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Clinical Laboratory Medicine > Chest X-Ray > Flashcards

Chest X-Ray Flashcards

1
Q

Why are PA CXRs more accurate than AP views?

A

AP = enlarged heart/mediastinal shadow

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2
Q

What is it called when materials of the same radiographic density meet, resulting in a lack of border?

A

silhouette sign

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3
Q

What are two examples of silhouette sign?

A

heart + pleural effusion

heart + infiltrate

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4
Q

When reviewing a film, when should you examine the part of the chest you are most interested in?

A

last

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5
Q

What are 4 Rs to consider before reviewing a film?

A

Right patient, right date, right study, right side?

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6
Q

How do you assess for rotation of a patient on a CXR?

A

Clavicles equidistant from spinous proceses

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7
Q

On inspiration CXR, how many posterior and anterior ribs should sit above the diaphragm?

A

8-10 posterior

5-7 anterior

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8
Q

Regardless of PA or AP view, how does the reader view a film?

A

as if they are facing reader

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9
Q

What is ABCDEFGHI for CXR Interpretation?

A 
Airway/Assess quality
Bones
Cardiac
Diaphragm
Effusion/Extrathoracic soft tissue
Fields/fissures/foreign bodies
Great vessels/Gastric Bubble
Hila & mediastinum
Impression
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10
Q

How can you identify the first rib/T1?

A

T1 has upward angled spinous process

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11
Q

When reviewing the diaphragm/abdomen on CXR, is the right or left side of the diaphragm usually higher?

A

right side

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12
Q

Blunting of the diaphragm on CXR indicates…

A

scarring/fluid

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13
Q

What should you assess for when looking just below the diaphragm?

A

air/gas: pneumoperitoneum

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14
Q

A low-flat diaphragm is suggestive of…

A

COPD

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15
Q

Paralysis/nerve damage, trauma, or loss of lung volume due to atelectasis/PNA would cause what radiographic finding of the diaphragm?

A

unilateral high diaphragm

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16
Q

A healthy costophrenic angle should have what appearance?

A

sharply pointed acute angles

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17
Q

bubbling below the left diaphragm in the LUQ is a normal/abnormal finding…

A

normal (bowel gas)

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18
Q

On supine or AP CXR, the mediastinum will appear…

A

wider

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19
Q

Which hilum typically sites higher?

A

Left higher

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20
Q

The hila are made up of what structures?

A

main pulmonary arteries and major bronchi

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21
Q

A bump off the left side of the mediastinum around the 2nd or 3rd rib is the…

A

aortic knob

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22
Q

On a lateral view, the upper and middle lobes are separated by the…

A

minor fissure (horizontal)

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23
Q

On a lateral view, the upper/middle lobes are separated from the lower lobe by the…

A

major fissure (oblique line)

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24
Q

The right lung has how which fissures and how many lobes?

A

3 lobes, horizontal and oblique fissures

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25
Q

The left lung has which fissures and how many lobes?

A

oblique fissure, 2 lobes (no middle)

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26
Q

What are two unique features to the left lung?

A

lingula (superior/inferior) and cardiac notch

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27
Q

Where are vascular markings more prominent in lung fields?

A

lower and central

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28
Q

Pleural/vascular markings should extend where?

A

to the chest wall

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29
Q

What structures are in the middle mediastinaum?

A

heart and great vessels

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30
Q

On PA view, the right heart contour is the border of what heart structure?

A

the right atrium

31
Q

On PA view, the left heart contour represents the border of what two heart structures?

A

left atrial border (superior)

left ventricle border (inferior)

32
Q

The aortic knob arched backwards over what two structures?

A

the left main bronchus and pulmonary vessels

33
Q

A chest to thoracic ratio (CTR) greater than what is considered abnormal?

A

> 1:2

34
Q

It is important to examine soft tissue around what three structures when reviewing a CXR?

A

neck, thoracic wall, breasts

35
Q

What is an indication of a good inspiratory effort for a CXR

A

8+ posterior ribs above diaphragm

36
Q

disk spaces seen, but bony details of spine not seen indicates good or bad penetration/exposure?

A

good

37
Q

What finding on CXR can be an indication of the below 4 conditions?

COPD, PTX, Pneumomediastinum, SubQ Emphysema

A

Air densities

38
Q

COPD on CXR can show what 3 abnormalities?

A

hyperlucency, flattened diaphragms, hyperinflation

39
Q

large bullae evident on CXR can indicate…

A

bullous emphysema and fibrosis

40
Q

If there is a shift of intrathroacic structures and/or tracheal deviation, what condition should you consider?

A

tension PTX

41
Q

the following presentation is concerning for…

20s & Tall
Pleuritic chest pain
Acute dyspnea

A

PTX

42
Q

What are two findings on CXR that may indicate PTX?

A

Hyperlucency

absent vascular markings

43
Q

With PTX, the lung collapses toward the…

A

mediastinum

44
Q

What type of film can identify a small PTX?

A

expiratory CXR

45
Q

What additional imaging study can be definitive in identifying PTX?

A

CT

46
Q

Why is PTX more visible on expiratory CXR?

A

lung volume shrinks, but PTX remains same size

47
Q

“tunnels” of hyperlucency can indicate…

A

pneumomediastinum

48
Q

What is the cause of pneumomediastinum?

A

air leakage into mediastinum

49
Q

A young adult male patient presents with acute CP that radiates to areas above, below, and behind the jaw…

A

pneumomediastinum

50
Q

What is gold standard for identifying pneumomediastinum?

A

CT

51
Q

What must be ruled out when assessing a possible pneumomediastinum?

A

esophageal perforation

52
Q

On CXR, you notice dark lines in lateral soft tissue. What is this?

A

subq emphysema

53
Q

The below are common causes of what CXR finding?

  • Recent surgery
  • trauma
  • peptic ulcer disease/duodenal ulcer
  • malignancy
  • IBD
A

subdiaphragmatic air

54
Q

Acute onset of abd. pain that radiates to shoulders can indicate…

A

subdiaphragmatic air

55
Q

A radiolucent area noted below the diaphragm and across the abdomen is indicative of…

A

pneumoperitoneum

56
Q

disruption of the wall of a hollow viscus via mechanical ventilation or post-op intraperitoneal gas is a common cause of…

A

pneumoperitoneum

57
Q

What are three causes of abnormal fluid collection?

A

pleural effusion, infiltrates, HF

58
Q

A patient presenting with the following is concerning for…

  • rheum disease
  • malignancy
  • recent illness
  • fever/dyspnea/sob
  • fever
  • recent travel/surgery
A

pulmonary effusion

59
Q

On a lateral decubitus film, an effusion would be evident via…

A

layering of pleural fluid

60
Q

A patient with the following S/S would be concerning for…

  • cough
  • fever
  • SOB
  • DOE
  • CP
A

infiltrate

61
Q

to properly identify the location of infiltrates, what two views are necessary

A

lateral and PA

62
Q

What radiologic findings should you look for on a patient with suspected CHF?

A

kerley b lines
air bronchograms
butterfly/bat-wing sign

63
Q

Interstitial edema shows on CXR as kerley-b lines. How do these appear on the film?

A

blurred edges of blood vessels

64
Q

Butterfly/bat-wing infiltrates are present in what area on CXR?

A

perihilar infiltrate

65
Q

are air bronchograms seen in effusion?

A

no

66
Q

This condition is the collapse or incomplete expansion of pulmonary parenchyma

A

Atelectasis

67
Q

the following findings on CXR are indicative of?

  • increased opacity/lung density
  • displaced fissures
  • crowded pulmonary vessels
  • shifted thoracic structures
  • elevated hemidiaphragm
  • overinflation
A

atelectasis

68
Q

What is the most common etiology of atelectasis?

A

bronchial obstruction (neoplasm, mucus, foreign body)

69
Q

What is a key way to differentiate infiltrate vs atelectasis?

A

structural shifts

70
Q

What are the 5 MC primary malignancies to have mets to lungs?

A

breast, colorectal, renal, uterine, head/neck SCC

71
Q

4 characteristics of benign lesions?

A

smooth, well defined margin, homogenous density, calcifications

72
Q

4 characteristics of malignant lesions?

A

large (1.5 cm)
irregular
non-homogenous density
spiculated

73
Q

An abscess will be indicated by the presence of what in the lesion?

A

air/fluid level

74
Q

What are three major causes for mediastinal widening?

A

trauma, pulm masses, thymus/thymoma

Clinical Laboratory Medicine (9 decks)

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