Q

causes of Pleural Effusion

A

Congestive heart failure
Kidney failure
Infection
Malignancy
Pulmonary embolism
Hypoalbuminemia
Cirrhosis
Trauma

67
Q

an abnormal enlargement of the heart

A

cardiomegaly

68
Q

causes of cardiomegaly

A

HTN
valvular disease
cardiomyopathy
pulmonary hypertension
pulmonary effusion
anemia
thyroid dysfunction
hemochromatosis (iron excess deposits in heart muscle)
amyloidosis (abnormal proteins build up in heart muscle)

69
Q

Lung markings seen on imaging that represent thickened interlobular septa in the pulmonary interstitium

A

Septal “Kerley” Lines

70
Q

2-6 cm oblique lines that course toward the hila

A

kerley A

71
Q

1-2 cm horizontal seen in the periphery of the lungs (perpendicular to the pleural surface)

A

kerley B

72
Q

same as Kerley B but coursing ventrally

A

kerley C

73
Q

same as Kerley B but seen on the lateral CXR in the retrosternal air space

A

kerley D

74
Q

causes of kerley lines

A

pulmonary edema, malignant lymphoma, viral/mycoplasmal pneumonia, pulmonary fibrosis, pneumoconiosis, sarcoidosis

75
Q

an enlargement of the mediastinal structures
what are these specific structures

A

Mediastinal Widening
1. heart and cardiac vessels
2. other organs
- esophagus
- trachea
- phrenic and cardiac nerves
- the thoracic duct
- thymus
- lymph nodes of the central chest

76
Q

what does this show?

A

R lung consolidation

77
Q

what does this show?

A

hyperexpansion

78
Q

what is this?

A

Costophrenic Angle Blunting

79
Q

what is this?

A

pulmonary edema

80
Q

what is this

A

Air Bronchogram

81
Q

what is this?

A

pneumothorax

82
Q

what is this

A

cardiomegaly

83
Q

what is this

A

pleural effusion

84
Q

what is this

A

mediastinal widening

Pulmonary: Clin Med II B (10 decks)

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