Exam #3: X-Ray Interpretation Flashcards
What is it called if materials of same radiographic density meet = NO border?
“Silhouette Sign”
What does ABCDEFGHI stand for?
- Assess quality/airway
- Bones
- Cardiac
- Diaphragm
- Effusions/extrathoracic soft tissue
- Fields/fissures/FBs
- Great vessels/gastric bubble
- Hila/mediastinum
- Impression
When counting ribs, approximately how many should you see posteriorly? Anteriorly?
- 9 posterior ribs
- 7 anterior ribs
Where can you begin counting the first posterior rib from, and how can you see this?
T1
- T1 transverse process is angled upwards (C7 transverse process above it is horizontal)
Is the left or right side of the diaphragm higher?
RIGHT higher
- Liver below
Sides of the diaphragm should be…
Sides equal and slightly rounded
What does a low, flat diaphragm indicate?
COPD
What does a unilaterally high diaphragm indicate?
Paralysis
- Due to nerve damage, trauma, loss of lung volume
On what x-ray view does the mediastinum appear thicker?
Mediastinum is thicker on supine AP view
Is the left or right hilum appear higher?
LEFT higher
What are four possible causes of mediastinal widening?
- Traumatic aortic injury
- Vascular issues
- Pulmonary masses
- Mediastinal LAD
What are 2 possible causes of mediastinal mass?
- Thoracic aortic aneurysm
- Thymoma
What is an abnormal Cardiac:Thoracic ratio?
Greater than 50%
1:2
How should spinous processes present location wise? If they are not, what might this indicate?
Midway between medial ends of clavicles
- If NOT central, consider patient rotation
If a patient has excellent inspiration, how many ribs are visible? Adequate inspiration? Poor inspiration?
- Excellent: 10+ posterior ribs
- Adequate: 8-9 posterior ribs
- Poor: <8 posterior ribs
What three CXR findings are indicative of COPD?
- Hyperlucency (air trapping)
- Flat diaphragm
- Hyperinflation (“barrel chest”)
What is large bullae (look like air bubbles) indicative of?
Bullous Emphysema/Fibrosis
What two normal findings will NOT be visible if Pneumothorax (PTX) is present?
- NO pleural markings
- NO vascular markings
What is a common location of Pneumothorax (PTX) aka it should always be checked?
APEX
What two symptoms are often associated with Pneumothorax (PTX)?
- Acute SOB
- Pleuritic CP
What two populations are more likely to experience a Pneumothorax (PTX)?
- Young, tall
- Older
What condition involves shift of intrathoracic structures with tracheal deviation?
Tension PTX
What type of CXR is used to diagnose a Small PTX? What other test can be used?
Expiratory CXR
- Also, CT
What condition involves air leaks into mediastinum? What test is used to diagnose this?
Pneumomediastinum
- CT
With a Pneumomediastinum, what should always be ruled out?
Esophageal perforation
What population are Pneumomediastinum most common?
Young males
What condition presents as dark lines following muscle/tissue planes?
Subcutaneous Emphysema
What exam finding is indicative of Subcutaneous Emphysema?
Crackly, “rice-crispy” sound with palpation of neck
- Like popping bubble wrap
What condition involves radiolucent area below diaphragm?
Pneumoperitoneum
What is often the cause of Pneumoperitoneum, and what might lead to this?
Disruption of wall of hollow viscous
- Often due to recent surgery, trauma, PUD, CA (bowel), acute onset abdominal pain
What CXR view should be used to evaluate for Pleural Effusion?
Left lateral decubitus view
What five sxs might present with infiltrate?
- Cough
- Fever
- CP
- SOB
- DOE
What finding is indicative of CHF? What two other findings may also be seen?
“Kerley-B lines”
- “butterfly” sign
- “bat-wing” sign
What condition involves “butterfly” or “bat-wing” sign?
CHF
What condition involves increased lung density, displaced fissures, shift of structures?
Atelectasis
What is the most common cause of Atelectasis, and what are three examples?
Bronchial obstruction
- Neoplasms
- Mucous plugging
- FB aspiration
What four PRIMARY CAs are often associated with metastasis to the lungs?
- Breast
- Colorectal
- Renal cell
- Uterine
What four findings of a Solitary Pulmonary Mass are indicative of malignancy?
- Large (15+ mm)
- Irregular
- Inhomogeneous (diff. densities)
- Spiculated
What four findings of a Solitary Pulmonary Mass are indicative of benign?
- Smooth
- Well-defined
- Homogeneous
- +calcifications
