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

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2
Q

When is CXR not helpful?

A
  • non specific chest pain
  • minor chest trauma
  • pre-op
  • no routine CXR
  • unnecessary repeats
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3
Q

Lung lobes

A
Right = 3
Left = 2
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4
Q

Fissures on lungs

A
Right = horizontal above oblique
Left = just oblique
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5
Q

What is the hilum

A

Medial part of lung where vasculature structures cross over

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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
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7
Q

Standard position for CXR

A

Erect PA

Unless ill = AP

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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)
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9
Q

How to check exposure

A

Should be able to make out vertebral bodies and IVD through mediastinum

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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)
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11
Q

Collapse

A
  • trachea shift towards affected side
  • volume of lungs reduced
  • compensatory hyperinflation of other lobes and lung
  • rib crowding
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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)
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13
Q

What causes cavitated consolidation?

A

INFECTION = pneumonia

  • from TB
  • Staph Aureus
  • Klebsiella
  • others = Wegners
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14
Q

Miliary TB

A
  • haematogenous spread
  • multiple nodular densities
  • sometimes sarcoid can form this or metastases
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15
Q

Pleural effusion

A
  • start of as blunting of costophrenic angle

- meniscus curved sign

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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