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Flashcards in Chest X-rays Deck (43)
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1

Describe how x-rays work

An electromagnetic wave of high energy and a very short wavelength
Absorbed to different degrees by different tissues due to density

2

What colour is gas on an x-ray?

Black

3

What colour is fat on an xray?

Grey

4

What colour is calcification on an xray?

Almost white

5

What is the normal projection of a chest x-ray?

PA
Posterior to anterior on the patient

6

When would an AP projection CXR be performed?

If the patient was very unwell
Sitting for this

7

What can't we comment on in AP CXRs?

Size of the heart
Will be enlarge due to being AP

8

What is the correct inclusion of a chest xray?

Just above the 1st to the costophrenic angles
Past the lateral margins of the ribs

9

How do we check for rotation in a CXR?

Look at the alignment of the spinous processes and the clavicles

10

Where do the lungs come down to an a CXR normally?

Between the 5th and 7th anterior ribs at the mid-clavicular line
We ask the patient to breathe in and hold it

11

What differs on the CXR if the patient gives incomplete inspiration?

Heart looks bigger
Increases lung markings (can see more clearly)

12

What is the penetration and what is adequate for a CXR?

The degree to which to x-rays have passed through the body
Adequate = vertebrae just visible through the heart and the complete left hemidiaphragm is visible

13

What is an artifact on a CXR?

External/iatrogenic material which obstructs view
Eg. Buttons, hair, vascular lines, pacemakers

14

How do we talk about the position of something in the lungs on a CXR?

Talk about zones
Upper, middle and lower
Don't mention lobes unless you are absolutely sure

15

Describe the things to note/look for when checking the anatomy of a CXR

Trachea - deviated
Hila - left should be slightly higher than right
Lungs
Diaphragm - sharp angles
Cardiac contours
Aortic knuckle on the left
Ribs
Scapulae
Breasts
Bowel/stomach gas

16

Should you be able to see the pleura?

No
Unless pleural effusion

17

Describe the systematic approach to CXR evaluation

Patient demographics
Comment on projection and adequacy (rotation, inspiration and penetration)
A = airway
B = breathing
C= circulation
D = diaphragm
E = everything else - bones and soft tissues
Check review areas

18

What are review areas?

Areas that we commonly miss pathology on CXRs

19

Name the review areas for CXRs

Apices
Thoracic inlet
Paratracheal stripe (lymph nodes)
AP window (between aortic arch and pulmonary artery)
Hila
Behind heart
Below diaphragm
Bones
Edges of films

20

What is silhouette sign on a CXR?

Adjacent structures of differing densities form a crisp silhouette
Loss of this contour can locate pathology
'Loss of the silhouette sign'

21

What things can push the mediastinum away?

Pleural effusions
Tension pneumothorax

22

What things can pull the mediastinum towards?

Collapsed lung
Fibrosis of lung

23

What is a pneumothorax?

Air trapped in the pleural space

24

What is the most common cause of pneumothorax?

Trauma
(Laceration of pleura eg from fractured rib)

25

In people with which diseases is a spontaneous pneumothorax most likely to occur?

Asthma
emphysema
Marfan's

26

How do we define a large pneumothorax?

Lung edge > 2 cm from the inner chest wall at the level of the hilum

27

What signs do we see of pneumothorax on a CXR?

Area of blackness
Mediastinal shift away
Depressed hemidiaphragm
Visible pleural edge

28

What is a pleural effusion?

Collection of fluid in the pleural space

29

Describe what you see for a pleural effusion on a CXR

Uniform white areas
Loss of costophrenic angles
Hemidiaphragm obscured
Meniscus

30

Why do we need to be aware of supine CXRs?

Pleural effusions
Fluid will be spread out across the lungs not collecting at the bottom
Grey/hazy