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Radiography OCSE Year 3 > PCE chest and abdomen > Flashcards

PCE chest and abdomen Flashcards

1
Q

Identify the structures of the heart

A

Right atrium
Right ventricle

Left atrium
Left ventricle

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2
Q

Where should the left hilar sit in relation to the right one?

A

Left hilar should sit higher than the right hilar because it goes over the pulmonary artery
If it is lower this indicates heart failure or something else wrong

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3
Q

where is the carina?

A

The carina is where the trachea bifurcates it sits just below the aortic knuckle usually

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4
Q

How many lobes is there in the lungs?

A

3 for the right
2 for the left

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5
Q

Anatomy levels going down in left lung

A

Great vessels/ left paratracheal stripe
Arch of aorta
Main pulmonary artery
Auricle of left atrium
Left ventricle
Fat pad

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6
Q

Anatomy levels going down in right lung

A

Great vessels/ right paratracheal stripe
Superior vena cava
Arch of azygous vein
Superior vena cava
Right atrium
Inferior vena cava

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7
Q

How is the lung split up

A

Apex
Upper zone
Mid zone
Lower zone

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8
Q

Felson search pattern
ATMLL (Are There Many Lung Lesions)

A

Abdomen
Thoracic Cage
Mediastinum
Lung (unilateral)
Lung (bilateral)

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9
Q

Types of opacity

A

Consolidation- air spaced opacity, patching shadowing, can be quite dense
Interstitial- smaller fine lines, crossing over lines (can also reduce lung volume)
Nodule- small node usually a simple circle
Mass- large, may not be a simple circle
Atelectasis- lung collapse

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10
Q

Lymph nodes can get enlarged and can distort the hilum so infection is important to note

A

Lymph nodes can get enlarged and can distort the hilum so infection s important to note

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11
Q

What is a sail sign

A

lung collapse, dense line where the lung collapse

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12
Q

Slide 28, example of PCE for chest “Interstitial shadowing in the mid to lower zones

A

Slide 28, example of PCE for chest “Interstitial shadowing in the mid to lower zones

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13
Q

What causes lung collapse?

A

in older patients it can be due to malignancy
in younger patients in children and children it can be a result of mucus plugin if they’re asthmatic

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14
Q

Right middle lobe collapse appearance

A

Increased density and distortion of the hemidiaphragm (it should be a nice dome)

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15
Q

left upper lobe collapse appearance

A

Increased opacity of the left lung, called the veil sign as it looks like someone has draped something over the lung

The aortic may also be distorted because the left lower lobe has hyperinflated because the upper lobe collapse

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16
Q

pneumothorax how to describe

A

The lung doesn’t fill the chest,
Remember to say what side it is and whether there is a mediastinal shift

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17
Q

pleural effusion how to describe

A

say what side is affected or whether its unilateral
Loculated plural effusion is where it goes up the side of the lungs (periphery of the pleura, all the way up to the apex)
if horizonal fissure, is thickened with pleural effusion at the bottom, its also a pleural effusion

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18
Q

What is a empyema

A

basically a pleural effusion that is made form pus
it looks like a bulging opacity

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19
Q

Mesothelioma what does it look like

A

if you see an opacity that looks like a pleural effusion (empyema) but there is no blunting of the costophrenic angles its mesothelioma

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20
Q

How do you look for heart failure

A

Kerley lines (horizontal lines)
Increased heart size
Pleural fluid
Perihilar opacity
Upper lobe blood distribution

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21
Q

Using the silhouette sign
loss of the silhouette sign

A

Right paratracheal stripe: right upper lobe

Right heart border: right middle lobe or (medial right lower lobe - small percentage)

Right hemidiaphragm: right lower lobe

Aortic knuckle: left upper lobe

Left heart border: lingula segments of the left upper lobe

Left hemidiaphragm or descending aorta: left lower lobe

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22
Q

Mediastinal Masses
Anterior
Middle
Posterior

A

Anterior
The 5 T’s

middle
Lymphadenopathy
Central Lung Tumours
Oesophageal lesions
(Look for splaying of the carina)

Posterior
Spinal/Paraspinal Abscess
Neurogenic Tumours
(Look at the intervertebral discs and vertebral bodies carefully
Look for rib splaying)

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23
Q

Normal diameters of the bowel
Small bowel =
Large bowel =
Caecum =

A

Normal diameters of the bowel
Small bowel = 3 cms
Large bowel = 6 cm
Caecum = 9 cm

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24
Q

appearance of large bowel

A

Large bowel is peripheral and has haustral folds

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25
Q

appearance of small bowel

A

Small bowel is central and have valvulae conniventes

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26
Q

what are haustral folds

A

the normal folds of the large bowl, if they become smooth or have thumbprinting there is a pathology

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27
Q

what is Adynamic/Paralytic Ileus
symptoms

Radiographic Features

A

Paralysis of motility
Not due to mechanical obstruction
(usually link to post surgery)

Can be asymptomatic
Distended and tympanic abdomen
Tachypnea and tachycardia
No flatus
Hiccups

Generalised and uniform distension of small and large bowel
Can be sentinel loop if localised

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28
Q

What anatomy can be seen on a abdomen x-ray

A

liver
spleen
stomach
right kidney
left kidney
psoas muscle
ascending colon
transverse colon
descending colon
small intestines
rectum
bladder
(if there is issues with the gallbladder or the pancreas sometimes these can be visualize)

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29
Q

What can be assessed on abdomen?

A

Bowel gas pattern
Bowel wall
Abnormal gases
Masses
Calcifications
Foreign bodies
Bones

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30
Q

what are valvulae conniventes

A

the lines on the small bowl which go through the bowel whereas haustra is like a bumpy line

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31
Q

What causes bowel distention or enlarging?

A

Adynamic Ileus

Mechanical Obstruction
LBO
SBO

Volvulus

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32
Q

Small bowel obstruction
radiographic appearance and causes?

A

Small bowel distension (greater than 3cms)
Ladder-like or stacked coin appearance
Little to no air in the large bowel
Fluid-filled obstructions can be occult on plain film

Causes
Adhesions
Hernia
Gallstone Ileus
Intussusception

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33
Q

What is gallstone ileus
appearance?

A

Gallstone which has migrated from the gallstone through the bile duct and cause a perforation through that, so you can see that communication.
So what happens is you get gas in the billery tree that you wouldn’t expect to see.

So if you see gas in a billery tray, sat of that right of the quadrant.
And appearances of a small bowel obstruction, it’s probably due to a gallstone ileus, even if you cant see the gallstone

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34
Q

Large bowel obstruction appearance
causes

A

Dilated large bowel to the point of obstruction (transition)

Little or no air in the sigmoid/rectum

Little or no gas in the small bowel if the ileocaecal valve remains competent

Causes
Tumour
Volvulus (Sigmoid or Caecal)
Hernia (Rare)
Diverticulitis
Intussusception (Rare in adults)
Faecal impaction

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35
Q

Sigmoid Volvulus appearance

A

Arises in pelvis/LLQ
Extends towards RUQ
Ahaustral
‘Coffee-bean’ appearance
Dilated large bowel

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36
Q

Caecal Volvulus appearance

A

Arises in RLQ
Extends towards epigastric region/LUQ
Hausta maintained
Small bowel dilated
May have air fluid level

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37
Q

What is volvulus

A

Volvulus occurs when a loop of intestine twists around itself and the mesentery that supplies it, causing a bowel obstruction.

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38
Q

What is Pneumoperitoneum?

A

gas outside the bowel, sometimes under the diaphragm. Needs to be reported back to the ward

Perforation of the bowel
Iatrogenic
Rigler’s sign (air sign)
Visualisation of the Falciform ligament

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39
Q

What is intramural gas?

A

gas within the bowel wall, bacteria in the wall causing it.

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40
Q

Gas within solid organs

A

describe what you see,
could be in the kidney, bladder, liver, spleen etc

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41
Q

Assessing the Bowel Wall

A

Bowel wall thickening
secondary to submucosal oedema
neoplasm

Loss of the normal haustral pattern

‘Thumbprinting’ of the colon

42
Q

Intra-abdominal Masses and Organ Enlargement
Causes mass effect (displacement of the surrounding tissue)

Urinary retention and bladder distension can mimic a mass

A

could happen to the bladder, or the liver

43
Q

Calcifications types

A

Are a pathology or indicate a pathology
Concretions-Stones

Conduit-Fluid filled hollow tube

Cystic-Wall of structure

Solid mass-Extensive but variable

44
Q

Calcifications examples

A

Renal and Ureteric Calculi
Gallstones
Porcelain Gallbladder
Vascular/cystic structures
Nephrocalcinosis
Lymph nodes
Phleboliths (in a vein)
Bladder calculi
Calcified aneurysms
Calcified splenic artery
dermoid cyst

45
Q

Renal tract calculi

A

Left large renal calculi (stathorn calculus)
VUJ (Vesico-ureteric junction)

46
Q

common foreign bodies, note slide
pessary ring, and that’s for prolapse
ueteric scent
hip replacement

A

common foreign bodies
pessary ring, and that’s for prolapse
ureteric scent
hip replacement

47
Q

PCE note say what side is affected and say what quadrant the issue is in if cant say what the pathology is

A

PCE note say what side is affected and say what quadrant the issue is in if cant say what the pathology is

48
Q

what is a dermoid cyst

A

usually in the midline and looks like teeth, germ cell tumour

49
Q

How to describe foreign bodies

A

where is it, how many, what is it/shape
if there is clothing state it so that there is no confusion

50
Q

What is ETT
Where should they be
What are they for

A

Endotracheal tube (ETT)
2cm above carina (ideally 5-7cm)

Wide bore plastic tube inserted into trachea to allow artificial ventilation

Adult tubes are usually around 1cm diameter
Radiopaque strip so they are visible on CXR
5-7cm above carina
Can move up and down depending on head/neck position

51
Q

What is NGT
where should they be
What are they for

A

Nasogastric tube
3-4cm below diaphragm

Extend from the nose to stomach
Allow administration of artificial hydration and feeding, and deliver drugs
Patients who are unable to swallow
Patients who have sub-optimal oral intake despite intake swallow mechanism

Can be kept in place for 6-8 weeks

52
Q

NG tube imaging criteria
Ideal PCE comment

A

(Request form should clearly state the purpose of the x-ray is to establish position of NG)
Does the tube follow the path of the oesophagus and avoid the contours of the bronchi?

Does the tube clearly bisect the carina or bronchi?

Does it cross the diaphragm in the midline?

Is the tip clearly visible below the left hemi-diaphragm?

“NG tube in situ, it bisects the carina and diaphragm in the midline. The tip is seen below the left hemi diaphragm overlying the gastric bubble”

53
Q

Ideal NG PCE comment

A

“NG tube in situ, it bisects the carina and diaphragm in the midline. The tip is seen below the left hemi diaphragm overlying the gastric bubble”

54
Q

Methods for confirming NG tube

A

Aspirate from tube and measure pH
Should be under 5.5

If no aspirate or pH is above 5.5 then an x-ray is justified

55
Q

Types of NG tube and appearance on x-ray

A

Narrow bore, which has a guide wire through the length of it

Wide Bore which the tip may only be visible

56
Q

Where does the carina sit

A

Level of T4 but on older patients it might become lower

57
Q

What should you do if you see a NG tube is not in the stomach?

A

Call the ward and let them know not to use it and also document telling them. Ask for GMC, NMC, HCPC

58
Q

If the tip of an NG tube is not visible what should you do?

A

do an upper abdominal view
The tube should go straight by the carina shouldnt bend before that point

59
Q

PCE comment for an NG in the wrong place example

A

NG tube has gone down right bronchi and is sitting in the lower zone of the right lung

Comment on any pulmonary oedema etc also
any other artefacts, e.g ECG artefact, clothing

60
Q

What happens if malposition of ETT?
Tube below the carina

A

Might go down right bronchus/only supply that one with air
left lung collapse due to no air
Right upper lobe collapse
Right lung over distension and cause pneumothorax

if in oesophagus
Stomach distended filled with air
Oesophagus will sit slightly lateral and not central as it should

61
Q

What does Consolidation mean?

A

patchy/fluffy appearance, something is in the airway that shouldn’t be there.

62
Q

ETT ideal location on x-ray

A

Endotracheal tube superimposes the trachea and sits above the carina around the level of T4

63
Q

Intercostal chest drain what is it for and appearance

A

Chest drains are inserted for pneumothorax/pleural effusions.

Drains usually point superiorly if its for a pneumothorax and inferiorly if its for a pleural effusion (but not always).

check that the holes are in lung fields

64
Q

intercostal chest drain PCE comment example

A

“intercostal chest drain in situ”

“There is also marked emphysema on right side” (if there is emphysema)

and the pathology
“right sided pneumothorax”
“Left side plural effusion”

65
Q

CVP central venous pressure line

A

inserted via jugular vein (sometimes subclavian veins) and goes to the superior vena cava (SVC)
Usually inserted on the right

they measure/monitor atrial pressure and give meds

Should be straight tip

if gone too far into right atrium it can cause arrhythmias

66
Q

CVP PCE comment example

A

“Central venous pressure line in situ in the superior vena cava”

67
Q

Cardiac pacing device
what are they for?
Where should the wires sit?
Risk of anything?

A

Used to treat arrhythmias and bradycardia
2 leads usually
Ventricular lead points towards the apex of the heart (right ventricule)
Atrial lead usually points superiorly

Check for pneumothorax

68
Q

Cardiac pacing device PCE comment example

A

“Cardiac pacing device in situ with wires in right ventricle and left atrium”
Comment on any pathology e.g pneumothorax

69
Q

Cardiac defibrillators
what are they for?
What do they look like?

A

Monitoring and therapy
look similar to pacemaker but have a thicker lead

70
Q

Cardiac defibrillator PCE comment example

A

“Cardiac defibrillator in situ with wires in right ventricle and left atrium”
could say cardiac device in situ also

Comment on any pathology e.g pneumothorax

71
Q

CRT-P and CRT-D
Appearance
what is it used for

A

similar to cardiac pace maker in appearance but has 3 wires

Extra lead in the coronary sinus, around the left side of the heart. Used to treat patients with marked heart failure who are poorly managed on maximum medical therapy.

72
Q

CRT-P and CRT-D PCE comment example

A

“Cardiac device in situ with wires in right ventricle and left ventricles and left atrium”

Mention any pathology

73
Q

Valve replacement PCE comment example

A

“prosthetic heart valve in situ”
circle in the heart is the appearance

74
Q

TAVI PCE comment example
and appearance

A

“TAVI in situ”
A cage like structure in the aorta

75
Q

LVAD
Left ventricular assist devices (LVAD)
PCE comment example

A

only parts of LVAD are radio-opaque
its a big device that sits under the heart

“LVAD in situ”

76
Q

Abdominal lactogenic object meaning

A

introduced by surgery

77
Q

Gastric band appearance and PCE comment example

A

it has a band/circle to it and then a wire going out from it
“Gastric band in situ”

78
Q

EVAR – Endovascular aortic repair and PCE comment example

A

“EVAR in situ”
This stent has ‘legs’ which go into the iliac arteries.

79
Q

Gastrostomy tube and PCE comment example

A

“Gastrostomy tube in situ”
circles in abdomen not a large circle or band like the gastric band

80
Q

Baclofen pump appearance
and PCE comment example

A

“Baclofen pump in situ”
Large device in abdomen region with wire going into the spinal cord
give meds

81
Q

IVC Filter what is it
whats it for?

A

inferior vena cava filter
Used for patients at risk of PE where anticoagulants are contraindicated. Filters will be removed. The longer the filter is in, the higher chance of complications or failed retrieval.

82
Q

IVC filter appearance and PCE comment example

A

“inferior vena cava filter in situ”
looks like a umbrella almost

83
Q

Peritoneal dialysis catheter and PCE comment example

A

“peritoneal dialysis catheter in situ”
A thick tube like structure siting in the side of the abdomen with thinner tube across and down the abdomen

84
Q

Encapsulating peritoneal sclerosis – constant ambulatory peritoneal dialysis
wont be in PCE

A

Encapsulating peritoneal sclerosis – constant ambulatory peritoneal dialysis
wont be in PCE

85
Q

Vaginal pessary appearance and PCE comment example

A

“Pessary ring in situ”
A right in the bladder region quite large but not radiopaque

86
Q

Nephrostomy appearance and PCE comment example

A

“left nephrostomy in situ”
A tube curling around in the kidney

87
Q

Ureteric stent appearance and PCE comment example

A

“left ureteric stent in situ”
A tube from kidney running down uretera to bladder
state whether there is calcification around the stent also

88
Q

Hernia mesh repair appearance and PCE comment example

A

Numerous small ‘spring-like’ artefacts overlying the lower right anterior abdominal wall.
These are from part of a mesh hernia repair of the abdominal wall
“mesh hernia repair in situ”

89
Q

Capsule endoscopy appearance and PCE comment example

A

A radiopaque little tube almost square, can be anywhere within the bowel, and even by the rectum
“Capsule endoscopy in situ”

90
Q

What does subpenic mean?

A

The subphrenic space is a peritoneal space between the anterior part of the liver and the diaphragm, separated into right and left by the falciform ligament, and postero-superiorly bounded by the coronary ligament.

91
Q

Quadrants of the abdomen

A

Right upper quadrant
Epigastric Region
Left upper quadrant

Right lumbar region
Umbilical region
Left lumbar region

Right iliac region
Hypogastric region
Left iliac region

92
Q

What is the appearance of ascites on an abdomen x-ray

A

Ascites is a build up of fluid due to liver failure.
It can lead to a swollen stomach and increase grey appearance (cant see bowel gas clearly) and unable to see the psoas muscles.

“psoas muscles shadows not visualized, there is an increased grey appearance and lack of bowel gas marking, in keeping with ascites”

93
Q

What is pneumobilia

A

Pneumobilia, is when there is air in the biliary tree of the liver.
This leads to a branching gas appearance in the liver. Can be due to recent surgery.

“There is a branching lucency in the RUG, liver in keeping with pneumobilia” “Surgical clips in situ”

94
Q

What is Chilaidaiti syndrome?

A

Where bowel is above the liver in a chest x-ray, may be normal for a patient if it is on previous imaging

95
Q

what is a staghorn calculi?

A

A kidney stone that has taken the shape of the inside of the kidney

“there is a left staghorn calculi”

96
Q

Small bowel obstruction comment

A

“there is a stacked coined appearance of distended bowel, in keeping with small bowel obstruction”

97
Q

Normal appearance of calcification of the splenic artery looks like what?

A

Calcification of the splenic artery looks like a Chinese dragon (known as the Chinese dragon sign.) if there are converging plagues of calcification, this indicates an aneurysm of the splenic artery.

98
Q

What is a phlebolith?

A

phlebolith - in veins round smooth opacities, may contain lucent centres, may confuse them with ureteric calculi

99
Q

What are osteophytes?

A

Osteophytes are little bits of bone growth that come off from the bone and are linked to osteoarthritis, they are around joints, (where ligaments attach) and may appear on the spine also

100
Q

What is rigler’s sign?

A

This is when you can make out both signs of the bowel, due to perforation, and the bowel has sharp edges to it.

Radiography OCSE Year 3 (23 decks)

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