X-ray Flashcards
A-H
- A- airway
- B- bones
- C- cardiac
- D- diaphragm’s - liver on the right - diaphragm is higher than the left, stomach under the right - gastric bubble
- E- expansion - need good expansion of chest for photo
- F- fields and fissures
- G- gadgets
H- hidden areas
quality of position
- Check clavicles
- Is the distance equal distance apart both sides
- Is one shoulder rotated forwards compared to the other
- Rotation impacts the ratios of the heart
- Often unvoidable and is the normal posture of the patient
airway
- Air is black - tissue fluid look white
- Look for trachea
trachea
- The trachea is normally located centrally or deviating very slightly to the right.
- If the trachea appears significantly deviated, inspect for anything that could be pushing or pulling the trachea. Make sure to inspect for any paratracheal masses and/or lymphadenopathy.
true trachial deviation
- Pushing of the trachea: large pleural effusion or tension pneumothorax.
- Pulling of the trachea: consolidation with associated lobar collapse.
Apparent tracheal deviation:
- Rotation of the patient can give the appearance of apparent tracheal deviation, so as mentioned above, inspect the clavicles to rule out the presence of rotation.
bones
- Scapula
- Clavicle
- Vertebra
- Ribs
Pathologies - Fractures #
- Dislocations
- Rib crowding
- Previous surgery
○ Plates
○ Pins
○ Cages
soft tissue
Breast shadows
Skin folds and soft tissue density
Surgical emphysema.
cardiac
right- 1/3rd
left- 2/3rds
sail sign cardiac
- wedge of collapsed tissue behind the heart boarder
- left lower lung collapse
- appears like a boat sail
diaphram
- right hemidiaphram is higher than the left due to the liver
- stomach underlies left hemidiaphram
- The diaphragm should be indistinguishable from the underlying liver
- if free gas is present (bowel perforation) air accumulates underdiaphram causing it to lift and become visibly separate from the liver
expansion
- To assess the degree of inspiration it is conventional to count ribs down to the diaphragm. The diaphragm should be intersected by the 5th to 7th anterior ribs in the mid-clavicular line. Less is a sign of incomplete inspiration.
- Less than 5 ribs indicates incomplete inspiration
- More than 7 ribs suggests lung hyper-expansion
Fields and fissures
- The left lung has two lobes and the right has three
- Fine grey lines that extend throughout the lung fields to within 2cm of the lung edge
- Equal density within the left and right lung fields
- Looking for areas that appear whiter (dense tissue or fluid) OR darker (air) than you would expect
fields - whiter than expected
increased density of lung markings or obscured by something else.
fields darker than expected
Darker suggest air where it shouldn’t be and absent lung tissue.
horizontal fissure
- Fluid in horiz fissure and associated pleural effusion.
- Opacity below the horiz fissure so it is clearly defined suggesting infection in middle lobe.
- Horiz fissure has moved from where you would expect it to be suggesting collapse of upper lobe.
gadgets
- Pacemaker
- ECG lead
- Tracheostomy
- Chest Drain
- Stomach tube Nasogastric
- Sternal wires - Holds sternum back together
- ETT endotracheal tube
- Rods
Hilar
- increased density around the hilar
- bats wing pattern
- pulmonary odema/ fluid overload/ heart failiure & increased blood flow to the area
- The left hilum is often positioned slightly higher than the right, but there is a wide degree of variability between individuals.
- The hilar are usually the same size, so asymmetry should raise suspicion of pathology.
- The hilar point is also a very important landmark; anatomically it is where the descending pulmonary artery intersects the superior pulmonary vein. When this is lost, consider the possibility of a lesion here (e.g. lung tumour or enlarged lymph nodes).
Causes of hilar enlargement or abnormal position
- Bilateral symmetrical enlargement is typically associated with sarcoidosis.
- Unilateral/asymmetrical enlargement may be due to underlying malignancy.
- inspect for evidence of the hilar being pushed (e.g. by an enlarging soft tissue mass)
- or pulled (e.g. lobar collapse).
pleural effusion
- Concave - meniscus
- Its not white and patchy so not consolidation
consolidation
refers to any pathological process that fills the alveoli with e.g. pus, blood, fluid
consolodation appearance
- patchy opacity
- may affect one side, lobe, ehole lung or both lungs
- silhouette sign
- air brochiograms
- all structures in expected positions
atelectasis
- uniform white appearance
- can be localised to one lobe or whole lung
- rib crowding
- eevidence of reduced expansion
- movements of structures towards the area that is more white
pleural effusions
- blunting of costophrenic angles
- uniform white appearance throughout a whole lung fieldwith a defined line and meniscus
- movement of structures away from this
pulmonary odema
- bilateral increased lung markings- perihilar and shaped like bat wings
- septal lines
- effusions may be present
bullae- common in COPD
- areas of lung that appear more black within/adjacent to areas with lung markings in
- due to emphysematous damage of the lung