Portable exams or for patients unable to perform a PA x ray
When is an AP chest x ray indicated? (Beam goes from the anterior aspect to the posterior aspect of the patient)
PA (lateral also used; oblique is reserved for analysis of findings from a PA or AP exam)
What is the most common chest x ray? (Beam goes from the posterior aspect to the anterior aspect of the patient)
Sail sign on the right side of the chest
How does the thymus appear on chest x rays of a child?
Beam burns through the lungs (so they are black)
You can see spine well below the hemidiaphragm
You can see spine well below the hemidiaphragm
What is seen in a chest x ray with poor exposure: over penetration?
Central vessels appear more prominent than is actual
Base appears to have bilateral infiltrates or atelectasis
Base appears to have bilateral infiltrates or atelectasis
What is seen in a chest x ray with poor exposure: under penetration?
Insure there are sharp margins (blunting can indicate small amounts of fluid or pleural thickening)
How should you evaluate the cardiophrenic and costophrenic angles?
Apical region (top of the lungs)
What is the most commonly missed area when doing a chest ray evaluation?
FACT: Don’t miss that clavicle fracture in the patient with chest pain
No in both counts
Is a chest x ray a substitute for a rib series? Is a specific pattern required to interpret a chest x ray?
Assesses for hemidiaphragm
As you take an agressive sniff, if one side of the diaphragm moves up you have a paradoxical hemidiaphragm, and that is a very bad sign that suggests phrenic nerve damage
As you take an agressive sniff, if one side of the diaphragm moves up you have a paradoxical hemidiaphragm, and that is a very bad sign that suggests phrenic nerve damage
What is the sniff test and what is it testing for?
FACT: The costovertebral angle is the most sensitive for detection of minimal fluid
Large heart mass on the left chest
How does LV hypertrophy show up in an x ray?
Notice the sharp visceral pleural line on the right chest (as well as no lung markings past the line)
How does a pneumothoxax show up in an x ray?
Right ventricle is anterior to the left ventricle
Above the left ventricle (and posterior to the right ventricle) you see the left atrium
Above the right ventricle (and anterior to the left atrium) you see the right atrium
Above the left ventricle (and posterior to the right ventricle) you see the left atrium
Above the right ventricle (and anterior to the left atrium) you see the right atrium
Lateral chest x ray: where is the right ventricle? Left ventricle?
Heart and mediastinum shifts away from the pneumothorax
Lung collapses medially
Patient usually in distress and pain
Lung collapses medially
Patient usually in distress and pain
How does a tension pneumothorax show up in a chest x ray?
Pneumothorax
A 20 year old presents with SOB, severe right sided chest pain and hx of MVA 3 days ago. Your immediate concern is…
Tall lungs
How does COPD show up in an x ray?
Early sign of pulmonary edema
What are Kerley B Lines and what are they a sign of?
False
True or false: ARDS always have pleural effusions
Thoracic ultrasound is a good guidance technique for thoracentesis
Provided the chest Xray has no significant chronic change, the V/Q scan has high sensitivity and specificity for detection of pulmonary thromboembolism
MRI thorax is not optimal for evaluation of lung pathology
CT angio (PE CT) IS a good way to detect PTE and evaluate other lung pathology
5) High resolution CT chest is primarily used to evaluate lung parenchymal disease.
6) AP chest Xray refers to the Xray beam direction passing from the anterior aspect of the patient toward the posterior aspect of the patient
7) PA refers to a posterior to anterior Xray beam path and is the preferred method to obtain a chest Xray.
8) A pneumothorax can be life threatening.
9) Criteria for pneumothorax diagnosis by Chest Xray include a sharp visceral pleural line, and lack of lung markings lateral to the suspected pneumothorax
10) Tension pneumothorax causes shift of the heart and mediastinal structures AWAY from the pneumothorax.
11) Kerley B lines are located peripherally and can be an early sign of interstitial pulmonary edema but lymphatic congestion may also be an etiology.
12) CHF usually has cardiomegaly, central vascular congestion, infiltrates and pleural effusions.
13) ARDS usually does not have cardiomegaly or pleural effusions but does have extensive bilateral pulmonary infiltrates
14) The minor fissure is in the right lung.
15) The major fissure can be found in both lungs.
16) The costovertebral angle blunting on the lateral chest Xray is the earliest radiographic sign of a small pleural effusion
17) Overpenetrated films and underpenetrated films should not be accepted since pathology can be missed.
18) Portable chest exams are NOT a substitute for a PA and lateral study.
19)When evaluating a chest Xray, each area should be reviewed in a systematic fashion
20) Lung collapse (atelectasis) may cause shift of the heart and mediastinum TOWARD the affected lung
21) A Pleural effusion may cause shift of the heart and mediastinum AWAY from the affected side.
22) A radiographic sign for pericardial effusion is the “water bottle heart”.
23) A right middle lobe infiltrate will cause ill definition of the right heart border.
24) A lingular (left upper lobe) infiltrate will cause ill definition of the left heart border.
