Session 8 Flashcards
Why are most CXR from a PA view?
Accurate assessment of cardiac size and the scapula are rotated out of the way
Outline DR of the DR ABCDE approach for interpreting CXR’s
Details/Demographics/projection
RIPE - rotation (spinous process between clavicles), inspiration (5-7 ant. Ribs at mid clav. Line), penetration (vertebrae just visible through heart), everything visible that should be (1st rib, costophrenic angle)
Outline ABCDE of the DR ABCDE approach for interpreting CXR’s
Airway - check trachea central and hila (left higher than right)
Breathing - lungs, pleural spaces, lung interfaces
Circulation - aortic arch, pulmonary vessels
Diaphragm - free gas/mass
Everything else - bones (fracture/mass) and soft tissues
What is a pneumothorax, what is the most common cause, how does it look on a CXR and what are the clinical features?
Air in pleural space. Trauma most common cause. Large if >2cm from inner chest wall at level of hilum. Under tension if mediastinum pushed away and the hemidiaphragm is flattened.
CXR - visible pleural edge and loss of lung markings beyond edge.
Clinical features - tachycardia,dyspnoea, acute pleuritic chest pain, hyper resonant on percussion
What is a pleural effusion what are the clinical features and what is seen on a CXR?
Collection of fluid in pleural space. There is a uniform white area, loss of costophrenic angle, obscured hemidiaphragm and obscured upper border.
Clinical features - pleuritic chest pain, dyspnoea, stoney dullness on percussion
What is a lobar lung collapse and what can cause it?
Volume loss within lung lobe (loss of air in alveoli). Causes include bronchial obstruction (tumour, mucus, foreign body, iatrogenic) or external pulmonary compression (effusion/mass)
What is seen on a CXR in lobar lung collapse?
Elevation of hemidiaphragm, mediastinum pulled towards lung, increase in density (less air) and possible compensatory overinflation of opposite lung
What is consolidation?
Replacement of alveolar air by fluid, cells, pus or other material
How are space occupying lesions classified and what are their causes?
Nodule if <3cm, mass if >3cm. Single vs multiple.
Causes - malignancy (primary/secondary), benign mass, congenital
What is seen on a CXR of pulmonary oedema due to cardiac failure?
Perihilar shadowing and cardiac enlargement
What is the interstitial space?
A potential space between the alveolar cells and the capillary basement membrane only apparent in disease states
What are the clinical features of interstitial lung disease?
Breathlessness, reduced exercise tolerance, dry cough, tachypnoea, reduced chest movement and course crackers
What are the different types of interstitial lung disease?
Occupational - asbestos, coal workers pneumoconiosis
Treatment related - radiation, chemotherapy
Connective tissue disease - Rh. Arthritis
Immunological - sarcoidosis, extrinsic allergic alveolitis
Idiopathic - fibrosing alveolitis
What is fibrosing alveolitis?
Progressive inflammatory condition of the lungs of unknown cause. There are increased activated alveolar macrophages that attract neutrophils and eosinophils -> local lung damage. CXR shows small lungs with micro nodular shadowing, predominantly lower zone. Finger clubbing. Treatment - steroids.
What is extrinsic allergic alveolitis?
A number of conditions in which the inhalation of organic material triggers a diffuse allergic reaction in the interstitium. Can be acute or chronic.
