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Diagnostic Interpretation PA 545: Pulmonary > Normal CXR > Flashcards

Normal CXR Flashcards

objectives

1
Q

Normal PA w/ landmarks

A
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2
Q

CXR indications via evaluation of symptoms

A
  • cough
  • dyspnea
  • orthopnea
  • PND
  • Chest pain, after other causes rules out
  • fever of unknown origin
  • unintentional wt loss
    • esp in smoker
  • abnormal lung exam
    • crackels
    • dullness to precussion
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3
Q

CXR indications via evaluation of signs

A
  • chest trauma
  • cyanosis/hypoxia
  • tachycardia
  • distended neck veins
  • heart murmur
  • diminished breath sounds
  • egophany
  • tracheal deviation
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4
Q

CXR- other indications

A
  • evaluation of plavement of lines/tubes
  • screening for pneumothorax after procedure
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5
Q

how to order a CXR

A
  • PROVIDE INDICATION
  • specify vies
    • bedside or “send in”
    • how to decide?
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6
Q

PA/Lat view

A
  • posterior to anterior
  • viewing image almost backwards
  • much better than AP view
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7
Q

AP portable

A
  • anterior to posterior
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8
Q

AP vs PA

A
  • heart looks smaller on PA and larger on AP
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9
Q

apical lordodic view

A
  • view gets the clavicle out of the way of the apices
  • should only use for looking at apices and no other lung areas
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10
Q

decubitis view

A
  • inspiritory
  • expiritory
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11
Q

lateral film

A
  • clear retrosternal space
  • no discrete masses present in hilar region
  • right hemi-diaphragm higher than left
  • sharp costophrenic angles
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12
Q

tissue densities

A
  • air
    • black
  • lead, bone
    • white
  • muscle, fat, liver
    • grey
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13
Q

criteria of a good CXR

A
  • ROTATION
    • symmetry via clavicles
  • penetration
    • overpenetration
      • may see vertebrae too clearly, should normally be able to just make them out under the heart
    • underpenetration
      • spinous process not seen at all
  • inspiration
    • you should be able to count 10 ribs w/ good effort
  • cropped
    • make sure to visualize every aspect of the lung, both costophrenic margins
  • crooked
    • ideal to have a straight film
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14
Q

stepwise evaluation of right pt CXR

A
  • label: name, date, DOB
  • orientation: L/R
  • view: PA, AP, Lat
  • quality of the film
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15
Q

ABCDEF system CXR

A
  • A= airways
    • trachea (deviation, obstruction)
    • R/L main bronchus
  • B= bones
    • ribs, clavicle, sternum, vertebrae
  • C= cardiac silouhette and mediastinum
    • size and widening
  • D= diaphragm and gastric bubble
    • elevation, sub diaphragm air, gastric bubble
  • E= effusions
    • costophrenic angle
  • F= fields
  • G=gastric bubble
  • H=hilum
  • I=iatrohenic stuff
    • lines
    • tubes
    • devices
    • surgeries
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16
Q

view for heart

A
  • PA
  • Lat
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17
Q

view for aortic knob

A
  • PA
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18
Q

view for trachea and carina

A
  • PA
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19
Q

view for hilum

20
Q

view for clavicles

21
Q

view for ant/post ribs

22
Q

view for sternum/ retrosternal clear space

23
Q

view for breasts/ nipples

24
Q

views for vertebral bodies/ disc space

25
Q

view for hemidiaphragms

26
Q

view for gastric air bubble

27
Q

view for fissures

28
Q

view for costophrenic angles/sulcui

29
Q

alveolar infiltrate

A
  • fluid of any type that displaces air in the alveoli
  • causes
    • water
    • pus
    • blood
    • proteinous fluid
30
Q

alveolar infiltrate via water

A
  • cardiogenic pulmnary edema
    • fluffy cloud-like radiopaque densities
    • batwing or butterfly pattern
      • perihilar congestion
    • cardiogenic (CHF)
      • develops acutely and resolves quickly w/ tx
        • peripheral sparing, advances for hilum, usually fairly symmetrical
31
Q

alveolar infiltrate via pus

32
Q

alveolar infiltrate via blood

A
  • hemoptysis
  • rupture
33
Q

alveolar infiltrate via proteinous fluid

A
  • ARDS, non-cardogenic pulm edema
    • fluffy, cloud-like radiopaque densities
    • diffuse pattern
    • develops gradually
    • not peripheral sparing or symmetrical
34
Q

interstitial infiltrate

A
  • thickening of interstitial tissues and pleural fissures in otherwise well-aerated lung fissures
    • linear densities
      • A-lines
        • radiate towards hila
        • located in mid and upper zones
        • thinner and adjacent to blood vessels
        • do not reach edge of lung
      • B-lines
        • horizontal lines
        • ,2cm
        • seen at periphery of lung
    • spherical densities superimposed on normal radiating pattern of blood vessels
35
Q

Silhouette sign

A
  • Loss of normal borders in thoracic structures
  • Typically obscured heart border or diaphragm:
    • RML obscures right heart border,
    • LLL: left heart border/diaphragm
    • RLL: R hemidiaphragm
    • LUL: descending aorta
    • RUL: ascending aorta
    • Lingual of LUL: left heart border
36
Q

Spine Sign

A
  • When on a lateral film, the thoracic spine appears darker/blacker as you go from shoulder to diaphragm
    • If the dz involves the posterior lower lobes, the xray beam will be absorbed more which adds density thus making it more white just above the posterior costophrenic sulcus
37
Q

Atelectasis

A
  • Caused by external compression fluid trapped b/w visceral and parietal pleura
  • The collapse or loss of volume of a lung, lobe, or segment.
38
Q

atelectasis on CXR

A
  • Shifts
    • Movement of structures toward the collapsed lobe
      • Fissures, mediastinum, and/or diaphragm
  • Compensatory expansion
    • The expansion of non-consolidated lobes
    • Fills the loss of volume from atelectatic lobe
  • Consolidation
    • The filling/solidifying of normally air-filled lung
    • Opacification takes on the shape of the lung, lobe, or segment
39
Q

atelectasis causes

A
  • Bronchial obstruction
  • pleural compression
    • pneumothorax
    • pleural effusion
40
Q

Bronchial obstruction

A
  • Air cannot enter the alveoli distal to the obstruction. The air already present is absorbed, and the lobe or segment decreases in volume
  • Bronchial neoplasm: carcinoma or granuloma
  • External compression by mass: neoplasm or enlarged lymph node
  • Intraluminal occlusions
41
Q

Pneumothorax

A
  • Air can enter the intrapleural space:
    • TRAUMA / IATROGENIC - through a communication from the chest wall
    • SPONTANEOUS / COPD - through the lung parenchyma across the visceral pleura.
  • CXR findings:
    • Line of pleura (forming edge of lung) that is separated by air from the chest wall, mediastinum, or diaphragm.
    • Absence of vessels outside this line
    • Expiratory lateral decubitus is another helpful view >> suspected side should be up (air goes up)
42
Q

Tension Pneumothorax

A
  • Life-threatening condition
  • Air is trapped in the pleural cavity
    • Under positive pressure
    • Displacing mediastinal structures
    • Compromising cardiopulmonary function.
  • Signs:
    • Mediastinum, trachea, and heart shift away from pneumothorax
    • Flattening or inversion of diaphragm
    • Partial or complete collapse of lung
43
Q

Pleural effusion

A
  • fluid trapped b/w the visceral and parietal pleura
44
Q

Free pleural effusion

A
  • Meniscal curve up the lateral chest wall
  • Radiographic findings of free fluid:
    • Fluid collects in the most dependent portion of the pleural cavity
    • Fluid obliterates costophrenic angles
  • Small effusion may only be visible on lateral view
    • Lateral decubitus film may help show effusion >>effected side will be down (fluid goes down)
45
Q

Loculater pleural effusion

A
  • Pleural fluid trapped within adhesions
  • May mimic a nodule, atelectasis, or consolidation
  • Often located within fissures
  • CT and ultrasound useful to:
    • Detect the presence, size, and shape of effusion
    • Guide thoracentesis

Diagnostic Interpretation PA 545: Pulmonary (5 decks)

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