X-ray

Question 1

A-H

Answer 1

• 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

Question 2

quality of position

Answer 2

• 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

Question 3

airway

Answer 3

• Air is black - tissue fluid look white
  
  • Look for trachea

Question 4

trachea

Answer 4

• 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.

Question 5

true trachial deviation

Answer 5

• Pushing of the trachea: large pleural effusion or tension pneumothorax.
• Pulling of the trachea: consolidation with associated lobar collapse.

Question 6

Apparent tracheal deviation:

Answer 6

• 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.

Question 7

bones

Answer 7

• Scapula
  
  • Clavicle
  • Vertebra
  • Ribs
    Pathologies
  • Fractures #
  • Dislocations
  • Rib crowding
  • Previous surgery
    ○ Plates
    ○ Pins
    ○ Cages

Question 8

soft tissue

Answer 8

Breast shadows
Skin folds and soft tissue density
Surgical emphysema.

Question 9

cardiac

Answer 9

right- 1/3rd
left- 2/3rds

Question 10

sail sign cardiac

Answer 10

• wedge of collapsed tissue behind the heart boarder
• left lower lung collapse
• appears like a boat sail

Question 11

diaphram

Answer 11

• 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

Question 12

expansion

Answer 12

• 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

Question 13

Fields and fissures

Answer 13

• 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

Question 14

fields - whiter than expected

Answer 14

increased density of lung markings or obscured by something else.

Question 15

fields darker than expected

Answer 15

Darker suggest air where it shouldn’t be and absent lung tissue.

Question 16

horizontal fissure

Answer 16

• 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.

Question 17

gadgets

Answer 17

1. Pacemaker
2. ECG lead
3. Tracheostomy
4. Chest Drain
5. Stomach tube Nasogastric
6. Sternal wires - Holds sternum back together
7. ETT endotracheal tube
8. Rods

Question 18

Hilar

Answer 18

• 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).

Question 19

Causes of hilar enlargement or abnormal position

Answer 19

• 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).

Question 20

pleural effusion

Answer 20

• Concave - meniscus
  
  • Its not white and patchy so not consolidation

Question 21

consolidation

Answer 21

refers to any pathological process that fills the alveoli with e.g. pus, blood, fluid

Question 22

consolodation appearance

Answer 22

• patchy opacity
• may affect one side, lobe, ehole lung or both lungs
• silhouette sign
• air brochiograms
• all structures in expected positions

Question 23

atelectasis

Answer 23

• 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

Question 24

pleural effusions

Answer 24

• blunting of costophrenic angles
• uniform white appearance throughout a whole lung fieldwith a defined line and meniscus
• movement of structures away from this

Question 25

pulmonary odema

Answer 25

• bilateral increased lung markings- perihilar and shaped like bat wings
• septal lines
• effusions may be present

Question 26

bullae- common in COPD

Answer 26

• areas of lung that appear more black within/adjacent to areas with lung markings in
• due to emphysematous damage of the lung