Lauren’s “Guide” to CXR “Interpretation” (AKA: The Blind Leading the Blind) Flashcards
Is there anything wrong here?
Yes lol they have a R sided pneumothorax
(plz note the complete absence of vascular markings)
Did this patient inspire deeply enough?
No. I think i numbered the anterior ribs right?! But she definitely said this was one wasn’t deep enough
What does the spine NORMALLY look like on a lateral view?
The vertebral bodies will become MORE black as you move from top to bottom. that’s NORMAL
Anything wrong here?
Many rib fractures.
This is called a “flail chest” because individual ribs are broken in more than one place, leaving “free floating” sections that will flail in and out with respiration
What is going on here?
They have pulmonary edema. Thats what all those “Fluffy” markings all over the place are
Anything wrong here?
Yes the mediastinum is widened
How do you evaluate the abdomen?
- Look BELOW the diaphragm. Right side is usually higher by ~3cm
- Sides should be equal and slightly rounded
- Costophrenic angles should be clear and sharp
- Check below diaphragm for free air
Is this a nodule or a cavitary lesion?
This is a nodule. (Nodules are solid circles, and cavitary lesions look like rings)
Did this patient inspire deeply enough?
Yes. You can see the anterior ends of 8 ribs ( I thinK!!!!))))
What considerations do you need to keep in mind when evaluations the patient identity and image data?
Right patient
right date
right study
image quality
systematic check of film
consider the clinical question- why did you order this x ray?
Adequate exposure?
Overexposed- too dark
Anything wrong here?
they have a “patchy infiltrate” in their LUL
Where are most abnormalities in pleural/vascular markings seen?
At the chest wall
Anything wrong here?
What soft tissue structures should you always look at in a CXR?
Neck
thoracic wall
breatss
The left heart contour consists of the left lateral border of which heart chamber?
Le f t v e n t ri cle
Adequate exposure?
Underexposed- too light
What is the “SPine sign?”
It is when you are looking at the spine on a lateral view, and the vertebrae do NOT appear to get blacker as you move down. It is caused by something interfering with your view of the lower thoracic spine: pneumonia, mass, fluid, etc. Anything that keeps more X rays from moving through that space than normal. This is a positive spine sign:
How could you tell if the “gastric bubble” was actually inside the stomach, or if it was free air just under the diaphragm?
The stomach has thick walls that you would be able to see. The diaphragm is very thin in comparison. Here’s an example that shows air under the diaphragm on both sides. Look at the THIN wall of the diaphragm
Old films are your ________ ______
Best friend
Air/gas appears (black/white) on x ray
Black
What is the aortic knob?
It represents the left lateral edge of the aorta as it arches backward
How do you tell if a patient is rotated (aka positioned obliquely to the X-ray beam)?
make sure that the spinous processes of the vertebrae lie right in the middle of the ends of the clavicles
Is this an adult or a child?
What is the pathology?
Child.
They have pneumonia in their Lower lobe, which you can apparently see on the lateral view, evidenced by the “Spine sign” ?????
Blunting of the costophrenic angle suggests ______
Scarring or fluid
What will you be able to see/not see if the film was not over or under exposed?
In the PA view, looking at the spine, the disk spaces should be visible, but the “bony details” of the spine should not be able to be seen. This one is good i think
Which lobe is this infiltrate in?
Right MIDDLE lobe. How can you tell it’s not the Right Lower Lobe? Look at the Right border of the heart. Thats right you can’t see it. its all fuzzy and obscured. That means its the middle lobe and not the lower
What the fuck is that>?!
That’s just the aortic knob is ok bb
Anything wrong here? (This one is really hard..)
The clavicles are not the same densities. I would have never seen this
What lobe?
What would suggest that a patient’s lungs are hyper-expanded?
More than 7 anterior ribs above the diaphragm in MCL
or
flattening of the diaphragm
What’s wrong here?
You can’t see the aortic knob
Anything wrong here?
No, that is just a normal sail sign (aka a thymus on a child). If it bowed out like the yellow dotted line, THAT would be a Spinnaker sign
Which bone can be seen in its entirety on a CXR?
Is this heart normal?
I think its a lil too big 😜
A diaphragm that is high on only one side suggests:
Paralysis, eventration (?), or loss of lung volume on that side
The right heart contour consists of the right lateral border of which heart chamber?
Right Atrium
A low, flat diaphragm suggests what disease?
COPD
Which ribs are posterior?
Anything wrong here
There is a giant mass in the RUQ
What is a “sail sign” when you’re looking at infant x rays?
It is the appearance of the normal thymus
Anything wrong here?
Blunted costophrenic angle due to fluid (pleural effusion)
Rib fractures
What does a “water bottle” shaped heart mean?
It means they have a pericardial effusion
Did this patient inspire deep enough?
Yes
Is there anything wrong here?
Yes they have a pleural effusion on the RIGHT.
(Whoaaaa where’s the costophrenic angle on the right?????)
What Quadrant?
RML
When looking at vascular markings, what should you check?
That the extend all the way to the chest wall!
Anything wrong here?
How can you tell if a patient has taken an adequate inspiration?
You should be able to see the anterior end of 5-7 ribs above the diaphragm in the mid clavicular line
On this XR, the anterior end of the 7th rib intersects with the diaphragm at the mid clavicular line
Anything wrong here?
Yes, they have a hemopneumothorax. L lung is collapsed and the cavity is filling with blood
When doing a CXR, structures that are closer to the pole look (bigger/smaller)
Bigger
Anything wrong here?
Ummm yeah their right lung collapsed and is entirely within the orange circle
Aka: They have a pneumothorax
What is circled in yellow?
Subcutaneous emphysema **always look at soft tissue**
You should never consider the heart size to be enlarged if the view is (AP/PA)
AP
Which will look darker: fat or muscle?
Fat! It is less dense than muscle
Centered or rotated?
Slightly rotated
What is a Spinnaker sign?
It is a sign of pneumomediastinum on a neonatal radiograph.
it refers to the thymus being outlined by air with each lobe being displaced laterally like “spinnaker sails.”
This is distinct from the normal thymus appearance which is the “sail sign”
What’s going on in the RUL?
Infilrate? Or Consolidation?
Consolidation! You can tell because it is SOLID and not “patchy”
Whatttt is going on here?
This person has a “water bottle heart” which means they have a pericardial effusion
When evaluating the Thorax, what are you looking for?
What does the mediastinum contain?
Heart
great vessels
potential spaces in front of, behind, and above the heart
What does ATMLL stand for
Are There Many Lung Lesions?
Abdomen
Thoracic wall- soft tissue and bones
Mediastinum
Lung fields (individually)
Lungs comparison
A Cardio:Thoracic ratio (CTR) of greater than __:__ should be considered abnormal
1:2
**100% on the test**
What is it called when there is air under the diaphragm?
Pneumo-peritoneum
Anything wrong here?
No!! This is normal bowel in the LUQ.
how can you tell? Is is NOT crescent shaped!
Anything wrong here?
Yes, there is free air under the diaphragm on the Right side
(note the ~crescent~ shape)
Anything wrong here?
flattened diaphragm = hyperinflation= this guy has COPD
What can cause a cavitary lesion?
TB
valley fever
What should the costophrenic angles look like on a frontal chest X ray?
They should form acute angles which are sharp to a point
How do you determine if the heart is enlarged?
If the widest width of the heart is more than 50% the widest width of the thorax, it is considered enlarged.
(Cardio:Thoracic Ratio)
Can you see normal lung through the gastric bubble?
Yes you should be able to!
Anything wrong here?
Yes, they have a hemopneumothorax on the Right. Note the lack of vascular markings and the blunted costophrenic angle
What Quadrant?
RUL
Can you see lung markings below the diaphragm?
Yes! The lungs are below the diaphragm in some areas
Anything wrong here?
If heart size is ______ on an AP view, you can safely say it is not enlarged
Normal
What quadrant?
LUL
What are those arrows pointing at?
I dont know :(((((( i wrote this on a picture on the same slide but i barely see it and i dont know what they are from
“Linear densities extending IN from periphery”
What do you see here? (Other than.. you know hehehe)
A cavitary lesion!!!
Anything wrong here?
Metastasis in the clavicle
How can you tell if the “penetration” of the image was correct?
When looking at the spin, the disk spaces are seen, but bony details of the spine cannot be seen
(i dont know what this means 😭)
Is this patient rotated?
Yes. Spinous processes are not equidistant from the medial ends of the clavicles.
(I think she said that this one may be due to scoliosis)
What quadrant?
RUL
Vascular markings are prominent in which part of the lung field?
base of lungs
Is this patient rotated?
No, the spinous processes are equidistant from the medial ends of the clavicle👍
Is this a tension pneumothorax or just a regular one?
Its a tension pneumothorax.
Look at how everything is pushed over to the LEFT. Even though the pneumothorax is on the RIGHT. (Always check to see if the trachea is midline….it is not midline)
Do these metastases affect the Right lower lobe?
yes, you can see lesions through the diaphragm (as well as though the gastric bubble on the left) so you can conclude that the lesions are in the posterior parts of the lung too.
Does this diaphragm and gastric air bubble look normal?
Yes, you can tell that it is air in the stomach because of the thick walls of the stomach.
That is a normal air-fluid level after a meal
Is this a normal sized gastric bubble?
Y E SSSSSS
Notice anything?
There is no breast on the Left
Ok, you’ve looked at the bones, the soft tissue, the mediastinum, the quality of the picture, can we LOOK AT THE LUNGS NOW…??
No, you can look at A lung.
Start by looking at one lung at a time and THENNNN you can compare them. Start at the hilum and go around, making sure the vascular markings extend to the edges, etc
