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Pulmonary Block > Lecture 2: Chest X Rays > Flashcards

Lecture 2: Chest X Rays Flashcards

1
Q

What are the ‘Shuns’

A 
Identification
Projection
Position/Rotation
Penetration
Inspiration
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2
Q

What are the types of projection?

A

PA: posterior anterior
Done while standing

AP: anterior posterior
Used for patients who are non ambulatory

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3
Q

Which is preferred? Why?

A

PA

With an AP film, the beam hits the anterior structure (heart) first and scatters. Therefore, heart may appear enlarged in an AP film. If heart takes up entire hemithorax space - cardiomegaly but do not know to what extent.

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4
Q

What occurs if you don’t have proper position?

A

If the patient is rotated, may appear as mediastinal shift

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5
Q

What is the proper penetration?

A

Should barely be able to see the thoracic spine disk spaces.

If the penetration is off (over or under) then may miss a finding

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6
Q

Sizing for pulmonary nodule vs pulmonary mass

A

Nodule: 3 cm

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7
Q

What’s the order from least dense to most in a radiograph? What color would least dense and most dense object appear on a radiograph?

A 
Least dense= black
Air
Fat
Soft tissue
Calcium
Bone
Contrast
Metal
Most dense= white
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8
Q

At inspiration, where is the diaphragm?

A

8th - 10th posterior rib

5th - 6th anterior rib

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9
Q

Why do you want the patient to take a deep breath when taking a chest X-ray?

A

If the patient does not take a deep breath in while taking the X Ray:

  • heart size is prominent
  • peri hilar areas are full
  • see interstitial markings

When the patient is in full inspiration
- diaphragm drops down and the image clears up so you don’t over-read certain findings

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10
Q

Anatomy in the chest X-Ray.

A

ABCDE

Air
Bones
Cardiovascular
Diaphragm 
Everything else
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11
Q

Air

A

Trachea - make sure it’s midline
Carina- bifurcation of the trachea
Bronchi-> airways: look at the lungs as upper, middle and lower thirds

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12
Q

Bones

A

Look at your clavicles (lined up) ribs (check through them to see if there’s lung pathology) and any bone that appears on the film. Check for fractures.

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13
Q

Cardiovascular inspection.

What are the contours?

A

Look at the shape and size of the heart
Clear cardiac silhouette

Left:
Aortic arch
Pulmonary trunk
Left atrium
Left ventricle

Right:
Right Atrium

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14
Q

Diaphragm inspection

A

Make sure there are two. If there is only one visible

  • fluid obscuring it (pleural effusion)
  • consolidation (pneumonia)
  • atelactasis so (partial lung collapse)

Too much air under the diaphragm
- perforated ab viscera

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15
Q

Everything else (inspection)

A

Look outside the lungs
Under the diaphragm, may miss pneumonia/nodule
Make sure gastric air bubble is present
Check for external hardware

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16
Q

What is the advantage of a lateral X ray

A

Can see the area behind heart, retrocardiac space (in the posterior mediastinum?) should be clear

17
Q

Seen in the mediastinum: What are the Terrible T’s?

A

Thymus
Thyroid
Teratomas
Terrible lymphoma

18
Q

What are potato lymph nodes? How do they appear on a lateral X-Ray?

A

Large hilar lymph nodes

(Enlarged hilar and mediastinal lymph nodes are indicative of sarcoidosis)

Donut sign

19
Q

What is an air bronchogram?

A

Visualization of air in the intrapulmonary bronchi

20
Q

What does alveolar filling look like? What are underling pathologies of an abnormal bronchogram?

A

White shadows - can see the subdivisions of airways

Alveolar filling

  • pus: pneumonia
  • water: edema
  • blood: hemorrhage
  • protein: alveolar proteinosis
  • cells: alveolar cell carcinoma
21
Q

If you get an abnormal film, what should you do?

A

Follow up film 6-8 weeks to make sure abnormality is not there anymore

22
Q

How do you determine interstitial abnormalities? What are the different type of interstitial patterns?

A

Follow the ‘lines’ from the hilum to the periphery to make sure it’s an abnormality and not just the vessels.
(Vessels get smaller and smaller-> should not be able to see towards the periphery)

Linear
Reticular
Nodular
Reticulonodular

23
Q

What’s a miliary pattern?

A

Many tiny diffuse dots seen on X-ray or CT scan

Indicative of the most infective form of TB

24
Q

What is a mycetoma? What’s a commone cause? What’s a common complication?

A

Movable fungus ball in a lung cavity.
Most often due to aspergillus (aspergilloma)
It has neovascularization, when it moves, bounces into immature blood vessels-> bleeding is a major complication.

25
Q

What is a pneumothorax?

A

Lung collapses, air in pleural space

26
Q

What is diaphragmatic calcification indicative of?

A

Asbestos exposure

Can be seen with pleural plaques

27
Q

Pleural effusion

A

Fluid in the pleura

Looks like a white shadow

28
Q

White outs can be due to __?

What helps with determining underlying pathology?

A

Lung completely filled with fluid
Lung completely collapsed

Mediastinal shift helps with diagnosis

29
Q

A barrel shaped chest is indicative of ___? How does it look like?

A

COPD

Hyper inflated lungs within rib cage. Ribs are fairly straight (not as curved) and the apex of the heart is more medial (PMI felt below the sternum)

30
Q

Ectatic aorta

A

Floppy aorta, does not stay in place (seen in an X-ray of an older person)

31
Q

How do you tell if an opacity is a pleural or lung based lesion?

A

Look at the angle of opacity

Obtuse - tends to be more of pleural origin (but not always the case)

32
Q

How can you tell if there’s a tension pneumothorax?

A

Collapsed lung - can see a clear demarcated separation of lung and air in pleura.
If mediastinum is shifter in the contra lateral direction of the collapsed lung - tension pneumothorax

33
Q

Which side of the diaphragm is normally lower?

A

Left

34
Q

What are some reasons why the diaphragm may be elevated?

A

Cervical spine injury
Phrenic nerve injury
Pericardial injury
Splinting due to pain

35
Q

What is splinting?

A

When a patient is in pain due to traumatic injury, the lung on the side of trauma will not inflate as much (breathing less on the injured side).

Pulmonary Block (7 decks)

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