Radiography pictures - Chest XRay

Question 1

AP or PA?

Answer 1

AP

Question 2

AP or PA?

Answer 2

PA

Question 3

AP or PA?

Answer 3

PA

Question 4

What view?

Answer 4

Lateral chest

Question 5

Rotated?

Answer 5

Yes, clavicle is rotated and PT isn’t in perfect anatomical position

Question 6

Rotated?

Answer 6

Yes, notice the gap on the left vs right.

Question 7

Rotated?

Answer 7

Yes. Look at the sternal-clavicular joint spaces. Should be equal.

Question 8

Rotated

Answer 8

Yes, this is rotated

Question 9

Inspired sufficiently?

Answer 9

Inspired OK. Can count 9 ribs. Ideally 10.

Question 10

Inspired sufficiently?

Answer 10

Can only count 8 ribs. Not well inspired.

Question 11

Penetration OK?

Answer 11

No. Underpenetrated. Can’t clearly see thoracic spinal vertebrae by clavicles or vertebrae in mediastinum of CFAs

Question 12

Penetration OK?

Answer 12

Overpenetration. Should not be able to see as much detail in a chest X-ray.

Question 13

Good Cardiothoracic Ratio?

Answer 13

Yes. Sum of A+B should be less than C.

Question 14

Which lobe?

Answer 14

Right Upper Lobe (RUL)

Question 15

Which lobe?

Answer 15

Right Middle Lobe (RML)

Question 16

Which lobe?

Answer 16

Right Lower Lobe (RLL)

Question 17

Which lobe?

Answer 17

Left upper lobe (LUL) with Lingula

Question 18

Which lobe?

Answer 18

Left Lower Lobe (LLL)

Question 19

What “special area” of the lungs?

Answer 19

Lingula

Question 20

Assessment?

Answer 20

Rotated? A little bit. Inspiration? 10 ribs. Good. Penetration? Can see spinal vertebrae in upper mediastinum. Good. Can trace diaphragm on R but not left side. There is an infiltrate on L side and cannot see heart borders. Notice parenchyma with fluffy/ cotton candy. If young PT then likely pneumonia, if older than likely CHF. “Alveolar Pattern”

Question 21

Assessment?

Answer 21

Rotation? Good. Inspiration? 10 ribs. Good. Penetration? Lacy in parenchyma (interstitial). “Interstitial Pattern”. White stuff over lungs is the vasculature. Common picture for CHF patient retaining fluid. Need lasix.

Question 22

Assessment?

Answer 22

Rotation? OK. Inspiration? 10+ too good. Penetration? Can clearly see vertebrae on top and bottom. OVER PENETRATED! Can see too clearly. “Vascular Pattern”

Question 23

Assessment?

Answer 23

Rotation? OK Inspiration? OK Penetration? OK. Right Upper Lobe is filled with fluid. Likely pneumonia. “Consolidation”

Question 24

Assessment?

Answer 24

Rotation? Maybe a bit. Inspiration? 10 ribs. Penetration? OK. Left side lower lobe looks weird. If cannot see heart border then likely lingular infiltrate. A lower lobe infiltrate usually lets you see the heart. “Consolidation”

Question 25

Assessment?

Answer 25

Atelectasis, loss of lung volume.

Question 26

Assessment?

Answer 26

Atelectasis at arrows. Penetrated? Under. Makes the atelectasis more prominent.

Question 27

Assessment?

Answer 27

Congestive Heart Failure. Very enlarged heart. Under penetrated film, difficult to determine actual heart size. Large hila with indistinct markings, fluid in interlobar fissures, pleural effusions, alveolar edema

Question 28

Assessment?

Answer 28

Rotated? No Penetration? Good Inspiration? 9 ribs, good. Aveolar pattern (white, fluffy, cottony pattern). Something likely in lungs. Kerley B Lines (Interstitial edema)=Fluid collection at minor fissures of lungs. Looks like little dashes out near CFAs. Cardiomegaly, dilated prominent upper lobe vessels, pleural effusion.

Question 29

Assessment?

Answer 29

Heart failure. Female. Kerley B linesLittle dashes near CFAs. PT has cariomegaly. Get an echo.

Question 30

What are these lines?

Answer 30

Kelrley B lines (Interstitial edema). Fluid collection at minor fissures of lungs. Looks like little dashes out near CFAs. Pathoneumonic for heart failure.

Question 31

Assessment?

Answer 31

Rotation? No. Inspiration? 10 ribs, good. Penetration? Over. External structures. Corocoid process sticking out. Ribs. Pleura is gone, only seeing air and no water or fat. 5th intercostal space mid clavicle line to decompress.

Question 32

Assessment?

Answer 32

PT's left side. Cannot clearly see heart which implies a problem in the lingular part of lung. Cannot see CFA. If can't see "double bubble" then bad. Pleural effusion.

Question 33

Assessment?

Answer 33

Look at lung parenchyma. Looks OK. Look at lung tissue. Notice the circle, not normal. Density similar to bone. Possibly calcium deposit, possibly TB. Try to find an old X-ray to compare to.

Question 34

Assessment?

Answer 34

Rotation? Good. Inspiration? 8-9. Penetration? Don't see discs so under. Air fluid level. Very dense, possibly blood. Must do needle aspiration.

Question 35

Assessment?

Answer 35

Rotation? Maybe mildly. Inspiration? Good Penetration? Good. Extra-thoracic structures? Good. Lung tissue? Aveolar. Common presentation in TB.

Question 36

Assessment?

Answer 36

Rotated? Maybe? Inspiration? Can't see many ribs. Penetration? Looks poor, over(?). Very large heart. CHF, Kerley b lines

Question 37

Assessment?

Answer 37

Rotation? Yes Inspiration? OK. Penetration: Overpenetration. Can see thoracic vertebrae too clearly. External structures: ok Pleura:ok Parenchyma: ok. Look at top left apex of left lung there is something in the soft tissue. There is only one Breast, PT has had mastectomy.

Question 38

Assessment?

Answer 38

Rotation? OK. Inspiration? Ok. Penetration? Little over, causing to undercall Diaphragm? External structures?ok Ribs? Nothing obvious Pleura?ok Lung tissue start from apicies. Left middle. Not metal, not bone, something fluidly or fat. Turned out to be a lung mass.

Question 39

Assessment?

Answer 39

Rotation? Slightly but OK Inspiration? Good Penetration? Good Diaphragm? Good CFAs? Good Ext Structures? Good. Pleura? Tough to tell but top left. Left upper lung pneumothorax!

Question 40

Assessment?

Answer 40

Pneumothorax