Imaging of the Lung I Flashcards
What are the cons to chest radiography?
- Susceptible to artifact/technical issues
- Can miss subtle disease, opposed to CT or MR
- Requires patient cooperation to take good breath and be able to stand for exam
IMPORTANT: describe how to take a PA x-ray
- Person faces away from radiation source
- They push their chest flat against the detector
- Beam goes posterior > anterior through chest onto detector
What will happen if you take an x-ray with the patient facing the beam source?
You will get the perception of an enlarged heart
- heart is further from detector causing a magnified shadow
What effect would over penetration have on your radiograph?
It would be too dark!
How do you know if the x-ray has the right amount of exposure?
Should be able to just barely make out the outlines of the vertebral bodies behind mediastinum
Rotation can also botch your xray and make you think something is wrong. What is the standard technique to gauge rotation?
Look at the clavicles bilaterally. Make sure they are roughly equidistant from the center of the spine
If you suspect a left lung pneumothorax what xray view should you use?
What about for left pleural effusion?
Left pneumothorax: right lateral decubitus (opposite side so you can see the air rise)
Left pleural effusion: left lateral decubitus (same side, because that’s where fluid falls)
To diagnose pneumonia you take a PA xray. What else will you need?
Lateral view!
“One view is no view”
What is a silhoutte sign?
When two structures of similar density contact eachother and the border is lost
**helps localize where disease is
If there is a loss of the left heart border, what lung structure has pathology?
Lingula (this thing is only on the left)
If there is obscured borders of the diaphragm, what lobes could be affected?
Right side: Right lower lobe
Left side: left lower lob
What is wrong with the patient? How do you know?
Left lower lobe pneumonia
**Spine sign: normally on lateral view the vertebrae get clearer as you approach the diaphragm border.
- Here it is opaque with infiltrates
Which lobe is affected if there is an indistinct right border of the heart?
right middle lobe: borders the right heart
Inhaled foreign bodies are more likely to go down which side of the lungs? Why?
Right
- There is slight right deviation in the trachea to avoid the aorta
- So the right side is wider/ more vertical
Which heart chamber does not have bumps (moguls) in the typical heart sillhoute?
Right Ventricle
Five moguls: see image
Why is this heart enlarged?
Water bottle heart - large pericardial effusion enlarging the cardiomediastinal silhouette
Which side of the cardiomediastinal silhouette is the abnormality?
The right side
=too many lines, caused by enlarged esophagus from achalasia (not important)
What’s wrong with this person?
Pleural effusion
**Note the decreased costophrenic angle/ sulci
What’s your diagnosis?
pneumothorax
What things can you find on this x ray?
- Pleural effusion
- Pleural nodularity (soft tissue mass on right side- you know this because its defying gravity)
- mesothelioma growth
Is C (blue) an anterior or posterior rib? What about the red?
Blue: anterior
Red: posterior
T/F: Sharp costophrenic sulci are abnormal
False: you would expect this in a health patient
Is the arrow pointing to the right or the left hemidiaphragm?
LEFT! You can see the air bubble beneath it where the stomach is
