Chest X-rays Flashcards
where is the left lingula?
which ribs do the lungs & pleura go down to
- on the mid clavicular line?
- on the mid axillary line?
- *lungs:**
- mid clavicular line: 6th rib
- mid axillary line: 8th rib
- *pleura:**
- mid clavicular line: 8th rib
- mid axillary line: 10th rib
where are the costophrenic and cardio-phrenic angles?
what is the neuronal control of breathing from?
central respiratory control: brainstem - pons & medulla
communicated to the thorax via the phrenic nerve (visceral c3-5) & intercostal nerves
what do dense substances appear as on the x-ray?
white :)
what is this?
costophrenic angle
what is this ?
cardio-phrenic angle
label this bestie xox
how you approach a chest x-ray? (explain 1 & 2)
- *1. Patient details: (normally in top corners)**
- name
- age / dob
- image type
- date
- previous imaging (for comparison)
- *RIPE**
- Rotation: the medial aspect of each clavicle should be equidistant from spinous process
- Inspiration: (patient should take deep breath in, you see:) 5-6 anterior ribs (or 8-10 posterior ribs), costo-phrenic angles and lateral rib edges should be present
- *- Projection:** AP or PA (standard)
- Exposure: (of the film). left hemi-diaphragm should be visible to the spine and verterbrae behind the heart
then,
how do u approach an x-ray? (overview)
- *1. Patient details: (normally in top corners)**
- name
- age / dob
- image type
- date
- previous imaging (for comparison)
- *RIPE**
- Rotation
- Inspiration
- Projection
- Exposure
- *ABCDE:
i) AIRWAY** - Trachea
- Carina
- Bronchi
- Hilar Structures
- *ii) BREATHING**
- Lung fields
- Pleural Space
- *iii) Circulation**
- Heart Size
- Heart Borders
- Mediastinum
- *iv) Diaphragm**
- Curvature
- Elevation
- Beneath diaphragm
- *v) Everythng else**
- Bones
- Soft tissue
- Other objects
what are the main things that could cause airways to not be correct? (4)
- non-central trachea
- airway obstructions
- foreign bodies
- englargement of hilar regions
how do you tell if an x-ray is PA or AP?
who is more likely to have an PA or AP x-ray?
- *PA**
- The standard / default
- Patient must be able to stand
- Can comment on cardiac size
- *AP**
- The ill / recumbent patient
- Scapulae in lung field
- anterior ribs more prominant
- Can’t comment on cardiac size
whats wrong here?
- tracheal deviation (to right)
whats up here?
hilum enlarged
what would you look for ABCDE BREATHING?
what look for that could go wrong? (3)
ii) BREATHING
- Lung fields
- Pleural Space
- *look for:
- opacification / whitening of lungs: infection :(
- collapse of lung
- air of fluid in pleural space**
whats wrong here?
whitening of the lung - in the right middle zone of the lung
whats wrong here?
how can you tell?
pneumothorax
- A pneumothorax is, when looked for, usually easily appreciated on erect chest radiographs. Typically they demonstrate:*
- visible visceral pleural edge is seen as a very thin, sharp white line*
- no lung markings are seen peripheral to this line*
- peripheral space is radiolucent compared to the adjacent lung*
- lung may completely collapse*
- mediastinum should not shift away from the pneumothorax unless a tension pneumothorax is present (discussed separately)*
- which areas do you look for with ABCDE CIRCULATION? (3)
- what things do you loo
ABCDE CIRCULATION:
- Heart size (width of the heart should be less than half the size of width of thorax)
- *- Heart borders
- Mediastinum**
Look for:
- Englarged heart - PA view only
- Loss of heart borders
what is a cardiomegaly?
- *normal**: width of the heart should be less than half the size of width of thorax
- *cardiomegaly:** width of the heart is more than half the size of width of thorax on PA film
whats wrong here?
loss of heart border !
what do you look for in ABCDE Diaphragm? (5)
things that might be wrong? (3)
- *Look for:**
- Curvature
- Elevation
- Beneath diaphragm
- Costophrenic and cardiophrenic angles
- *Wrong:**
- Blunted costophrenic and cardiophrenic angles
- Flattened diaphragm
- Sub-diaphragmatic air / gas (dont want !! )
whats wrong here?
blunted cardiophrenic and costophrenic angles
what do u look for ABCDE Everything else? (3)
what can go wrong?
v) Everythng else
- Bones
- Soft tissue
- Other objects
- *Wrong:**
- fractures
- discolations
- pacemakers
- inserted lines
whats this?
cardiopacemaker
