Chest Radiography

Front 1

Posterio-anterior xray

Back 1

Patient standing facing xray plate.

Twice as much flow to bottom as top of lungs so there should be many more markings in the lung base than in the apex.

Front 2

Anterior-posterior xray

Back 2

lying in bed. these are not as good as PA or lateral exams

Front 3

Silhouette sign

Back 3

in the chest in particular, you get this due to the juxtaposition of air space adjacent to soft tissue structures. It is defined as an obstruction of normal structure by pathology

Front 4

Long smooth lines vs fluffy borders in lung disease

Back 4

Long smooth lines are usually due to a process occurring adjacent to the pleura while fluffy borders are due to affecting the alveolar lobules

Front 5

You see a meniscus on chest film

Back 5

This is an effusion. It is fluid around the lungs and looks like a smiley face. If it is around the heart borders, it can produce a silhouette sign.

Effusions do not damage the lung

They can be caused by cardiovascular disease, heart failure, trauma, hemothorax, infections, tumor

Front 6

Define the mediastinums

Back 6

Anterior- everything anterior to the heart and great vessels. Thymus and a few lymph nodes are here. Think lymphoma and embryologic remnants

Posterior- from the anterior 1/3 of the vertebral bodies. Contains mostly nerves and some lymph nodes. Think neurogenic mass here (neuroma or schwannoma)

Middle- very busy. Great vessel, trachea, esophagus, most of the lymph nodes

Superior- everything above the aortic arch

Front 7

Patterns of lung disease

Back 7

Alveolar disease
Interstitial disease
Masses and nodules
Bronchial

Front 8

You see small air-filled bronchi surrounded by consolidated lung

Back 8

These are air bronchograms. They indicate alveolar disease. You will see an irregular white opacity with little black lines in the middle. They can only be seen in PA or lateral xrays reliably

Front 9

Alveolar disease differential

Back 9

Edema, infection, hemorrhage, tumor, alveolar proteinosis

Front 10

You see fine reticular lung markings prominent in the periphery

Back 10

This is interstitial disease. It looks like a net. Best seen near the pleural surface. They can be reticular (lots of little lines) or nodular (birdseed scattered around)

Front 11

You see nodular interstitial lung disease

Back 11

could be blastomycosis

Front 12

Characteristics of lung masses and nodules

Back 12

They are usually solid, spherical, well-defined borders, and less than 3 cm in diameter

Front 13

Nodules differential

Back 13

Lung cancer, metastasis, infection, benign tumor

Front 14

Most common benign masses

Back 14

hamartomas and amyloidosis

Front 15

Criteria to call a lung nodule benign

Back 15

patient under 35 with no history of malignancy

Calcified benign pattern

radiographic stability over 2 yrs

Front 16

What would you see on xray with obstructive lung disease

Back 16

over inflated lungs (hyperlucent - too black)

Diaphragm would be black

disorganized vessels and/or bullar

Front 17

You see upper lobe emphysema in a smoker

Back 17

Think centriacinar

Front 18

What do you see with xray of restrictive lung disease

Back 18

lungs are too small

increase in pulmonary markings, especially near periphery

usual interstitial pneumonitis produces peripheral honeycombing

Front 19

Describe cardiogenic edema

Back 19

Known heart disease

Heart is enlarged

Effusions are common

Pattern begins to develop in the perihilar region and it is worse in the lung base because it reflects lung flow

Front 20

Describe ARDS

Back 20

This is non-cardiogenic. It is usually from a known cause such as sepsis, trauma, transfusions, smoke inhalation.

Heart size stays normal

Pleural effusions are rare

Equally bad effusions in the upper and lower parts of the lungs due to capillary leak. Doesn't follow distribution of blood flow because of the number of capillaries all over the lung.