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NURA-606-01 Advanced Health Assessment > Lecture 3: CXR_interpret_STUDENT-2020-EDITED AL > Flashcards

Lecture 3: CXR_interpret_STUDENT-2020-EDITED AL Flashcards

1
Q

Justification for CXR

A 
pneumonia (confirmation) 
immunosuppressed pt 
COPD w/acute exacerbation 
foreign body 
CHF 
aspiration pneumonia 
blunt trauma 
lung tumor 
chest pain 
suspected pneumothorax 
SOB (severe) 
hemoptysis 
pulmonary HTN 
PE 
interstitial lung ds 
ICU pt (adm, inv lines, ETT)
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2
Q

Basic Tissue Densities

• Black =

A

• Black – air

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3
Q

Basic Tissue Densities

• Dark gray =

A

• Dark gray – subcutaneous tissue, fat

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4
Q

Basic Tissue Densities

• Light gray =

A

• Light gray – soft tissue (muscles, heart, blood vessels, pus, etc)

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5
Q

Basic Tissue Densities

• Off white =

A

• Off white – bone

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6
Q

Basic Tissue Densities

• Bright white =

A

• Bright white – metal (pacemakers, surgical clips, bullets, etc)

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7
Q

Supine
• supine position limits ?
• ________ push is noted- (____________ contents)
• small pleural effusions will layer in ?- can easily be ?
• Be _______ interpreting supine films!

A
  • supine position limits full inspiration
  • cephalic push is noted- (liver and abdominal contents)
  • small pleural effusions will layer in posterior pleural space- can easily be missed
  • Be careful interpreting supine films!
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8
Q

Upright position

inspiration is ?

A

inspiration is greater/better

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9
Q

Inspiration and Expiration

Good inspiration = ?

Hypoinflation= ?

A

Good inspiration = hemi diaphragm down to level of posterior 10th or 11th ribs.

Hypoinflation= dome at 7th rib

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10
Q

• PA (posteroanterior)
• AP (anteroposterior)
Can you explain the two terms????????????

A 
PA:
X-ray beam is entering/exiting =
pt position =
detector position =
heart size =
diaphragm =
AP:
X-ray beam is entering/exiting =
pt position =
detector position =
heart size =
diaphragm =
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11
Q

Terminology

Position is TREMENDOUSLY important because the following might be affected:

A
  • magnification
  • organ position
  • blood flow
  • gravitational pull
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12
Q

Which view is most preferred?

Why? See other slides

A

PA & Upright

Well demarcated costophrenic angle + see other slides

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13
Q

Expiration usefulness

small pneumothorax: expiration will make the lung larger/smaller and more/less dense, and at the same time will relatively make the pneumothorax appear larger/smaller?

A

small pneumothorax: expiration will make the lung smaller and denser, and at the same time will relatively make the pneumothorax appear larger

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14
Q

Expiration usefulness

lodged foreign body: “ball-valve phenomenon” – air can move past the object during inspiration, but during expiration (the bronchus gets smaller) and air can not exit around the obj. As a result, the expiration image will show air trapping in the affected lung and a mediastinal shift will occur toward ?

A

lodged foreign body: “ball-valve phenomenon” – air can move past the object during inspiration, but during expiration (the bronchus gets smaller) and air can not exit around the obj. As a result, the expiration image will show air trapping in the affected lung and a mediastinal shift will occur toward the unaffected side

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15
Q

Pneumothorax =

supine vs upright?

Where is the first place to look for pneumothorax?

deep sulcus sign =?

A

Pneumothorax—air positioned between the visceral and parietal pleura

  • trauma, subclavian venous catheter, liver biopsy
  • spontaneous (bleb rupture)
  • metastatic tumors

upright

Where is the first place to look for pneumothorax (UPPER)

deep sulcus sign = costophrenic angle getting deeper? (supine?) ~ look up!!!

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16
Q

Pleural effusion

Pleural effusion =

Look for:

Causes:

What is the preferred X-ray position (upright or supine)?

A

Pleural effusion—collection of fluid between the visceral and parietal pleura (~100 mLs to be detected on upright CXR)

Look for (reference image on pg 87 of reading):
blunting of costophrenic angles
increased basilar density (whiteness)
loss of normal lung-hemidiaphragm is noted

Causes: malignancies, pancreatitis (left-sided), cirrhosis (right-sided), CHF (bilateral), pneumonias (40%)

What is the preferred X-ray position? upright

17
Q

Mediastinal shifts:
• Tension pneumothorax—the mediastinum is shifted toward the (affected, unaffected) side?
• Atelectasis—collapse of entire lung segment might result in severe volume loss. Will see mediastinal shift toward the (affected, unaffected) side?
• Airway obstruction—mediastinal shift toward the (affected, unaffected) side?

A

Mediastinal shifts:
• Tension pneumothorax—the mediastinum is shifted toward the unaffected side.
• Atelectasis—collapse of entire lung segment might result in severe volume loss. Will see mediastinal shift toward the affected side.
• Airway obstruction—mediastinal shift toward the unaffected side.

18
Q

male vs female CXR?
• nipple shadows → men and women
• overlying breast tissue → accentuate pulmonary vasculature (careful, not to dx as ?)
• can tape BB or other metal object and reshoot film?

A

compare both sides
infiltrate
?

19
Q

Exposure

Overexposure
• Image is white or dark ?
• Easy to see:
• Cannot see:

A

Overexposure
• Image is dark
• Easy to see: Thoracic spine, clavicles, behind the heart, NG & ET tube placement
• Cannot see: pulmonary vessels in the periphery, small nodules, or fine structures

20
Q

Exposure

Underexposure
• Image is white or dark ?
• Easy to see:
• Cannot see:

A

Underexposure
• Image is white
• Easy to see: pulmonary vasculature (don’t mistake for infiltrate)
• Cannot see: behind the heart, spinal anatomy, or behind hemidiaphragms

21
Q

Know the major landmarks: Slides 27-30!

A

Know the major landmarks: Slides 27-30!

22
Q

Silhouette Sign
• very useful in interpreting a CXR
• it helps to determine the location of an abnormality in relation to ?
• RML vs RLL (pneumonias, masses)
- loss of right heart border indicates that the infiltrate is in the ?
- loss of right hemidiaphragm indicates that the infiltrate is in the ?
- loss of left hearth border indicates that the infiltrate is in the ?
- loss of left hemidiaphragm indicates that the infiltrate is in the ?

A

Silhouette Sign
• very useful in interpreting a CXR
• it helps to determine the location of an abnormality in relation to normal structures
• RML vs RLL (pneumonias, masses)
- loss of right heart border indicates that the infiltrate is in the RML
- loss of right hemidiaphragm indicates that the infiltrate is in the RLL
- loss of left hearth border indicates that the infiltrate is in the lingula of the LUL
- loss of left hemidiaphragm indicates that the infiltrate is in the LLL

23
Q

Aspiration pneumonia

Aspiration:

CXR usually performed immediately after ?

F/U should be performed w/in X hrs ?

A

Aspiration pneumonia

Aspiration: the inhalation of gastric contents
*following seizure, cardiac resuscitation, anesthesia related complication

CXR usually performed immediately after incidence

F/U should be performed w/in 12 hrs
* may take several hours for the gastric contents to react with the lung to cause fluid exudate and an alveolar infiltrate

24
Q

Mediastinal mass → ?

Anterior:

A

Mediastinal mass → widening or bulge in the central soft tissue of the chest

Anterior:
thymoma
thyroid lesions
teratoma
T cell lymphoma
*The 4 Ts*
25
Q

Mediastinal mass → ?

Middle:

A

Mediastinal mass → widening or bulge in the central soft tissue of the chest

Middle:
t. aortic aneurysms
neoplasms
adenopathy
diaphragmatic hernias
26
Q

Mediastinal mass → ?

Posterior (lat view):

A

Mediastinal mass → widening or bulge in the central soft tissue of the chest

Posterior (lat view):
neurogenic (90%)
neuroblastomas
schwannomas
ganglioneuromas
27
Q

Systematic approach:

  1. Who
  2. What
  3. When
  4. Why
  5. Exposure
A

Systematic approach:

  1. Who (correct patient)
  2. What (film orientation) → AP, PA, supine, upright
  3. When (date)
  4. Why (reason for X-ray) → history and PE are extremely important
  5. Exposure
28
Q 
Systematic approach:
A
B 
C
D
E
A 
Systematic approach:
Airway 
Bones 
Cardiac 
Diaphragm/mediastinum 
Everything else
29
Q

Read Lecture 3 - Essentials of Radiology-Mettler prior to exam!!!
EX: List of why we do CXRs

A

Read Lecture 3 - Essentials of Radiology-Mettler prior to exam!!!
EX: List of why we do CXRs

30
Q

Study class exercise….slide and photo answers!

A

Study class exercise….slide and photo answers!

NURA-606-01 Advanced Health Assessment (9 decks)

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