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34 Cards in this Set
- Front
- Back
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How do you check the Rotation on a CXR?
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Check the spacing between the medial borders of the clavicles and the spinous processes
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which way should patients face when having a chest x-ray taken?
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they should face the machine
ICU patients sometimes have to go back first |
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Why is it important which way the patient faces on the x-ray machine?
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If the patient's back is against the machine it can cause the heart to be magnified
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How can you tell if the Penetration is correct on a CXR
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Thoracic spine is barely visible through heart
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How can you tell if the Penetration is over-penetrated?
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Too Dark
Lung Markings (vessels/bronchi) will be obscured |
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How can you tell if the Penetration is under-penetrated?
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Too Light
Lung markings will be prominent Lower Lung Zones and Diaphragm Obscured |
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Elements and Order of Systematic Review?
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Pulmonary
CV Skeletal Soft Tissues GI |
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Regional Review?
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1. Heart and Mediastinal Structures
2. Lungs-Apices and Costophrenic Angles 3. Corners of Film-shoulders, neck 4. Below Diaphragm 5. Behind Heart |
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Normal Pulmonary Vascular Size?
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In upright position, the upper lobe vessels are smaller than lower lobe vessels
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Supine Pulmonary Vascular Size?
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Upper Lobe Vessels and Lower Lobe Vessels are the same size
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Inhalation (muller maneuver) Pulmonary Vascular Size?
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Decreased Intrathoracic Pressures => vessels larger
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Exhalation (valsalva) Pulmonary Vascular Size?
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Inc Intrathoracic Pressures => vessels smaller
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CHF signs on CXR
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-Cephalization/Redistribution of Pulmonary Blood Flow
-Interstitial Edema -Alveolar Pulmonary Edema -Pleural Effusion |
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How does Cephalization/Redistribution of Pulmonary Blood Flow appear on CXR?
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In upright position, vessels going to upper lobes are larger than vessels to lower lobes
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What is the most common pulmonary vascular abnormality?
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Pulmonary Venous HTN
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Common causes of Pulmonary Venous HTN?
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Left Heart Failure
Bilateral Heart Failure High Output Failure Fluid Overload Mitral Stenosis Veno-occlusive disease |
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What is Pulmonary Venous HTN often associated w/?
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Congestion of all vessels (SVC, Azygous, etc)
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Three Elements(?) of Pulmonary Congestion?
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Pulmonary Venous HTN (excess fluid in vessels)
Interstitial Edema (high press-->diffusion through caps) Alveolar (Pulm) Edema (fluid press>air press in alveoli) |
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3 CXR Signs of Interstitial Edema?
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Kerley's B Lines
Bronchial Cuffing Indistinct Margins of Vessels |
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What are Kerley's B Lines and what do they represent?
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They're horizontal lines about 1cm long on the pleural surface. Most prominent in lower lung zones
They = fluid in interlobular septae |
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What is a Bronchial Cuffing?
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Thick white line seen around outside of bronchi
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What is going on with Indistinct Margins of the blood vessels?
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Fluid in the interstitial spaces (outside vessels) obscures the vessels
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What does Alveolar Pulmonary Edema look like?
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Patchy (fluffy) densities in the perihilar areas
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What happens to Alveolar Pulmonary Edema as CHF worsens?
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The edema will fill in the perihilar areas and extend peripherally to create a bilateral symmetric pattern
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What's up with an Air Bronchogram?
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Fluid filling the alveolar spaces or collapsed alveoli will cause a density difference w/ the air filled bronchi
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What are collapsed alveoli called?
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Atelectasis
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How are air bronchograms identifiable on CXR?
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you can follow the bronchi farther out into the lungs than normal
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How does Pleural Effusion look on CXR?
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Silhouetting of the Diaphragm and costophrenic angles
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What do the Mediastinal borders represent on PA CXR?
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Right Side = SVC and RA
Left Side = Aortic Arch, Pulmonary Artery, LA, LV |
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How can you visualize Pulmonary Emboli?
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Pulmonary Arteriogram (not much anymore)
Computed Tomography Nuclear Medicine Ventilation/Perfusion Scan (not much anymore) |
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Kicker sign of Pulmonary Embolism on CXR?
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wedge shape
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Which chest study is best for visualizing the lower lung zones?
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Decubitus Radiographs of Chest
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If patchy densities are present in the perihilar regions bilaterally in a CHF patient, and the densities are symmetric, then which spaces are filled with fluid?
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Alveolar Sacs
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What is the most sensitive radiographic study to detect pleural effusion?
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Decubitus radiographs of the chest??
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