Imaging Flashcards
What do you need to ask when reading film?
Is it PA or AP? is the patient supine or upright? is this an adequate inspiration? is the patient rotated? is the penetration adequate?
What is PA?
right side is on your left
What is AP?
the heart is enlarged, and the diaphragm is higher up and everything is skewed. look at the clavicles!
What do the Vs indicate?
Pointing up means upright, down means supine. or, supine the beads are at the bottom, upright beads are at the rim
How do you know it’s an adequate inspiration?
when you can count all 10 ribs
How to know if the patient is rotated?
Check if the clavicles are symmetrical, spinous processes of the vertebrae, equidistance between clavicular heads and trachea
What does ABCDEFGH mean?
Airways
Bone
Cardiovascular
Diaphragm
Extra-pulmonary
Lung Field
Gastric bubble
Hilum
What are abnormalities deviating the trachea away from lung?
pneumothorax, pleural effusion
What are abnormalities deviating the trachea towards the affected lung?
collapsed lung, lobectomy, pnuemonectomy, pleural fibrosis, pulmonary fibrosis (rarely unilateral)
If someone choked on something, where does it go down (where should you look in the xray)?
The right main bronchus
What is subcutaneous empheysema?
Air between the subcutaneous tissue and skin, harmless but evident in xray like the patient is glowing a bit, often from surgery
What do you absolutely need to remember?
Ensure patient isn’t crooked, can you see the lung pieces above clavicles (adequate inspiration?), ensure spinous processes are equal distances
What can airways be?
Narrowed, deviated, subglottic (steeple church)
At what angle is the carnal angle strained?
> 90 degrees
What is the normal cardiothoracic ratio?
40% or less…anything more is concerning
How do you spot pericardial effusion?
water bottle morphology
What is a signature sign of cancer in an xray?
snowball, spikey spiculated
What are some key things to remember regarding lung fields?
look for lung markings and extra lines; clear black means there is no lung there!
What’s a signature sign of pnuemothorax?
deep sulcus sign, very pronounced side, common in tall thin young men with smoking
How to spot pleural effusions?
uni or bi lateral, whiteness in the bottom of the lung; blunting on lateral film. Can be free flowing or loculated
How to tell what type of pleural effusion it is?
Lay down patient and take another image, and history will help you with what the fluid is
What causes loculated pleural effusion?
infection, “sticky” adhesions
What is a subpulmonic effusion?
heightened diaphram
If anything is irregular, what will you probably have to do?
get a CT
What is a pnuemoperitoneum?
free air in the abdomen from dialysis or trauma. Emergency, get CT, OR, invert the color
What are the two types of diffuse lung disease?
cardiogenic (CHF) and noncardiogenic (acute lung injury, resp distress)
What is diffuse lung disease?
alveaolor opacities with hazy, little margins, blood, edema, pus, or interstitial opacities
How can you tell the difference between cardiogenic and noncardiogenic pulmonary edema?
-air bronchograms (can SEE bronchi–> noncardio)
- Kerley B lines -> (more common) CHF, horizontal lines in lung periphery (cardio)
-Bat’s wing, CHF, concentration of opacification (Cardio)
cardio = enlarged heart
What are interstitial opacities?
reticular (lung disease, interstitial), nodular (like dots) (TB), reticulonodular (both)
What is hyperinflation?
increased lung volume due to emphezema, COPD, flattened diaphram (know from counting ribs)
What are Kerley A lines?
diagonal, unbranching extending from hilum, not very common
What is cardiogenic pulmonary edema?
cause of CHF
