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Year 3 Clin Skills > X-Ray interpretation > Flashcards

X-Ray interpretation Flashcards

1
Q

What anatomy can you see on a CXR?

A 
Trachea
Hila
Lungs
Diaphragm
Heart
Aortic knuckle
Ribs
Scapulae
Clavicles
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2
Q

What is the structure of interpreting CXR’s?

A 
Confirm details
Assess image quality
Obvious abnormalities
ABCDE approach
Review areas
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3
Q

What pt details are important?

A

Projection
Name, DOB, ID no.
Date and time
Previous films

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4
Q

What do you look for when assessing image quality?

A

Rotation
Inspiration
Projection
Exposure

‘Well inspired, non-rotated, well penetrated Xray with adequate exposure’

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5
Q

How do you assess rotation?

A

Medial aspect from each clavicle should be equidistant from spinous processes

Spinous processes should be vertically orientated against the vertebral bodies and lie halfway between the clavicles

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6
Q

How do you asses inspiration?

A

5-6 anterior ribs
10 posterior ribs
Costophrenic angles and lateral rib edges should be visible

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7
Q

What do you check re projetion?

A

AP or PA

Should be labelled but if not labelled assume PA

AP - scapula within lung field and enlarged mediastinum

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8
Q

What does projection matter?

A

Size of the heart will be different

Larger on AP

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9
Q

What is important re exposure?

A

Left diaphragm should be visible to the spine
Vertebrae should be visible behind the heart
Make sure there is adequate penetration

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10
Q

How should you describe the obvious abnormalities?

A

Site? - which lung, which lung lobe/part?

Size?

Shape? - round, diffuse, well/poorly demarcated, focal, diffuse

Density? - more or less compared to surrounding tissue

Texture? - uniform or heterogenous

Number and distribution? - single/multiple or focal/widespread

Other features? - fluid levels, air bronchograms, bony changes, equipment

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11
Q

What is A in the A-E approach?

A

Airway

Trachea? - central or deviating
Pushing or pulling

Carina

Lung hilar

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12
Q

What causes deviation away from the lesion?

A

Pleural effusion
Mass
Tension pneumothorax

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13
Q

What causes deviation towards from the lesion?

A

Volume loss e.g. consolidation or collapse

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14
Q

What are the differences between the right and left bronchus?

A

Right bronchus is wider than left

Foreign objects usually go via the right

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15
Q

Why is the carina significant?

A

Where left and right bronchi form

Landmark for NG tube placement

NG should bisect the carina, you know it is not in the airway

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16
Q

What comprise the lung hilar?

A

Major bronchi
Pulmonary vessels
Lymph nodes

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17
Q

What causes lung hilar enlargement?

A

malignancy (unilateral), sarcoidosis (bilateral_

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18
Q

What is B in the A-E assessment?

A

Breathing

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19
Q

How do you assess breathing?

A

Lung fields

Start in apices, work down to costophrenic angles

Compare both lungs as you do

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20
Q

What do marking indicate?

A

Increased air space shadowing - consolidation

Absence of markings - pneumothorax

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21
Q

Give an example of how you would describe consolidation?

A

Large area of patchy air space shadowing near the right border of the heart

Suggestive of consolidation

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22
Q

What is C in the A-E assessment?

A

Cardiac
Heart size and borders
‘cardiothorocic ratio and cardiophrenic angle’

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23
Q

How do we assess heart size?

A

heart should occupy no more than 50% of the thoracic width

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24
Q

What conditions can cause cardiomegaly?

A

HF, valvular heart disease, cardiomyopathy, pulmonary hypertension and pericardial effusion

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25
Q

How do we assess heart borders?

A

Well-defined
The right atrium makes up most of the right heart border.

The left ventricle makes up most of the left heart border.

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26
Q

What is reduced definition of the right heart border commonly associated with?

A

typically associated with right middle lobe consolidation

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27
Q

What is reduced definition of the left heart border commonly associated with?

A

Typically associated with lingular consolidation

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28
Q

What is D in the A-E assessment?

A

Diaphragm

Height
Under
Costophrenic angles

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29
Q

What does a normal diaphragm look like?

A

Right normally higher

Curved

30
Q

What does flattening of the diaphragm’s mean?

A

Suggest lung hyper-expansion

Air-trapping COPD

31
Q

What should you check for under the diaphragm?

A

Free air under the diaphragm

Pneumoperitoneum

Can cause right hemidiaphragm to lift and visibly separate from the liver

Air will look black under a thin white line which is the diaphragm

32
Q

What commonly causes pneumoperitoneum?

A

Bowel perforation

33
Q

What are you looking for in the costophrenic region?

A

Well defined acute angle

Loss of this is known as costophrenic blunting

34
Q

What can cause blunting of the costophrenic angles?

A

Fluid

Consolidation

35
Q

What is E?

A

Everything else

Bones - fractures, lesions

Soft tissues - surgical emphysema, clips, masectomy

Equipement - NGs, pacemakers

36
Q

What is surgical emphysema?

A

Air in the soft tissue

Usually resolves by itself

37
Q

What can cause surgical emphysema?

A

After surgery, insertion of chest drain, NIV

38
Q

What ares of interpretation are commonly missed?

A

Apices
Hilar
Behind the heart
Under the diaphragm

39
Q

What is the key difference between pneumothorax and tension pneumothorax

A

Tension you get entire shifting of mediastinum

40
Q

What are the signs of lung collapse?

A

Loss of volume
Raised hemidiaphragm ipsilaterally
Tracheal and medistinal shift towards the collapsed side
Narrowing of the space between the ribs compared to other side
Homogenous opacity

41
Q

What are the signs of pleural effusion of CXR?

A

Blunting of the costophernic angles

Homogenous opacification

Fluid level manifesting as a meniscus

42
Q

What are the main features of tension pneumothorax

A

Significant mediastinal shift
Depressed hemidiaphragm
Lung collapse?

Medical emergency
Diagnosed clinically and treated immediately with needle thoracentesis
Never diagnosed on CXR

43
Q

What is the structure for interpreting AXR’s?

A 
Confirm details
Assess image quality 
Obvi
Bowels
Bones
Calcification (and artefact)
44
Q

How do we assess quality on a AXR?

A

Projection:
Most of them are AP with pt. lying flat
Decubitas - used in paeds

Exposure:
Ensure whole abdomen is visible, from level of hemidiaphragm to bowel

45
Q

If bowel perforation is suspected what is the best imaging?

A

Errect CXR must be done

Must sensitive at detecting the presences of free gas in abdomen

46
Q

What are the typical characteristics of the large bowel?

A 
Typically runs around outside of abdomen
Follow along (rectum --> caecum)

May contains faeces which will appear as mottled due to gaseous content

Diameter no wider than 6cm
Caecum can be up to 9cm

Haustra and haustral folds

47
Q

What are haustra/haustral folds?

A

Haustral folds represent folds of the mucosa
within the colon

Hastra refer to the small segemented pouches of bowel separated by haustral folds

48
Q

What are the typical characteristics of small bowle?

A

Lies centrally

Diameter should be no wider than 3cm

Valvulae conniventes
- thin, circular folds of mucose

49
Q

What are the features of small bowel obstruction on a AXR?

A

Dilation of the small bowel <3cm

More prominent vavulae conniventes

50
Q

What are the causes of small bowel obstruction?

A

Adhesions (75%) post surgery
Hernias
Malignancy

51
Q

What are the features of large bowel obstruction?

A

Colonic distention > 6cm

May cause small bowel dilatation in prolonged obstruction or poor competence of the ileo-caecal valve

52
Q

What are some causes of large bowel obstruction?

A

Colorectal cancer
Diverticulitis
Volvulus

53
Q

What do you see on a AXR in sigmoid volvulus?

A

Coffee bean sign

54
Q

What can you see when there is air in the abdomen?

A

Both sides of the bowel wall become visible

Known as Rigler’s sign

55
Q

What are the causes of penumoperitoneum?

A

Perforated bowel
Perforated duodenal ulcer
Recent abdominal surgery

56
Q

What are features of IBD on AXR?

A

Thumb-printing: mucosal thickening due to inflammation and oedema, appears like thumbprints projecting inwards

Lead pipe: Loss of normal haustral markings

Toxic megacolon: colonic dilatation

57
Q

What other organs should you check on a AXR?

A

Lung - inspect bases

Liver - evidence of hepatomegaly

Gallbladder - gallstones, but most are radiolucent

Kidneys - both should be visible

Bladder - variable appearance depending on how full

58
Q

What bones might you visualise on a AXR?

A 
Ribs
Lumbar vertebrae
Sacrum
Coccyx
Pelvis
Proximal femurs
59
Q

What artefact may you see on a AXR?

A

Surgical clips
Jewellery
Indwelling lines
Surgical lines

60
Q

What calcification might be seen on a AXR?

A 
Calcified gallstones in the right upper quadrant
Renal stones/staghorn calculi
Pancreatic calcification
Vascular calcification
Costochondral calcification
61
Q

What are the 3 types of shadowing?

A

Alveolar ‘fluffy’ - pneumonia

Homogenous - Pleural effusion

Reticulonodular

62
Q

How do you diagnose cause of pleural effusion?

A

Pleural tap

Exudate (high protein) vs Transudate

63
Q

What do you see on CXR in pulmonary odema?

A

Bat’s swing airspace shadowing

64
Q

What external objects could be seen on CXR?

A

Metallic valves
Sternotomy wires
Pacemaker

65
Q

What can cause pulmonary odeoma?

A

ARDS
Pulmonary hypertension
HF

66
Q

When might you see batswing shadowing?

A

Pulmonary odema

ILD

67
Q

What might cause coin lesions?

A 
Malignancy
TB
Abscess
Cyst
Benign tumour e.g. schwannoma
68
Q

What are causes of bihilar lymphadenopathy?

A 
Sarcoidosis
TB
AIDS
Recurrent Chest Infections
Tumours e.g. lymphoma
69
Q

What are causes of unilateral hilar lymphadenopathy?

A

TB
AIDS
Recurrent Chest Infections
Tumours e.g. lymphoma

70
Q

What is the difference between Sarcoidosis and TB?

A

TB - caseating granulomas

Sarcoidosis - non-caseating

71
Q

What are multiple coin lesions called?

A

Canonball mets
seen in renal cancer
can also be caused by prostate cancer

72
Q

What can cause a widening of the mediastinum?

A

Aortic aneurysm/dissection
Goitre
Lymphoma

Year 3 Clin Skills (4 decks)

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