CXR’s Flashcards
How is image quality assessed on chest X-rays
RIPE
Rotation (is clavicles = to spinous process)
Inspiration (5-6 ribs should be visible)
Projection (PA or AP)
Exposure (vertebrae should be visible behind heart)
What is the ABCDE approach to reading a cxr
Airways
Breathing
Cardiac/circulation
Diaphragm
Everything else
What are you looking for during airway examination of a cxr?
Trachea deviation- what is pushing/pulling?
Visible carina?
Hilar structures symmetrical
What are you looking for during breathing examination of a cxr?
Lung zones: apical, upper, middle, lower
Look for symmetry and lung markings all the way to the edges
No lung markings = pneumothorax
Pleura shouldn’t be visible if it is = mesothelioma (cancer that forms in tissue lining due to asbestos exposure)
What are you looking for during cardiac/ circulatory examination of a cxr?
Borders of the heart well defined
Right atrium = right border
Left ventricle = left border
Heart side should be no more than 50% of thoracic width
Name causes of cardiomegaly
Valvular heart disease
Cardiomyopathy
Pulmonary hypertension
Pericardial effusion
What are you looking for during diaphragm examination of a cxr?
Right hemidiaphragm is higher in healthy individuals due to liver
Costophrenic angles should be acute and not blunted
What are you looking for during the everything else examination of a cxr?
Mediastinal contours
Aortic knuckle
Aorta pulmonary window
Bones - fractures
Tubes
Lines
Valve replacements
Pacemaker
What would a tension pneumothorax present on a cxr?
Trachea pushed away from pneumothorax
Heart border pushed away
Lung collapse
No lung markings
Lunged costophrenic angles
Diaphragm would be unusually unequal
Very dark due to air in pleural cavity
What is the difference between a lung collapse and tension pneumothorax?
Tension pneumothorax:
Trachea and apex beat are displaced away from the affected side
Lung collapse:
Trachea and apex best are pulled towards affected side
Lung becomes smaller
Usually due to mechanic obstruction ie
Bronchi tumour
Mucus plug: cystic fibrosis
Bronchiectasis
Foreign object
How to identify a right upper lobe collapse
Right upper lobe is much more dense
Well defined horizontal fissure
Trachea deviated towards
Loss of volume in right lung
Widened mediastinum
Lung markings still go to peripheries
Acute costophrenic angles
Name the three types of pneumonia:
Lobar pneumonia
Bronchopneumonia
Interstitial/atypical pneumonia
How to tell the difference between pneumonias on cxr
Lobar pneumonia:
Consolidation forms a triangle shape occupying a certain lobe
Bronchopneumonia:
Patchy and diffuse
Reticular (extending squiggly lines) and reticular nodes
Usually bilateral and at the base
Interstitial/atypical:
Patchy and reticular but concentrated around the heart borders and perihilar region
What is pulmonary oedema and how is it presented on a cxr?
Fluid builds up inside the lungs usually due to congestive hf
Very hazy and more hazy than pleural effusion
Deviated trachea
Shadowing around the hilum
What is pleural effusion and how is it shown on a cxr?
Fluid builds up in pleural layer
Blunting of costo/cardiophrenic angles
What is pericardial effusion?
How can it be caused?
And how is it presented on a cxr?
Fluid in pericardium between visceral and partial pleura
Virus ie flu, hiv
Pneumonia, TB, rheumatic fever
Fungus
MI
Drugs
Globular shaped heart (more round on cxr)
How is cardiomegaly defined on cxr?
Can only be measured on a PA cxr
Heart is more than 50% of thoracic space
How is pulmonary fibrosis defined on a cxr?
Fluffy/ grainy
Shadowing in lung fields
Not homogenous
Ground glass shadowing
Honey comb effect at later stage
Reduced lung size due to reduced lung elasticity
Causes of pulmonary fibrosis:
Upper lobe:
TB, Extrinisic allergic alveolitis (bird fancier’s lung etc.), Ankolysing spondylitis, Radiotherapy, Sarcoidosis
Lower zone:
Idiopathic pulmonary fibrosis, Asbestosis, RA/SLE
Drugs:
Amioderone, busulfan
Conditions:
Any damage to lung tissue will give a degree of fibrosis ie COPD/ bronchiecstasis
What is the difference between fibrosis and consolidation on a cxr?
Fibrosis is more sand like where as consolidation is more cotton wool like and from an infection
Enlarged hilum on a cxr
Prominent hilum
May be due to enlarged lymph nodes in hilum or enlarged vascular structures
May be a unilateral peri-hilar mass
COPD on cxr
Hyper inflated lungs
Flat diaphragm
Featureless lungs
Small cardiothoracic ratio
Bullae
What is bronchictasis?
How is it presented on a cxr?
And what are the main causes?
Airway hypersecretion of mucus and inflammatory material, inability to clear from airways, gradual fibrosis of airways, traction
• Cause thickened dilated bronchioles (proximal to alveoli)
• CXR= Ring shadows (sometimes with honeycomb appearance), tramlines (diseased bronchi seen from the side)
• Causes: Severe infection/childhood infection (pertussis, measles, TB, pneumonia)
• Cystic fibrosis, Kartageners Syndrome
• Bronchial obstruction (cancer, foreign body)
Pleural plaques on a cxr
Multiple well defined lesions - maybe calcified
Patchy and map like appearance
Do not follow outline of individual lobes
Calcified plaques on diaphragm
Thickened pleura
Caused by aspestos exposure
Maybe 20-30 years later
Benign condition
What is sarcoidosis and how is it identified on cxr?
Rare diseases caused by genetic and environmental factors leading to inflammation. It usually occurs in the lungs and lymph nodes, but can occur in any organ.
Sarcoidosis in the lungs is called pulmonary sarcoidosis. It causes small lumps of inflammatory cells in the ,lungs.
CXR could present bilateral hilar lymphadenthopy
Fibrosis
Interstitial lung disease pattern
Reticular and reticular modular opasity
