Session 8 - Radiology of the chest Flashcards Preview

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Flashcards in Session 8 - Radiology of the chest Deck (35)
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Which is ideal, a PA or AP chest xray? When is each done?

• PA (posterior to anterior) – Xray done when person is facing a wall and is ideal. This is because the heart is closer to the chest and if the Xray hits the heart first it would magnify it, in much the same way that a shadow puppet is magnified when closer to the source of light.

• AP (anterior to posterior) – Done when the patient is sitting down, usually because they are unable to stand. Inferior to PA. Can see the scapula in AP.


How do you use the trachea to align yourself in an chest X ray?

• Spinous process of the trachea should be in the middle of the ends of the clavicles. Otherwise there is tracheal deviation.


Why should the patient take a complete inspiration before taking the CXR? Where is the diaphragm located in a full inspiration CXR?

• Patient must take a full inspiration in so that the diaphragm can be located between the 5th and 6th intercostal space.


• If incomplete inspiration:

o Structures compressed upwards making heart look bigger and ribs closer


What is an artifact?

external or surgical material which obstructs the view





What part of the heart is depicted in the left and right heart borders?

Left heart border is the left ventricle.

Right heart border is the right atrium.


Which hilar point is higher? What could the hilar points be used to indicate?

Left hilar points should always be above the right.

Collapse in the lung moves the hilar points


What is the carina and what can make it smaller?

Splitting of the bronchi. Angle is very important and can be made larger by a growth underneath e.g. growth of atria


What might loss of a silhouette of an organ indicate?



Give the ABC approach for assessing CXR.

• Adequacy

• Airway

• Breathing

• Circulation

• Diaphragm / Dem bones


How would you assess adequacy?


R – Rotation – Spinous processes at midpoint between medial ends of the clavicles?

I – Inspiration – Diaphragm found at 5th to 6th intercostal space?

P – Penetration – Spine visible behind the heart?


How would you assess airways in a CXR?

• Hila – check left hilum is above right

• Trachea – check trachea is central


How would you assess breathing in a CXR?

• Check the lungs, pleural spaces, lung interfaces.

• Are there any nodules? Consolidation? Calcification? Compare the 2 sides.


How would you assess circulation in a CXR?

Check the mediastinum:

o Aortic arch

o Pulmonary vessels with hila

o Right heart border – right atrium

o Left heart border – left ventricle and lingula interface (tongue of left lung)


How would you assess diaphragm / bones?

Check for free gas, nodules, fractures, and masses


What is a pneumothorax? What would be shown on an xray of a tension pneumothorax?

Air trapped in a pleural space Lung is black due to trapped air in chest

Trachea may deviate due to higher pressure

Depression of diaphragm due to pressure

Loss of lung markings


What is a pleural effusion? What would be shown on a CXR of a pleural effusion?

Collection of fluid in the pleural space

Uniform white area

Loss of costophrenic angle - angle at which diaphragm and chest wall meet

Obscured diaphragm

Visible meniscus

Mediastinal shift due to pressure


What are the 3 likely causes of lobar lung collapse?

Child - aspirated foreign material

>40 - cancer

Asthmatics - mucous plugging


What would be shown on a CXR of a lobar lung collapse?

Mediastinal shift towards collapse due to lower pressure

Elevation of diaphragm.


Define consolidation

Filling of the small airways / alveoli with stuff


What would be shown on a CXR of consolidation?

Dense opacification over the area with preservation of volume


What would cause a space occupying lesion? Give 3 things

Inflammation, malignancy, congenital


How would you identify cardiac enlargement on a CXR?

Cardiac index - Ratio of heart to thoracic cavity should be less than 50% on a PA image


Give the pathology of fibrosing alveolitis. What would be shown on a CXR? What would a lung function test reveal?

Increased activated alveolar macrophages which attracts neutrophils and eosinophils, resulting In lung damage due to ROS and proteases. Tissue destruction and fibrosis occurs. idiopathic


X-ray – Small lungs with micro-nodular shadowing predominating in the lower lobes with ragged heart borders


Lung function test shows reduced compliance and reduced gas transfer


What would a CXR of sarcoidosis reveal?

Miliary and nodular shadowing and diffuse fibrosis


Give 4 factors that would increase pleural fluid in the pleural space.

• Lymphatic obstruction

• Increased capillary permeability,

• Decreased oncotic pressure,

• Increased capillary venous pressure,


Give the terms for extra: a) blood b) chyle c) pus d) serous fluid in the pleural space.

a) haemothorax b) chylothorax c) empyema d) simple effusion


Define a transudate and an exudate

Transudate – Low protein content <30g/litre

Exudate - High protein content >30g/litre


Give 3 factors that would result in transudate pleural effusion

• Increased hydrostatic pressure e.g. cardiac failure

• Decreased oncotic pressure e.g. hypoalbuminaemia, nephrotic syndrome

• Increased capillary permeability e.g. sepsis


Give 3 factors that would result in exudate pleural effusion.

• Neoplasms – cancers producing pleural fluid

• Infection e.g. pneumonia and TB

• Immune disease e.g. connective tissue diseases