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CI1 > CXR Interpretation > Flashcards

CXR Interpretation Flashcards

1
Q

Why are CXRs sometimes hard to read?

A

Because they are a 2D picture of a 3D structure

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2
Q

Where is the horizontal fissure?

A

In between the right upper lobe and middle lobe

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3
Q

When can you see the horizontal or oblique fissure in a CXR?

A

When there’s an issue, e.g. fluid on the fissure

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4
Q

What is the carina of the lungs?

A

The point where the two main bronchi split

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5
Q

What does a black area below the left lung indicate?

A

Gas in the stomach

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6
Q

What is the hilar region of the lungs?

A

Area with lots of vessels, including bronchi and pulmonary arteries and veins

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7
Q

What are the 12 steps to interpreting CXRs?

A
  1. Patient’s name
  2. Date & time of film
  3. View
  4. Exposure
  5. Alignment & expansion
  6. Attachments
  7. Bones
  8. Soft tissues
  9. Mediastinum
  10. Hilar region
  11. Lung fields
  12. Pleural margins
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8
Q

What are the 2 main ways of taking a CXR?

A

PA (posteroanterior)

  • Most satisfactory
  • Standing, arms resting up on top of machine
  • Scapulae rotated out of the way
  • Normal heart shadow

AP (Anteroposterior)

  • Portable (e.g. ICU)
  • Magnification of heart
  • Scapulae in normal position
  • Supine: diaphragm rises, lungs tend to look poorly expanded
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9
Q

What is a less common way of taking a CXR?

A

Lateral view

  • Very rare
  • May be used to look for tumours etc
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10
Q

What is the optimal exposure for a CXR?

A
  • Should just be able to make out the IV discs through the heart
  • Overexposed = too dark
  • Underexposed = to white
  • Check exposure when comparing films
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11
Q

What needs to be considered when looking at the alignment of a CXR?

A
  • Angle of clavicles (should be equidistant)
  • Relationship of spinous processes & proximal clavicles (should be right behind trachea)
  • Symmetry of ribs
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12
Q

What needs to be considered when looking at the expansion of a CXR?

A
  • How low is the diaphragm sitting
  • 7th rib anteriorly intersecting diaphragm at mid clavicular line
  • Ribs 9-11 posteriorly sitting on diaphragm
  • R hemidiaphragm higher than L (due to liver)
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13
Q

What are some of the attachments that may appear on a CXR?

A
  • Endotracheal tube (ETT)
  • Central line (CVC)
  • Tracheostomy
  • Nasogastric tube (NGT)
  • Inter-costal catheters (ICC)
  • ECG dots
  • Pacemaker
  • Sternal wires
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14
Q

Where would an endotracheal tube (ETT) appear on a CXR?

A
  • Breathing tube in through mouth into trachea
  • Sitting within trachea
  • Should terminate 3-5cm above carina
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15
Q

Where would a central line (CVC) appear on a CXR?

A
  • Should terminate just above right atrium

- Internal jugular (neck) or subclavian

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16
Q

Where would a tracheostomy appear on a CXR?

A
  • Tube from trachea to outside
  • About width/length of finger, curving around
  • Look for circle where trachea is facing camera
17
Q

Where would a nasogastric (NGT) appear on a CXR?

A
  • Starts at top of XR
  • Travels down oesophagus into stomach
  • Tip of tube is below diaphragm
  • Does not follow the path of the bronchus
  • Tube is not coiled anywhere in chest
18
Q

Where would an intercostal catheter (ICC) appear on a CXR?

A
  • Draining fluid/air from intrapleural space
  • Usually connected to UWSD
  • Width of finger, extend beyond rib cage, coming out side of chest
19
Q

What is a pigtail catheter used for & how is it different to an ICC?

A
  • Only used to drain air

- Much narrower than an ICC

20
Q

Where would a pacemaker, sternal wires and ECG dots appear on a CXR?

A

Pacemaker

  • Lump under skin
  • Wires going to heart

Sternal wires

  • Around trachea, wires going around in circle/figure 8
  • Hold sternum in place while healing

ECG dots
- Clear spots with wires

21
Q

What does a spring in the lung on a CXR represent?

A

An external ventilator (ICU patients)

22
Q

What is flail chest?

A
  • Multiple fractures within same ribs

- One segment starts moving in opposite way to breathing

23
Q

What should be considered when looking at bones on CXRs?

A
  • Rib fractures/displacements
  • Flail chest
  • Position of ribs - if horizontal, may be overexpanded/hyperinflated
  • Locate border of scapula
  • Not rotated away in AP view
24
Q

What should be considered when looking at soft tissues on CXRs?

A
  • Breast tissue
  • Adipose tissue
  • Subcutaneous emphysema (air tracking through soft tissues, shows as black outside of lungs, striation of pec major)
25
Q

What should be considered when looking at the mediastinum on CXRs?

A
  • Trachea: Midline position (relationship to spinous processes)
  • Heart: Cardiac diameter should be no more than half the diameter of the lungs
26
Q

What should be considered when looking at the hilar region on CXRs?

A
  • Proximal main bronchi (L higher than R)
  • Proximal pulmonary arteries, draining veins & lymph nodes
  • Prominence = enlargement
27
Q

What are some of the causes of hilar enlargement?

A
  • Infection
  • Tumour
  • Vascular (aneurysm, stenosis etc)
28
Q

What should be considered when looking at the lung fields on CXRs?

A
  • Consolidation
  • Collapse (atelectasis)
  • Pulmonary oedema
29
Q

What is consolidation?

A

When alveoli are full of something other than air (e.g. water, pus, blood)

30
Q

What are the causes of consolidation?

A
  • Infection (e.g. pneumonia, TB)
  • Pulmonary haemorrhage
  • Aspiration (e.g. gastric contents)
  • Infiltration (e.g. lymphoma)
31
Q

What are the CXR signs of consolidation?

A
  • Areas of increased density (white)
  • Air bronchograms: Contrast between dark air in bronchi & surrounding white airless parenchyma (looks like tree branches)
  • Silhouette sign: Border of structure is lost because of whiteness
32
Q

What are some of the causes of atelectasis?

A
  • Mucous plug
  • Inhaled foreign body
  • Tumour
  • Handling of lung tissue (almost always post cardiac surgery)
  • Hypoventilation (upper chest breathing)
33
Q

What are the CXR signs of atelectasis?

A

Loss of volume resulting in:

  • Increased density (whiteness)
  • Silhouette signs
  • Displacement of fissures
  • Elevation of hemidiaphragm
  • Displacement of trachea towards side of collapse
  • Displacement of hilar
  • Crowding of ribs
34
Q

How does pulmonary oedema appear on a CXR?

A
  • Fluid overload in alveoli
  • Increased lung markings throughout (speckles everywhere)
  • Wet or fluffy
35
Q

What needs to be considered when looking at the pleural margins on CXRs?

A
  • Pneumothorax

- Pleural effusion

36
Q

How does a pneumothorax appear on a CXR?

A
  • Trace border of lung (visceral border)

- Note absence of lung speckles in pneumothorax space (looks unusually dark)

37
Q

How does a pleural effusion appear on a CXR?

A
  • Fluid appears white
  • Flattening of bases (straight lines)
  • Curved fluid line (meniscus sign) sometimes visible
38
Q

How does the positioning of the trachea differ between pleural effusion and atelectasis CXRs?

A
  • Atelectasis: Trachea moves towards side of collapse

- Pleural effusion: Trachea moves away from side of collapse

CI1 (21 decks)

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