How to look at a CXR Flashcards
1
Q
What scans use ionising radiation?
A
X-ray
CT
Nucelar medicine scan
PET
Not MRI or US
2
Q
When is CXR not helpful?
A
- non specific chest pain
- minor chest trauma
- pre-op
- no routine CXR
- unnecessary repeats
3
Q
Lung lobes
A
Right = 3 Left = 2
4
Q
Fissures on lungs
A
Right = horizontal above oblique Left = just oblique
5
Q
What is the hilum
A
Medial part of lung where vasculature structures cross over
6
Q
4 broad densities on x-ray
A
1 = air = black = no absorption 2 = fat =dark = little absorption 3 = water/soft tissue = mid grey = more absorbed 4 = bone/calcium = white
7
Q
Standard position for CXR
A
Erect PA
Unless ill = AP
8
Q
How to read a CXR?
A
Patient Name Male/Female Age Hospital Number Position on top right Check central trachea between clavicles Check exposure Heart size = CTR<0.5 (only PA) Aorta-pulmonary window (between aorta and pulmonary artery) Hilar (R. slightly lower) Diaphragm (R. higher) Densities of lungs in zones on both sides Clavicles in tact? Ribs count (7-10)
9
Q
How to check exposure
A
Should be able to make out vertebral bodies and IVD through mediastinum
10
Q
Pneumonia CXR
A
- consolidation
- air space changes (reduced, replaces with fluid/pus)
- increased density = whiteness
- silhouette sign = loss of normal outlines
- air bronchograms (residual air in larger airways surrounded by fluid/pus filled alveoli)
11
Q
Collapse
A
- trachea shift towards affected side
- volume of lungs reduced
- compensatory hyperinflation of other lobes and lung
- rib crowding
12
Q
TB
A
- patchy
- patchy, nodular between ribs
- fluffy
- calcified granuloma
- gohn focus (usually lower down)
- cavity (consolidated ring with air space in middle)
13
Q
What causes cavitated consolidation?
A
INFECTION = pneumonia
- from TB
- Staph Aureus
- Klebsiella
- others = Wegners
14
Q
Miliary TB
A
- haematogenous spread
- multiple nodular densities
- sometimes sarcoid can form this or metastases
15
Q
Pleural effusion
A
- start of as blunting of costophrenic angle
- meniscus curved sign
16
Q
Hiatus hernia
A
- double heart border
- horizontal air fluid level
- absence of stomach air bubble
17
Q
Early sign of tension pneumothorax
A
Depressed hemidiaphragm
18
Q
Congestive Heart Failure
A
- Kerley B lines near base
- enlarged heart
- increased backpressure on venous system
19
Q
Pulmonary oedema
A
- haziness
- Kerley B lines
20
Q
Lymphangitis
A
- lung cancer
- involved locking lymphatic channels
- lymph nodes affected
21
Q
Interstitial Lung Disease
A
- pulmonary fibrosis
- mesh
- honeycombing
- shaggy heart
- reduced lung volume
22
Q
Bronchiectasis
A
- lots of circular airspaces = bronchi
- tram track sign = double parallel signs
- need CT scan to characterise it as difficult to see
23
Q
Pericardial effusion
A
- massive lobular heart = cardiomegaly
24
Q
Metalwork
A
- sternotomy wires
- CABG = clips
- valves = mitral or aortic
