Introduction and Normal Variants Flashcards
The standard chest examination consists of ___ xray views
PA and lateral chest views
Perform a __ view of the chest to reduce magnification of the heart
left lateral view
what is the right border of the heart
right atrium
what is the left border of the heart
left ventricle
what do you COUNT to evaluate a chest film
how many should be seen
what would cause a decrease or increase number seen
ribs (dont miss the 2nd rib - commonly missed)
9-10.5
decrease in ribs - not full inspiration when taking film or phrenic nerve issues
increase in ribs - COPD - air trapping
when you see see a left or right on the lateral chest film, what does this mean
if it was a left lateral chest view, the left side of the patient is closest to the FILM (not the tube)
when examining a patients chest films you should set them up after imaging and look at them how
PA on left
lateral on right
which bronchus is more vertical
right bronchus - more likely for something inhaled to land here
PA film is obtained when patient is facing the cassette (away from tube) and the tube is how far away from the patients back
6 ft
AP supine chest view the xray tube is how far away
40 inches
what are the differences between AP and PA views
what is preferred
AP - magnifies the heart and widens mediastinum
PA with inspiration is preferred
what is lateral decubitus position or cross table lateral position used for
assess volume of pleural effusion
determine if mobile or loculated based on if effusion travels to the side of the lung which the patient is laying on
what are the indications of inspiration an expiration views
pneumothorax accentuated on expiration
diaphramatic paradoxical motion
obstruction
what are the indications of lordotic views
apical lung disease
right middle lobe disease
lingular lobe disease
what are the indications of oblique chest views
small peripheral lesions
rib fractures
on PA chest view, the diaphragm should be seen at the level of the right __
right 10th posterior rib
how can you determine if the patient is rotated on a PA film
trachea may be shifted
clavicular heads should be equal distance from the spinous processes
how many secondary bronchi to left and right lung
left - 2
right - 3
how many alveoli in a pair of human lungs
300 million alveoli
what is inflammation of these membranes that causes them to secrete fluid that collects in the thoracic cavity
how do you treat
pleurisy
steroids
what divides the right middle and right upper lobe
minor horizontal fissure
right and left major oblique fissures are seen on what view
best seen on lateral view
also seen on PA but not as well
what does the fissure appear as if there is fluid in the fissure
increase in density
what is the slice thickness of a HRCT scan
.625 mm to 1.5 mm
left minor fissure is present in what percent of people
8-18%
what does the left minor fissure separate
left upper lobe from the lingula
the azygos fissure consists of what
2 layers of parietal pleura and 2 layers of visceral pleura
where is the azygos fissure located
upper medial region of the right upper lobe
where is the inferior accessory fissure located
lower medial region of the right lower lobe
where is the superior accessory fissure located
divides right lower lobe into superior segment and 4 basal segments
where is the rhomboid ligament located
aka costoclavicular ligament
between 1st rib and clavicle
normal variant that looks like lytic lesions under the medial surface of the clavicles
how do you know if a breast implant is leaking
rim of calcification
what are companion shadows
shadows of clavicle
seen above clavicle
what are findings of pectus excavatum on xray
what is treatment
obliteration of lower right heart border
sternum protruding inwards
flattening of the heart
verticality of the anterior ribs
tx - pectus bar
what are clinical findings of pectus carinatum and excavatum
mitral valve prolapse
what are the xray findings of straight back syndrome
xray ratio < 1/3
distance between T8 and posterior sternum on lateral view
/
distance of trasnverse diameter of thorax at the level of diaphraphm on PA view
loss of normal kyphosis on xray
leftward shift of the heart
prominent pulmonary artery
what are symptoms of straight back syndrome
most are asymptomatic
systolic ejection murmur - made louder with chest compression
1/2 the cases involve mitral valve prolapse
palpitations
chest pain
in straight back syndrome, the AP diamete of the chest is what
10-11 cm or less
what do you do when you suspect a mitral valve prolapse
echocardiogram
children with pectus carinatum have what
scoliosis
pectus carinatum treatment
external bracing technique
what are the xray findings of pectus carinatum
marked protrusion of the upper third of sternum
chicken or pigeon breast deformity
the L pulmonary artery arches over what
the R pulmonary artery passes posterior to what
L - left upper lobe bronchus
R - ascending aorta
what is normal thorax:heart width
2:1
how do you evaluate for rib fractures
examine posterior ribs first and then anterior ribs and then lateral aspects of ribs
fracture of the upper 3 ribs is associated with what
aortic injury
fracture of the lower 3 ribs is associated wtih what
liver or spleen injury
multiple bilateral rib fractures in various stages of healing suggest what
child abuse in children
or
alcohol abuse
what is a term for multiple rib fractures that can cause paradoxical movement of the thoracic cage
flail chest
majority of CT scans of the chest are what type
intravenous contrast spiral CT studies
best assess the pulmonary, pleural, and mediastinal structures
what are the applications of spiral CT
pulmonary nodules
hilar and mediastinal masses
lung cancer
pulmonary emboli
aortic diseaes - aneurysm and dissection
pleural diseases
what are the applications of HRCT
bronchiectasis
interstitial disease
alveolar diseases
emphysema
