S10 The Chest X-ray

Question 1

Describe lobar collapse on a CXR

Answer 1

Volume loss within the lung, due to aspirated foreign material, iatrogenic.
CXR shows shift of the mediastinum towards the side of the collapse due to loss of volume.
Sail sign.

Question 2

Describe consolidation on a CXR

Answer 2

Filling of alveoli with pus (pneumonia), fluid (pulmonary oedema), blood (haemorrhage) or cells (cancer).
Non-homogenous opacification.
Air bronchogram is a characteristic sign of consolidation.
Dull percussion .

Question 3

Describe pleural effusion on a CXR

Answer 3

A collection of fluid in the pleural space.
Homogenous opacification with a meniscus at the upper border.
Stony dull percussion

Question 4

Describe a pneumothorax on a CXR

Answer 4

Air trapped in the pleural space, appears darker.
Occurs spontaneously, or due to underlying lung disease
Visible pleural edge, lung markings not visible, lung collapsed edge.

Question 5

Describe a tension pneumothorax on a CXR

Answer 5

Tracheal/mediastinal shift is away from the pneumothorax.
Anything that increases volume in one hemithorax will push the trachea away from that side.
Percussion – hyperresonance.

Question 6

Describe a space occupying lesion on a CXR

Answer 6

Nodule if <3cm, mass if >3cm.

Causes can be malignant (primary or metastases), benign mass lesion, inflammatory e.g. pneumoniae.

Question 7

Describe tuberculosis on a CXR

Answer 7

Ill defined patchy consolidation, caseating granuloma, eventually calcifies to become Ghon lesion.

Question 8

Describe COPD on a CXR

Answer 8

Lung hyperinflation with blunting of both costophrenic angles, and flattened diaphragms.

Question 9

Describe a pneumoperitoneum on a CXR

Answer 9

Air is seen under the diaphragm. This is a sign of bowel perforation.