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Resp > Lecture 16 - Chest x-rays > Flashcards

Lecture 16 - Chest x-rays Flashcards

1
Q

What is indicative of a pneumoperitoneum on a chest x-ray?

A

Dark stripe under the diaphragm

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2
Q

What is the approach used to assess a chest x-ray?

A

ABCDE

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3
Q

What do you have to assess before you even start using the ABCDE approach to a chest x-ray?

A

Confirm the patient details

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4
Q

What is the A in ABCDE to chest x-ray assessment?

A

Airways

Is trachea central (thyroid goitre)

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5
Q

What is the B in ABCDE to chest x-ray assessment?

A

Breathing

Any lung changes?

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6
Q

What is the C in ABCDE to chest x-ray assessment?

A

Circulation (Heart size)

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7
Q

What is the D in ABCDE to chest x-ray assessment?

A

Disability/densities

So bones
Any fractures

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8
Q

What is the E in ABCDE to chest x-ray assessment?

A

Everything else

Soft tissues

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9
Q

What size should the heart be relative to the thorax?

A

Longest transverse diameter of the heart shouldn’t be more than 50% of the transverse diameter of the thorax

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10
Q

Where do rib fractures often occur?

A

Lateral edges

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11
Q

What diagnosis should you consider:

20yr old
1wk of lethargy, myalgia, fever and cough with brown sputum?

A

Pneumonia

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12
Q

What signs on a chest x-ray can be seen with pneumonia?

A

Air space narrowing
Air bronchograms (lines running in the fluffy white area)

Bulging/thickenign of fissures of lung

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13
Q

What diagnosis should you consider:

65yr female
Cough
Haemoptysis
Weight loss

A

Lung cancer

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14
Q

What signs on a chest x-ray can be seen with lung cancer?

A

Rounded opacity
Possible pleural effusion
Possible lymphadenopathy

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15
Q

What diagnosis would you consider:

60yr male
1 day of increasing SOB
Frothy white sputum

A

Likely pulmonary oedema due to heart failure

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16
Q

What are Kerley B lines?

A

Short sharp horizontal lines from the edge of lungs indicating theres fluid in the interstitium of the lung (pulmonary oedema)

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17
Q

What signs on a chest x-ray can be seen with pulmonary oedema?

A

Bat wings (perihilar shadowing)
Peripheral lines (Kerley b lines from interstital fluid)
Pleural effusions

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18
Q

What should you’re first thought be if sputum is brown/green?

What should you’re first thought be if sputum is red/haemoptysis?

What should you’re first thought be if sputum is frothy white?

A

Brown green = pneumonia
Red = lung cancer
White frothy = cardiac failure (pulmonary oedma)

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19
Q

What is dextrocardia?

A

When the heart sits/faces the right side instead of the left side

20
Q

What is situs inversus totalis?

A

When all of the organs in the abdomen/thorax are on the wrong side

21
Q

What is the point of changing window width and level on CTs?

A

Can see different structures/details

22
Q

What are the signs of COVID infection on a chest x-ray?

On CT?

A

Multi focal peripheral opacities

Get ground like glass/opacities on CT

23
Q

What is the first thoughts on diagnosis:

25yr F
Known chronic lung disease
Cough + Increased sputum production

A

Bronchiectasis/CF

24
Q

What are the signs of cycstic fibrosis on chest x-ray?

What is the sign seen on CT called?

A

Bronchiectasis
Thickened parallel bronchial airways that aren’t normally visible

Airway plugging
Can have a venous Catheter

Signet ring sign

25
Q

What imaging presentation can a pulmonary embolism have?

A

Normal CXR
Peripheral opacity due to infarction

CTPA: filling defect
Straightening of interventricular septum since inc RV pressure

26
Q

What is a saddle embolus?

A

Embolus that spans the width of teh pulmoary artery affecting the 2 main branches

27
Q

What diagnosis would you consider:

20yr M
Retching followed by sudden onset sharp central chest pain

A

Likely tear of lower oesophagus causing Pneumomediastium

28
Q

How does a pneumomediastium present on a CXR?

A

Streaky lines parallel to mediastinum
Gas in neck and Axillae
Boerhaave syndrome

29
Q

What is boerhaave syndrome?

A

Oesophageal tear

30
Q

How do you normally treat pneumomediastium?

A

Treat nil by mouth to allow oesophagus to heal

31
Q

What diagnosis should you consider:
70yr M
Retired factory worker
Intermittent SOB

Why do you consider this?

A

Pleural plaques

Likely exposed to asbestos which has this affect

32
Q

What are some signs of pleural plaques on CXR?

A

Calcified plaques
Normally very visible on diaphragm surface

33
Q

What diagnosis do you consider in this patient:

70yr M
Retired factory worker
Worsening SOB
Weight loss
Fatigue

Why?

A

Mesothelioma

Red flags for cancer
Likely exposed to asbestos so mesothelioma is caused my asbestos

34
Q

What is mesothelioma?

A

Malignancy of the lung pleura
Usually due to asbestos exposure

35
Q

Why can mesothelioma present with chest wall pain?

A

Malignancy compresses chest wall nerves

36
Q

What is a sign of mesothelioma on CXR?

A

Lung encased by ring of tissue

Associated within asbestos exposure

37
Q

Go to the last slide and look at CXR 1:

20yr old
1wk of lethargy, myalgia, fever and cough with brown sputum

What is your diagnosis?
What signs support this?

A

Pneumonia

Airspace shadowing
Air bronchograms (can see lines runnngi in white fluffy areas)

Well defined bulging fissures

38
Q

Go to the last slide and look at CXR 2:

65yr old F
Cough, Haemoptysis and weight loss

What is your diagnosis?
What signs support this?

A

Lung cancer

Rounded opacity
Pleural effusion (lost of sharp costophrenic angles)

39
Q

Go to the last slide and look at CXR 3:

60yr old M
1 day of increasing SOB and frothy white sputum

What is your diagnosis?
What signs support this?

A

Pulmonary oedema secondary to heart failure

Perihilar shadowing/bats wings
X-ay is an AP from resus so patient likely very unwell
Kerley b lines

40
Q

Go to the last slide and look at CXR 4:

25yr old M
Fit and well, CXR for immigration purposes

What is your diagnosis?
What signs support this?

A

Situs inversus totalis

Dextrocardia
Stomach on right (gastric bubbles)
Aortic knuckle on right

41
Q

Go to the last slide and look at CXR 5:

50yr old F
3 day dry cough, malaise and fever

What is your diagnosis?
What signs support this?

A

COVID
Multifical peripheral opacities

42
Q

Go to the last slide and look at CXR 6:

25yr old F
Known chronic lung disease, cough and inc sputum production

What is your diagnosis?
What signs support this?

A

Cystic fibrosis

Bronchiectasis
Thickened parallel airway (indicate inflammation)
Airway plugging

43
Q

Go to the last slide and look at CXR 7:

85yr old M
Syncope, postural dizziness, hypoxia and tachycardia
What is your diagnosis?
What signs support this?

A

Pulmonary embolism

Hazy right lower lobe

Lost right sharp costophrenic angle

44
Q

Go to the last slide and look at CXR 8:

20yr old M
Retching followed by sudden onset sharp central chest pain
What is your diagnosis?
What signs support this?

A

Pneumomediastium

Branching dark lines of gas parallel to oesophagus/mediastium

45
Q

Go to the last slide and look at CXR 9:

70yr old M
Retired factory worker, intermittent SOB

What is your diagnosis?
What signs support this?

A

Pleural plaques

Exposed to asbestos likely
Plaques visible on Left lung
Can see dense calcified plaque on diaphragm surface

46
Q

Go to the last slide and look at CXR 10:

70yr old M
Retired factory worker, worsening SOB, weight loss and fatigue

What is your diagnosis?
What signs support this?

A

Mesothelioma

Asbestos exposure likely
Lung encase by rind of tissue
Cancer red flags

Resp (23 decks)

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