Reading CXRs

Question 1

What to initially check on a CXR?

Answer 1

Correct patient,
Quality of XR- projection, inspiration, penetration,
Position of patient

Question 2

What can you see on a CXR?

Answer 2

• The lines of the lung- they are pulmonary arteries, need to identify if they go to the end of the chest wall or do they come to an abrupt end?
• Is there a contrast eg one side dense the other not
• Is there change in position of the hilum or heart
• What is the position and shape of the diaphragm

Question 3

Why would a meniscus appear on CXR (a meniscus of the diaphragm)?

Answer 3

Fluid in the lung

Question 4

What does a crisp line identified at the end of the pulmonary arteries show? (accompanied with dense space surrounding the dense line?)

Answer 4

A pneumothorax

The crisp line is the outside of the lung

Question 5

If you can’t see the left diaphragm what is the site of pathology?

Answer 5

Left lower lobe

Question 6

If you can’t see the right diaphragm what is the site of pathology?

Answer 6

Right lower lobe

Question 7

If you can’t see the left cardiac border what is the site of pathology?

Answer 7

Left upper lobe

Question 8

If you can’t see the right cardiac border what is the site of pathology?

Answer 8

middle lobe

Question 9

What is consolidation on CXR represent?

Answer 9

That the air spaces (alveoli) are filled with:

• Pus (pneumonia)
• Fluid (pleural effusion)
• Blood (haemoptysis)
• Tumour

Question 10

What does collapse on CXR represent?

Answer 10

Loss of air in the air spaces.

• Often caused by an obstruction in the large airway (tumour or dense secretions)
• There is volume loss with/without hyperinflation of the remaining lobes

Question 11

What further investigations may be needed after a CXR?

Answer 11

Further imaging:

• CXR (to ensure treatment was effective)
• CT (obstructing lesion)

Bronchoscopy:

• Identify obstructing lesion
• Biopsy tumour

Question 12

What are the findings of pulmonary oedema on a CXR?

Answer 12

Cardiomegaly,
Upper zone pulmonary venous diversion, 
Interstitial fluid accumulation (Kerley B lines),
Alveolar oedema (Batwing opacification),
Pleural effusions

Question 13

What are Kerley B lines and what do they represent on CXR?

Answer 13

Appear as horizontal white lines.

They represent interstitial oedema

Question 14

How does alveolar oedema appear on CXR?

Answer 14

“Batwings”,
Fluffy appearance,
can draw around the area

Question 15

At what projection can you see cardiomegaly?

Answer 15

PA only