Normal CXR Flashcards
objectives
1
Q
Normal PA w/ landmarks
A
2
Q
CXR indications via evaluation of symptoms
A
- cough
- dyspnea
- orthopnea
- PND
- Chest pain, after other causes rules out
- fever of unknown origin
- unintentional wt loss
- esp in smoker
- abnormal lung exam
- crackels
- dullness to precussion
3
Q
CXR indications via evaluation of signs
A
- chest trauma
- cyanosis/hypoxia
- tachycardia
- distended neck veins
- heart murmur
- diminished breath sounds
- egophany
- tracheal deviation
4
Q
CXR- other indications
A
- evaluation of plavement of lines/tubes
- screening for pneumothorax after procedure
5
Q
how to order a CXR
A
- PROVIDE INDICATION
- specify vies
- bedside or “send in”
- how to decide?
6
Q
PA/Lat view
A
- posterior to anterior
- viewing image almost backwards
- much better than AP view
7
Q
AP portable
A
- anterior to posterior
8
Q
AP vs PA
A
- heart looks smaller on PA and larger on AP
9
Q
apical lordodic view
A
- view gets the clavicle out of the way of the apices
- should only use for looking at apices and no other lung areas
10
Q
decubitis view
A
- inspiritory
- expiritory
11
Q
lateral film
A
- clear retrosternal space
- no discrete masses present in hilar region
- right hemi-diaphragm higher than left
- sharp costophrenic angles
12
Q
tissue densities
A
- air
- black
- lead, bone
- white
- muscle, fat, liver
- grey
13
Q
criteria of a good CXR
A
- ROTATION
- symmetry via clavicles
- penetration
- overpenetration
- may see vertebrae too clearly, should normally be able to just make them out under the heart
- underpenetration
- spinous process not seen at all
- overpenetration
- inspiration
- you should be able to count 10 ribs w/ good effort
- cropped
- make sure to visualize every aspect of the lung, both costophrenic margins
- crooked
- ideal to have a straight film
14
Q
stepwise evaluation of right pt CXR
A
- label: name, date, DOB
- orientation: L/R
- view: PA, AP, Lat
- quality of the film
15
Q
ABCDEF system CXR
A
- A= airways
- trachea (deviation, obstruction)
- R/L main bronchus
- B= bones
- ribs, clavicle, sternum, vertebrae
- C= cardiac silouhette and mediastinum
- size and widening
- D= diaphragm and gastric bubble
- elevation, sub diaphragm air, gastric bubble
- E= effusions
- costophrenic angle
- F= fields
- G=gastric bubble
- H=hilum
- I=iatrohenic stuff
- lines
- tubes
- devices
- surgeries
16
Q
view for heart
A
- PA
- Lat
17
Q
view for aortic knob
A
- PA
18
Q
view for trachea and carina
A
- PA
19
Q
view for hilum
A
- PA
- Lat
20
Q
view for clavicles
A
- PA
21
Q
view for ant/post ribs
A
- PA
22
Q
view for sternum/ retrosternal clear space
A
- PA
- Lat
23
Q
view for breasts/ nipples
A
- PA
24
Q
views for vertebral bodies/ disc space
A
- PA
- Lat
25
view for hemidiaphragms
* PA
* Lat
26
view for gastric air bubble
* PA
27
view for fissures
* PA
* Lat
28
view for costophrenic angles/sulcui
* PA
* Lat
29
alveolar infiltrate
* fluid of any type that displaces air in the alveoli
* causes
* water
* pus
* blood
* proteinous fluid
30
alveolar infiltrate via water
* cardiogenic pulmnary edema
* fluffy cloud-like radiopaque densities
* batwing or butterfly pattern
* perihilar congestion
* cardiogenic (CHF)
* develops acutely and resolves quickly w/ tx
* peripheral sparing, advances for hilum, usually fairly symmetrical
31
alveolar infiltrate via pus
* pnemonia
32
alveolar infiltrate via blood
* hemoptysis
* rupture
33
alveolar infiltrate via proteinous fluid
* ARDS, non-cardogenic pulm edema
* fluffy, cloud-like radiopaque densities
* diffuse pattern
* develops gradually
* not peripheral sparing or symmetrical
34
interstitial infiltrate
* thickening of interstitial tissues and pleural fissures in otherwise well-aerated lung fissures
* linear densities
* A-lines
* radiate towards hila
* located in mid and upper zones
* thinner and adjacent to blood vessels
* do not reach edge of lung
* B-lines
* horizontal lines
* ,2cm
* seen at periphery of lung
* spherical densities superimposed on normal radiating pattern of blood vessels
35
Silhouette sign
* Loss of normal borders in thoracic structures
* Typically obscured heart border or diaphragm:
* RML obscures right heart border,
* LLL: left heart border/diaphragm
* RLL: R hemidiaphragm
* LUL: descending aorta
* RUL: ascending aorta
* Lingual of LUL: left heart border
36
Spine Sign
* When on a lateral film, the thoracic spine appears darker/blacker as you go from shoulder to diaphragm
* If the dz involves the posterior lower lobes, the xray beam will be absorbed more which adds density thus making it more white just above the posterior costophrenic sulcus
37
Atelectasis
* Caused by external compression fluid trapped b/w visceral and parietal pleura
* The collapse or loss of volume of a lung, lobe, or segment.
38
atelectasis on CXR
* Shifts
* Movement of structures toward the collapsed lobe
* Fissures, mediastinum, and/or diaphragm
* Compensatory expansion
* The expansion of non-consolidated lobes
* Fills the loss of volume from atelectatic lobe
* Consolidation
* The filling/solidifying of normally air-filled lung
* Opacification takes on the shape of the lung, lobe, or segment
39
atelectasis causes
* Bronchial obstruction
* pleural compression
* pneumothorax
* pleural effusion
40
Bronchial obstruction
* Air cannot enter the alveoli distal to the obstruction. The air already present is absorbed, and the lobe or segment decreases in volume
* Bronchial neoplasm: carcinoma or granuloma
* External compression by mass: neoplasm or enlarged lymph node
* Intraluminal occlusions
41
Pneumothorax
* Air can enter the intrapleural space:
* TRAUMA / IATROGENIC - through a communication from the chest wall
* SPONTANEOUS / COPD - through the lung parenchyma across the visceral pleura.
* CXR findings:
* _Line of pleura_ (forming edge of lung) that is separated by air from the chest wall, mediastinum, or diaphragm.
* _Absence of vessels_ outside this line
* Expiratory lateral decubitus is another helpful view \>\> suspected side should be up (air goes up)
42
Tension Pneumothorax
* _Life-threatening condition_
* _Air is trapped in the pleural cavity_
* Under positive pressure
* Displacing mediastinal structures
* Compromising cardiopulmonary function.
* Signs:
* Mediastinum, trachea, and heart shift **_away_** from pneumothorax
* Flattening or inversion of diaphragm
* Partial or complete collapse of lung
43
Pleural effusion
* fluid trapped b/w the visceral and parietal pleura
44
Free pleural effusion
* Meniscal curve up the lateral chest wall
* Radiographic findings of free fluid:
* Fluid collects in the most dependent portion of the pleural cavity
* Fluid obliterates costophrenic angles
* Small effusion may only be visible on lateral view
* Lateral decubitus film may help show effusion \>\>effected side will be down (fluid goes down)
45
Loculater pleural effusion
* Pleural fluid trapped within adhesions
* May mimic a nodule, atelectasis, or consolidation
* Often located within fissures
* CT and ultrasound useful to:
* Detect the presence, size, and shape of effusion
* Guide thoracentesis
