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50 Cards in this Set
- Front
- Back
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basic approach list for the CXR
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Film quality
Lines & tubes bones soft tissues heart mediastinum pleural space lungs |
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what 3 things are important in fol quality?
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penetration, position, includes all structures
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what does it look like if it's under-penetrated?
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too white
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over-penetrated looks how?
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too dark - one can see the spine
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what bones do we see on CXR?
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Vertebra - lower cervical, thorachic and upper lumbar
shoulder = proximal humerus, scapula + clavicle ribs manubrium sternum xyphoid |
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what soft tissues are seen on CXR?
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neck, chest wall, abdomen: liver/gall bladder, stomach, spleen, colon
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for lines on the CXR, what is important?
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is the line in the correct anatomic location? GET a lateral - 90 degrees to the first view
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where should the endotracheal tube be placed?
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3-5 cm above carina for optimal position
flex neck: ET goes down 2.5cm extend neck: ET goes up 2.5cm!! |
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Dobhoff tube
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Nasoduodenal Feeding Tubes
A small-bore, flexible silicone tube usually inserted into the nose with a weighted tip that should preferentially be past the pylorus Used for nutrition in patients who Require mechanical ventilation Have an altered mental status Have swallowing disorders It is a narrow-bore (3mm-8 French) which can be left in place for 6 weeks or more Causes less local irritation than nasogastric tubes Unlike a large-bore nasogastric tube, it is not attached to suction |
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Quinton Catheter
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The QUINTON™* PERMCATH™ Dual Lumen Catheter functions as a bridge device during fistula maturation or a long-term vascular access for hemodialysis, apheresis or infusion. It's round lumens provide blood flow rates of 350-400 mL/min as well as maintain low arterial and venous pressures. The catheter is made of a soft, silicone material and is designed with a staggered tip to provide a 2.5cm separation between the arterial lumen and venous tip. The oval shape of the catheter, in combination with its silicone construction, affords it superior kink resistance making it ideal for left-sided or difficult placements.
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WHat happens when the ET passes carina into main stem bronchus?
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into RMSB 27/28 of cases
Lt LUNG atelectasis - LMSB blocked Can cause RUL atelectasis by blocking RUL bronchus occlusion of the main stem bronchus: -amounf of atelectasis depends on: 1) ammount of air in lung when tube obstructs bronchus 2) high O2 increases progression of atelectasis |
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where should the Enteric tube pass?
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below the left hemi-diaphragm
-NG tube -Dobhoff - deadly tube - stiff tube - can go down MSB |
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where could you approach putting a vascular catheter line?
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1) Subclavian (lt. vs rt.) line
2) Internal jugular line Types of LINE -Quinton Catheter -Swan-Ganz catheter -Normal vascular catheter |
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percutaneous central venous catheter complications
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Pneumothorax (5.6%) for subclavian approach
perforation of a vein catheter coiling, kinking, breaking thrombophlebitis |
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what's the major dange of putting chest tubes? how to avoid?
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-hemorrhage from lacerated intercostal vessel
-insert tube as close as possible to the superior surface of the rib - go over top of rib |
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chest tube for pneumothorax vs effusion?
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pneumo: go anterior
effusion: go posterior |
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how can I tell where the chest tube has the enterence?
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the break in the white line = first / proximal hole, going from outside to in
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viewing the mediastinum - what can we see on the anterior view? lateral view?
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the three compartments are superimpsed on themselves in PA view
lateral view: spreads the mediastinum out to three distinct compartments |
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what's in the anterior mediastinum normally?
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boundaries:
-front of trachea, aorta and heart, -behind the anterior chest wall contents: -internal mammary vessels -internal mammary and prevascular Lymph nodes -thymus |
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what are the terrible T's
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the 4 most common masses in the anterior mediastinum:
Terrible lymphoma Thymoma Teratoma Thyroid |
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what's the most common anterior mediastinal mass in an adult?
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Terrible lymphoma
90% Hodgkin's Lymphoma --> mediastinal nodal 50% non-hodgkin's L lobulated mass rarely Ca2+ (unless rxed) |
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Thymoma/abnormal thymus
-age range -assoc with? -Ca 2+?? -growth?? |
age 45-50
assoc w/ myasthinia gravis (30-55%) 25% Calcificed Grow around (soft) other structures - trachea is not displaced |
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what are the kinds of teratoma seen in the anterior mediastinum?
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Germ cell tumors:
-Teratoma -Seminoma -Choriocarcinoma -Endodermal sinus tumors -Embryonal cell carcinomas |
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where do the teratomas of the mediastinum come from?
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arise from collections of primitive germ cells that arrest in anterior mediastinum on journey to gonads during embryonic development
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what kinds of tissues are in teratomas?
what's the age range? M:F? is it often malignant?? |
has ecto- meso- and endo-dermal tissue
age: 20-40 M:F = 40/60% malignant - usually males |
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what are some characterisitics of teratomas:
1) position 2) margins? 3) malignant? 4) Ca? 5) cystic?? |
1) 90% in anterior, 10% posterior mediastinum
2) round/smooth margins = benign; irregular/lobulated margins = malignant 3) must obtain tissue to determine if benign or malignant 4) Ca 33-50% 5) can be cystic |
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what does the thyroid nass do?
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a firm thyroid mass pushes other structures around - such as trachea
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what are the contents of the middle mediastinum?
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heart, ascending aorta, pulmonary srteries & veins, main stem bronchi, lymph nodes
boundaries: -anterior and posterior aspect of trachea, pericardium and heart, rt. and left hila the hila: Lymph nodes are lobular Vascular structures have smooth edges and are tapered |
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what should you think if there are abnormalities in the HILA?
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Lymph nodes:
-lymphoma -sarcoid -mets Vessels -pulmonary artery hypertension |
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what do mediastinal lymphoma look like?
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unilateral or bolateral hilar enlargement and subcarinal adenopathy
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what are signs of Sarcoid?
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1,2,3, sign:
-rt.paratracheal, rt and left hilar hilar enlargement -rare to have pleural effusion -may be associated with sarcoid changes of the lungs |
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describe the vessels in pulmonary hypertension
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smooth edges on the vessels with tapered structures
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what's in the posterior mediastinum?
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mid-distal esophagus, nerve structures
90% post med. masses are neural in origin anterior boundary: post to trachea, heart and IVC posterior boundaries: spine and proximal ribs |
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what's a pneumomediastinum?
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air in the lateral aspect of soft tissues of mediastinum
may see air in vascular sheaths in neck note air tracking in mediastinal soft tissues pneumomediastinum in infant: air displacing the thymus superiorly and laterally |
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if you see a pericardium its..
if it's calcified? |
abnormal -
calcified = usually 2/2 TB |
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how can we see a bleed into the pericardium?
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enlarged cardiac silhouette - s/p heart surgery
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On the PA CXR, the borders on the heart are:
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Left: LV
Right: RA |
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On the Lat CXR, the borders on the heart are:
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Post Sup: LA
Post inf: LV Anterior: RV |
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heart size criteria
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normal:
adult <50% CT ratio child <65% CT ratio (cardio-thoracic) cardiomegaly: -adult >50% -Child >65% |
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on the lateral CXR, draw a line LUL bronchus
so, bottom black hole to anterior chest and anterior diaphragm what's above / below?? |
above line: aortic
below line: mitral |
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what's the posterior sulcus sign?
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on a supine film, there is a black space between diaphragm and lung = pneumothorax
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what mimics a pneumothorax?
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a skin fold
line does not conform to throax curvature (straighter) lung markings lateral to line lung area more dense medial to line 2/2 increase thickness of skin older pt, supine position from ICU, CCU, portable wards, shock room ER Pneumo: curved line, no lung markings, nl lung density medial to line, line continuous skin fold: -line straight, lung markings beyond line, increased lung intensity medial to line, line non-continuous |
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pleural effusion upright- PA
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fluid layers out:
1) posterior sulcus fills first 2) costophrenic angles (meniscus sign) 3) develop black/white sign and loss of Black/Grey/white sign |
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don't mistake a pleural effusion for a
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grid-cut-off
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hydropneumothroax
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straight line across hemi-thorax on PA CXR
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pleural calcifications due to...
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Asbestosis and TB
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in pleural Calcifications 2/2 asbestosis and TB, the most abnormal part of the CXR is ...
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is laterally and at diaphragm, not perihilar area
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PCP lung
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ground glass apprance - interstitial diserase - also infected BULLA LLL
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CHF CXR changes
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nl lung with pulmonary edema
-vascular congestion -alveolar filling emphysematous lungs with pulmonary edema -vascular congestion -interstitial filling (linear) 2 stagesL 1) Hilar and perihilar congesion 2) Bat wing distribution 2/2 alveoli filling with fluid |
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what's atelectasis
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alveoli collapse
bronchi remain patent see air bronchograms but they are close together 2 causes: 1) obstructive 2) compressive |
