Exam 2: CXR Flashcards
What is the key to recognizing abnormality in chest x-rays?
Knowing what a normal CXR looks like
What should you always compare with when interpreting a CXR?
Previous CXR if available
What are the general principles for interpreting a CXR?
Systematic approach, clinical findings, assess changes
What does the systematic approach for interpreting a CXR include?
- Name/marker/rotation/penetration
- Lines/metal work
- Heart
- Mediastinum
- Lungs
- Zones
- Bones
- Diaphragm
- Soft Tissues
In a systematic approach, what should be true about the clavicles?
Clavicles equidistant from spinous processes of thoracic spine
What is the significance of sternal wires in a CXR?
Implies previous thoracic surgery
Where should the tip of the endotracheal tube be positioned?
2cm above carina
How much of the maximum internal thoracic diameter does the heart occupy in a standard PA erect view?
Up to 50%
Why can’t heart size be commented on in an AP view?
Because of magnification of heart
What should be true about the hilar vascular structures in a CXR?
They should be crisply defined
What is the importance of the trachea’s position in a CXR?
It should be central
When comparing lung zones, which zones should be examined?
- Upper zone
- Middle zone
- Lower zone
What should the diaphragms form with the lateral chest wall?
A sharp margin
What is a sign of enlarged nodes in soft tissues?
Supraclavicular fossae
What should you look for under the diaphragm in a CXR?
Pneumoperitoneum
How would you summarize a normal erect chest X-Ray of an adult male?
“The heart is not enlarged, the mediastinal contours are normal and the lungs are clear”
What are some common abnormalities that can be identified in a CXR?
- Airway issues
- Atelectasis
- Pleural Effusion
- Tumor
- Pneumonia
- ARDS
- Pneumothorax
What is the proper placement for a right internal jugular central line?
Correct placement
What can indicate a feeding tube’s proper placement?
Proper placement in distal esophagus
Systematic Approach: Name/marker/rotation/ penetration
clavicles equidistant from spinous processes of thoracic spine
can just see lower thoracic spine
Systematic Approach: Lines/metal work
Look for:
Sternal wires (implies previous thoracic surgery)
Tip of endotracheal tube (2cm above carina)
Tip of central venous lines at origin of superior vena cava. See tubes and lines presentation.
Systematic Approach: Heart
Occupies up to 50% of the maximum internal thoracic diameter on a standard PA erect view
Cannot comment on heart size on AP view because of magnification of heart
Systematic Approach: Mediastinum
Hilar vascular structures should be crisply defined
No widening of mediastinum
Trachea should be central
Not midline trach could indicate - tension pneumo, thyroid goiter
Systematic Approach: Lungs
Compare upper, mid and lower zones
Look between ribs for lung detail
Remember to look “behind” the heart
Lower Lobe Positioning:
-lower lobe appears in the lower lung zone anteriorly, but in reality, it extends higher in the posterior view.
- a lower lobe disease (pneumonia, effusion) may not always be clearly seen anteriorly because it is positioned more posteriorly.
Systematic Approach: Bones
Look at each rib in turn
Clavicles
Scapulae and humeri if visible
Lower cervical and thoracic spine
Systematic Approach: Diaphragm
Both diaphragms should form a sharp margin with the lateral chest wall
Both diaphragm contours should be clearly visible medially to the spine
Position of stomach gas bubble may be present
Systematic Approach: Soft Tissue
Supraclavicular fossae (enlarged nodes)
Lateral chest wall (surgical emphysema)
Under diaphragm (pneumoperitoneum)
Identify CXR
Central line placment -want in SVC or RA – at right atrial appendage. If too deep, tickles heart
Identify CXR
Feeding tube in R lung with infiltrate
Identify CXR
NG Tube proper placement
Identify CXR
Right Mainstem
Identify CXR
Pneumothorax on R
Identify CXR
Subclavian central line placed, leading up into neck - incorrect placement
Identify CXR
R IJ correct placement
Identify CXR
Pneumoperitoneum
Identify CXR
Pneumonia
R middle lobe - aspiration typically
Otherwise most pneumonia lower, by gravity
Identify CXR
Tumor
Identify CXR
Pleural Effusion (fluid in pleural space)
In between chest wall and lungs themselves- it is in the pleural space
Identify CXR
Atelectasis
Recruitment breath helpful
Identify CXR
ETT proper placement
