Exam 1: xrays Flashcards
Would bones be more present with overexposure or underexposure?
overexposure
S4
What type of body habitus results in underexposed x-rays?
Obesity
S4
With overexposure, a chest x-ray will appear too ______.
dark
* the bones are very white but small nodules and fine structures in the lung aren’t seen
S4
With underexposure, a chest x-ray will appear too ____.
bright
* this is hard to interpret
* small pulmonary blood vessles appear prominent and could lead you to think there are infultrations
S4
Major difference b/w male and female cxr
- caused by breast tissue: breast tissue absorbes some xr beam
- this can cause underexposure of the tissues in the path
- not a problem if the breasts are above the hemidiaphragms
S4
Pt position with PA and AP xr views
PA: (usually ambulatory pts) the xr tube is behind the pt and the beam passes from the pts back and exits the front of the chest
AP: if laying down, xr tube passes antrior to posteior
AP makes the heart look a little larger because the beam spreads out a little more
*But PA (upwright) helps with lung expension and pulm. vessels - i.e. a hemothorax will become gravity dependent (run down)
S5
What mnemonic should guide x-ray assessment?
Are There Many Lung Lesions?
Abdomen
Thorax
Mediastinum
Lung
Laterality
S7
Laterally= bilateral lung
- In the thorax assessment, sharp ____ angles will have ____ fill in the gaps if there’s a ____
- There is a ____ if the air goes ____ the angles instead of filling in the gaps.
- In the thorax assessment, sharp costophrenic angles will have blood fill in the gaps if there’s a hemothorax
- There is a pneumothorax if the air goes around the angles instead of filling in the gaps.
S13
In the mediastinum assessment, what tells you there is cardiomegaly?
Cardiac silhouette > than 1/2 to 2/3 greater than normal
S17
From K: I believe this should say 1/2-2/3rds of the space in thorax
What is the systematic order of approach for chest x-ray assessment?
- Bony framework
- Soft tissues
- Lung fields and Hila
- Diaphragm and pleural spaces
- Mediastinum & heart
- Abdomen and neck
Beautiful Sky, Lets Hike Down Mountain Above
S21
What structures make of the pulmonary Hila?
Pulmonary arteries & veins
* the hila is the shadow of the pulm artery and vein adjacent to the heart shadow
S24
Abnormalities in lung fields are marked by excessive ____ and ____.
radiolucency and radiopacity (or opacified areas)
S24
What do you look for with bony framework?
Ribs
Sternum - sometimes hard to see
Spine
Shoulder girdle
Clavicles
*Anterior view sometimes gets lost in mediasteinum
S22
What do you look for with soft tissues?
Breast shadows be mindful of breasts obscuring the costophrenic angles
Supraclavicular areas
Axillae - more pneumothorax accumulation
Tissues along side of breasts
S23
What do you look for with Lung fields?
Hilum (base/root of lung – close to heart)
Lungs: Linear and fine nodular shadows of pulmonary vessels
Blood vessels
40% obscured by other tissue
S24
What do you look at with the diaphragm and pleral surfaces?
Diaphragm (liver sits higher on the R so that dome is higher)
Dome-shaped
Costophrenic angles
Normal pleura is not visible on the cxr unless two layers come together to form interlobar fissures
S25
What do you look at with the mediastinum and heart (Right side)?
Heart size on PA
Right side: Inferior vena cava, Right atrium, Ascending aorta, Superior vena cava
biggest takaways are to look for the aortic knob and the size of the cardiac silhouette
S26
What do you look at with the mediastinum and heart (Left side)?
Left side: Left ventricle, Left atrium, Pulmonary artery, Aortic arch, Subclavian artery and vein
Order from bottom to top: LV, LA, pulm art, aortic arch and subclav artery and vein
S27
What do you look at with the abd and neck?
Abdomen: Gastric bubble, Air under diaphragm
Neck: Soft tissue mass, Air bronchogram
S28
What structure is indicated by 1 on the figure below?
Superior Vena Cava
S26
What structure is indicated by 2 on the figure below?
Inferior Vena Cava
S26
What structure is indicated by 3 on the figure below?
Right atrium
S26
What structure is indicated by 4 on the figure below?
Right ventricle
S26
What structure is indicated by 5 on the figure below?
Left ventricle
S26
What structure is indicated by 6 on the figure below?
Ascending Aorta and Aortic Arch
S26
What structure is indicated by 7 on the figure below?
Pulmonary vasculature
S26
What would the results be for a poor inspiration on a chest x-ray?
- High diaphragm
- Crowding of lung markings
S30
What would be the result of over or under penetration?
- Can obliterate or exaggerate important findings
- A proper PA cxr, you can make out the thoracic vertabrae
S30
What would be the result of rotation of the pt?
- Distortion of normal structures. Check proper orientation by looking if the clavicles are equally long or look at equal distance from vertebral spines to the end of the calvicle
S30
What describes the anatomical position of the right upper lobe (RUL) ?
- Upper ⅓ of right lung
- Posteriorly, adjacent to first 3 - 5 ribs
- Anteriorly, reaches as far down as 4th rib
S34
What lobe of the right lung is located primarily posteriorly?
Right Lower Lobe (RLL)
Which of the right lung lobes is typically smallest and triangular in shape and is narrowest near the hilum?
Right Middle Lobe (RML)
S35
How high up posteriorly will the RLL extend?
How low will the RLL extend?
T6 down to as low as L2 with full inspiration
S36
What structures do the major and minor fissues seperate?
- Major fissure: more expansive and seperates RUL and RML from the RLL
- Minor fissure: seperates RUL from RML (this representates the visceral pleural surfaces of both these lobes) at the level of T4
S37
Which right lung fissure is oriented obliquely?
Major Fissure
S37
The portion of the left lung that coresponds anatomically to the RML is incorperated where?
what fissure devides the two left lobes?
- LUL
- major fissure (identical to the R lung)
S40
What is the silhouette sign?
Lung lesion that obscurs normal anatomy (in this case the aortic arch).
S43
What is the Air Bronchogram Sign?
- In the lungs, bronchi should not be visible because there is air density surrounded by alveoli (soft tissue has different density)
- Air bronchogram = visulization of intrpulmonary bronchi which indicates abnormal lung i.e. consolidation
with lung consolidation, pulmonary vessels are no longer visulalized because they are surrounded by other soft tissue density
AKA: bad news bears
S44
What is consolidation?
Inflammatory exudate of WBC, plasma, bacteria, and debris. i.e. a density corresponding to a segment or lobe
RML consolidation pictured.
S49
What is the most common reason for consolidation?
Pneumonococca (pneumonia)
S49
Is there loss of lung volume noted with consolidations?
No
S49
What are examples of localized lung liquid densities?
- Infiltrate
- Consolidation
- Cavitation
- Mass
- Congestion
- Atelectasis
ICC MAC
S48
What are examples of generalized lung liquid densities?
- Diffuse alveolar
- Diffuse interstitial
- Mixed
- Vascular
David Always Inturrupts Many Vamipres
S48
What are some disease states consistent with increased air density?
- Emphysema
- Bulla
- Localized airway obstruction
- Diffuse airway obstruction
D- LOBE
S48
What signs are seen in an atelectatic lung space? (3)
- Density corresponding to segment or lobe
- Loss of volume
- compensatory hyperinflation
there is no ventilation to the lobe beyond the obstruction
S50
4 Steps of cxr evaluation
- identify abnormal shadows
- anatomically localize the leasion
- identify the pathology
- identify the etiology
- after that confirm you clinical suspition with MRI, CT, contrast etc
Shady Leonard Paces Easily
S51
What disorder is likely from the radiograph below?
Gohn’s Complex. Lesion of calcified infection with associated lymph node involvement. Usually results from tuberculosis.
We done GROWN some calcium
S66
What disorder is likely from the radiograph below?
Anterior Medistinal Mass
we can’t see the aortic knob here - aortic rupture or mass or esophageal rupture?
Corndog mostly wants us to see something is wrong
S67
What is the likely pathology based on the x-ray below?
RUL Pneumonia
S61
What is the likely pathology based on the x-ray below?
Right Pleural Effusion
no costophrenic angle
S59
What lung lobe is affected by the effusion noted in the image below?
Trick Question. Costophrenic angle still visible. This is likely a RLL pneumonia, not an effusion.
S62
What is the likely pathology based on the x-ray below?
Free air under the diaphragm
S64
What is the likely pathology based on the x-ray below?
LUL mass
S68
What is the likely pathology based on the x-ray below?
Metastatic Cancer
also a porticath on the L side and a neck fusion
S69
What is the likely pathology based on the x-ray below?
Pulmonary Metastasis Hematogenous
S70
What is the likely pathology based on the x-ray below?
Pneumomediastinum
- shadow on the L side of the heart
S72
What is the likely pathology based on the x-ray below?
Pneumothorax
S75
What is the likely pathology based on the x-ray below?
Subcutaneous Air
- diaphragm also looks weird - depressed maybe?
S76
What is the likely pathology based on the x-ray below?
Deep Sulcus Sign indicative of pneumothorax
- *we also have a gastric silhouette on the left (the diaphragm is way at the bottom)
S77
How can one differentiate if a swallowed coin is in the trachea or the esophagus?
If the coin sits flat then its likely to be in the esophagus.
*FB’s always go to the path of least resistance - usually if its in the trachea, this coin will sit a little higher (i.e. the carina)
S81-82
What is the likely pathology based on the x-ray below?
Post-operative pneumonectomy
* but we also have some tracheal shift, so follow up with clincial correlation - haha sounds like a rad…
S88
What is the likely pathology based on the x-ray below?
Pulmonary Edema
Large cardiac silhouette and its hard to make out other scructures
S86
What is the likely pathology based on the x-ray below?
Transverse Aortic Arch aneurysm or a large tumor
S90
What is the likely pathology based on the x-ray below?
Cardiomegaly
well over the 50% normal cardiac silhouette
S91
What is the likely pathology based on the x-ray below?
Aortic Dissection
distended and widened mediasteinum
S93
What is the likely pathology based on the x-ray below?
Chiladiti Sign indicative of interposition of bowel in between liver and the diaphragm. Not good. Especially after bowel surgery.
*per Corndog: usually this causes no symptomes!
You’re CHILLY when your bowel is torsed
S94
Chilaiditi syndrome refers to what? and is only in the presence of what?
- Chilaiditi syndrome refers only to complications in the presence of Chilaiditi’s sign.
- These include: abdominal pain, torsion of the bowel or shortness of breath
S94
From K:Chilaiditi syndrome is a generally benign condition in which a segment of the intestine is interposed between the liver and diaphragm
What is the likely pathology based on the x-ray below?
Mediastinal air secondary to esophageal rupture
* AKA: Boerhaave’s syndrome
BORING, you HAVE air in your mediastinum
S95
What is the likely pathology based on the x-ray below?
Bilateral Hilar Adenopathy - lots of fluid retention
S96
What is the likely pathology based on the x-ray below?
LUL Atelectasis
S103
What is the likely pathology based on the x-ray below?
Bilateral “cotton-ball” appearance is likely for TB
S112
