CXR Flashcards
What are the broad steps of assessing an X-ray?
Confirm patient details (Name, DOB, unique ID number)
Assess quality of image (RIPE)
Structured interpretation of CXR (ABCDE)
What does RIPE stand for?
Rotation: spinous process should be betwen medial ends of both the clavicles
Inspiration: should see at least 7 anterior or 9 posterior ribs
Projection: AP or PA?
Exposure: Vert should be visible behind the heart and left hemidiaphragm should be visibile to the edge of the spine
What considerations needed for AP CXR? [1]
Heart size is magnified in AP view - can’t tell if that is pathological or due to XR
Indiviudally what do the ABCDE stand for?
Airway
Breathing
Circulation
Diaphragm
Everything else
When investigating abnormalites in airways on a CXR, what would you look out for? [3]
Tracheal deviation
Obstruction/inhaled foreign bodies
Hilum abnormalities
What pathology would be indicated by trachea being pushed to R/L?
Trachea push indicates pneumothorax due to increase in volume forcing the trachea in opposite direction
Tension pneumothorax is a medical emergency
What pathology would be indicated by trachea being pulled to R/L?
Trachea push indicates pneumothorax due to decrease in volume (and pressure) forcing the trachea in opposite direction
E..g Lobar collapse;
Lobectomy
Inhaled foreign objects are more likely to be lodged into which bronchus? [1]
Right bronchus
What pathology would be indicated by englarged hilum?
Asymmetry/enlargement raises suspicion of pathology e.g:
* Lymphadenopathy and tumours
* Pulmonary venous hypertension
* Pulmonary arterial hypertension
What are common CXR presentations for breathing dificulties? [6]
Common presentations
Consolidation
Lung mass
Pulmonary oedema
Pneumothorax
Pleural effusion
How does consolidation appear on a CXR?
What is consolidation commonly caused by? [3]
Consolidation: opacification
Mostly due to pneumonoia BUT also due to malignancy / PE
(would repeat CXR to see if DD)
What can cause a lung mass on CXR? [4]
- Lung cancer
- Abscess
- Infection
- Granuloma
What does pulmonary oedema look like on CXR? What markers do you look for?
Pulmonary oedema:
- Fluid in alveolar and interstitial space
- Kerley B linees
- Batwing opacities
What does pleural effusion look like on CXR? What markers do you look for?
Fluid in the pleural space:
- Blunting of the costrophrenic and cardiophrenic angles
What is pneumothorax caused by?
What does it look like on a CXR?
Pneumothorax: Air within the pleural space
/ a collapsed lung
What 3 things are you looking for when assessing cardiac pathology in CXR? [3]
- Heart size: Normal cardiothoracic ratio ≤ 0.5
- Heart borders
- Mediastinal contours
What can cardiomegaly be caused by? [4]
Commonly due to heart failure with a long list of possible causes…
* Hypertension
* Valvular heart disease
* Cardiomyopathy
* Myocardial infarction
What causes indistinguishable heart borders on a CXR?
Pathology of overlying tissue (e.g infection)
Which diaphragm is more raised in a CXR?
Right > left
What 4 things are you looking for when assessing diaphragm pathology in CXR? [4]
- Hemidiaphragm levels- R>L
- Shape
- Costophrenic and cardiophrenic angles
- Air beneath diaphragm: pneumoperitoneum
Pneumoperitoneum is
commonly caused by? [1]
Pneumoperitoneum (air under diaphragm) is
commonly caused by perforation of the bowel
How can you ID hyperinflated lungs on a CXR? [3]
- Marked hyperinflation
- Flattened diaphragm
- Can see 10 anterior ribs- much more than normal
What would hyperinflated lungs most commonly be caused bY?
Seen most commonly in COPD
What could cause diaphragm elevation? [1]
phrenic nerve palsy [1]
