CHEST Flashcards
(44 cards)
What is below aortic knob and splits after carina of trachea?
Bronchus in hilar region
Smaller bronchi are INVISIBLE bc filled with air, so all looks black on NORMAL film
Where are vessles seen commonly?
lung bases d/t gravity
taper as they move peripherally
What structures should be noted when viewing?
BE aware of scapula border, humerus, nipple shadow, breast tissue
How should the spine be viewed laterally?
lucent/dark-Moving superior to inferior should opaque to more dark
Retrosternal should ALWAYS BE Lucent/CLEAR
WHAT is systematic approach for viewing xray?
Name date-M, F Large abnormality- WHITE STUFF which lobe Technique- PA, AP, Lateral, Upright, Lateral decubitus RIPMA Full view- costorphrenic, apices Bones Soft tissue- trachea, mediastina, vascu Heart Pleura and fissures Lungs Diaphragm Lines Stomach bubble Free stuff- 7th cervicle spine rib, Air fluid level
What determines rotation adequacy?
SP equal btwn clavicle. Whatever clavicle is opened more that side is rotated away
Bad outcomes- heart size, vessels hila diaphragm distorted
What determines inspiration adequacy?
See at-least 8-9 post ribs, Count 1-3 closely
Bad outcomes- lungs compressed, may look like LL PNA
What determines penetration adequacy
Should see spine through heart. Lateral- R diaphragm behind heart, pulm vessels 1/3 of lung periphery
BAD- OVER-lungs look like emphysema (dark). UNDER (opaque) penetration creates false PNA inLL
What determines magnification adequacy
AP films enlarge heart. AP do apical lordoctic position
What determines angulation adequacy
Clavicle should be S shaped. Medial ends superimposed on 3-4ribs.
Sometimes can see UL better bc apex w/in mid 1/3 of clavicle
BAD- if clavicle highset, apical lordotic heart is large
What are reasons for LLD position?
Air fluid level
Pleural effusion layers out >75ml
Loculated effusion
*Expiratory films needed for…
Small pneumothorax
Can CXR diagnosis Cancer?
NO
Highly suspicious
What is fluid (pus, blood, gastric, water) filled space around bronchi, which makes bronchi more visible?
Air bronchograms
Finding in Air space DZ/Alveolar Dz
Air space
Peribronchial- same, but on end
What would opacities look like with alveolar dz?
Confluent merged Poor defined borders Consolidation and Lobar stays in lung section Hazy fluffy Bat wing w/in lobes \+Silhouette sign
The minor and major fissure are located where?
R lobe
Minor- upper horizontal R lobe
Major- lower lateral to medial diagonal R Lobe
L lobe
ONLY one Major lower, obliquely
Which condition can be segmental, interstitial, streaky, round and cavitary, overlap?
Pneumonia- Strep Pneumonia MC
Round- H.flu, strep, no SS
Segmental- multi lobar staph, pseudo, few bronchograms
TB
ARDS
List the DDX Airspace and key findings?
Pneumonia- lobar UPPER mostly
Aspiration- bronchi opaque, then bc lucent, lower lobes
Pulmonary edema-CHF late, drown, drugs
TB
Hemorrhage
ARDS- BIL infiltrate acute/adult resp. distress syndrome.
Chronic alveolar DZ- Emphysema
What are the DDX cavity lesions/ REACTIVATION TB? *
Cavitary lesion have cleared center, discreet border
- TB
- Staph
- Strep
- Klebsiella
- Coccidiomycosis
Is TB always in upper lobes?
NO
Primary- ANYWHERE (CT) ipsilateral hilar adenopathy
Reactivation TB- cavitation anywhere, MC UL w/ effusion
Miliary TB- starry night CT everywhere. Pillets on CXR
What disease has the following white line, netlike dots mass, nodules, honeycomb NO AIR BRONCHOGRAMS NO LOBAR focal and diffuse
Interstitial DZ
Systemic and Bilateral
What are characteristic findings of CHF?
Interstital DZ- EARLY CHF
Alveolar - LATE CHF
This DDX are common in what kind of locale DZ:
- Atypical PNA- viral, myoc, fungal, miliary TB, varicella, PCP
- Mass, nodules, tumor
- BiL hialar adenopathy-sacroid, restricts
- RA
- Pulmonary fibrosis
- Silicosis, asbestosis etc
- Early CHF, non cardiac
INTERSTIAL DZ
XRAY show dark, white fluffy patches, denser white area. Describe each.
LUCENCY- darker, absent. Bulla, PNeumothorax, cycst
OPAGUE- white less dense, fluid mass
CONSOLIDATION- dense white
