32. Chest x-rays Flashcards Preview

Year 2 CR > 32. Chest x-rays > Flashcards

Flashcards in 32. Chest x-rays Deck (17):
1

What does the following show on a chest x-ray?

Black
Dark grey
Light grey
White
Bright white

Black - air
Dark grey - fat
Light grey - soft tissues
White - bone/fluid
Bright white - metal

LOOK AT THIS AND RECOGNISE FROM AN IMAGE

2

How do the anterior and posterior ribs appear on a chest x-ray?

The posterior ribs are the ones that are attached to the sternum
These then follow the lungs around towards the front and these (anteriorly) are the anterior ribs

3

Which rib dissects the diaphragm?

The seventh rib (check)

4

What are the first things you should look for on a chest x-ray?

Patient details i.e. name and DOB
Date/time of the CXR

5

What is the difference between a PA and AP chest x-ray and why might each be used?

PA - this is the most common CXR
This is preferred
Can accurately comment on the size of the heart
Ask the patient to hug a block and the clavicles and the sternum are moved out of the way and do not obscure the x-ray

AP - This will be used for a patient who may be bed-bound in hospital and cannot stand up for a PA view
The heart appears larger in this
The scapular is visible over the lung field
The clavicles are horizontal and are not moved out of the way

6

How can you recognise a PA x-ray from an AP x-ray?

NB. look at the label !!
OR
See if the scapula is present over the lung fields
See if the clavicles are present horizontally

7

Give a pneumonic of things to look for in a chest x-ray

Airways
Breathing
Circulation
Diaphragm
Everything else

8

What should you look for on a CXR regarding the airways?

Trachea - is it deviated? (Will be pulled to the same side of a collapsed lung and pushed to the opposite side in a pneumothorax)
Left and right main bronchi - is the lumen clear?
Are there any masses present?
Any reduced lung volume?
Any consolidation?

9

What should you look for on a CXR regarding breathing?

Compare the lung zones on both sides - upper, middle and lower
See any pleural effusion? Consolidation? - small airways will fill with dense white material

10

How can a pneumothorax be recognised in a chest x-ray?

Asymmetrical zones of the lung
There is a lack of lung markings to the edge of the lung field

11

How can a pleural effusion be recognised on a chest x-ray?

This is a collection of fluid in the pleural space
Fluid gathers in the lowest part of the chest (according to the patient's position)
Will appear white (fluid)
There will be a meniscus at the top
GOOD IMAGE ON SLIDE 31

12

What should you look for on a CXR regarding circulation?

Cardiothoracic ratio (length of the lungs to the lenght of the heart) - 50% is considered normal
Mediastinum - the aortic knuckle should be present, should not be widened
Heart contours should be visible

13

What should you look for on a CXR regarding the diaphragm?

Should be dome shaped
The right hand side should be higher than the left hand side - to the top of the 5th intercostal space compared to the bottom of the 5th intercostal space
Have a look - is there any air under the diaphragm?

14

What is under the diaphragm on the left and right hand side respectively?

Left hand side - bowel
Right hand side - liver

15

What should you look for on a CXR regarding 'everything else'?

Bones - are there any fractures?
Soft tissues - are there any swellings? any breast shadows?
Lines - ECG, endotracheal tubes, pacemakers, chest drains

16

What will you see on a CXR in COPD?

Hyperinflation - due to trapping of air in the bullae
Can tell this if you can see more than 6 anterior/8 posterior ribs before the diaphragm
A flattening of the hemidiaphragm - will not be at the 6th intercostal space in this case but will be located LOWER

17

What can you see on a CXR in congestive heart failure?

A - alveolar oedema
B - kerley B lines
C - cardiomegaly (boot shaped)
D - upper lobe diversions
E - bilateral effusions