Chest notes Flashcards
(11 cards)
Chest normal appearance
Should have a minimum 8 posterior ribs
there should be no blunting of costophrenic angles
Left hilum sits higher than the right but difference less than 2.5cm should concave and similar densities
Lateral chests
Retrosternal space
Oblique fissue
Zones of the chest
The upper zone lies above the anterior border of the 2nd rib
The middle zone between the right anterior borders of the 2nd rib and 4th ribs
The lower zone between the right anterior border of the 4th rib and the diaphragm
Look at the borders of a lesion if the lesion is next to a structure, then the border between the lesion and that structure is loss (silhouette sign)
Therefore if the lesion is in the right lung and obscures part of the heart border, it must be in the right middle lobe.
Collapse descriptions
Right upper lobe collapse, there is an area of whiteness in the upper zone of the right lung. This has a straight inferior border.
Right middle lobe collapse, there is a subtle triangular area of whiteness which blends with the right heart border and mediastinal structures (could be mistaken for consolidation but there is no air bronchogram)
The right diaphragm is slightly raised.
There is a subtle triangular density in the right lower lobe zone medially in keeping with a right lower lobe collapse.
Right lower zone collapse. White triangular density that hides the right diaphragmatic contour.
Left upper lobe collapse. There is a subtle haziness over the left lung and there is air density adjacent to the aortic knuckle which is caused by over inflation of the left lower lobe called air sickle sign. White haziness
Left lower lobe collapse increased density behind the heart border triangular shaped sail sign.
Artifact notes
Right internal jugular central line noted
For consolidation you will see an air bronchogram sign
Pneumonectomy
The right hemithorax is white and the trachea has shifted to the right.
Notice there is a discontinuity of the right posterior 6th rib due to the surgery.
Tracheal deviation can be the result of a mass lesion in the mediastinum most often enlarged thyroid gland.
Consolidation
Shadowing not uniform
Border is not well demarcated
Air bronchogram.
Which lobe or area or zone.
Widespread or lobular or zone
Shadowing can be homogenous if the consolidation is so dense its loss the air bronchogram.
Patchy airspace shadowing
The hila are prominent
Shadowing around the hilum
Enlargement of the hilum
Pleural effusions
Bilateral pleural effusions differing sizes
Whiteness with a meniscus
the whiteness is solid and there is no air bronchogram sign.
loss of costophrenic angle
Mediastinum may be pushed away from midline by the large volume of fluid.
Supine veil like an appearance across the lungs.
