Flashcards in CXR Interpretation Deck (30):
Step 1 of CXR interpretation?
Details (patient details, Xray date and time, previous Xrays)
Projection (Supine/standing. PA/AP - hard to interpret can't comment on cardiac size)
Rotation (poor/well centred - heads of clavicles equidistant from spinous processes)
Inspiration (poor/good - 6 anterior ribs above diaphragm, hyperinflation in COPD)
Penetration (well, over - can see vertebrae too clearly behind heart, under - cant see vertebrae)
A in CXR interpretation?
Airways - trachea, carina, hilar (symmetry, size, density)
Where should an NG tube pass over?
The carina of the lungs ensuring its in the stomach
What does bilateral enlargement of the hilum commonly indicate?
Sarcoidosis (hilar lymphadenopathy)
What does unilateral hilar enlargement suggest?
What is the hilar region?
Main pulmonary vasculature and major bronchi
Lymph nodes that arent usually visible
B in CXR interpretation?
Breathing - look for lung markings in all zones (different from lobes)
(apices, upper, middle, lower), compare each zone, look at pleura (should not be visible, thickening in asbestosis)
What does increased shadowing in lung zones indicate?
What does an absence of lung markings indicate?
Pneumothorax (look for thin pleural lining)
C in CXR interpretation?
Cardiac - heart size (<50% of thoracic width, >50% indicate cardiomegaly), heart position (1/3 on RHS of midline, 2/3 on LHS midline), heart border (RA, LV), aortic knuckle and descending aorta
What does a displaced heart suggest?
What does an obscured aortic notch/descending aorta suggest?
Left lower lobe disease
What does a loss of definition in the heart borders suggest?
Right heart border - R middle lobe consolidation
Left heart border - L upper lobe consolidation (lingula area)
D in CXR interpretation?
Diaphragm - check hemidiaphragm and costophrenic angles (normally dark and sharply pointed, right hand side is often a bit higher due to liver, gas can be seen over stomach). Look for gas under the hemidiaphragm (small bowel perforation - help + CT abdo)
What does blunting of the costophrenic angle suggest?
Pleural effusion, consolidation, lung hyperinflation
What does clouding of the hemidiaphragm suggest?
LLL or RLL consolidation
What does a hemidiaphragm thats moved up indicate?
What does a flattened hemidiaphragm suggest?
Over expanded lungs (COPD)
E in CXR interpretation?
Everything else - Bones (lytic/fractures), tubes (ET, NG, central venous), pacemakers (left clavicle), valves
5 review points on a CXR?
Diaphragm for intrperitoneal gas
Small pleural effusion in costophrenic angles
Pleural effusion in fissures
What does trachea deviate away and to?
Away: pneumothorax, large pleural effusion
Why is the RHS more commonly affected by aspiration pneumonia?
R bronchus is shorter, wider and more verticle
What is the aortic knuckle?
Aorta as it arches over left main bronchus
How can you localise lung disease?
RLL: diaphragm obscured
RML: loss of LH border, sharp demarcation at horizontal fissure
RUL: sharp demarcation at horizontal fissure
LUL: RH border loss, loss of aortic knuckle
LLL: diaphragm or descending aorta obscured
Signs of pneumonia on CXR?
Shadowing in the lung fields indicating consolidation
(lobar or diffuse)
Signs of pleural effusion on CXR?
Blunted costophrenic angles, meniscus sign (hemidiaphragm inverted)
Signs of pneumothorax on CXR?
Loss of lung markings, visible pleural lining
Signs of lung Ca on CXR?
Consolidation, mass, effusion
Signs of pulmonary odema on CXR?
Alveolar bat wings
kerly B lines (interstitial pulmonary odema, bat wings)
Dilated upper vessles