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Flashcards in CXR Interpretation Deck (38)
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1

Why are CXRs sometimes hard to read?

Because they are a 2D picture of a 3D structure

2

Where is the horizontal fissure?

In between the right upper lobe and middle lobe

3

When can you see the horizontal or oblique fissure in a CXR?

When there's an issue, e.g. fluid on the fissure

4

What is the carina of the lungs?

The point where the two main bronchi split

5

What does a black area below the left lung indicate?

Gas in the stomach

6

What is the hilar region of the lungs?

Area with lots of vessels, including bronchi and pulmonary arteries and veins

7

What are the 12 steps to interpreting CXRs?

1. Patient's name
2. Date & time of film
3. View
4. Exposure
5. Alignment & expansion
6. Attachments
7. Bones
8. Soft tissues
9. Mediastinum
10. Hilar region
11. Lung fields
12. Pleural margins

8

What are the 2 main ways of taking a CXR?

PA (posteroanterior)
- Most satisfactory
- Standing, arms resting up on top of machine
- Scapulae rotated out of the way
- Normal heart shadow

AP (Anteroposterior)
- Portable (e.g. ICU)
- Magnification of heart
- Scapulae in normal position
- Supine: diaphragm rises, lungs tend to look poorly expanded

9

What is a less common way of taking a CXR?

Lateral view
- Very rare
- May be used to look for tumours etc

10

What is the optimal exposure for a CXR?

- Should just be able to make out the IV discs through the heart
- Overexposed = too dark
- Underexposed = to white
- Check exposure when comparing films

11

What needs to be considered when looking at the alignment of a CXR?

- Angle of clavicles (should be equidistant)
- Relationship of spinous processes & proximal clavicles (should be right behind trachea)
- Symmetry of ribs

12

What needs to be considered when looking at the expansion of a CXR?

- How low is the diaphragm sitting
- 7th rib anteriorly intersecting diaphragm at mid clavicular line
- Ribs 9-11 posteriorly sitting on diaphragm
- R hemidiaphragm higher than L (due to liver)

13

What are some of the attachments that may appear on a CXR?

- Endotracheal tube (ETT)
- Central line (CVC)
- Tracheostomy
- Nasogastric tube (NGT)
- Inter-costal catheters (ICC)
- ECG dots
- Pacemaker
- Sternal wires

14

Where would an endotracheal tube (ETT) appear on a CXR?

- Breathing tube in through mouth into trachea
- Sitting within trachea
- Should terminate 3-5cm above carina

15

Where would a central line (CVC) appear on a CXR?

- Should terminate just above right atrium
- Internal jugular (neck) or subclavian

16

Where would a tracheostomy appear on a CXR?

- Tube from trachea to outside
- About width/length of finger, curving around
- Look for circle where trachea is facing camera

17

Where would a nasogastric (NGT) appear on a CXR?

- Starts at top of XR
- Travels down oesophagus into stomach
- Tip of tube is below diaphragm
- Does not follow the path of the bronchus
- Tube is not coiled anywhere in chest

18

Where would an intercostal catheter (ICC) appear on a CXR?

- Draining fluid/air from intrapleural space
- Usually connected to UWSD
- Width of finger, extend beyond rib cage, coming out side of chest

19

What is a pigtail catheter used for & how is it different to an ICC?

- Only used to drain air
- Much narrower than an ICC

20

Where would a pacemaker, sternal wires and ECG dots appear on a CXR?

Pacemaker
- Lump under skin
- Wires going to heart

Sternal wires
- Around trachea, wires going around in circle/figure 8
- Hold sternum in place while healing

ECG dots
- Clear spots with wires

21

What does a spring in the lung on a CXR represent?

An external ventilator (ICU patients)

22

What is flail chest?

- Multiple fractures within same ribs
- One segment starts moving in opposite way to breathing

23

What should be considered when looking at bones on CXRs?

- Rib fractures/displacements
- Flail chest
- Position of ribs - if horizontal, may be overexpanded/hyperinflated
- Locate border of scapula
- Not rotated away in AP view

24

What should be considered when looking at soft tissues on CXRs?

- Breast tissue
- Adipose tissue
- Subcutaneous emphysema (air tracking through soft tissues, shows as black outside of lungs, striation of pec major)

25

What should be considered when looking at the mediastinum on CXRs?

- Trachea: Midline position (relationship to spinous processes)
- Heart: Cardiac diameter should be no more than half the diameter of the lungs

26

What should be considered when looking at the hilar region on CXRs?

- Proximal main bronchi (L higher than R)
- Proximal pulmonary arteries, draining veins & lymph nodes
- Prominence = enlargement

27

What are some of the causes of hilar enlargement?

- Infection
- Tumour
- Vascular (aneurysm, stenosis etc)

28

What should be considered when looking at the lung fields on CXRs?

- Consolidation
- Collapse (atelectasis)
- Pulmonary oedema

29

What is consolidation?

When alveoli are full of something other than air (e.g. water, pus, blood)

30

What are the causes of consolidation?

- Infection (e.g. pneumonia, TB)
- Pulmonary haemorrhage
- Aspiration (e.g. gastric contents)
- Infiltration (e.g. lymphoma)