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Radiography OCSE Year 3 > PCE chest and abdomen > Flashcards

PCE chest and abdomen Flashcards

1
Q

Identify the structures of the heart

A

Right atrium
Right ventricle

Left atrium
Left ventricle

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2
Q

Where should the left hilar sit in relation to the right one?

A

Left hilar should sit higher than the right hilar because it goes over the pulmonary artery
If it is lower this indicates heart failure or something else wrong

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3
Q

where is the carina?

A

The carina is where the trachea bifurcates it sits just below the aortic knuckle usually

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4
Q

How many lobes is there in the lungs?

A

3 for the right
2 for the left

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5
Q

Anatomy levels going down in left lung

A

Great vessels/ left paratracheal stripe
Arch of aorta
Main pulmonary artery
Auricle of left atrium
Left ventricle
Fat pad

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6
Q

Anatomy levels going down in right lung

A

Great vessels/ right paratracheal stripe
Superior vena cava
Arch of azygous vein
Superior vena cava
Right atrium
Inferior vena cava

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7
Q

How is the lung split up

A

Apex
Upper zone
Mid zone
Lower zone

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8
Q

Felson search pattern
ATMLL (Are There Many Lung Lesions)

A

Abdomen
Thoracic Cage
Mediastinum
Lung (unilateral)
Lung (bilateral)

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9
Q

Types of opacity

A

Consolidation- air spaced opacity, patching shadowing, can be quite dense
Interstitial- smaller fine lines, crossing over lines (can also reduce lung volume)
Nodule- small node usually a simple circle
Mass- large, may not be a simple circle
Atelectasis- lung collapse

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10
Q

Lymph nodes can get enlarged and can distort the hilum so infection is important to note

A

Lymph nodes can get enlarged and can distort the hilum so infection s important to note

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11
Q

What is a sail sign

A

lung collapse, dense line where the lung collapse

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12
Q

Slide 28, example of PCE for chest “Interstitial shadowing in the mid to lower zones

A

Slide 28, example of PCE for chest “Interstitial shadowing in the mid to lower zones

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13
Q

What causes lung collapse?

A

in older patients it can be due to malignancy
in younger patients in children and children it can be a result of mucus plugin if they’re asthmatic

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14
Q

Right middle lobe collapse appearance

A

Increased density and distortion of the hemidiaphragm (it should be a nice dome)

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15
Q

left upper lobe collapse appearance

A

Increased opacity of the left lung, called the veil sign as it looks like someone has draped something over the lung

The aortic may also be distorted because the left lower lobe has hyperinflated because the upper lobe collapse

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16
Q

pneumothorax how to describe

A

The lung doesn’t fill the chest,
Remember to say what side it is and whether there is a mediastinal shift

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17
Q

pleural effusion how to describe

A

say what side is affected or whether its unilateral
Loculated plural effusion is where it goes up the side of the lungs (periphery of the pleura, all the way up to the apex)
if horizonal fissure, is thickened with pleural effusion at the bottom, its also a pleural effusion

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18
Q

What is a empyema

A

basically a pleural effusion that is made form pus
it looks like a bulging opacity

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19
Q

Mesothelioma what does it look like

A

if you see an opacity that looks like a pleural effusion (empyema) but there is no blunting of the costophrenic angles its mesothelioma

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20
Q

How do you look for heart failure

A

Kerley lines (horizontal lines)
Increased heart size
Pleural fluid
Perihilar opacity
Upper lobe blood distribution

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21
Q

Using the silhouette sign
loss of the silhouette sign

A

Right paratracheal stripe: right upper lobe

Right heart border: right middle lobe or (medial right lower lobe - small percentage)

Right hemidiaphragm: right lower lobe

Aortic knuckle: left upper lobe

Left heart border: lingula segments of the left upper lobe

Left hemidiaphragm or descending aorta: left lower lobe

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22
Q

Mediastinal Masses
Anterior
Middle
Posterior

A

Anterior
The 5 T’s

middle
Lymphadenopathy
Central Lung Tumours
Oesophageal lesions
(Look for splaying of the carina)

Posterior
Spinal/Paraspinal Abscess
Neurogenic Tumours
(Look at the intervertebral discs and vertebral bodies carefully
Look for rib splaying)

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23
Q

Normal diameters of the bowel
Small bowel =
Large bowel =
Caecum =

A

Normal diameters of the bowel
Small bowel = 3 cms
Large bowel = 6 cm
Caecum = 9 cm

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24
Q

appearance of large bowel

A

Large bowel is peripheral and has haustral folds

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25
appearance of small bowel
Small bowel is central and have valvulae conniventes
26
what are haustral folds
the normal folds of the large bowl, if they become smooth or have thumbprinting there is a pathology
27
what is Adynamic/Paralytic Ileus symptoms Radiographic Features
Paralysis of motility Not due to mechanical obstruction (usually link to post surgery) Can be asymptomatic Distended and tympanic abdomen Tachypnea and tachycardia No flatus Hiccups Generalised and uniform distension of small and large bowel Can be sentinel loop if localised
28
What anatomy can be seen on a abdomen x-ray
liver spleen stomach right kidney left kidney psoas muscle ascending colon transverse colon descending colon small intestines rectum bladder (if there is issues with the gallbladder or the pancreas sometimes these can be visualize)
29
What can be assessed on abdomen?
Bowel gas pattern Bowel wall Abnormal gases Masses Calcifications Foreign bodies Bones
30
what are valvulae conniventes
the lines on the small bowl which go through the bowel whereas haustra is like a bumpy line
31
What causes bowel distention or enlarging?
Adynamic Ileus Mechanical Obstruction LBO SBO Volvulus
32
Small bowel obstruction radiographic appearance and causes?
Small bowel distension (greater than 3cms) Ladder-like or stacked coin appearance Little to no air in the large bowel Fluid-filled obstructions can be occult on plain film Causes Adhesions Hernia Gallstone Ileus Intussusception
33
What is gallstone ileus appearance?
Gallstone which has migrated from the gallstone through the bile duct and cause a perforation through that, so you can see that communication. So what happens is you get gas in the billery tree that you wouldn't expect to see. So if you see gas in a billery tray, sat of that right of the quadrant. And appearances of a small bowel obstruction, it's probably due to a gallstone ileus, even if you cant see the gallstone
34
Large bowel obstruction appearance causes
Dilated large bowel to the point of obstruction (transition) Little or no air in the sigmoid/rectum Little or no gas in the small bowel if the ileocaecal valve remains competent Causes Tumour Volvulus (Sigmoid or Caecal) Hernia (Rare) Diverticulitis Intussusception (Rare in adults) Faecal impaction
35
Sigmoid Volvulus appearance
Arises in pelvis/LLQ Extends towards RUQ Ahaustral 'Coffee-bean’ appearance Dilated large bowel
36
Caecal Volvulus appearance
Arises in RLQ Extends towards epigastric region/LUQ Hausta maintained Small bowel dilated May have air fluid level
37
What is volvulus
Volvulus occurs when a loop of intestine twists around itself and the mesentery that supplies it, causing a bowel obstruction.
38
What is Pneumoperitoneum?
gas outside the bowel, sometimes under the diaphragm. Needs to be reported back to the ward Perforation of the bowel Iatrogenic Rigler’s sign (air sign) Visualisation of the Falciform ligament
39
What is intramural gas?
gas within the bowel wall, bacteria in the wall causing it.
40
Gas within solid organs
describe what you see, could be in the kidney, bladder, liver, spleen etc
41
Assessing the Bowel Wall
Bowel wall thickening secondary to submucosal oedema neoplasm Loss of the normal haustral pattern ‘Thumbprinting’ of the colon
42
Intra-abdominal Masses and Organ Enlargement Causes mass effect (displacement of the surrounding tissue) Urinary retention and bladder distension can mimic a mass
could happen to the bladder, or the liver
43
Calcifications types
Are a pathology or indicate a pathology Concretions-Stones Conduit-Fluid filled hollow tube Cystic-Wall of structure Solid mass-Extensive but variable
44
Calcifications examples
Renal and Ureteric Calculi Gallstones Porcelain Gallbladder Vascular/cystic structures Nephrocalcinosis Lymph nodes Phleboliths (in a vein) Bladder calculi Calcified aneurysms Calcified splenic artery dermoid cyst
45
Renal tract calculi
Left large renal calculi (stathorn calculus) VUJ (Vesico-ureteric junction)
46
common foreign bodies, note slide pessary ring, and that's for prolapse ueteric scent hip replacement
common foreign bodies pessary ring, and that's for prolapse ureteric scent hip replacement
47
PCE note say what side is affected and say what quadrant the issue is in if cant say what the pathology is
PCE note say what side is affected and say what quadrant the issue is in if cant say what the pathology is
48
what is a dermoid cyst
usually in the midline and looks like teeth, germ cell tumour
49
How to describe foreign bodies
where is it, how many, what is it/shape if there is clothing state it so that there is no confusion
50
What is ETT Where should they be What are they for
Endotracheal tube (ETT) 2cm above carina (ideally 5-7cm) Wide bore plastic tube inserted into trachea to allow artificial ventilation Adult tubes are usually around 1cm diameter Radiopaque strip so they are visible on CXR 5-7cm above carina Can move up and down depending on head/neck position
51
What is NGT where should they be What are they for
Nasogastric tube 3-4cm below diaphragm Extend from the nose to stomach Allow administration of artificial hydration and feeding, and deliver drugs Patients who are unable to swallow Patients who have sub-optimal oral intake despite intake swallow mechanism Can be kept in place for 6-8 weeks
52
NG tube imaging criteria Ideal PCE comment
(Request form should clearly state the purpose of the x-ray is to establish position of NG) Does the tube follow the path of the oesophagus and avoid the contours of the bronchi? Does the tube clearly bisect the carina or bronchi? Does it cross the diaphragm in the midline? Is the tip clearly visible below the left hemi-diaphragm? “NG tube in situ, it bisects the carina and diaphragm in the midline. The tip is seen below the left hemi diaphragm overlying the gastric bubble”
53
Ideal NG PCE comment
“NG tube in situ, it bisects the carina and diaphragm in the midline. The tip is seen below the left hemi diaphragm overlying the gastric bubble”
54
Methods for confirming NG tube
Aspirate from tube and measure pH Should be under 5.5 If no aspirate or pH is above 5.5 then an x-ray is justified
55
Types of NG tube and appearance on x-ray
Narrow bore, which has a guide wire through the length of it Wide Bore which the tip may only be visible
56
Where does the carina sit
Level of T4 but on older patients it might become lower
57
What should you do if you see a NG tube is not in the stomach?
Call the ward and let them know not to use it and also document telling them. Ask for GMC, NMC, HCPC
58
If the tip of an NG tube is not visible what should you do?
do an upper abdominal view The tube should go straight by the carina shouldnt bend before that point
59
PCE comment for an NG in the wrong place example
NG tube has gone down right bronchi and is sitting in the lower zone of the right lung Comment on any pulmonary oedema etc also any other artefacts, e.g ECG artefact, clothing
60
What happens if malposition of ETT? Tube below the carina
Might go down right bronchus/only supply that one with air left lung collapse due to no air Right upper lobe collapse Right lung over distension and cause pneumothorax if in oesophagus Stomach distended filled with air Oesophagus will sit slightly lateral and not central as it should
61
What does Consolidation mean?
patchy/fluffy appearance, something is in the airway that shouldn't be there.
62
ETT ideal location on x-ray
Endotracheal tube superimposes the trachea and sits above the carina around the level of T4
63
Intercostal chest drain what is it for and appearance
Chest drains are inserted for pneumothorax/pleural effusions. Drains usually point superiorly if its for a pneumothorax and inferiorly if its for a pleural effusion (but not always). check that the holes are in lung fields
64
intercostal chest drain PCE comment example
"intercostal chest drain in situ" "There is also marked emphysema on right side" (if there is emphysema) and the pathology "right sided pneumothorax" "Left side plural effusion"
65
CVP central venous pressure line
inserted via jugular vein (sometimes subclavian veins) and goes to the superior vena cava (SVC) Usually inserted on the right they measure/monitor atrial pressure and give meds Should be straight tip if gone too far into right atrium it can cause arrhythmias
66
CVP PCE comment example
"Central venous pressure line in situ in the superior vena cava"
67
Cardiac pacing device what are they for? Where should the wires sit? Risk of anything?
Used to treat arrhythmias and bradycardia 2 leads usually Ventricular lead points towards the apex of the heart (right ventricule) Atrial lead usually points superiorly Check for pneumothorax
68
Cardiac pacing device PCE comment example
"Cardiac pacing device in situ with wires in right ventricle and left atrium" Comment on any pathology e.g pneumothorax
69
Cardiac defibrillators what are they for? What do they look like?
Monitoring and therapy look similar to pacemaker but have a thicker lead
70
Cardiac defibrillator PCE comment example
"Cardiac defibrillator in situ with wires in right ventricle and left atrium" could say cardiac device in situ also Comment on any pathology e.g pneumothorax
71
CRT-P and CRT-D Appearance what is it used for
similar to cardiac pace maker in appearance but has 3 wires Extra lead in the coronary sinus, around the left side of the heart. Used to treat patients with marked heart failure who are poorly managed on maximum medical therapy.
72
CRT-P and CRT-D PCE comment example
"Cardiac device in situ with wires in right ventricle and left ventricles and left atrium" Mention any pathology
73
Valve replacement PCE comment example
"prosthetic heart valve in situ" circle in the heart is the appearance
74
TAVI PCE comment example and appearance
"TAVI in situ" A cage like structure in the aorta
75
LVAD Left ventricular assist devices (LVAD) PCE comment example
only parts of LVAD are radio-opaque its a big device that sits under the heart "LVAD in situ"
76
Abdominal lactogenic object meaning
introduced by surgery
77
Gastric band appearance and PCE comment example
it has a band/circle to it and then a wire going out from it "Gastric band in situ"
78
EVAR – Endovascular aortic repair and PCE comment example
"EVAR in situ" This stent has ‘legs’ which go into the iliac arteries.
79
Gastrostomy tube and PCE comment example
"Gastrostomy tube in situ" circles in abdomen not a large circle or band like the gastric band
80
Baclofen pump appearance and PCE comment example
"Baclofen pump in situ" Large device in abdomen region with wire going into the spinal cord give meds
81
IVC Filter what is it whats it for?
inferior vena cava filter Used for patients at risk of PE where anticoagulants are contraindicated. Filters will be removed. The longer the filter is in, the higher chance of complications or failed retrieval.
82
IVC filter appearance and PCE comment example
"inferior vena cava filter in situ" looks like a umbrella almost
83
Peritoneal dialysis catheter and PCE comment example
"peritoneal dialysis catheter in situ" A thick tube like structure siting in the side of the abdomen with thinner tube across and down the abdomen
84
Encapsulating peritoneal sclerosis – constant ambulatory peritoneal dialysis wont be in PCE
Encapsulating peritoneal sclerosis – constant ambulatory peritoneal dialysis wont be in PCE
85
Vaginal pessary appearance and PCE comment example
"Pessary ring in situ" A right in the bladder region quite large but not radiopaque
86
Nephrostomy appearance and PCE comment example
"left nephrostomy in situ" A tube curling around in the kidney
87
Ureteric stent appearance and PCE comment example
"left ureteric stent in situ" A tube from kidney running down uretera to bladder state whether there is calcification around the stent also
88
Hernia mesh repair appearance and PCE comment example
Numerous small 'spring-like' artefacts overlying the lower right anterior abdominal wall. These are from part of a mesh hernia repair of the abdominal wall "mesh hernia repair in situ"
89
Capsule endoscopy appearance and PCE comment example
A radiopaque little tube almost square, can be anywhere within the bowel, and even by the rectum "Capsule endoscopy in situ"
90
What does subpenic mean?
The subphrenic space is a peritoneal space between the anterior part of the liver and the diaphragm, separated into right and left by the falciform ligament, and postero-superiorly bounded by the coronary ligament.
91
Quadrants of the abdomen
Right upper quadrant Epigastric Region Left upper quadrant Right lumbar region Umbilical region Left lumbar region Right iliac region Hypogastric region Left iliac region
92
What is the appearance of ascites on an abdomen x-ray
Ascites is a build up of fluid due to liver failure. It can lead to a swollen stomach and increase grey appearance (cant see bowel gas clearly) and unable to see the psoas muscles. "psoas muscles shadows not visualized, there is an increased grey appearance and lack of bowel gas marking, in keeping with ascites"
93
What is pneumobilia
Pneumobilia, is when there is air in the biliary tree of the liver. This leads to a branching gas appearance in the liver. Can be due to recent surgery. "There is a branching lucency in the RUG, liver in keeping with pneumobilia" "Surgical clips in situ"
94
What is Chilaidaiti syndrome?
Where bowel is above the liver in a chest x-ray, may be normal for a patient if it is on previous imaging
95
what is a staghorn calculi?
A kidney stone that has taken the shape of the inside of the kidney "there is a left staghorn calculi"
96
Small bowel obstruction comment
"there is a stacked coined appearance of distended bowel, in keeping with small bowel obstruction"
97
Normal appearance of calcification of the splenic artery looks like what?
Calcification of the splenic artery looks like a Chinese dragon (known as the Chinese dragon sign.) if there are converging plagues of calcification, this indicates an aneurysm of the splenic artery.
98
What is a phlebolith?
phlebolith - in veins round smooth opacities, may contain lucent centres, may confuse them with ureteric calculi
99
What are osteophytes?
Osteophytes are little bits of bone growth that come off from the bone and are linked to osteoarthritis, they are around joints, (where ligaments attach) and may appear on the spine also
100
What is rigler's sign?
This is when you can make out both signs of the bowel, due to perforation, and the bowel has sharp edges to it.

Radiography OCSE Year 3 (23 decks)

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