Chest X-ray Flashcards
(45 cards)
Systematic approach to the chest X-ray
D- Details ( Name, DOB, type of Film)
R- RIP (Image quality) : Rotation, Inspiration, Penetration
S- Soft tissues and bones
A- Airway – is the trachea normal? Deviated? To which side? Is the patient incubated?
B- Breathing – are both lungs normal? Is there effusion or consolidation? Lesions? Fluffy looking areas? Any evidence of collapse
C- Circulation – Is the silhouette sign present? What is the cardiac thoracic ratio? Heart position, size and shape? Are there any lines in?
D- Diaphragm – Costophrenic angles? Is the diaphragm in its usual location/ position?
E- Everything else- anything else relevant, ECG leads, pacemaker, NG tube
Types of X-ray
PA
- x-rays from the posterior to the anterior of the patient
- image is viewed as if looking at the patient face-face
AP
- xrays pass from the anterior to posterior of the patient
- image still viewed as if the patient is face to face
- usually unwell patients
Consolidation definition
alveolar air replaced with fluid/pus extra
Lobes and fissures of the lung
Right upper lobe collapse
Horizontal fissure separates RU for ML
Collapse fissure moves upwards and medially
Right middle lobe collapse
Horizontal and oblique fissures collapse up against the heart
Loss of right cardiact sillohette and haze!! with diaphragm maintained
Right lower lobe collapse
The Right Lower lobe is a posterior structure
lower lobe collapses medially against the diaphragm (loss of diaphragm) with maintained right heart border
Sharp edge
Which type of collapse is shown
Right lower lobe collapse
Left upper lobe collapse
Oblique fissure separates the two structures
- Left upper lobe collapses forward
- densely collapsed upper lobe
- Aortic arch is aeriated (heart is anterior)
- haze!!
What type of collapse is this?
Right upper lobe collapse
What does this radiograph show?
Complete collapse of the lung
white out!
heart moves towards where it has collapsed
What does this radiograph show?
Pneumonectomy
- lung is removed
- heart moves over
- pleura not removed “heart weeps for his missing buddy” causes an effusion
- fluid is dense and therefore WHITE
How to tell the difference between pneumonectomy and complete collapse
Look at the ribs
2-5 ribs are cut out in pneumonectomy !!!
Consolidation vs collapse
AIR BRONCHOGRAMS IN CONSOLIDATION
What is another name for collapse
Atelectasis
Review areas
- apex - often obscure underlying lung
- cardiac shadow- hiding a considerable amount fo lung posteriorly
- hilar vessels - obscuring lung anteriorly and posteriorly
Abnormal masses by site of origin
- within the lung
- arising from the mediastinum
- within the plerual space
Most common cause of multiple intrapulmonary nodules
Metastases or septic emboli
Causes of cavitating masses
tumours have air inside them! hollow cavity
- abscess - most common
- necrotic tumours
Solitary masses causes
Malignancy
- primary
- secondary
Infection
TB
Causes of pulmonary massess
Bronchial carcinoma - can arise in any bronchus
- peripheral- distal bronchioles
- central
Other pulmonary masses
- benign pulmonary masses
- non neoplastic pulmonary masses
Tuberculosis
Periperal tumour
- 40-60% patients have a peripherally located mass
- round or oval
- edge is usually spiculated- term corona radiata is sometimes used
size position shape margin
Central tumour
- unilaterlal hilar enlargement
- and/or unilateral dense hilum
- mass in, or superimposed on the hilum +/- hilar lymph nodes
- obstruction of a major bronchus leads to atalectasis (reduced ventilation of affected lung) or consoldation (failure to evacuate secretions)
If no airbronchograms + collapse whats the diagnosis
- foregin body
- most COMMON CAUSE CENTRAL LUNG CANCER
