Imaging XR chest and abdo

Question 1

To remember before all else

Answer 1

• always identify
  
  • type of imaging modality
  • plane (coronal, sagittal, axial OR longitudinal/transverse)
  • sequences and windows where relevant (e.g. fluid-weighted fat saturated MRI, include windows here!)
  • region imaged

Question 2

List chest densities

Answer 2

• recall densities, from most to least dense
  
  • lead/barium sulphate/bone (white)
  • muscle
  • liver
  • fat
  • air (black)
    
    • note that lungs are black because of air, with white lung markings
      
      • The white ‘lung markings’ on a CXR are branching blood vessels (not bronchi, too thin and usually filled with air. If visible –> an issue e.g. bronchiectasis)

Question 3

Describe the ABCD approach

Answer 3

• [Assessment of quality / Airway](https://radiopaedia.org/articles/chest-radiograph-assessment-using-abcdefghi#nav_assessment-of-quality-airway
  
  • position
  • projection
  • exposure
  • foreign objects, lines, etc
• Bones and soft tissues
  
  • symmetry
  • fractures
  • osteoporosis
  • (assess rotation with equidistance between ribs and spinous processes; rotated to larger gap)
• Cardiac
  
  • evaluate the eight cardiomediastinal contours
    
    • paratracheal stripe should be thin, if not = lymphoma, lung cancer, retrosternal goitre
    • main pulmonary artery can be located medial to fuzz of LPA branches, first hard edge
    • fuzzy RHB = R ML consolidation
    • squiggly outline of aortic arch, wiggly ribs = coarctation of aorta
    • LMA prominent - pulmonary hypertension
  • note, LHB= LV, RHB= RA
  • note also the cardiac position: tension pneumothorax shifts away from black
  • note also the cardiac size
• Diaphragm
  
  • white out of angles indicates effusion or collapse
• Equal Fields
  
  • if left whited out and heart shifted to left, loss of volume e.g. lung collpase or pneumonectomy
  • if shifted away from white-out: lung consolidation +- effusion, pleural effusion, mass
• foreign bodies
  
  • check that tubes are going the right way
• Great vessels / gastric bubble
• [Hila and mediastinum]
• [Impression]

Question 4

What should be identified on PA CXR

Answer 4

• cardiomediastinal contours: right paratracheal stripe, aortic knuckle, main pulmonary artery, LHB, descending aorta, left hemidiaphragm, right hemidiaphragm, RHB

Question 5

What should be identified on lateral CXR

Answer 5

• trachea
• sternum
• scapula
• ribs
• vertebra
• note also: pedicles, lamina, neural exit foramina, IV disc, +/- osteophytes
• hemidiaphragm that extends fully anterior to posterior = R
• hilar adenopathy and pulmonary hypertension difficult to differentiate

Question 6

List some common pathologies

Answer 6

• tension pneumothorax
• hypertrophy
• adenopathy
• RUL pneumonia

Question 7

list some rarer conditions

Answer 7

• Kartagener: ![[Pasted image 20240501180051.png]]
• bronchiectasis: ![[Pasted image 20240501180112.png]]
• PE and infract (PE seen on CT): ![[Pasted image 20240501180133.png]]
• coarctation of aorta: ![[Pasted image 20240501180303.png]]

Question 8

What could a white blob indicate

Answer 8

White Blob
* Infection
* Cancer
* Collapsed lobe
* Rarities

Question 9

conisderations for abdomen CXR/CT

Answer 9

• we don’t just do XR and CT due to radiation risk
• need to do pregnancy test before to be sure

Question 10

clincial considerations for abdomen pathology

Answer 10

• Pain (colicky)
• Nausea
• Vomiting
• Abdominal ‘fullness’
• Constipation
• Duration of symptoms
• Mode of onset
• Weight loss?
• Bleeding per rectum?
• peritonism and rigitidy red flags
• distension
• fever tach?

Question 11

What should be identified on PA abdomen

Answer 11

Mainly bony anatomy:
- ribs 10,11,12
- vertebrae
- pedicles
- spinous processes
- tranverse processes
- IV disc space
- R and L ilium
- sacrum
- coccyx
- R and L hip joints
- R and L femoral heads
- R and L sacroiliac joint

Soft tissue:
- Air in stomach
- spleen
- air in colon
- R and L psoas
- R and L kidney
- rectosigmoid - air is generally a good sign
- liver

Question 12

List some common conditions abdomen

Answer 12

• bowel obstruction - highlights plicae due to air trapped
• another example:
• strong of pearls indicates mechanical obstruction, and multiple air fluid levels![[Pasted image 20240501181039.png]]
• another obstruction: ![[Pasted image 20240501181205.png]]

Question 13

List some rarer conditions

Answer 13

• caecal volvulus: ![[Pasted image 20240501181243.png]]
• • ## Meckel’s:/intussusception