X-rays

Question 1

CXR: what may cause white shadowing in the lungs?

Answer 1

• consolidation
• pleural effusion
• collapse
• pneumonectomy
• specific lesions e.g. tumours
• fluid e.g. pulmonary oedema

Question 2

CXR: if there is a ‘white-out’ of a hemithorax, it is useful to assess what?

Answer 2

the position of the trachea- is it central, pulled or pushed from the side of opacification

Question 3

CXR: what might cause the trachea to be pulled towards a white out?

Answer 3

• Pneumonectomy
• Complete lung collapse e.g. endobronchial intubation
• Pulmonary hypoplasia

Question 4

CXR: what condition may the trachea be central in?

Answer 4

• Consolidation
• Pulmonary oedema (usually bilateral)
• Mesothelioma

Question 5

CXR: what may cause the trachea to be pushed away from the white-out?

Answer 5

• pleural effusion
• Diaphragmatic hernia
• Large thoracic mass

Question 6

CXR: features of pulmonary oedema?

Answer 6

• interstitial oedema
• bat’s wing appearance
• upper lobe diversion (increased blood flow to the superior parts of the lung)
• Kerley B lines
• pleural effusion
• cardiomegaly may be seen if there is cardiogenic cause

Question 7

What are commonly used to check the position of NG tubes?

Answer 7

CXR

Question 8

How to check the position of NG tube on CXR?

Answer 8

identify that the end of the tube is below the diaphragm in the stomach

Question 9

Failure to recognise that NG tube is not correctly positioned eg. with CXR can have what consequences?

Answer 9

aspiration pneumonia, death so get radiologist to report on CXR before using NG tube

Question 10

CXR: most common cause of mediastinal widening on CXR?

Answer 10

technical factors such as patient rotation

Question 11

CXR: causes of actual mediastinal widening? (not technical factors eg. pt rotation)

Answer 11

• vascular problems: thoracic aortic aneurysm
• lymphoma
• retrosternal goitre
• teratoma
• tumours of the thymus

Question 12

How to determine cause of mediastinal widening?

Answer 12

CT

can use lateral view of CXR to determine whether mass is anterior or posterior; CT better

Question 13

Lung mets are seen with what cancers?

Answer 13

wide variety eg:
- breast
- colorectal
- renal cell
- bladder
- prostate

Question 14

What are ‘cannonball metastases’?

Answer 14

multiple round, well-defined lung secondaries (mets); most commonly seen with renal cell ca but may also occur secondary to choriocarcinoma and prostate ca

Question 15

CXR: is calcification in lung mets common?

Answer 15

uncommon except in chondrosarcoma or osteosarcoma

Question 16

CXR: common causes of lobar collapse?

Answer 16

• lung ca (most common in older adults)
• asthma (due to mucous plugging)
• foreign body

Question 17

CXR: general signs of lobar collapse on CXR?

Answer 17

• tracheal deviation towards the side of collapse
• mediastinal shift towards side of collapse
• elevation of hemidiaphragm

Question 18

CXR: cavitating lung lesion differentials?

Answer 18

• abscess (Staph aureus, Klebsiella and Pseudomonas)
• squamous cell lung cancer
• TB
• Wegener’s granulomatosis
• PE
• rheumatoid arthritis
• aspergillosis, histoplasmosis, coccidioidomycosis

Question 19

What is a cavitating lung lesion on CXR?

Answer 19

area within the lung that shows a cavity or hollowed-out space, typically caused by the destruction of lung tissue. Cavities form when a part of the lung becomes necrotic (dies) and then liquefies, leaving behind an air-filled space or a fluid-filled cavity.

Question 20

What may a cavitating lung lesion look like on CXR?

Answer 20

round or irregular area with a dark (lucent) center, representing the air or fluid-filled space

surrounded by denser tissue, often representing an area of infection, inflammation, or malignancy.

The cavity may have a visible thick or thin wall around it, which can give clues about the underlying cause.

Sometimes, the cavity might have a fluid level, which appears as a horizontal line indicating air above and fluid below.