Quiz III Flashcards
differentiate between conditions that will cause air space disease and interstitial lung disease to show up on CXR
ASD: fluid, pus, blood, tumors
ILD: fluid or inflammation leading to fibrosis

cavitary TB
what is this? when would you take this?

expiratory AP
looking for pneumothorax

right upper lung opacity
what structures should be examined in a systematic review of a chest xray (9)
- general
- bony structures
- soft tissues
- lungs
- pleura
- hila
- fissures
- mediastinum
- artificial changes
how will aspiration pneumonia caused by anaerobic organisms present on CXR
lower lobe airspace disease the cavitates
is pneumonia airspace, interstitial, or both?
which is most likely
it can be either one, or both
airspace
three indicators of aspiration pneumonia
almonst alwats occurs in the dependent portions of the lung
right side more likely that left
acute looks like airspace disease
what 6 structures are found in the mediastinum
- heart
- great vessels
- trachea
- mainstem bronchi
- esophagus
- lymph nodes
three rules of a lateral chest x ray
- diaphragm shadows should be clear
- show of the upper vertebrae is whiter than the lower
- retrosternal and retrocardiac spaces should both be the same color and are both normally dark
DDx for interstitial opacities
- idiopathic interstitial pnemonia
- infection
- pulmonary edema from CHF
- idiopathic pulmonary fibrosis
- environmental factors
- hemorrhage
- sarcoidosis
- tumor/metastases

reticulonodular interstitial disease

interstitial pneumonia

segmental pneumonia
36yo male with fever, cough and SOB of 1 week duration
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette
- silhouette right heart border
- Diaphragm
- ill defined opacity on the right
- Equal lung fields
- RML opacity with a sharp superior border and difffuse inferior border
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum: OK
DX: pneumonia, RML atelectasis, lung carcinoma
what is the DDx for chronic air space opacity
- bronchoalveolar cell carcinoma
- alveolar cell proteinosis
- sarcoidosis
- lymphoma
two divisions of focal disease patterns
nodules/masses
blebs/bullae/cysts/cavities
what is the acute DDx for air space opacity
- pneumonia
- pulmonary alveolar edema
- hemorrhage
- aspiration
- near-drowning
consolidation
infiltrate or solid engorgement
obstructuve ateleactasis
blocked bronchus causes reabsorption of air in the alveoli distal to the obstruction leading to collapse

trachea
differentiate between air space disease and interstitial lung disease in term of location in the lung
there is no difference both diesease can be in any zone
barrel chest is a sign of what
COPD emphysema

pneumothorax on inspiration
two signs of congestive heart failure on CXR
hilar engorgement and increase heart size

A aortic arch
B aortopulmonary window
C descending pulmonary artery
D left atrium
E left ventricle
F gastric bubble
G splenic flexure of the colon
H descending aorta

miliary TB

A Pulmonary vein
B Right atria
C aortic valve
D mitral valve
E tricuspid valve
F Right ventricle
G Lefr ventricle
why is an AP view usually taken supine
they are taken on the portable when the patient cant make it to radiology

lobar pneumonia
38yo male with fever, chills and SOB of 4 days duration
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette: OK
- Diaphragm: OK
- Equal lung fields
- fluffy indistinct opacity in the LLL
- silhouette against the left diaphragm on PA
- sillhouette on spine in lateral
- Foreign bodies: none
- Gastric bubble: ok
- Hilum/mediastinum: ok
DX: pneumonia
lobar pneumonia
cause
four indicators on CXR
pneumococcal pneumonia (s pneumoniae)
- classically fills most or all of a lobe or lung
- may have a sharp border
- almost always produce a silhoutte sign with heart, aorta, diaphragm
- almost always have air bronchogram
what happens to the heart during congestive heart failure/pulmonary edema
heart enlarges
three indicators of cardiomegaly on AP radiograph
left heart border touching or almost touch left lateral chest wall = heart enlarged
heart appears significantly enlarged = heart probably enlarged
heart appears borderline enlarged = probably normal size

interstitial pneumonia

pneumocystic pneumonia

aspiration pneumonia

left ventricle

pulmonary interstitial edema
signs to look for in pleural effusion
blunting of the costophrenic angle
movement of opacity
two divisions of diffuse disease pattern
airspace disease and interstitial opacity

pleural effusion

pneumothorax on expiration
alveolar refers to what part of the lung
air sacs
should a CXR be symmetrical?
if not, why?
mostly symmetrical
- right hemidiaphragm should be a little higher
- left heart shadow more prominent
- aortic knob projects right
define the mnemonic I Quit And Wanna Be Free
Identify the patient
Quality of the film
Air
Water (fluid)
Bone
Funny looking things (foreign bodies)
what sign will be visable on CXR during left ventricular failure
interstitium widening followed by alveolar and pleural filling
fluid will back up into the pulmonary veins and lungs
compressive atelectasis
passive compression of the lung due to pleural effusion, pneumothorax, or space occupying mass

lymphadenopathy
how far is the xray source from the plate in an AP? PA? Lateral?
AP is 3 feet
PA is 6 feet
lateral is 6 feet

nodule
cysts
location
defining characteristic
cavities that can be congential or acquired through infection
occur in the lung parenchyma and mediastinum
thin walled but larger than bullae (<3mm)
52yo female smoker presents to the clinic with 5 month history of a chronic productive cough
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA and lateral
- Airway
- cant see because the view in under pentrated
- Bones
- increased AP diameter
- Cardiac Silhouette
- appears small
- Diaphragm
- flattened
- Equal lung fields
- hyperlucency bilateraly
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum: OK
DX: COPD
when can you see lung fissures on a chest xray
when the beam is parallel to the fissure

- superior vena cava
- right atria
- inferior vena cava
- aortic arch
- left pulmonary trunk
- left pulmonary artery
- left atrium
- left ventricle
- cardiophrenic angle

tension pneumo

lymphadenopathy
subsegmental atelectasis
lung collapse of part of a lung usually caused by patients not taking deep breaths, often related to surgery or pleuritic chest pain
bullae
less than 1cm cavitys associated with emphysema, only partially visable on CXR
four signs of atelectatsis
- displacement of the interlobar fissure toward the collapsed lobe
- increased density of the affected lung
- shift of mobile structures in the thorax
- overinflation of the ipsilateral lobes and/or contralateral lung
7 year old previously healthy Hispanic male presented to an emergency department with 1 week of a non-productive cough and intermittent fevers measured at home to 103.5°F
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA/lateral
- Airway: OK
- Bones: OK
- Cardiac Silhouette: OK
- Diaphragm: OK
- Equal lung fields
- RUL opacity
- Foreign bodies: OK
- Gastric bubble: not visable
- Hilum/mediastinum
- slightly increased vascularity
DX: pneumonia

reticular intestitial disease
four indicators of cavitary pneumonia from primary TB
cavitation is rare
upper more likely than lower lobes
hilar adenopathy
large, often unilateral pleural effusions
what are two structures that can mimic pneumothorax
how can they be differientated from pneumo
overlapping skin folds
scapular border
follow the lung markings
name the three parts of the bronchial tree
define the first part
carina, bronchi, bronchioles
carina: the bifurcation of the trachea into bronchi
58 yo male with SOB
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette
- not visable on the right
- Diaphragm
- not visable on the right
- Equal lung fields
- no lung markings on the right
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum: OK
DX: pleural effusion, hemothorax, right pneumoectomy

pulmonary artery
if air bronchogram sign is present where is the lesion causing the issue
in the lung

nodular interstitial disease
two examples of diseases would cause pleural abnormalities on CXR
- pleural effusion
- pneumothorax
three causes of inadequate inspiration on CXR
obesity
pregnancy
ascites
five patterns of disease lung disease
- diffuse
- focal
- lung volume
- pleural disease
- lymphadenopathy
two chest wall deformities that might cause cardiac enlargement on CXR
straight back syndrome
pectus excavatum

mediastinal widening
in what disease would a miliary pattern appear on xray
tuberculosis
four signs of pulmonary interstitial edema
thickening of the interlobular septa
peribronchial cuffing
fluid in lung fissures
pleural effusions
what are three examples of disease that can lead to fibrosis/interstitial lung disease
- industrial lung disease
- inflammation
- sarcoidosis
5 ways to describe a nodule or mass
- single vs multiple
- size
- border defintion
- calcification
- location

right mainstem bronchus
what should be ordered if you are unsure if there is a pneumo but have high clinical suspicion
get an expiratory film
what are three examples of artificial changes to note on CXR
- surgical clips
- foreign bodies
- pacemakers

right ventricle
cardiothoracic ratio
the size of the heart compared to the size of the thorax
four unique facts pneumocystis pneumonia
perihilar, reticular, institial pneumonia or airspace disease
may mimic pulmonary edema
no hilar adenopathy or pleural effusion
found in AIDS patients
what is this view? why is it done

oblique
to look around the heart at the trachea, esophagus, or vertebrae

left ventricle

liver

pericardial effusion

interstitial lung disease from advanced pulmonary fibrosis

right middle lobar pneumonia

pleural effusion

diaphragm

right atrium

normal vs alveolar opacity
what are the structures of the lungs that should be noted in alphabetical order
(D, E, and H have two things)
A- airway
B- bones
C- cardiac
D- densities and diaphragms
E- effusions and equal lung fields
F- foreign bodies
G- gastric bubble
H- hilum and mediastinum
I- inspiration
how will primary lung cancer look on xray
ill defined, speculated, lobulation

pneumopericardium

aortic arch

A Superior vena cava
B azygoesphageal recess
C right main pulmonary artery
D right descending pulmonary artery
E Right atrium
F cardio phrenic angle
G Liver
H Breast Shadow
hilum of the lungs
where the pulmonary arteries enter the lung and branch off
what three structures in the thorax can shift due to atelectasis
trachea, heart, lungs
why is it important to find lung markings and follow them to the edge of the chest
because they determine the size and contour of the lung
hilum
the origin of the lungs
what changes in the mediastinum should be noted on a systematic review of a CXR
- cardiothoracic ratio
- widening
- shifts or abnormalities

diaphragm shadow
Kerly B lines
short (1-2) cm long very thin and horizontal lines four at or near the costophrenic angle
35yo female with history of heavy smoking and chronic lung disease
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA
- Airway
- right deviation
- Bones: OK
- Cardiac Silhouette: OK
- Diaphragm: OK
- Equal lung field
- linear/curvilinear opacities bilateraly
- assymetry of the left breast
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum: OK
DX: CHF, diffuse pneumonia, interstitial lung disease
63 yo male smoker with history of dyslipidemia, HTN and myocardial infarction presents with increasing SOB of 1 week duration
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA
- Airway: midline
- Bones: OK
- Cardiac Silhouette: slightly enlarged
- Diaphragm: OK
- Equal lung fields
- increased vascular markings
- engorged hilar vasculature
- kerly B lines
- fluid in horizontal fissure
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum: engorged hilar vasculatire
DX: CHF, diffuse pneumonia, pulmonary edema
45yo female with productive cough and fever for 1 week
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette: OK
- Diaphragm: OK
- Equal lung fields
- hazy opacity in the left lingual segment on PA
- more pronounced on lateral over the heart
- Foreign bodies: none
- Gastric bubble: ok
- Hilum/mediastinum: ok
DX: LUL lingual pneumonia
what is wrong with this CXR

over penetrated
mediastinum
the extrapleural space between the lungs
five boney structure of the thorax
- ribs
- clavicles
- shoulder articulation
- spine
- scapula
define the reticular/nodular pattern found in interstitual lung disease
small, well defined white nodules and lines that cna be fine, thin, lacy densities
T/F air bronchogram is specific to pneumonai
false
three indicators of cavitary pneumonia from post primary TB
cavitation is common (thin walls with smooth margins)
no air fluid level
apical or posterior segments of the upper lobes that may be bilateral

round pneumonia
how will hematologic mets look on x ray
multiple smooth round lung nodules often variable in size

round pneumonia

segmental pneumonia

nodule

linear interstitial disease
interstitial pneumonia
causes
two indicators on CXR
viral pneumonia, mycoplasm pneumoniae, pneumocystis
- involve airway walls and alveolar septa
- fine, reticular pattern in the lungs spreading to alveoli (patchy confluent airspace disease)
pneumonia
consolidation of lung produced by inflammatory exudate, commonly caused by infection
34yo male with cough of 10 days duration
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA/lateral
- Airway: OK
- Bones: OK
- Cardiac Silhouette: OK
- Diaphragm: OK
- Equal lung fields
- RUL opacity
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum: OK
DX: lobar pneumonia - RUL
extracardiac causes of cardiac enlargement
- AP radiograph
- inadequate inspiration
- chest wall deformities
- rotation
- pericardial effusion
62 yo male presents to the ER with worsening SOB
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette
- silhouette right heart border due to opacity
- Diaphragm
- silhouette obscuring right hemi diaphragm
- Equal lung fields
- right fluid density ove the RML and RUL
- peribronchial cuffing on the right and upper left lobes
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum
- slightly increased vascularity on the right
DX: pleural effusion
where are bullae found?
why are they only partiall visable on CXR
lung parechyma
very thin wall

pulmonary alveolar edema

pleural effusion
what lateral view would you get for a left sided lesion
a left lateral view
blebs
very small blister like lesions that form in the visceral pleura, usually in the apices

COPD
four common causes of lymphadenopathy
- lymphoma
- metastatic carcinoma
- sarcoidosis
- TB

lateral chest

air bronchogram
two pleural layers visable on chest xray
parietal and visceral

right middle lobe opacity

pulmonary artery
what four bony structures should be examined on a systematic review of a CXR
- shoulder joint
- ribs
- spine
- scapula
what is wrong with this CXR

underpenetrated
why can the ipsilateral lobes/contralateral lungs overinflate due to atelecatsis
there will be an attempt to overcompensate due to volume loss
characteristics of malignant nodules
- steady, predictable growth
- larger than 5cm
- can be smooth round or ill defined depending on source
how will interstitial look different than airspace pneumonia
interstitial pneumonia are have more interstitial markings, spread to adjacent airways
airspace wil appear fluffly, homogenous, and indistinct
two indicators of miliary tuberculosis
small nodules 1mm in size that can grow to 2-3mm
clear rapidly once treated
why is a lordotic view done
to see the apices of the lungs

calcified nodules
48yo female with substernal chest pain
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette: OK
- Diaphragm: OK
- Equal lung fields: OK
- Foreign bodies: breast implants
- Gastric bubble: OK
- Hilum/mediastinum
- calcification in the aortic knob
DX: athersclerosis
describe the orientation of the lung fissures with respect to the lobes
the left oblique fissure separates the upper and lower lobe
the right oblique fissures separates the middle and lower lobe
the horizontal fissure separates the upper and middle lobe
interstitial lung disease
development of particles in the interstitium
three characteristics of interstitial lung disease
- reticular, nodular, or reticulonodular pattern
- packets of disease surrounded by normal lung
- can be focal of diffuse
segmental pneumonia (bronchopneumonia)
cause
5 indicators on CXR
staph aureus or pseudomonas aeruginosa
- involved several segments
- margins tend to be fluffy or indistinct
- produce exudate the fill bronchi
- NO AIR BRONCHOGRAM
- may see atelectasis
what should you do if you suspect pleural effusion or lung infiltrate
move the patient effusion will move in response to gravity infiltrate wont

interstitial lung disease vs normal lung
differentiate between air space disease and interstitial lung disease in term of appearance on CXR
ASD: confluent shadows with air bronchogram
ILD: linear/reticular/nodular shadows
characteristics of benign nodules
- can be slow or fast growing
- usually round and less than 4cm
- usually found in non smokers under 35
- can be calcified
- well definded edges
pleural effusion
fluid in the pleural cavity

retrocardiac space
interstitium
connective tissue, lymphatics, blood vessels, and bronchi that surround and support airspaces

interstitial pneumonia
what does pneumonia look in CXR
denser than normal lung
may see air bronchogram
distinguish between a nodule and mass
nodule is any pulmonary radiographic lesion that is sharply defined, discrete, nearly circular, and less that 3cm
a mass is larger than 3cm

round pneumonia
how would cardiomegaly be identified on a lateral CXR
note the space posterior to the heart and anterior to the spine at the level of the diaphragm
if the cardiac silhouette extends posteriorly over the spine = cardiomegaly
why will an AP radiograph make the heart appear enlarged
a combination of magnification, rotation, and poor inspiration
how will lymphatic mets look on xray
more like interstitial lung disease
20yo with gradually increasing SOB & cough over 6 mo
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette
- numerous opaque densities bilaterally
- Diaphragm: OK
- Equal lung fields
- numerous round opaque densities bilaterally
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum
- widenend
DX: metastatic disease

horizontal fissure
why are lungs hyper inflated in COPD/Emphysema
air trapping due to incomplete expiration

COPD
what three features of the lungs should be reviewed on CXR
- pulmonary vessels
- airspace
- interstitial pattern
38yo male with dyspnea and pleuritic chest pain for a week
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette: ok
- Diaphragm: ok
- Equal lung fields: left lung cavitary lesion in the LUL with and air fluid level
- Foreign bodies: none
- Gastric bubble: NA
- Hilum/mediastinum: ok, loss of aortic knob
DX: cavitary lesion associated with community acquired MRSA

COPD
what view is this?
three indentifiers

- diaphragm is more lifted
- clavicle is higher
- heart is less defined
atelectasis
collapse of the lung due to obstruction
what is the gold standard view?
why
PA
it gives maximum visabilty of the heart
what usually causes pneumopericardium
direct wound
commonalities between blebs, bullae, cysts, and cavities
four points of variation between them
all air and or fluid containing lesions in the lung
- size
- location
- wall composition
- fluid content
what is wrong with this CXR? how can you tell?

it is rotated
the clavicles are not equidistant from the spinous processes
how does normal cardiothoracic ratio differe between adults and children
a normal pediatric cardiothoracic ratio can be up to 65%

lateral costophrenic angles
two fissures of the lungs visable on chest xray
major and minor

horizontal and oblique fissure
what does the parietal pleura cover?
visceral pleura?
what is the space between them?
the interior of the chest wall
the lungs
a potential space that can fill with air or fluid
describe what the airspace disease will look like on xray
hazy, fluffy, confluent opacities with indistinct margins and airbronchogram or silhouette sign
what is the probability of malignancy if a malignant lung nodule is larger that 5cm
95%
how will subsegmental atelectasis look different from other atelectasis on CXR
linear densities parallel to diaphragm seen at the lung bases
what is snowball sign used to do
elaborate on how
determine if a mass or nodule comes from the lung or surrounding tissue
if the snow ball is round, it is in the lung, if the snow ball is flat it is in the surrounding tissue

round pneumonia

round pneumonia
round pneumonia
causes
two identifiers on CXR
haemophilus influenzae, streptococcus, pneumococcus
mostly in kids
usually the posterior, lower lobes
list the lobes of the left and right lungs
left: upper and lingual, lower
right: upper, middle, lower
cavity
location
wall characteristic
description
often includes what
variable in size and shape
lung parenchyma
wall greater than 3mm
white soft tissue density ring with an air density center
air fluid level
what will definitely be visable on CXR in the case of pneumothorax
a white viseceral line at the periphery
60yo female with cough and SOB over the last 6 days
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA/Lateral
- Airway: OK
- Bones: OK
- Cardiac Silhouette: OK
- Diaphragm
- high
- Equal lung fields
- opacity RUL with air bronchogram
- Foreign bodies: OK
- Gastric bubble: not visable
- Hilum/mediastinum: silhouette with RUL
DX: pneumonia with air bronchogram

Ap costophrenic angles
pattern of pulmonary interstitial edema
thickening of the interlobular septa (kerly A and B)
peribronchial cuffing
fluid in fissures
pleural effusions
what are the individual sides of the diaphragm called
left and right hemidiaphragm

round pneumonia
24 yo male with sudden onset of SOB while lifting weights
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette: OK
- Diaphragm: OK
- Equal lung fields
- expanded right lung
- left pulmonary lines lost
- visceral line noted
- hyperlucent hemithorax
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum: OK
DX: pneumothorax
what three abnormalities might you see in the fissures of the lung on CXR
- presence
- shift in location
- abnormalities
26yo female who presents with an abrupt onset of SOB following a motorcycle accident
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA
- Airway
- Left shift
- Bones: OK
- Cardiac Silhouette
- left shift
- Diaphragm
- loss of costophrenic angle due to mediastinal shift
- Equal lung fields
- hyperlucent right side
- no lung markings
- haziness over left lung
- Foreign bodies: OK
- Gastric bubble: NA
- Hilum/mediastinum
- left shift
DX: tensio pneumothorax
60yo female with history of congestive heart failure presents to the clinic with a 3 week history of worsening SOB
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View
- Airway: OK
- Bones: OK
- Cardiac Silhouette: NA
- Diaphragm: NA
- Equal lung fields
- RLL and LLL obscured by fluid density
- fluid in the right horizontal fissure
- Foreign bodies: OK
- Gastric bubble: NA
- Hilum/mediastinum
- widened, opaque
DX: pleura effusion

stomach
what are the radiological signs of heart failure
fluid in lung fissures
kerley B lines
prominent upper lobe pulmonary arteries
fluild in the lung interstitium
large heart
pleural effusion
when examining the lung air space, what would be four features you might note
- nodules
- masses
- atelectasis
- COPD

kerly b an kerly a
define the mnemonic Are There Many Lung Lesions
Abdomen
Thorax
Mediastinum
Lungs individually
Lungs comparitively

right middle lober pneumonia

lordotic

right middle lobar pneumonia

reticular interstitial disease
what is the most common mediastinal mass
lymphadenopathy

A Left upper
B Right Upper
C Right middle lobe
D Lingula
E Right lower lobe
Left Lower Lobe
what is the normal cardiothoracic ratio of an adult
<50%
signs of COPD or emphysema
- hyperinflation
- flattened diaphragm
- heart appears smaller

milliary intertstitial disease
description of interstitial opacities based on pattern
- reticular (too many lines)
- nodular (too many dots)
- reticulonodular (too many lines and dots)

COPD

atelectasis
can blebs always be seen on CXR?
what sequla is associated with blebs
not usually
spontaenous pneumo
what is the main way to determine if pulmonary edema is cardiogenic in nature
enlarged heart
kerly B lines
65yo male with DOE and a feeling that he “can’t catch my breath”
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette
- slightly enlarged
- borders less distincton the RML and RUL
- Diaphragm: OK
- Equal lung fields
- reticular opacity bilaterally
- Foreign bodies: EKG wires noted
- Gastric bubble: NA
- Hilum/mediastinum
- hazy vascular margins
DX: CHF exacerbation leading to pulmonary edema

tension pneumo
four microbial causes of cavitary pneumonia
straph, strep, klebsiella, coccidomycosis, tuberculosis
pulmonary alveolar edema
how will this look on CXR
elevated venous pressure pushes fluid from the interstitium into the alveoli
fluffy indistinct patchy “batwing” airspace densities that are usually centrally located, more likely in the lower than upper lung
during a systematic review of CXR, what are the features examined on general overiew (6)
- contrast
- projection
- orientation L.R
- correct patient
- correct films
- inspiration
what is the difference between these two radiographs

the left is inspiratory, right is inspiratory

left and right hilar points
what are the three costophrenic angles
anterior, posterior, lateral
deep recesses formed by the diaphragm and the ribs on PA and lateral views
58 yo male smoker with complaints of SOB
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette
- narrowed
- Diaphragm: OK
- Equal lung fields
- bullae
- hyperlucent bilaterally
- opaque lesion on the right lower lobe
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum
- narrow
DX: emphysema, asthma, bronchiolitis
what will airspace disease look like
is it focal or diffuse
a confluent fluffy or hazy opacity resulting from fluid density in the alveoli
it is diffuse and can involve part or the whole lung
what are two considerations when examining cardiothoracic ratio in pediatrics
infants dont take deep inspiration
lobulated thymus can overlap portions of the heart
what 8 views are used to view the chest
- PA
- AP
- lateral
- inspiratory
- expiratory
- lordotic
- decubitus
- oblique

cyst

cyst with an air fluid level
where are the pulmonary arteries found on radiograph
superior to the atria on both sides
the left pulmonary artery is inferior to the aortic arch
signs of heart failure in chronological order
heart enlargement
kerly B line
Kerly A line
fluid in lung fissures
fluid in the interstitium (batwing)
45yo non-smoker presents with rhinorrhea and sneezing
View
- Airway
- Bones
- Cardiac Silhouette
- Diaphragm
- Equal lung fields
- Foreign bodies
- Gastric bubble
- Hilum/mediastinum
DX

View: PA
- Airway: OK
- Bones: OK
- Cardiac Silhouette: OK borders not well defined
- Diaphragm: OK
- Equal lung fields: round opaque lesion in the RML
- Foreign bodies: none
- Gastric bubble: NA
- Hilum/mediastinum: mostly ok, maybe a little wide
DX: carcinoid tumor

aortic arch
when examining soft tissue (lung, breast, diaphragm) on CXR what four qualities should be noted
- thickness
- contour
- foreign body
- densities

A Left brachial vein
B Superior vena cava
C Ascending aorta
D Aorta
E Pulmonary artery
F Left Pulmonary artery

what view is this?
give three indicators

PA chest
- clavicles are low
- heart is well defined
- diaphragm is more flat
what is a common cause of subsegmental atelecatasis
two conditions that would lead to this
patients who arent taking deep breaths
post-op patients or patients with pleuritic chest pain
signs to look for to indicate pneumothorax
- symmetrical
- lung markings to periphery
- white visceral lines and bones

retrosternal space
kerly A lines
extend from the hila for up to 6cm and dont reach to lung periphery
how will lymphadenopathy present on xray
medialstinal widening and hilar prominence
what is air bronchogram sign
what is it indicative of
indication of airspace disease
an air filled bronchus surrounded by an airless lung
what is this view? why is it done

decubitus
looking for an air fluid level
what will atelectasis look on xray
white tissue due to lack of air volume
interstitial
spaces within a lung or tissue/spaces between alveoli
causes of lung cysts
abscesses, TB, carcinoma

anterior/middle/posterior mediastinum
why would the heart look larger on expiration than inspiration
the diaphragm moves up and compresses the heart

kerly B
T/F a small, acute atelectasis will create a larger overinflation of the the contralateral lung
false, a large or chronic atelectasis will produce a larger compensation
pneumothorax
air in the pleural cavity

A Right Pulmonary artery
B Knob of the aortic arch
C Right pulmonary artery
D Left pulmonary artery
E Right pulmonary artery (lower lobe)
F RIght border fo the heart
G inferior vena cava
26 yo with cough for the past 3 weeks
View:
- Airway:
- Bones:
- Cardiac Silhouette:
- Diaphragm:
- Equal lung fields:
- Foreign bodies:
- Gastric bubble:
- Hilum/mediastinum:
DX:

View: PA/lateral
- Airway: OK
- Bones: OK
- Cardiac Silhouette
- right heart border a little enlarged
- Diaphragm
- mininimally flattened
- Equal lung fields: OK
- Foreign bodies: OK
- Gastric bubble: OK
- Hilum/mediastinum: OK
DX: Normal - indicates asthma or bronchitis based on symptoms
atelecatsis
three types
collapse or volume loss
obstructuve, compressive, subsegmental

air bronchogram