W4 - Cardio Chest X-rays Flashcards
How is a chest X-ray produced
By electromagnetic beams passing through the thorax & exposing a photographic silver film/plate which turns black as soon as the X-ray strikes it
What are less dense tissues referred to as
Radiolucent
What colour to less dense tissues referred appear on an X-ray
Black
Name an example of a less dense tissues
Air or air filled structures
What colour do more dense tissues appear under an X-ray
White
What are more dense structures on an x-ray referred to as?
Radiopaque
Name an example of the more dense structure that would appear white on a x-ray
Bone or metal (ribs and the sternum)
Give an example of structures that would appear grey under an x-ray
Fats (lipid tissue around a muscle or soft tissue such as heart, blood vessels & muscles)
Name the two main types of chest x-rays and describe what they are
Posterioanterior
X-ray passes posterior lead to anteriorly with the plate placed anteriorly to the patient’s chest. The patient is upright and the scapular are rotated away from the lung field.
Anterioposterior
Portable x-ray that passes anteriorly to posteriorly and the heart will appear bigger
What are two important things to check before interpreting a chest x-ray?
The quality is right(not over or under exposed)
The x-ray film isn’t rotated
What is the difference between an overexposed x-ray and an under exposed x-ray?
Over exposed
The x-ray intensity is too high or the x-ray has been projected for too long
Under exposed
The x-rays intensity is too low or it hasn’t been projected for long enough
When interpreting an x-ray what are the preliminary checks we must do first?
Check for
Patient’s name and date of birth
The projection of the x-ray (OA or AP)
Expose
Position
Inspiration
What questions must we ask when interpreting a chest x-ray?
Who?
What
When
How
Why
When interpreting a chest x-ray what system must we follow?
A = alignment
B = bone
C = cardiac
D = diaphragm
E = exposure
F = lung field
G = gadgets
Name five common abnormalities you’d see in the chest x-ray
Consolidation
Collapsed lung
Pleural effusion
Pneumothorax
Pulmonary oedema
Fractures
What other machines could we use to examine the chest?
CT scan or MRI scan
What should we think about when looking at the alignment of a chest x-ray?
Is the film straight?
Check this by looking at the proximal ends of the clavicles in relation to the spinous process
What should we consider when observing the bones on a chest x-ray?
Are they all there?
Are they intact and in their normal position?
What should we look at in relation to cardiac when observing a chest x-ray?
Is there a clear heart border?
Is it a normal size? (1/3 of the chest diameter)
Is there anything else to note?
Is there any evidence of shifting structures?
What should we look at when observing diaphragms on a chest x-ray?
Are both hemidiaphragm clearly visible?
Are they cardiophrenic and costophrenic angles there?
What should we consider when looking at expansion when observing a chest x-ray?
How well expanded is the chest
The 10th posteriorly and the sixth rib anteriorly should cut through the hemidiaphragm
What should we consider when looking at fields when observing a chest x-ray?
Are all the long fields clear?
Are there any areas where density has increased or decreased?
Can you see the edge of the lung?
Can you see a fluid level?
Is there ever any shifting structures or crowding of the lung markings (collapsed lung)
What should you consider when looking at gadgets when observing a chest x-ray?
What drips?, Drain, tubes, lines and other gadgets are visible
Are they in, on or around the patient?
What does consolidation look like on a chest xray
Grey/white shadowing with no loss of volume
Define consolidation
Condition where the lung tissue become firm and solid rather than elastic & air filled due to it accumulating fluids & tissue debris
What are the 3 main causes of consolidation
Pneumonia
Chest infection
Lung contusion following trauma
What will you hear on auscultation with someone who has consolidation
Increased breath sounds/bronchial breathing, decreased breath sounds with or without crackles or wheezing
Define atelectasis/collapsed lung
Airless state of the lung which may involve all or part of the lung
What will you seen on a chest X-ray of someone with a collapsed lung
White/grey shadowing with a loss of volume and shifting of structures
A total collapsed lung may pull the mediastinum towards the affected side
What would you hear on auscultation with someone who has a collapsed lung
Quiet breath sounds if occluded in the bronchus
Bronchial breathing sounds if patent bronchus, fine end inspiratory crackles with smaller atelectasis
Main causes of collapsed lung
Shallow breathing
Bronchial obstruction
Absorption of trapped gas
Surfactant depletion
Define pleural effusion
Excess fluid in the pleural cavity
Signs in a chest X-ray of pleural effusion
White, small amount of fluid will cause a loss of costo-phrenic angle.
More fluid then you may see this tracking up the pleura laterally
Large amounts of fluid will push the mediastinum towards the non-affected area
Sounds on auscultation with someone with pleural effusion
Quiet breath sounds over pleural effusion with bronchial breathing just above the top of the fluid
Main causes of pleural effusion
Changes in membrane permeability
Malignancy
Pneumonia
T.B
Define pneumothorax
Air in the pleural space secondary to a rupture in wither pleural layer. Lung squashed towards the hilum in proportion to the amount of air there
Signs in a chest X-ray of pneumothorax
Air in pleural space will be black, no lung markings
Squashed lung will appear white towards the hilum
Mediastinum may be displaced to the non-affected side
Sounds on auscultation for pneumothorax
Quiet over the area
Causes of pneumothorax
Fast growth
Blebs
Trauma (rib#)
Define pulmonary oedema
Extravascular water in the lungs (interstitial and alveoli)
Signs on chest X-ray of pulmonary oedema
Cloud like image
Sound son auscultation of someone with pulmonary oedema
Crackles more evident in deeper
Sometimes fine crackles or bubbly noises
Causes of pulmonary oedema
Fluid overload
Back pressure from failing left heart
Osmotic/hydrostatic pressure changes
Increased capillary permeability
