Pathologies

Question 1

How many are there?

Answer 1

8

Question 2

State all 8 pathologies:

Answer 2

COPD- Emphysema
Pneumonia/infection
Cancer
Pleural effusion
Pneumothorax
Cardiomegaly
Tubes, lines & clips
Hiatus hernia

Question 3

How can be COPD- EMPHYSEMA identified?

Answer 3

Chronic obstructive pulmonary disease
- Abnormal permanent enlargement of the airspaces
-caused by smoking

Question 4

How can Pneumonia be identified in chest xray

Answer 4

Alveolar air replaced with fluid
Obscures lung markings
Airspace opacification - Consolidation
Patchy or extensive
+/- atelectasis (collapse)
Air bronchograms in progressive disease

Question 5

Nasogastric
Tube (NGT)

Answer 5

A nasogastric (NGT) tube is a thin, soft tube that goes in through the nose, down the throat, and into the stomach.

Question 6

Deviation of trachea towards

Answer 6

means collapse, fibrosis, alectasis,

Question 7

Deviation of trachea away

Answer 7

is effusion, pneumothorax, tumours

Question 8

Cancer

Answer 8

CXR cannot determine invasive features of lesions
Masses may be central or peripheral
Central (squamous cell carcinoma and small call carcinoma)
Peripheral (Mostly adenocarcinoma and large cell carcinoma)

Question 9

Lung hilar mass

Answer 9

Right hilum abnormal
* Mediastinum widened
due to lymph node
enlargement
* Pleural effusion also
present

Question 10

How to identify PULMONARY
METASTASES

Answer 10

Secondary malignant
tumours
* Originate from cancer in
separate organ
* Single or multiple
rounded nodules
* Peripheral distribution
and usually bilateral

Question 11

How can right upper lobe collapse be identified?

Answer 11

• Dense opacity in right
  upper zone due to lobar
  collapse
• Highly likely that a mass
  is obstructing the right
  upper lobe bronchu

Question 12

How to identify pleural effusion?

Answer 12

• Accumulation of fluid in the pleural space
• Erect position (supine and semi-erect radiographs mask findings)
  On an erect radiograph:
• Small volume only seen on lateral CXR (posterior costo-phrenic recess)
• > 250ml - radiopaque meniscus at costo-phrenic angle(s)
• Large volume can create mass effect and collapse
  Causes: Infection | heart failure | malignancy | cirrhosis

Question 13

How do you identify PNEUMOTHORAX/ PTX

Spontaneous | Traumatic | Tension

Answer 13

Sudden, often severe onset chest pain and SOB
- Air in pleural space (Commonly apical on erect radiograph)
- Lung edge visible with no lung markings peripheral
- Collapse of lung (towards hilum)
Closed or penetrating
- Penetrating: rib # +/- subcutaneous emphysema
Intercostal catheter (ICC) used to drain large volume

Question 14

Tension of the pneumothorax

Answer 14

Air collection constantly enlarging
- Deviation of the trachea away
- Compression of the contralateral side
- Mediastinal shift
- ICC inserted to drain air from pleural
space

Question 15

How do you identify hiatus hernia?

Answer 15

Air fluid level behind heart.
- faint gap behind the heart on CXR

Question 16

State the different tubes, wires and CVC

Answer 16

Tubes: Endotracheal tube
(ETT); Naso-gastric tube
(NGT); Intercostal catheter
(ICC) - chest drain

Clips/ wires: Sternal sutures/wires; ECG clips and wires; Pacemaker

Central venous
catheters (CVC); Peripherally inserted
central catheter (PICC); Internal jugular line; Implantable ports

Question 17

identify the first 4 pathologies

Answer 17

COPD- Emphysema
Pneumonia/infection
Cancer
Pleural effusion

Question 18

identify the last 8 pathologies

Answer 18

Pneumothorax
Cardiomegaly
Tubes, lines & clips
Hiatus hernia

Question 19

How to identify the cardiomegaly?

Answer 19

Cardio-ventricular dysfunction - unable to pump blood sufficiently for
body’s need
- Enlarged heart (dangerous)

Question 20

Inspiration

Answer 20

breathing in

Question 21

Exspiration

Answer 21

breathing out

Question 22

How to diagnose COPD

Answer 22

Lungs are hyperinflated (long); flatted diaphragms; increased air space
- Blackness

Question 23

How to diagnose pneumonia

Answer 23

increase in diaphragm; fluid in the lungs; SOB

Question 24

How to diagnose pneumothorax

Answer 24

right atypical areas, black areas in between, less lung air- look wider, no vascular markings

Question 25

How to diagnose pleural effusion

Answer 25

fluid outside the lungs - pushes trachea away from abnormal lung - SOB
- costophrenic angles - radiopaque/whiter