Lecture 3: CXR_interpret_STUDENT-2020-EDITED AL Flashcards Preview

NURA-606-01 Advanced Health Assessment > Lecture 3: CXR_interpret_STUDENT-2020-EDITED AL > Flashcards

Flashcards in Lecture 3: CXR_interpret_STUDENT-2020-EDITED AL Deck (30)
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1

Justification for CXR

pneumonia (confirmation)
immunosuppressed pt
COPD w/acute exacerbation
foreign body
CHF
aspiration pneumonia
blunt trauma
lung tumor
chest pain
suspected pneumothorax
SOB (severe)
hemoptysis
pulmonary HTN
PE
interstitial lung ds
ICU pt (adm, inv lines, ETT)

2

Basic Tissue Densities
• Black =

• Black – air

3

Basic Tissue Densities
• Dark gray =

• Dark gray – subcutaneous tissue, fat

4

Basic Tissue Densities
• Light gray =

• Light gray – soft tissue (muscles, heart, blood vessels, pus, etc)

5

Basic Tissue Densities
• Off white =

• Off white – bone

6

Basic Tissue Densities
• Bright white =

• Bright white – metal (pacemakers, surgical clips, bullets, etc)

7

Supine
• supine position limits ?
• ________ push is noted- (____________ contents)
• small pleural effusions will layer in ?- can easily be ?
• *Be _______ interpreting supine films!*

• supine position limits full inspiration
• cephalic push is noted- (liver and abdominal contents)
• small pleural effusions will layer in posterior pleural space- can easily be missed
• *Be careful interpreting supine films!*

8

Upright position
inspiration is ?

inspiration is greater/better

9

Inspiration and Expiration

Good inspiration = ?

Hypoinflation= ?

Good inspiration = hemi diaphragm down to level of posterior 10th or 11th ribs.

Hypoinflation= dome at 7th rib

10

• PA (posteroanterior)
• AP (anteroposterior)
Can you explain the two terms????????????

PA:
X-ray beam is entering/exiting =
pt position =
detector position =
heart size =
diaphragm =

AP:
X-ray beam is entering/exiting =
pt position =
detector position =
heart size =
diaphragm =

11

Terminology
Position is TREMENDOUSLY important because the following might be affected:

• magnification
• organ position
• blood flow
• *gravitational pull*

12

Which view is most preferred?
Why? See other slides

PA & Upright
Well demarcated costophrenic angle + see other slides

13

Expiration usefulness

small pneumothorax: expiration will make the lung larger/smaller and more/less dense, and at the same time will relatively make the pneumothorax appear larger/smaller?

small pneumothorax: expiration will make the lung smaller and denser, and at the same time will relatively make the pneumothorax appear larger

14

Expiration usefulness

lodged foreign body: “ball-valve phenomenon” – air can move past the object during inspiration, but during expiration (the bronchus gets smaller) and air can not exit around the obj. As a result, the expiration image will show air trapping in the affected lung and a mediastinal shift will occur toward ?

lodged foreign body: “ball-valve phenomenon” – air can move past the object during inspiration, but during expiration (the bronchus gets smaller) and air can not exit around the obj. As a result, the expiration image will show air trapping in the affected lung and a mediastinal shift will occur toward the unaffected side

15

Pneumothorax =

supine vs upright?

Where is the first place to look for pneumothorax?

deep sulcus sign =?

Pneumothorax—air positioned between the visceral and parietal pleura
*trauma, subclavian venous catheter, liver biopsy
*spontaneous (bleb rupture)
*metastatic tumors

upright

Where is the first place to look for pneumothorax (UPPER)

deep sulcus sign = costophrenic angle getting deeper? (supine?) ~ look up!!!

16

Pleural effusion

Pleural effusion =

Look for:

Causes:

What is the preferred X-ray position (upright or supine)?

Pleural effusion—collection of fluid between the visceral and parietal pleura (~100 mLs to be detected on upright CXR)

Look for (reference image on pg 87 of reading):
blunting of costophrenic angles
increased basilar density (whiteness)
loss of normal lung-hemidiaphragm is noted

Causes: malignancies, pancreatitis (left-sided), cirrhosis (right-sided), CHF (bilateral), pneumonias (40%)

What is the preferred X-ray position? upright

17

Mediastinal shifts:
• Tension pneumothorax—the mediastinum is shifted toward the (affected, unaffected) side?
• Atelectasis—collapse of entire lung segment might result in severe volume loss. Will see mediastinal shift toward the (affected, unaffected) side?
• Airway obstruction—mediastinal shift toward the (affected, unaffected) side?

Mediastinal shifts:
• Tension pneumothorax—the mediastinum is shifted toward the unaffected side.
• Atelectasis—collapse of entire lung segment might result in severe volume loss. Will see mediastinal shift toward the affected side.
• Airway obstruction—mediastinal shift toward the unaffected side.

18

male vs female CXR?
• nipple shadows → men and women
• overlying breast tissue → accentuate pulmonary vasculature (careful, not to dx as ?)
• can tape BB or other metal object and reshoot film?

compare both sides
infiltrate
?

19

Exposure

Overexposure
• Image is white or dark ?
• Easy to see:
• Cannot see:

Overexposure
• Image is dark
• Easy to see: Thoracic spine, clavicles, behind the heart, NG & ET tube placement
• Cannot see: pulmonary vessels in the periphery, small nodules, or fine structures

20

Exposure

Underexposure
• Image is white or dark ?
• Easy to see:
• Cannot see:

Underexposure
• Image is white
• Easy to see: pulmonary vasculature (don’t mistake for infiltrate)
• Cannot see: behind the heart, spinal anatomy, or behind hemidiaphragms

21

Know the major landmarks: Slides 27-30!

Know the major landmarks: Slides 27-30!

22

Silhouette Sign
• very useful in interpreting a CXR
• it helps to determine the location of an abnormality in relation to ?
• RML vs RLL (pneumonias, masses)
- loss of right heart border indicates that the infiltrate is in the ?
- loss of right hemidiaphragm indicates that the infiltrate is in the ?
- loss of left hearth border indicates that the infiltrate is in the ?
- loss of left hemidiaphragm indicates that the infiltrate is in the ?

Silhouette Sign
• very useful in interpreting a CXR
• it helps to determine the location of an abnormality in relation to normal structures
• RML vs RLL (pneumonias, masses)
- loss of right heart border indicates that the infiltrate is in the RML
- loss of right hemidiaphragm indicates that the infiltrate is in the RLL
- loss of left hearth border indicates that the infiltrate is in the lingula of the LUL
- loss of left hemidiaphragm indicates that the infiltrate is in the LLL

23

Aspiration pneumonia

Aspiration:

CXR usually performed immediately after ?

F/U should be performed w/in X hrs ?

Aspiration pneumonia

Aspiration: the inhalation of gastric contents
*following seizure, cardiac resuscitation, anesthesia related complication

CXR usually performed immediately after incidence

F/U should be performed w/in 12 hrs
* may take several hours for the gastric contents to react with the lung to cause fluid exudate and an alveolar infiltrate

24

Mediastinal mass → ?

Anterior:

Mediastinal mass → widening or bulge in the central soft tissue of the chest

Anterior:
thymoma
thyroid lesions
teratoma
T cell lymphoma
*The 4 Ts*

25

Mediastinal mass → ?

Middle:

Mediastinal mass → widening or bulge in the central soft tissue of the chest

Middle:
t. aortic aneurysms
neoplasms
adenopathy
diaphragmatic hernias

26

Mediastinal mass → ?

Posterior (lat view):

Mediastinal mass → widening or bulge in the central soft tissue of the chest

Posterior (lat view):
neurogenic (90%)
neuroblastomas
schwannomas
ganglioneuromas

27

Systematic approach:
1. Who
2. What
3. When
4. Why
5. Exposure

Systematic approach:
1. Who (correct patient)
2. What (film orientation) → AP, PA, supine, upright
3. When (date)
4. Why (reason for X-ray) → history and PE are extremely important
5. Exposure

28

Systematic approach:
A
B
C
D
E

Systematic approach:
Airway
Bones
Cardiac
Diaphragm/mediastinum
Everything else

29

***Read Lecture 3 - Essentials of Radiology-Mettler prior to exam!!!***
EX: List of why we do CXRs

***Read Lecture 3 - Essentials of Radiology-Mettler prior to exam!!!***
EX: List of why we do CXRs

30

Study class exercise....slide and photo answers!

Study class exercise....slide and photo answers!