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Radiology > Radiology of the Chest #1 > Flashcards

Radiology of the Chest #1 Flashcards

1
Q

Chest X-ray

A
  • Most commonly ordered radiographic test
  • “Window” into the patient’s health
  • Old films are invaluable for comparison
  • Nearly every admitted patient gets one
  • Posteroanterior (PA) and Lateral (Standard views, read together)
  • Anteroposterior (AP) only if pt cannot stand (Sitting or lying down)
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2
Q

When do you order a CXR

A 
SOB 
Chest pain 
Fever 
Cough 
Weight loss 
Trauma 
Lines/Tubes 
Foreign bodies
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3
Q

What are you looking for on a CXR

A
  • Pneumonia, infection
  • Pleural effusion
  • Pneumothorax
  • Pulmonary edema
  • Cancer, mass
  • Heart size
  • Mediastinum
  • Perforated viscous
  • Much, much more…
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4
Q

Adequacy of the PA CXR

A
  • Identifiers (name, date)
  • All structures visualized? (The entire chest, neck, full lung fields, costophrenic angles)
  • Determine adequacy by evaluating the film for: Rotation, Inspiration, Penetration, Magnification (is it a PA or AP film?), Angulation
  • Remember: R.I.P. MA
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5
Q

Adequacy PA CXR - Rotation

A

-Clavicular heads should be equidistant from spinous process of thoracic vertebrae -Is this pt rotated to his own left or his own right (PA film) !

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6
Q

Adequacy PA CXR - Inspiration

A

Posterior ribs (numbered):

  • More prominent
  • Horizontal-ish

Anterior ribs (stars):

  • Less prominent
  • Oriented downward

Full inspiration: 9-10th posterior ribs, 8th anterior rib
-Start with the 1st rib Usually count posterior

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7
Q

Adequacy PA CXR - Penetration

A
  • Tech controlled PACS controlled
  • Lower thoracic vertebrae can be seen behind heart
  • Pulmonary vessels visualized to 1/3 of lung periphery
  • Right diaphragm seen behind heart on lateral
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8
Q

Adequacy PA CXR - Angulation

A
  • Semi-recumbent view (AP) (Pt sitting in bed, beam straight, pt angled)
  • Apical Lordotic view (AP) (Pt upright, beam angled or pt leaning back - Useful if you wish to highlight the apices)

If Lordotic: Clavicles high (normal = overlap 3rd or 4th posterior rib), Normal subtle “S” shape of clavicle lost; look straight, Heart appears larger

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9
Q

Adequacy - lateral view

A
  • Sternum on end
  • Two sets of ribs posteriorly - barely
  • Arms up, minimal overlap Look at:
    1. Retrosternal space
    2. Hilar region
    3. Fissures
    4. Thoracic spine
    5. Diaphragms and costophrenic angles
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10
Q

CXR - lateral view ribs and diaphragm

A

“True” lateral (red arrows: right, blue arrows: left): Ribs nearly superimposed R diaphragm: see entire length, higher than left L diaphragm: stomach bubble, anterior hidden by heart

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11
Q

Diaphragm

A

usually 2-3 cm higher on the right

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12
Q

Cardiac size - Cardiomegaly

A
  • Cardiac width on PA, at the greatest point, should be less than 1/2 width of the entire thoracic cavity in adults
  • Normal: width of the heart < width of half the thoracic cavity
  • Larger = cardiomegaly, pericardial effusion, etc
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13
Q

Ways in which the heart can appear falsely enlarged

A
  • Magnification (AP view)
  • Rotation
  • “squishing” due to: pregnancy, ascites, obesity, expiration
  • Bony abnormalities: pectus excavatum, kyphosis
  • pericardial effusion (water bottle shape)
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14
Q

ML needed to blunt each of the costophrenic angles

A

Lateral - 75ml

Anterior - 200-300ml

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15
Q

Describing lung opacities

A
  • Well defined (discrete) or ill defined borders?
  • Infiltrate? Air Space or Interstitial? Air bronchograms?
  • Nodule (<3cm)? Mass? Appear solid? Calcified? Cavitary
  • Dense consolidation or patchy infiltrate?
  • Air-fluid level?
  • Unilateral? Bilateral? Multiple? Disseminated?
  • Where is it located??
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16
Q

Silhouette Sign

A
  • When present, useful to locate an infiltrate/process by lobe of the lung
  • Fluid-filled lung will obscure border of the structure it is anatomically contiguous with (same density)
  • RML and Left Lingular infiltrates may create a silhoutte sign with the cardiac border (on PA, AP)
  • RLL and LLL infiltrates may create silhoutte sign with the diaphragm (on PA, AP)
17
Q

“spine sign” on lateral

A
  • L or R lower lobe
  • Thoracic spine density normally decreases (less white)
  • Lateral showing progressive increase in density of spine from top to bottom: spine sign
18
Q

Lucencies in the Lung

A
  • Lucencies are black areas. Lung markings are not symmetric
  • Lucencies = absence of normal lung markings
  • Check for lung markings to the periphery throughout, every time
  • Look for blacker areas, straight lines, margins
  • Possible etiologies: Pneumothorax, Bullae from COPD, Cystic structures
19
Q

Vascular Markings

A
  • Prominent central vasculature with elevated pulmonary artery pressure
  • Engorged hilar vessels, azygos
  • Pulmonary edema, CHF, mitral stenosis, renal failure (fluid overload), smoke inhalation, etc
  • Prominent vasculature in upper lobes - “cephalization”
20
Q

Correct position of an endotracheal tube

A

Tip should be 3-5cm above carina

21
Q

CT Chest/Lung - indications

A
  • Provides details: size, extent, character
  • Lung nodules, masses, staging
  • Systemic lung disease
  • Pleural effusions
  • Pulmonary embolus
  • Aorta
  • Mediastinal masses
  • Trauma
22
Q

CT chest/lung

A
  • IV contrast common (Check renal function)
  • Significant amount of radiation
  • Stable patient
23
Q

adequacy of chest x-ray

A
  • RIP MA
  • rotation
  • inspiration
  • penetration
  • magnification
  • angulation

Radiology (4 decks)

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