Label this chest x-ray
- Aortic knuckle
Label this diagram
- A - Right main bronchus
- B - Trachea
- C - Aorta
- D - Left main bronchus
- E - Carina
What happens at the carina?
The right and left main bronchus join
Label this diagram
- A - Costophrenic recess
- B - Costophrenic angle
What is this radiograph showing?
A lobar collapse
What is the radiological indicator of lobar collapse?
Displacement of the horizontal fissure
When is the horizontal fissure displaced upwards?
If there is volume loss of the right upper lobe (i.e. in a collapse)
When is the horizontal fissure displaced downwards?
If there is volume loss of the right lower lobe (i.e. in a collapse)
What is this radiograph showing?
How can consolidation be identified on a radiograph?
Compare the middle zones
When is the lung said to be consolidated?
If the alveoli and small airways fill with dense material
What may consolidation be due to?
What may cause consolidation in infection?
When may consolidation due to infection occur?
When may consolidation due to fluid occur?
When may consolidation due to blood occur?
When may consolidation due to cells occur?
What happens on an x-ray if an area of the lung is consolidated?
It becomes dense and white
How can you tell if larger airways have been spared in consolidation of the lung?
They are of relatively low density, and therefore appear blacker on a x-ray
What is the phenomenon whereby the x-ray of a patient with consolidation appears dense and white known as?
What is being shown in this diagram?
A large, round, thick-walled lung cavity
What has caused the cavity in this x-ray?
Squamous cell lung carcinoma
What is being shown in this x-ray?
What is a pleural effusion?
A collection of fluid in the pleural space
Where does fluid gather in a pleural effusion?
In the lowest part of the chest, depending on the patient's position
What will be shown on an x-ray of a patient with pleural effusion if the x-ray is taken when the patient is standing?
The pleural effusion will obscure the costophrenic angle/hemidiaphragm
When is a pleural effusion difficult to see on a x-ray?
When the patient is supine
Why is a pleural effusion difficult to see on a x-ray when the patient is supine?
Because the pleural effusion layers along the posterior aspect of the chest cavity
How do pleural effusions appear on x-rays?
Uniformly white, with the Meniscus sign
What is the Meniscus sign?
A concave area on the top of a pleural effusion, shown on x-ray
When does a pneumothorax form?
When there is air trapped in the pleural space
Why may a pneumothorax occur?
- May occur spontaneously
- May occur as a result of underlying lung disease
How does trauma cause a pneumothorax?
Laceration of the visceral pleura by a fractured rib
When is a pneumothorax a medical emergency?
When it is a tension pneumothorax
What is a tension pneumothorax?
If there is tracheal or mediastinal shift away from the pneumothorax, the pneumothorax is said to be under tension
What pushes the trachea in a tension pneumothorax?
Air in the pleural cavity
Why is the left hemithorax black in a x-ray of a tension pneumothorax?
Because of air in the pleural cavity
What are the signs of a tension pneumothorax on an x-ray?
Illustrate these signs on an x-ray
- The lung lung is completely depressed (arrowheads)
- The trachea is pushed to the right (arrow)
- The heart is shiften to the contralateral side, and the right heart border is pushed to the right (red line)
- The left hemidiaphragm is depressed (yellow line)
What should you do if you diagnose a pneumothorax clinically?
Treat the patient, do not request an x-ray to confirm
What is shown in this x-ray?
Label this x-ray
- A - Soft tissue mass
- B - Tracheal shift
- C - Spinous process
- D - Medial clavicles
When may the trachea not genuinely be displaced to one side?
If the patient is rotated
What should you do if the trachea is displaced to one side?
Try to establish if it has been pushed or pulled by a disease process
What will push the trachea and mediastinum away from it?
Anything that increases pressure or volume in one hemithorax
Give 3 examples of things that may push the trachea and mediastinum away from it
- Tension pneumothorax
- Pleural effusion
What will pull the trachea towards it?
Any disease that causes loss of volume in one hemithorax
Give two examples of things that may pull the trachea towards it?
- Collaped lung
What is this x-ray showing?
Calcified asbestos related pleural plaques
Are asbestos plaques malignant or benign?
Generally considered to be benign
What is the characteristic apperance of asbestos plaques?
- Classically said to look like holly leaves
What does this x-ray show?
What can lead to hyperinflation of the lungs?
What does lung hyper-expansion lead to on an x-ray?
- Blunting of both costophrenic angles
- Flattened hemidiaphragms
What condition is shown in this x-ray?
What is seen on x-ray with a pneumoperitoneum?
Lungs are normal, but air is seen under the diaphragm
What is pneumoperitoneum a sign of?
What is measured when calculating the cardiac index (cardiothoracic ratio)?
The widest part of heart and ribcage
When is the heart said to be enlarged?
If the heart is over 50% the width of the thorax