Radiology

Question 1

CXR Checklist

Answer 1

1. Projection - AP or PA
2. Patient details - name, age/DOB, CHI, when image taken
3. Technical Quality - all thorax visible, RIP
   - — Rotation - heads of clavicles equidistant from spinous processes
   - — Inspiration - 6 anterior or 10 posterior
   - — Penetration - can just see vertebral bodies behind heart
4. Obvious abnormalities
   - Which lung and which zone of lung involved
   - Size
   - Shape - focal/diffuse, round/spiculated, well/poor demarcated
   - Density - whiter = greater density, blacker = less dense
   - Other - i.e. surgical clips / drains
5. Review of x-ray
   - Airway - tracheal deviation
   - Breathing - apices to angles, around border, hila same density
   - Cardiac and Mediastinum - heart size and borders
   - Diaphragm - visible and convex, right higher, free air
   - Everything else - bones, surgical emphysema, surgical clips, lines (ET, NG, Central lines)
6. Review areas - apices, hila, behind heart, costophrenic angles, under diaphragm
7. Summary
   - Summary of findings and differential
   - ?see previous images
   - suggest further imaging / ix
   - suggest mx plan

Question 2

Pneumonia: which lobes contact heart / diaphragms

Answer 2

Diaphragms - left and right lower lobes
Right heart border - right middle lobe
Left heart border - lingual (part of left upper lobe)

If can’t tell - use upper, middle, lower zones

Question 3

Signs consistent with pleural effusions

Answer 3

Blunting of costophrenic angles

Fluid level presenting as meniscus

Question 4

Features of pulmonary oedema

Answer 4

A - Alveolar and interstitial shadowing
B - kerley B lines (small, white, horizontal lines in lateral edges)
C - Cardiomegaly
D - Diversion of upper lobe venous blood
E - effusions
F - fluid in horizontal fissure

Question 5

Features of pneumothorax and tension PT

Answer 5

air in pleural space
loss of lung markings

TPT - mediastinal shift - trachea pushed away from mediastinum

Question 6

Features of lobar collapse

Answer 6

Volume loss:

Raised hemidiaphragm on same side
Tracheal and mediastinal shift towards collapsed side
Displaced hila
Narrowed space between ribs in comparison to other side

LUL - veil sign
LLL - sail sign (double left heart border)
RUL - increased opacification of R upper zone and raised horizontal fissure
RML - depression of horizontal fissure, indistinct R heart border and preserved R hemidiaphragm - more obvious on CT
RLL - sail sign on R heart border