Understanding the abnormal chest X-ray

Question 1

how do you check position of equipment

Answer 1

CXR

Question 2

pushed away from pathology and trachea too black

Answer 2

pneumothorax

Question 3

pushed away from pathology trachea too white

Answer 3

pleural effusion

Question 4

pulled towards pathology and too white

Answer 4

collapse/atelectasis or fibrosis

Question 5

tension pneumothorax

Answer 5

the mediastinum is pushed away

Question 6

deviated trachea towards pathology

Answer 6

pneumonectomy/lobectomy

lobar collapse

Question 7

trachea deviated away from pathology

Answer 7

tension pneumothorax

massive pleural effusion, or any mass effect

Question 8

opacity adjacent to heart show

Answer 8

left upper lobe

Question 9

opacity not adjacent to heart shadow

Answer 9

left lower lobe

Question 10

consolidation

Answer 10

replacement of normal air space gas with fluid or solid material

Question 11

consolidation vs collapse

Answer 11

consolidation keeps volume where as collapse loses volume

Question 12

blurring of heart border

Answer 12

consolidation

Question 13

horizontal fissure on a CXR

Answer 13

anterior 4th rib

Question 14

atalectasis

Answer 14

Collapsing of a lung - reduction in inflation of all or part of the lung

Question 15

atalectasis chest xray telling signs

Answer 15

Volume loss
Displacement of trachea
Displacement of diaphragm
Displacement of lung fissures
Compensatory over inflation of non collapsed lung Crowding of vessels & bronchi

Question 16

Opacification, Too white or white in the wrong place

Answer 16

• Fluid

* Increased tissue e.g lymphadenopathy

Question 17

What signs would you find on clinical examination?

Answer 17

Inspection Palpation Percussion Auscultation

Question 18

five causes of consolidation

Answer 18

Pus = infection
blood = pulmonary haemorrhage 
fluid = pulmonary oedema, drowned lung 
cells = lung cancer 
protein = alveolar proteinosis

Question 19

Air bronchogram. -snow on trees

Answer 19

Large airways are spared so become visible (black) against the white background
Dull to percussion
Increased vocal resonance Bronchial breathing

Question 20

Left upper lobe atelectasis

Answer 20

• “veil like” opacification of left lung field
• Elevated hemi diaphragm
• Loss of cardio mediastinal contour

Question 21

Covid

Answer 21

Patchy opacification
Bilateral
Peripheral distribution Towards the base of the lungs

Question 22

Pleural effusion

Answer 22

fluid collecting within the pleural cavity
• Trachea is pushed away
• Left lower zone uniformly white
• Concave upper border (meniscus)

• Sample the effusion (USS guided)
• Exudate (high protein) malignancy , infection, rheumatoid
• Transudate (low protein) CCF ,

Question 23

Pulmonary oedema ABCDE

Answer 23

A - alveolar oedema = bat bind appearance

B - Kerley B lines

C - Cardio-thoracic ratio (cardiomegaly)

D - dilated upper lobe vessels

E - pleural effusion

Question 24

Bilateral hilar lymphadenopathy

Answer 24

• Lymphoma (hodgkins) • Sarcoid
If unilateral or asymmetrical
TB
Metastatic spread