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Clin D III > Lecture 2- CXR Basics > Flashcards

Lecture 2- CXR Basics Flashcards

1
Q

Viewing CXR

steps for viewing

A
  1. position radiograph correctly
  2. view as a whole for obvious abnormality
  3. view systematically
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2
Q

within the body… radidation is

3

A
  1. completely absorbed
  2. transmitted unchanged through the pt
  3. scattered within the body
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3
Q

Views

4 typical views

A
  1. posterior anterior (PA)
  2. lateral
  3. anterior posterior (AP)
  4. lateral decubitus
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4
Q

Views

describe CXR PA view

4 components

A
  • gold standard for front view of lungs
  • pt stands upright with the anterior of chest placed against the front of the film (radiation goes through the back to the front)
  • shoulders are rotated forward to touch the film to ensure the scapula are out of the way
  • take image with full inspiration
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5
Q

Views

describe CXR AP view

4 components

A
  • used when the pt is immobilized or unable to do PA procedure
  • patient is supine with patient’s back against the film
  • heart is at a greater distance from the film so it will be enlarged
  • scapula are visible
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6
Q

Views

describe CXR lateral view

3 components

A
  • pt standard upright with one side of the chest against the film
  • allows the viewer to see behind the heart and diaphgragmatic dome
  • done in conjunction with PA view to help determine 3D location of anormalities
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7
Q

Views

describe CXR lateral decubitus view

A
  • pt lies on the L or R side (ensure it’s labelled properly)
  • often used to reveal pleural effusion that can’t be observed in upright view
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8
Q

what constitutes the hilum

A
  • pulmonary arteries & branches
  • pulomnary veins
  • adjacent airways
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9
Q

Views

which CXR view shows the truest size of the heart?

A
  • PA view
  • AP view magnifies the heart
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10
Q

Views

t/f the heart may also seem enlarged if the pt doesn’t take a full breath

A

TRUE- must take full breath in to truly gauge heart size

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11
Q

Chest Anatomy

go to ppt and label the components of the mediastinum.

A

ok

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12
Q

define

  • radiolucent
  • radio-opaque
A
  • radiolucent: allows xray to go through (black/air)
  • radio-opaque: blocks xray from going through (white/bone)
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13
Q

CXR Interpretation

ABCs of CXR Interpretation

A
  • Assess the quality of the CXR
  • Airway
  • Bones/Borders
  • Cardiac Assessment
  • Diaphragms
  • Effusions
  • Fields
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14
Q

CXR Interpretation

Describe components of assessing the quality of an image

A

PIER
* Positioning (PA, Lat, AP, decubitus)
* Inspiratory Effort (8-10 countable ribs)
* Exposure/penetration (vertebrae are just visible behind the heart)
* Rotation (clavicular heads equi-distant from spinous process; clavicular head attached at T4)

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15
Q

CXR Interpretation

A-Airway: what are you assessing?

A
  • trachea - look for midline/shifting/narrowing
  • maybe can see where trachea splits at the carina?
  • want to see through to the aortic arch
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16
Q

CXR Interpretation

B- Bones, Borders, Soft Tissues
what do we evaluate here?

A

Bones:
* look at each rib
* clavicles
* lower cervical and thoracic spine
* scapulae/humeri if visible
* are there bone lesions? spinous processes lined up?

Soft Tissues
* abnormalities of the skin/breast/body parts?

Borders
* supraclavucular fossae (nodes)
* Lateral chest wall
* Under diaphragm

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17
Q

CXR Interpretation

what can breast tissue obscure?

A

costophrenic angles

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18
Q

CXR Interpretation

what may lucencies within soft tissue represent?

A

gas

19
Q

CXR Interpretation

C- Cardiac
what do we evaluate here?

A
  • 2/3 of heart should lie on L side of chest w/ 1/3 on the R side
  • heart should take up less than 1/2 of the thoracic cavity (measured horizontally)
  • LA and LV create L heart border
  • RA creates R heart border
20
Q

CXR Interpretation

D- diaphragm
what do we evaluate here?

A
  • both diaphragms should form a sharp margin w/ the lateral chest wall
  • both diaphragm contours should be clearly visible medially to the spine
21
Q

CXR Interpretation

E- effusions
what do we evaluate here?

A
  • effusion: fluid where fluid shouldn’t be (outside border of lung)
  • the pleura and pleural spaces will only be visible when there is an abnormalities present
22
Q

CXR Interpretation

F- fields
what do we evaluate here?

A
  • normally, there are visible markings throughout the lungs due to the pulm arteries/veins which continue to the chest wall
  • both lungs should be scanned starting at the apex and working downward
23
Q

CXR Interpretation

describe lung fissures on CXR

A
  • likely not visible but can be seen
  • horizontal & transverse on R lung/transverse on L lung
  • the major fissures are not usually seen on a PA view because they are viewed obliquely
24
Q

CXR Interpretation

go to ppt and label the lobar anatomy.

A

ok

25
Q

Lung Disease

6 basic patterns of lung disease

A
  1. air space opacities
  2. interstitial opacities
  3. nodules/masses
  4. lymphadenopathy
  5. cysts/cavities
  6. pleural abnormalities
26
Q

Lung Disease

what might cause air space opacities

A
  • replacement of air in the alveolar space by inflammatory cells, pus, blood, water, tumor cells
27
Q

Lung Disease

what is an air bronchogram?

A
  • characteristic manifestation of air-space opacity which refers to the phenomenon of air-filled bronchi (dark) being made visible by the opacification of surrfounding alevoli
  • looks like a dark spot (literally just an air space)
28
Q

Lung Disease

what are interstitial opacities?

A
  • involvement of the supporting tissue of the lung parenchyma
  • generalized miliary patterns, Kerley B lines, reticular/septal lines, peribronchovascular thickening, nodules
29
Q

Lung Disease

what does generalized miliary pattern mean?

A

innumerable amount of small opacities in the interstitial space

30
Q

Lung Disease

differentiate Kerley A and B lines

A
  • A: around hilum
  • B: around bases/lateral sides
31
Q

Lung Disease

what are reticular formations typically seen with?

A

pulmonary fibrosis

32
Q

Lung Disease

differentiate nodules and masses

A
  • nodules: < 3 cm
  • masses: > 3 cm
  • both: clearly defined opacities
33
Q

Lung Disease

describe solitary pulmonary nodules

A
  • common clinical probelm (>50% of smokers aged 50+)
  • single, small (< 3cm), well-circumscribed, radiographic round opacity on chest imaging surrounded by normal lung
  • not associated with infiltrate, atelectasis, or adenopathy
34
Q

Lung Disease

describe multiple pulmonary nodules

A
  • more worrisome for malignancy than SPNs
  • same risk factors for malignancy, but more likely to be metastatic than a SPN
35
Q

Lung Disease

which cancers are most likely to metastasize

5

A
  • colorectal
  • breast
  • renal cell
  • uterine leiomyosarcoma
  • head/neck squamous cell carcinoma
36
Q

Lung Disease

describe lymphadenopathy

A
  • abnormal contouring of mediastinal shadows (LOOK AT THE HILUM!)
  • characteristic locations: R paratracheal area, hilar regions, aortopulomary window, subcarinal region, superior mediastinum
37
Q

Lung Disease

describe cysts/cavities

A
  • occur in the pulmonary parenchymal space and when abnormal they contain air/fluid/both (normal = lung tissue)
  • cysts: thin walled filled with cellular elements
  • Cavities: created by tissue necrosis within a lung nodule/mass (become air-filled when the internal necrotis elements are expelled into the tracheobronchial tree)
38
Q

Lung Disease

what pleural abnormalities can be seen?

3

A
  • pleural effusion
  • pleural thickening
  • pleural calcifications
39
Q

Lung Disease

describe pleural effusion findings on CXR

A

blunting of the costophrenic angle to form a crescent shaped opacity

40
Q

Lung Disease

describe pleural thickening CXR findings

A

nondependent and non free flowing

41
Q

Lung Disease

describe when pleural clacifications are seen?

A
  • asbestos-related pleural disease
  • sequelae of prior hemothorax or tuberculosis
42
Q

infiltrates vs consolidation

A
  • infiltrate: fluid in the lung
  • consolidation: hardening or thickening of the infiltration
43
Q

Lung Disease

pneumothorax

A
  • no lung markings in pleural space
  • mediastinum shifts to the CONTRALATERAL side
  • deep sulcus sign: the costophrenic sulcus is significantly lower than on the ipsilateral side
  • prominent vascular markings in the opposite lung (because it is receiving entire cardiac output)

Clin D III (11 decks)

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