CXRs Flashcards
Pneumothorax
Lung collapse away from pleural lining
> 2 cm = 50% lung reduction
Lung fibrosis
Extensive reticular pattern
Can cause pneumothorax
Sarcoidosis
Hilar lymphadenopathy
Associated with eythema nodusum
Mesothelioma
Large calcified pleural plaques
Ship yard worker - occupational asbestos exposure
Middle lobe pneumonia
Superior edge of pneumonia has horizontal fissure
Systematic approach
Rotation - spinous processes midpoint between two heads of clavicles
Inspiration - 5-7 ribs anteriorly
Penetration - spine visible behind heart
AIRWAY - Trachea (central)
BREATHING
- Zones (consolidation, pneumothorax)
- Diaphragm (hemidiaphragm elevated, flattened)
- Pleural thickening (effusion, mesothelioma)
CARDIAC
- Size (50% thorax diameter)
- Border (obscured)
- Hilar (bilateral, unilateral consolidation)
- Mediastinum (central, enlarged)
EXTRAS
- Bone (mets, fracture)
- Soft tissue (surgical emphysema, mastectomy)
Enlarged mediastinum ddx
Lymphoma
Thoracic aneurysm
White cavity cxr ddx
Empyema
Septic embolus
Abscess
Consolidation causes
Pus, infection, blood, cancer
CXR presentation
The image is of adequate quality.
The first abnormality to comment on is…
OR
I cannot see any abnormality at first glance but looking at the image systematically…
The trachea is central
The upper, middle and lower zones of the lungs are symmetrical and clear
The costophrenic angles and hemidiaphragms are well-defined
The heart size and contours are normal
The hilar structures are normal
I can see no abnormality of the bones or soft tissues
In summary this radiograph demonstrates evidence of…
These findings are consistent with the clinical suspicion of…
In this situation I would manage this patient by…
COPD CXR
Hyperinflation > 8 ribs Flat hemi-diaphragms Decreased lung markings Bulla Prominent hilar
Collapse vs consolidation
Collapse = uniform soft tissue density (pure white) Consolidation = non-uniform soft tissue density (blotchy white) + peri-hilar air bronchogram
