Respi week: chest xrays

Question 1

What respi condition should never be seen on a CXR

as it should be treated urgently before confirming diagnosis with CXR

Answer 1

Tension pneumothorax

Question 2

How to systematically look at CXR

Answer 2

Airways: lung markings, lung expansion

Breathing: trachea

Cardio: size of heart

Diaphragm: costophrenic angles

Everything else: bone abnormalities + count ribs (may be destroyed by tumours)

Question 3

At what level should a diaphragm normally be in CXE

Answer 3

6th anterior rib/
8-10th posterior ribs

If below this level, may be hyperexpanded (will also have blunting of costophrenic angles)

Question 4

What may cause blunting of costophrenic angles in CXR

Answer 4

• pleural effusion

- lung hyperexpansion eg in COPD

Question 5

When R heart border is lost on CXR, where is the abnormality in the lung

Answer 5

R middle lobe

Question 6

When L heart border is lost on CXR, where is the abnormality in the lung

Answer 6

Lingula in L upper lobe (wraps over L ventricle)

Question 7

Most CXR are inspiratory films. When would an expiratory film be indicated?

Answer 7

To detect small pneumothoraxes

Question 8

Which hemidiaphragm is higher

Answer 8

Right is higher

Question 9

Most common lung lobe collapse + what sign does this show on CXR

Answer 9

Left lower lobe collapse

Sail sign

Question 10

How does a left upper lobe collapse show on CXR

Answer 10

Luftsichel (air crescent around aortic arch)

+ possible blurring of L heart border (if large collapse)
+ L oblique fissure may move up

Question 11

How does a right upper lobe collapse show on CXR

Answer 11

Horizontal fissure (middle lobe) moves upwards.

Question 12

How does a right middle lobe collapse show on CXR

Answer 12

Blurring of R heart border

Question 13

How does a right lower lobe collapse show on CXR

Answer 13

Triangular shaped opacity at medial base of R lung

R heart border can still be seen