Chest X-Ray and Kidney/Urinary/Bladder X-Ray Flashcards Preview

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Flashcards in Chest X-Ray and Kidney/Urinary/Bladder X-Ray Deck (37):
1

Things to situate to when viewing CXR (6 c methods of evaluation)

  1. Male or female?
    • Breast contours (usually) = female
  2. Good inspiration?
    • Diaphragm should lie at 10th ribs in PA view, 6 ribs in AP view
    • R hemidiaphragm is usually higher than L hemidiaphragm because of liver 
  3. Good penetration?
    • Lower thoracic vertebral bodies should be visible thru heart, but intervertebral spaces should not
    • Disc spaces SHOULD be visible sup to heart
    • Translucent shadow of trachea visible up to clavicles
    • Lungs dark, but not black
    • Overexposure: vertebral column + intervertebral spaces clearly visible through entire thorax 
    • Underexposure: Faint shadow of vertebral column will not be visible at all. Translucency of trachea will not be clearly visible. Opaque heart
  4. Is pt rotated?
    • ​​Spionous processes of thoracic vertebrae should be midway between medial ends of clavicles 
  5. What view is the image?
    • ​​Options: AP, PA, Lateral
    • Most are PA, if pt is ambulatory. Significance: heart lacks illusion of enlargement in PA views. If reading an AP view, be sure to accomodate for heart size
  6. Right patient and direction (aka, is the film flipped)?
    • ​​Read ID and directional markers on scan

 

See normal x-ray and markers

2

Structures to evaluate in every PA CXR (8 c descriptions)

  1. Mediastinal contours
    • ​​Clear
    • Are they widened? (If not, mediastinal adenopathy potential)
  2. Trachial position
    • ​Midline (If not, pneumothorax potential)
  3. Heart Size
    • ​​1/2 of thorax
      • 1/3 R of midline

      • 2/3 L of midline

    • Angles should be clear enough to measure (If not, pericardial effusion or stomach contents)
  4. R Heart border
    • ​​Only applicable in PA view
    • Clear and discernable, with SVC just superior
  5. Lung fields
    • ​​Gray-ish when full of air 
    • Look for sharp costophrenic angles
    • Scan both lungs in a coordinated fashion
      • Apex → Base
      • Medial → Lateral
  6. Hemidiaphragms
    • ​​Downward curve
    • Should be bottom border of sharp costophrenic and cardiophrenic angles
    • White matter underneath (no free air)
  7. Ribs
    • ​Intact and congruous 

 

See normal CXR with landmarks below

3

Things to evaluate on every Lateral CXR (3 c descriptions) 

  1. Heart lies antero-inferiorly
    • ​​Anterior and superior to heart should be gray/black becasue it contains aerated lung tissue
  2. Evaluate area superior to heart
    • ​Posterior to heart should be gray/black down to diaphragms 
      • If darkened (without posterior darkening), suspect anterior mediastinal or upper lobe disease
  3. Evaluate area posterior to heart
    • ​​This area should be the same color as superior heart
      • If darker, suspect lung collapse or consolidation

4

Typical CXR Report (read only, unless you really want to memorize it...)



This is a frontal chest radiograph of a young male patient. The patient has taken a good inspiration and is not rotated; the film is well penetrated. The trachea is central, the mediastinum is not displaced. The mediastinal contours and hila seem normal. The lungs seem clear, with no pneumothorax. There is no free air under the diaphragm. The bones and soft tissues seem normal. 
 

5

Identify Pathology 

 R. Middle Lobe Pneumonia

Significant findings:

  • Airspace opacity consolodated in RML
  • Interstitial opacities
  • Some pleural effusion present

Explaination: 

  • Airpsace filled c microbes and pus, creating opacity
  • Disease can progress from perihilar consolodation to patchy as disease spreads

6

Identify Pathology

L. Lower Lobe Pneumonia

7

Identiy Pathology

R. Upper and Middle Lobe Pneumonia

Significant Findings

  • Aggressive "white out" in RUL and RML
  • Some opacity at great vessels

Pathophys. Explaination

  • Probably legionella pneumonia
  • Rapid onset, highly aggressive

8

Classic CHF Signs on CXR

In conjunction c H&P...

 

  1. Cardiomegaly due to ineffective pumping (specifically, L. ventricular hypertrophy)
  2. Prominant upper lobe vessels from high pressure causing leakage into lung
  3. This interstitial edema will fall to the costophrenic angles and cause pleural effusion
  4. Diffuse cloudiness in "bat's wing" shape from alveolar edema

 

*Classic PANCE Question 

9

Identify Pathology

Cardiomegaly

Significant Findings:

  • Heart greater than 1/3 of thorax width 

Note: 

  • Remember that AP views artifically inflate heart size, since the heart is closer to the x-rays. Be sure to check correct orientation and substatiate c relevant s/sx

10

Identify and Describe Pathology

CHF c Kerley B Lines

Significant Findings:

  • Cardiomegaly 
  • Prominent upper lobe vessels (kind of)
  • Pleural effusion c Kerley B Lines - swirled lines congretating in costophrenic angles
  • Beginnings of "bat wings"

Note:

  • While radiologist will note Kerley B Lines, you do not have to recognize them specifically. Noting pleural effusion is sufficient

11

Identify Pathology

Severe CHF

Significant Findings: Classic CHF Signs

  • Cardiomegaly
  • Alveolar edema (advanced past bat winging stage)
  • Costophrenic interstitial edema (thick and spreading Kerley B Lines)
  • Haziness of vascular margins (slightly more opaque in central vasculature)

12

Identify Pathology

Pulmonary Edema

Significant Findings:

  1. Diffuse opacity 
  2. Loss of both hemidiaphragms 
  3. Loss of heart contours
  4. Loss of vertebral bodies (almost looks underpenetrated)

13

Identify Patholgoy

Pulmonary Edema (treated)

Significant Findings:

  • Diffuse opacity throughout lungs
  • Hemidiaphragms still soft
  • Heart contours undefined at bottom

Note:

  • This is likely after tx c a diuretic
  • Lungs heal very quickly, as they deteriorate very quickly 

14

Identify Pathology 

LUL Lung Cancer

Significant Findings

  • Mass c well-defined borders
  • Be careful not to confuse c pneumonia, which has more diffuse borders 

Note

  • Biopsy and CT required for official diagnosis

15

Identify Pathology

R. 4th Rib Fx s Pneumothorax

Significant Findings

  • Irregular margin in costal R. 4th rib
  • Normal lung margins, indicating no pneumothorax

Note

  • Remember to get multiple views of each pt. Lateral view does not readily expose fx
  • You can request a specific CXR for suspected rib Fx, it is just a magnified view of ribs

16

Identify Pathology

R. Lung Pneumothorax

Significant Findings

  • Clear visceral line - border between black air and gray/white compressed lung near midline

17

Identify Pathology

R. Tension Pneumothorax c Right-sided Lucency and Leftward Mediastinal Shift

Significant Findings

  • Visceral line near medial border of R. lung
  • Left trachial deviation

Note

  • Medical emergency! Place R. chest tube ASAP to allow venous return

18

Identify Pathology

L. Lung Pneumothorax

Significant Findings

  • Visceral line at L. midclavicular line
  • Potential minor R. mediastinal deviation

19

Identify Pathology

Bilateral Pleural Effusions

Significant Findings:

  • Dull costophrenic angles
  • General diffuse opacity 
  • Thickening at pulmonary vessels
  • No cardiomegaly (thus, no CHF)

20

Identify Pathology

R. Pleural Effusion, Pre and Post Tx

Significant Findings

  • R. costophrenic angle softening pre-tx
  • RLL opacity pre-tx

21

Identify Pathology

R. Pleural Effusion 

Significant Findings:

  • Lack of R. costophrenic angles
  • Significant opacity in RLL and RML(fluid buildup in line c gravity; does not totally follow lobular lines)

22

Identify Pathology

COPD/Emphysema

Significant Findings

  • Bilateral diaphragmatic flattening
  • Significant hyperinflation - 11 ribs visualized
  • Also note barrel-chest in lateral view here

23

Identify Pathologies (each image is different)

1. Bilateral PA Enlargement (left image)

Significant Findings

  • Smooth contours of pulmonary ateries

2. Bilateral Hilar Adenopathy (right image)

Significant Findings

  • "Lumpy-bumpy" opacities 

24

Identify Pathology

Tuberculosis

Significant Findings

  • Bilateral pulmonary infultrates localized s gravitational influence
  • Bilateral coalescing opacities
  • Opaque cavities c regular borders (see arrows)

25

Identify Pathology

Tuberculosis

Significant Findings

  • Coalescing bilateral infiltrates
  • Cavity w/i infiltrate, mid RML

26

Identify Pathology (don't peak at the writing on the picture!)

Pulmonary Embolism

Significant Findings

  • Hampton's Hump: Rounded opacities corresonding c clot location (can be anywhere in the lung)

​*Common PANCE Question 

27

Identify Pathology

Normal Abdominal Flat Plate (tricked ya!)

This is a KUB

28

Identify Pathology

Kidney Stones in R. Renal Pelvis

Significant Findings

  • Opacities c sharp borders in RRP 
  • Plentiful gas, probably due to hyperventilation due to KS pn

Note

  • Stone opacity level varies upon stone composition
  • If stone is not opaque, follow up c US
  • Pt will present c flank/abo pn

29

Identify Pathology

Kidney Stones in R. Ureter

Significant Findings

  • Opacities following ureter anatomy (although ureter is not visible)

Note

  • Must rely on anatomy knowledge to ID location of stones, as tissues may not always be visible
  • These are large stones
  • Stone opacity level varies upon stone composition
  • If stone is not opaque, follow up c US
  • Pt will present c flank/abo pn

30

Identify Pathology

Hydronephrosis c Stone in R. Renal Pelvis

Significant Findings

  • Opacity at RRP anatomic location
  • Enlarged kidney

Note

  • Fluid backup due to blockage in renal pelvis 

31

Identify Pathology

Constipation

Significant Findings

  • Hazy spots in the shape of intestines

Note

  • Common PC complaint; pt will come in complaining of abdo pn not remembering that his/her last bowel movement was two weeks ago. Be sure to question this in all abdo pn pts
  • Typically, only utilize x-ray c geriatrics. Younger populations will almost have more revealing hx

32

Identify Pathology

Free Air Under Diaphragm, Perforated Viscus (Peptic Ulcer)

Significant Findings

  • Air space that reveals R. diaphragm shape compared to superior liver border
  • (not sure why this is perforated viscus...just reading my notes)

Note

  • Any GI structure that ruptures will send air up to the diaphragmatic level (granted the pt is standing, think gravity)
  • This is a medical emergency!

33

Identify Pathology

Free Air Under Diaphragm, Significant

Significant Findings

  • Visible diaphragm shape bilaterally, separated from liver and stomach
  • This is significant becuase it is bilateral (more commonly just R. sided)

Note

  • Any GI structure that ruptures will send air up to the diaphragmatic level (granted the pt is standing, think gravity)
  • This is a medical emergency!

34

Identify Pathology

Pneumoperitoneum, aka Bowel Perforation 

Significant Findings

  • Air under R. hemidiaphragm (white arrow)
  • Bowel loops air fluid levels (black arrowheads)
  • Air fluid level in stomach (black arrow)

35

Identify Pathology (try not to cheat!)

Small Bowel Obstruction

Significant Findings

  • Violated and air-filled intestine proximal to obstruction
  • NOTHING (air, fluid, feces) distal to obstruction, as colon is collapsed

36

Identify Pathology

Small Bowel Obstruction

Significant Findings

  • Violated and air-filled intestine proximal to obstruction
  • NOTHING (air, fluid, feces) distal to obstruction, as colon is collapsed

37

Identify Pathology 

Small Bowel Obstruction c Air Fluid Levels and Dilated Jejunum

Significant Findings

  • Larger jejunum than typical 
  • NOTHING (air, fluid, feces) in colon, as it is blocked from receiving contents due to SBO
  • Visualization of border b/w air and fluid in small bowel - atypical for SBO