Imaging the thorax Flashcards
Which review areas should you pay special attention to on a chest x-ray?
–Apices
–Costo-phrenic angle
–Behind the heart
–Hila
–Peripheries
Where is -
- Aortic arch
- Left and right heart borders
- Aortic arch - M1
- Left heart border - M3
Right heart border - M4
How can you ensure there is no rotation on a chest x-ray?
Align: spinous processes of thoracic vertebrae (posterior) with medial ends of both clavicles
Distance should be equal
What are the causes of cardiomegaly on chest x-ray
Left ventricular failure (CCF)
Pericardial effusion - heart normal size
Dilated cardiomyopathy
What chambers are these?
What anatomical structures makes up the left and right heart borders?
Right - right atrium
Left - left ventricle
Where is the hilar point?
Hilar point:
‘v’ shaped point where the lower lobe pulmonary arteries cross the upper lobe pulmonary veins
-Should be symmetrical
Where is the pulmonary artery and pulmonary vein?
V - pulmonary artery
* - pulmonary vein
What does a raised hilum indicate?
- upper lobe collapse / fibrosis
What does an obscured hilum indicate?
?Lymphadenopathy / tumour / mediastinal mass
Complete the diagram of pulmonary arteries and hila
MPA - Main pulmonary artery
Complete the diagram of pulmonary arteries and hila
Where is the trachea and what is abnormal about this trachea?
A
Veers slightly to the right
What is hyperexpansion?
Hyperexpansion: if greater than 6 anterior ribs above dome of hemidiaphragm.
- normal in young
- Asthma
- COPD / emphysema
How can you look for hyperexpansion on a chest x-ray?
6th anterior rib should clip the middle of the diaphragm (blue line)
What soft tissues can you see on a chest x-ray?
Breast shadow - S
Axillary tail - AT
Gastric fundus and bowel gas below diaphragm - GF
What does this image show?
Air under diaphragm - caused by bowel perforation
What does this chest x-ray show?
Tension pneumothorax
Heart shifted to right from tension caused by valve effect
What does this chest x-ray show?
Non-tension pneumothorax
What does this show?
Cardiomegaly
How can you tell if a chest x-ray has cardiomegaly?
Which lobe is the lung shadowing in?
Lower lobe
Complete the diagram
Which lobe is the mass in?
Upper lobe
Complete the diagram
Assess myocardial thickness
X - tricuspid valve
V - descending/thoracic aorta
D - left atrium
Y - mitral valve
Left wall thicker
What is A and B?
What scan is this?
What is the diagnosis?
A - RV
B - LV
Myocardial perfusion scan
Bad MI - damaged left ventricle wall
Where does the interventricular septum recieve most of its blood supply from?
Interventricular septum recieves majority of blood supply from the circumflex branch.
Also some from right coronary artery.
What is the diagnosis?
75% narrowing.
Likely occlusion of left anterior descending artery (LAD)
What is the purpose of red cell scans and white cell scans?
Red cell scan - for patients who are slowly losing blood but don’t know where
White cell scan - for patients who have a hidden infection
Which organs are showing on this red cell scan?
Heart, liver and kidneys
What structures are showing on this white cell scan?
Spleen, bone marrow
Which organ do you ignore on red and white cell scanning?
Bladder - how contrast is excreted
What is A and B?
A - left subclavian artery
B - internal thoracic / mammary artery
What type of image is this?
Label the diagram
Venegram
