Diagnostic Imaging Lecture Flashcards
air appears (what color)
black
fat appears (what color)
gray/black (faint)
water appears (what color)
white
bone appears (what color)
bright white
xray front to back is what view
AP
which chest view is more accurate interpretation of heart size
PA
WHAT cxr view is good for seeing an effusion
Lat decub
pneumonic for looking at xray
A-airway B - Bones C - cardiac silhouette/size D - diaphragm/costophrenic angle E -everything else
Airway documentation
midline trachea, no deviation
potential problems with x ray to assess (technique)
penetration - if its too dark, make it lighter and vs versa
position - assess for correct labeling of position
rotation - make sure they are not rotated (look at clavicles to make sure they are symmetrical)
in an outpatient setting, do you need a chest x ray to diagnose pneumonia
no, clinically diagnosed with tachypnea, fever and focality on auscultation
what lobes are more common in aspiration pneumonia
RU and R Middle lobe pneumonia
Loculated bubble with an air fluid level
complication of what?
pneumatocele - complication of staphylococcal pneumonia
most common with bilat, hazy appearance
perihilar densities/peribronchial cuffing seen
bronchiolitis
can range in size from trace to large, and in complexity with cavitations/loculations being hardest to resolve
pleural effusion
can range from trace to large and can be life threatening if evolves
pneumothorax
what can pneumo turn into if not treated
how to treat?
tension pneumo - medical emergency treat with needle decompression … mid clavicular line between 2nd and 3rd intercostal space
image shows the water bottle sign
pericardial effusion
Air accumulation in the pericardial cavity
pneumopericardium
optimal endotracheal tube placement
T3-T4
above the carina
(t 1 is where the first rib comes off)
AP image of abdomen through pelvis
KUB
kidney ureters bladder
intraluminal gas within the bowel wall, giving the bowel a mottled appearance with dilated loops
what is this and what is it most consistent with
Pneumatosis intestinalis
most consistent with necrotizing enterocolitis (NEC)
Can see dilated loops > 3 cm, stepladder appearance or string of pearls
small bowel obstruction
see dilations >7cm, haustration
large bowel obstruction
twisting of intestine and mesentery upon itself with distal obstruction - coffee bean sign
Volvulus - surgical emergency
telescoping of intestine upon itself at multiple possible points
target sign
meniscus or crescent sign
intussusception
target sign
intussusception
step ladder appearance
small bowel obstruction
string of pearls
small bowel obstruction
coffee bean sign
volvulus
meniscus sign
intussusception
crescent sign
intussusception
best for addressing bones, blood (bleeding)
CT scan
takes multiple x rays (slices)
CT scan
best for addressing fine details of soft tissue (looking for brain lesion not noted on CT) Gray/white matter differentiation
MRI
looking for brain lesion not noted on CT
MRI
bleed lens shaped being pushed away brain from skull inward
bleed between skull and dura mater
epidural hematoma
“hugging the brain” “c shaped or crescent”
bleed between dura mater and brain, usually due to stretching/tearing of blood vessels
subdural hematoma
type of bleed common in shaken baby
subdural hematomas
rarely found in isolated fashion if caused by trauma, almost always found in concert with another bleed
subarachnoid bleed
s/s terrible headache, n/v/ ams
requires coils or clipping and vasospasm reduction
subarachnoid bleed
dilation of ventricles in response to either excess csf production or due to obstruction somewhere in path of CSF flow
Hydrocephalus
what chest view gives a more accurate depiction of heart size
PA
1st rib comes off of what vertebrae
T1
how many ribs should you see on x ray
8-10
lobes and fissures for R lobe vs L lobe
R 3 lobes 2 fissures
L 2 lobes 1 fissure
How can you tell if pneumonia is RUL vs RML….
For RML your heart border is more hazy where as RUL is a clear hear border
diagnosis described: area of focality, focused to a specific lobe or lobes of lung
Bacterial Pneumonia
ABX for bacterial pneumonia
home oral vs inpatient IV
if they arent getting better on the IV abx what are you going to change to
If they still continue to worsen/look toxic
45mg/kg Amoxicillin
Ampicillin
Rocephin
Vanc
most common secondary infection following influenza
Staph ….can loculate off and form a pneumatocele
where should your ET tube show up on the x ray (vertebrae)
T3
in an intubation if you have a lung collapse. what do you do
You can try some retraction of tube in an infant. In an adult you will prob have to extubate, bag and re-intubate
what x ray view allows free fluid to layer out with air which will let air rise to top
lateral decub
what is diagnostic for and also therapeutic for Intussusception
Barium Enema
what do you do if you have a confirmed ng tube placement into the lung
leave it….and get assistance. at risk to perf the lung when you remove
Nasoduodenal tube placement x ray
crosses the midline - past spine, should be outside the stomach….should start to curve downward
subdural intervention depends on
size…sometimes they will monitor, sometimes needs surgical intervention
treatment for hydrocephalus
Neurosurgery consult -possible ICP monitoring
ETV vs VP shunt
Ophthalmology consult
MRI with contrast
infection
Hem onc patients usually depending on what looking for
if not concerned for infection, then without
CT with contrast
for abd, usually lights up better with contrast….
CTA - looking for vascular abnormalities
