Indications for CXR
1. Dyspnea, Cough, Hemoptysis 2. Chest pain 3. Fever 4. Weight loss 5. Suspected pulmonary or CV involvement from systemic disease 6. Monitoring of previously defined Pulmn or CV abn 7. ‘Routine’
ABC CXR Mnemonic
A – Address B – Bony Cage C – Cardiac silhouette D – Diaphragm E –ETT, Esophagus, Lines etc F – Fields of the lung G – General impression
Four basic densities in XR
bone fat soft tissue air
(PA/AP) is for normal, healthy patients who can stand.
What is the lantern effect?
due to the AP view of the XR, the heart appears larger (hand in front of a flashlight)
What lobe does not extend posteriorly? What lobe does not extend anteriorly?
Which lobe has the lingula?
Airspace disease shows up as...
acinar shadows, which appear as "cotton ball" patterns or dots
Interstitial disease shows up as...
lines or reticulations; web-like
Air bronchograms occur classically in what condition?
What condition? CXR shows cardiomedaly with perihilar infiltrate
2 abnormalities seen on this CXR
What is this abnormality called? What's the related condition?
bat wing infiltrate
Radiologic signs of CHF
3. Perihilar infiltrates
4. Peribronchial cuffing
5. R. Pleural effusion
6. Enlarged Azygos vein
7. Kerley B lines (lymphatics containing excess fluid)
Earliest radiologic sign of CHF?
What's wrong with this guy?
What is cephalization?
LV dysfunction causes increased pressure in pulmonary veins; upper lobe vasculature is more prominet and blood flows cephalic instead of caudal
How is the CXR on the R abn?
What is abn?
Fluid in the fissures
5 air space diseases, and what substance you see in CXR:
Pulmonary edema – fluid
Pneumonia - Exudate, or WBCs
Pulmonary hemorrhage – blood
Tumor/ Broncho alveolar cell carcinoma
Idiopathic – e.g., Pulmn Alveolar proteinosis
What do you see on CXR in a patient with sarcoidosis?
interstitial lung disease with reticulonodular infiltrates
bilateral hilar adenopathy
What conditionas cause bilateral hilar and mediastinal lymphadenopathy?
What does honeycomb pattern indicate?
advanced stage interstitial dz
What are 2 conditions that will show a honeycomb pattern?
What is abnormal about CXR in COPD?
increased lung markings
narrow vertical heart (if no CHF)
(*also, bullous disease possible)
What is this condition?
(you shouldn't see ribs 11 and 12!)
1. asc aorta
3. PA (pulm artery?)
4. D. Aorta
What is bronchiectasis?
persistent dilation of terminal bronchi
What is the most common CXR pattern for a patient with a pulmonary embolus?
most common = normal
(but pleural effusions may be present when PE is small; atelectasis may be present)
Possible CXR associated with pulm embolus:
elevated L hemi diaphragm
westermark sign (no vasc markings, not pneumo)
What % of solitary pulm nodules are malignant?
Features of benignity in solitary pulm nodules
Well defined nodules
No associated lymph node or mediastinal masses
No satellite lesions
Types of Benign calcifications
Features of Malignancy in solitary pulm nodules
Associated mediastinal or Lymph node masses
Presence of Cavitation
What would cause a R silhoutte sign? L?
RML infiltrates (cannot see R border)
The RV enlarges towards the _____; the LV enlarges towards the _____.
An obtuse carina demonstrates:
Air fluid levels are seen with:
No air fluid level (meniscus) is seen with:
2. pleural effusion