CXR Interpretation - Exam 1 Flashcards by Johannah Crumpton

on an Xray, what color is dense tissue? What color is air?

dense (bone) is lighter and air is black

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Which view (AP/PA) will the heart look larger? Which view is standard?

heart will look larger in AP view

PA view is standard

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What are the standard 2 CXR views?

PA and lateral

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What is the correct pt positioning for PA and lateral?

PA - performed with the chest against the detector

Lateral - performed with the left side of the body against the detector

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When would you order a lateral decubitus chest xray?

pleural effusions vs consolidation
loculated effusions vs free pleural fluid
evaluate for small pneumothorax

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What is the positioning for a pleural effusion? pneuomothorax?

pleural effusions - the side of interest should be down (because fluid will draw down away from the sterum so you can see it around the lateral chest wall)

pneumothorax - the side of interest should be up (because air rises and want to see the around NOT around the sterum)

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expiratory view, foreign body with air trapping, what side will appear larger?

affected side will appear larger

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What is a lordotic view? Why would you order one?

shoot xray at an upward angle.

evaluation of the lung apices that appear obscured on the PA/AP

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When would you order an AP CXR? How is it performed?

reserved for patients who cannot stand erect

performed supine or sitting

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How can you tell if an xray is PA or AP?

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What is the way to remember how we know the CXR image is of good quality?

PAIR

Penetration
Artifact
Inclusion
Rotation

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_______ is the degree to which X-rays have passed through the body. How can you tell?

penetration

Vertebrae are slightly visible behind the heart

Left hemidiaphragm should be visible to the edge of the spine

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Is this image under or over pentrated?

under penetrated

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Is this image over or under penetrated?

over penetrated

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What are 3 radiologic artifacts?

Abnormal rotation of patient
Incomplete inspiration
Incorrect penetration

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What are 6 patient artifacts?

Poor cooperation of patient
Movement
Clothing, hair, jewelry
Metal or implants in the body
Skin folds
Adipose or breast tissue

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What are 4 things to look for when making comments about an image’s inclusion?

5-7 Anterior Ribs : angled (PA)

10 Posterior Ribs: horizontal (PA)

Costophrenic Angles

Lateral edges of Ribs

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How do you determine if an image has rotation present?

Spinous processes of the thoracic vertebrae should be at the midline of the posterior chest

The medial ends of the clavicles should form a vertical line and should be equidistant from the midline

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What is the pneumonic to interpreting a chest xray?

A-B-C-D-EF-G-H

Airway: Trachae/Bronchi
Bones
Circulation: Heart size/mediastinum
Diaphragm
Extra Features:
Gastric air/ free air
Hilium

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In a good chest xray: Trachea should be _____, straight and branches off to R/L mainstem bronchus at the ______

mideline

carina

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How many lobes does the left lung have? Right? What are the fissures called for each?

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Draw and label the right lung from a lateral view with the different lobes and fissures clearly labeled.

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In a good quality CXR, how many anterior ribs should be seen? posterior?

anterior: 5-7
posterior: 10

cardiothoracic ratio (CTR) should only be assessed confidently if a ____ view was acquired. What is considered abnormal?

Cardiac width > 50% of the total thoracic width is abnormal

mediastinal contours and compartments include the borders of the ______ as well as the spaces in front and behind the _____. Borders should be _____

heart and great vessels heart sharp

Label this entire picture

What are the sub divisions of the mediastinum relative to the heart?

A transverse plane passing through the sternal angle to the junction of vertebrae T4/T5 separates superior from inferior mediastinum Or think of superior mediastinum as above Heart. Space in front of heart is anterior mediastinum. Space behind heart is posterior mediastinum. Region of heart is the middle mediastinum.

What does a normal diaphragm look like? Is it normal for one side to be higher than the other? Why?

rounded, domed structure with a crisp white edge contrasted against the adjacent dark lung often the right diaphragm will be slightly higher than the left because the liver sits on the right side

Point out the right and left hemidiaphragm.

Blue= right: will be seen up to the anterior chest wall red= left: blends with the heart

What forms the costophrenic angle? What is a normal measurement in degrees? What is abnormal?

Formed by the hemidiaphragms and the chest wall CPA should be < 30° Costophrenic “blunting” is used to refer to CPA > 30°

What angle is represented by the red stars?

cardiophrenic angle

_____ should not be visualized unless pathology is present. Lung markings should reach the ____

Pleura thoracic wall

Give some examples of normal extra feature findings

Breast - symmetry Nipple markings Pseudo-blunting of CPA’s due to rotation or large pendulous breast

What does free air under the diaphragm indicate?

indicative of perforated intestinal organ black arrow is free air red arrow is gastric air bubble

hilar structures contains major ______ and ______. ____ hilum is often higher than the _____

bronchi and pulmonary vessels left hilum is often higher than the right

What is a consolidation?

a solidification of lung tissue with liquid or solid material that normally contains gas (air)

What is hyperexpansion? What will also be seen along side it?

an excessive amount of gas trapped in the alveoli of the lungs over a long period of time lungs appear elongated and diaphragm is flattened

What is the pathophys behind hyperexpansion? What is the MC cause?

loss of elasticity preventing expulsion of air COPD

What is the MC etiology of costophrenic angle blunting?

pleural effusion

What is pulmonary edema? What is the MC cause?

a collection of fluid in the alveoli of the lungs preventing adequate air exchange Cardiogenic pulmonary edema

Name some additional causes of pulmonary edema.

Acute respiratory distress syndrome (ARDS): chest wall trauma, sepsis, pneumonias Neurogenic pulmonary edema (NPE): head trauma, seizure, Subarachnoid hemorrhage (SAH) Adverse drug reaction Pulmonary embolism Viral infections Lung injury

What is air bronchogram?

a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates aka can see the tree like/root like image on the chest xray

What is happening during a pneumothorax? Name some causes

occurs when air leaks into the pleural space idiopathic chest wall trauma lung disease ruptured blebs (cyst like things inside lungs) mechanical ventilation

What is pleural effusion? What are some common etiologies?

Excess fluid builds in the pleural space CHF, kidney failure, infection, malignancy, PE

What are septal "Kerley" lines?

Lung markings seen on imaging that represent thickened interlobular septa in the pulmonary interstitium

Describe Kerley A lines. B

Kerley A lines - 2-6 cm oblique lines that course toward the hila Kerley B lines - 1-2 cm horizontal seen in the periphery of the lungs (perpendicular to the pleural surface)

Describe Kerley C lines. D.

Kerley C lines - same as Kerley B but coursing ventrally Kerley D lines - same as Kerley B but seen on the lateral CXR in the retrosternal air space

What are some causes of Kerley lines?

pulmonary edema, malignant lymphoma, viral/mycoplasmal pneumonia, pulmonary fibrosis, pneumoconiosis, sarcoidosis

What am I?

mediastinal mass

What am I?

left pneumothorax

What am I?

right consolidation

What am I?

pulmonary edema with flat diaphragm

What am I? What position?

poor quality image, possible mediastinal widening with blunted costophrenic angles AP view because clavicles are horizontal

What am I?

Kerley lines with possible right lower lobe consolidation, some flattened diaphragm, COPD barrel chest