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Flashcards in Chest Radiology Deck (78):
1

What are the four main radiographic densities?

Soft tissue (water)
Fat
Air
Bone

2

Dense object appear what color on x-ray? Why?

White d/t absorption of more photons

3

Object that are not dense appear what color on x-ray? Why?

Black
lower absorption of photons

4

Should CXR be performed with full inspiration or expiration?

Inspiration

5

The midpoint of the hemidiaphragm should be at what posterior rib level?

9th or 10th

6

True or false: on a PA view of the chest, the thoracic spine should be visible through the heart, with bony details well seen

False-should be visible, but fine detail is not usually seen

7

How do you determine if there is adequate x-ray penetration with a lateral CXR?

-The spine should darken as you move caudally
-the sternum should be on edge
-posteriorly should be 2 sets of ribs

8

true or false: on a normal lateral CXR, the ribs should align

false--rarely do they align

9

what identifies an under penetrated film?

inability to make out any of the vertebral bodies

10

What identifies an over-penetrated CXR?

Clear vertebrae, but inability to make out lung structures

11

What should happen to the spine on a lateral CXR as you move inferiorly?

Should get darker

12

How do you determine rotation for a CXR?

Assess the clavicular heads--should be equidistant from the spinous processes of the vertebral bodies

13

What are the three major determinants of an adequate CXR?

Good inspiration
Adequate penetration
No rotation

14

How do you differentiate the anterior and posterior ribs on a CXR?

Posterior = horizontally oriented
Anterior = vertically oriented

15

What is the right paratracheal stripe?

Border of the right bronchus on CXR

16

What is the normal size of the right paratracheal stripe?

No more than 5 mm in diameter

17

The right heart border is formed by which structure of the heart?

Right atrium

18

The left heart border is formed by which structure of the heart?

Left ventricle

19

Where is the ascending aorta seen on a CXR?

Right side of the chest, (second bump after the RA bump)

20

Where is the SVC seen on a CXR?

just above the ascending aorta

21

Where is the right brachiocephalic vein seen on a CXR?

Just above the SVC

22

What is the order of vascular structures on the left side of a CXR going from superior to inferior?

Left brachicephalic
Aortic arch
AP window
Descending thoracic aorta
LV

23

What is the AP window on a CXR?

Space between the undersurface of the aortic arch and the superior surface of the left pulmonary artery

24

What is responsible for the delineation of the vascular structures of the chest?

Difference in density of the lungs vs the vascular structures

25

True or false: in order to see a structure on CXR, the XR beam must pass parallel or tangential to the structure

True (cannot by perpendicular)

26

Where does the left brachiocephalic vein lay in relation to the right brachiocephalic artery?

Anterior to the artery

27

What is the vascular structure that sits to the right of the ascending aortic arch on a transverse section of a CT?

SVC

28

What structures bound the LV?

lingula and the LLL

29

What structures bound the right atrium?

RLL
RML

30

What structures bound the SVC?

RUL

31

What structures bound the aortic arch?

LUL

32

What are the lung fissures, generally?

The space between the lobes where the visceral pleural surfaces touch

33

What are the two fissures of the right lung?

horizontal and oblique

34

What is the fissure that divides the left lung?

Oblique fissure

35

What is the pleural space?

Potential space between the visceral and parietal pleura

36

Which sits anterior: the right middle lobe or the right lower lobe?

Right middle lobe

37

The lung fissure are only visible when the x-rays are in what relation to the fissures?

Only if they are parallel--cannot be perpendicular or oblique

38

The major fissures will be best seen on which views? Minor fissures?

Major = lateral view
Minor = PA or lateral

39

On a lateral CXR, how does the major fissure of the left lung relate to the right lung?

Left is posterior to the right

40

How does the right upper lobe bronchus appear on a lateral CXR?

Area of radiolucency in the trachea

41

Radiolucent areas in the bronchi on a lateral CXR mean are what?

branching bronchi

42

True or false: you cannot really appreciate much of the aorta on a lateral CXR unless the pt has COPD

True

43

How does the left pulmonary artery appear on a lateral CXR?

Comma shaped opacity that sits over the continuum of the left bronchus

44

What is the radiodense structure that sits anterior to the pulmonary bronchus on a lateral CXR?

Right pulmonary artery and the right superior pulmonary vein

45

What obscures the superior margin of the aortic arch on CXR?

Great vessels or axillary folds

46

What is contained within the aortic-pulmonic window?

Lymph nodes
Left recurrent laryngeal nerve
Fat

47

How do you identify the aortic-pulmonic window on CXR?

It is the crescent shaped lucency between the inferior border of the aortic arch, and the superior border of the left pulmonary artery

48

Why are the right ribs magnified with a lateral CXR?

Because the left side is adjacent to the detector

49

The left hemidiaphragm is obscured by what structure anteriorly?

the heart

50

How do you identify the right hemidiaphragm from the left?

Left should go to non magnified ribs, and never goes to the anterior chest

Right should follow magnified ribs

51

What are the two structures of the heart the comprise the posterior wall of the heart?

LA
LV

52

Where is the pulmonary outflow tract on a lateral CXR?

anterior-superior part of the heart

53

Where is the posterior border of the IVC on a lateral CXR?

Just below the left ventricle

54

What are the three clear spaces seen on a CXR?

Retrosternal
Retrotracheal
Retrocardial

55

What does a retrosternal clear space indicate? (5 T's)

Terrible lymphoma
Thymoma
Teratoma
Thyroid
Thoracic AA

56

What are the pathologies that correlate to a retrotracheal clear space? (3)

Vascular abnormalities
Esophageal disease
Lung CA

57

What are the diseases that can present in the retrocardiac clear space? (4)

Hiatal hernias
Esophageal disease
LV enlargement
Pneumonia

58

On a lateral CXR, what are the black spaces between the vertebrae?

Neural foramen

59

Which are magnified on a lateral CXR, the right or left ribs?

Right

60

What are the four major structures that reside in the anterior mediastinal space?

Thymus
Lymph nodes
Fat
Internal mammary vessels

61

True or false: if something crosses the midline of the chest, it is likely a lung pathology

False-- lungs do not communicate with one another, so not likely

62

How can you differentiate anterior vs posterior masses in the chest?

Anterior ones will still show the descending aorta well since it is still bounded by air

63

What is contained within the middle mediastinum?

Heart/pericardium
Ascending aorta and arch
SVC/IVC

64

Which part of the mediastinum houses the AP window?

Middle

65

How do you identify the AP window on a chest x-ray?

Concavity on the left side beneath the aorta and above the pulmonary artery

66

What is the right paratracheal stripe? What is the normal thickness of this?

The interface between the right lateral wall of the trachea and the RUL

Normal thickness is less than 5 mm

67

What are the 4 major structures in the posterior mediastinum?

Esophagus
Descending aorta
Azygous and hemiazygous veins
Thoracic duct

68

What is the normal cardio:thoracic ratio?

Less than 0.5

69

When is the cardiothoracic ratio only valid?

If the CXR is a PA

70

What is the spatial relationship between the left hilar structures compared to the right?

Left are usually higher (97% of cases, other 3% same level)

71

What is the spatial relationship between the left hemidiaphragm compared to the right?

The right hemidiaphragm is normally slightly higher than the left d/t liver

72

What is the very first step in evaluating a CXR?

"administrative work" (pt, time, type)

73

What is the second step in evaluating a CXR?

Ensure adequate penetration, rotation, inspiration vs expiration

74

True or false: by definition, you cannot do a supine PA chest

True

75

A ring in the heart = ?

Prosthetic valve

76

Line that enters the heart = ?

Swan-Ganz catheter

77

Air beneath the right hemidiaphragm = ?

Pneumoperitoneum

78

Curving of the costophrenic angle = ?

Pleural effusion