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58 Cards in this Set
- Front
- Back
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System for interpreting CXR
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Check technical aspects (projection, rotation, penetration, inspiration)
Cardiac shadow (size, shape, calcification (pericardial, valve, or coronary) Medinastium (position, width, outline, density, tracheobronchal tree) Hila (size, position, density, concave lateral borders) |
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How to tell if CXR is rotated
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Distances between midline and clavicles
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CXR penetraation
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Should just be able to see IV disc spaces through mid-cardiac shadow
Pulmonary structures visible with clarity Few vessels in outer third |
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CXR breathing
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Should be full inspiration
Should be able to see 6-7 anterior ribs before it crosses the hemidiaphragm, 10-11 posterior ribs |
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Normal cardiac XR
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Should be less than 50% of chest horizontally (cardiothoracic ratio)
Shape - enlarged, reflux, VSD / PDA, failing LV |
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Things to check of mediastinum on CXR
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Mass, deviation, ratio of heart R:L is 1:2, deviation of the trachea, Needs straight PA CXR
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Borders of mediastinum
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Aortic arch, main (left) pulmonary artery, left atrial appendage, left ventricle, Brachiocephalic vein, SVC, RA, IVC
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Hila in CXR
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Constituents, position of hilar point, outline (v shaped, smooth not lobulated), Left 2.5cm higher than right, displacement indicates collapse
Density |
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Bilateral large dense hila
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Sarcoid unless proven otherwise
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Lungs on CXR
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Size, translucency, fissures, focal density, or generalised pulmonary infiltration
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Emphysema on CXR
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Overinflated, increased translucency, low flat diaphragms, attenuated vessels
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Centrilobular emphysema
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Upper lobes, seen in smokers
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Pulmonary collapse on CXR
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Regional volume loss
Medinastinal shift HIlar displacement Splayed vessels Rib crowding Abnormal transradiency Reduced is compensatory emphysema Increased is a collapsed lobe |
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Focal densities in lung cancer CXR
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Solitary peripheral mass, irregular spiculated pleural tail
Cavitation - blacker in the middle due to necrosis (16%) Central mass (38%) Unilateral hilar enlargement Pulmonary collapse |
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Air space shadowing
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Air-space shadowing (alveolar)
Air bronchogram (air alveologram) Ill defined Non-segmental May coalesce May have nodules = fluid filled alveoli Consolidation |
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Intersitital shadowing on CXR
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Linear - thickened interlobular septa, lymmphatic causes, venous causes eg LVF, connective tissue causes
Nodules - Infections, granulomatous conditions, metastasis, pneumoconiosis |
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Pleural effusions
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Typical
Interlobar Sub-pulmonary Massive Tension |
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Abnormal gas collections
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Pneumoperitoneum on AXR
Riglers sign - gas outlining serosal surface of bowel Triangular gas collections Loss of liver opacity Gas outlining falciform ligament Gas outlining umbilical ligaments |
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Hernias
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External - inguinal, femoral, obturator, lumbar, ventral, spielian
Internal - formaen of Windlow, Ligament of Treitz Gas may be not present normally in bowel as instead is in the herniation |
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Biliary gas
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..slide
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Retroperitoneal gas
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Looks like bubblerap
Due to perforation Very severe necrotising acute pancreatitis |
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Bladder gas
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Colovesical fistula - diverticular disease, colon cancer, IBD
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Ureteric gas
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Fistula, gas forming infection..
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Bowel wall gas
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Simple - pneumatosis cystoides intestinalis
Serious - Bowel necrosis, diabetic, necrotising enterecolitis (neonates) |
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Abdominal calcifications
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Gall stones, (gall bladder - clefts within it filled with nitrogen gas, biliary traact, small bowel)
Gall bladder wall - porcelain gall bladder, more common in females, can precede cancer |
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Renal tract calfication
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Renal area (mostly done on CT)
Staghorn calculi Ureteric calculi Renal tract calfication (TCC) Renal parenchymal calfication (Tuberculous autonephrectomy)) |
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Pancreatic calfication
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Chronic pancreatitis - tiny spots of calfication
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Pleural masses
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Homogenous density
Borders Well defined on one aspect Ill defined elsewhere and blends with the pleura |
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Vascular calcification
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Aortic aneurysm
Linear areas of calfication outlining a mass Is peripheral in intima |
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Bowel related opacities
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Faecolith - Appendix, diverticulum, Bezoar (eating indigestible items)
Dermoid cyst |
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Liver
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Hepatomegaly
Displaces everything away from it |
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Kidneys
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Outlined by perinephric fat, renal outline. 3.5 vertebral bodies
Obliquely orientated |
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Abdominal wall
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Psoas lines - absent in 29% of normal individuals. Loss of line may indicate retroperitoneal mass or haematoma
If present should be bilateral |
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Pneumothorax
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White line of pleural edge
Avascular zone <2cm deep is small >2cm deep is large |
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Tension pneumothorax
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Mediastinal displacement
Tracheal displacement Diaphragmatic depression |
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Interpreting lungs
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Size, translucency, fissures, docal or generalised pulmonary infiltration, pleural spaces - effusions soft tissue masses calcifications, pneumothorax
Bone - fractures, lytic lesions, sclerotic lesions, metastasis |
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Bones
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Fractures, lytic lesions, sclerotic lesions, commonest bone lesion in over 40s is a metastasis
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Soft tissues
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Look for masses, calcification
Check for breast shadows Left supraclavicular soft tissue Hodgkin's lymphoma Left axillary soft tissue Non-Hodgkins Lymphoma |
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System for looking at abdominal x rays
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Check technical aspects - Name date projection (will be supine) peentration, coverage
Bowel gas pattern Hernial orifices Calcification Viscera retroperitoneum and abdo wall Bones |
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Small bowel gas patterns
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Valvulae - 2mm thick
Bowel wall 2mm thick Narrow curvature Small bowel should not really be bigger than 3cm - if so is abnormally dilated (obstruction, ileus) Fluid levels Dilated loops of small or large bowel - sentinel loops - acute pancreatitis/cholecystitis/appendicitis/pyelonephritis/diverticulitis Usually adjacent to the effected organ |
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Large bowel gas pattern
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Haustral folds
Peripheral Faecal residue <6cm transverse <9cm caecum Wall thickening in Colitis, ischaemia, diverticular disease, malignancy. Normal is 3mm. |
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Round target / popcorn lesions on CXR |
Calcification, indicates that the lump is benign. Eccentric lesions may not be benign however |
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Features of PE on CXR |
Cardiomegaly (usually left side??!), upper lobe venous distention, intersitial lines, pleural effusions, bats wing perihilar consolidation |
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Large pleural effusion without mediastinal shift? |
Lobar collapse, indicative of cancer |
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Band shadows on CXR |
Small area of colapse - atelectasis. Can be an entire lobe, or a whole lung |
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Sail sign, ribs closer together |
Left lower lobe collapse. |
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Can't see heart |
Left upper lobe collapse - same density so no border appeared. Veil like density |
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ill defined pulmonary density, air bronchogram, silhouette sign |
Consolidation. Water, pus blood, tumour, protein |
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Groud glass seen on CT |
Bilateral consolidation |
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What can cause pseudopneumothorax |
Skin folds. But a real pneumothorax will NEVER have visible vasculature |
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Bubblewrap in the neckLow density streaks in the mediastinum, unusually welll defined structures |
Surgical emphysema Pneumomediastinum |
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Lungs too darkFlattened hemidiaphragms (<1.5cm)7+ anterior ribsBarrel chest |
Overinflation / emphysema |
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Large airspace in lung outlined |
Bulla, in tall thin people can promote pneumothorax |
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Nodule vs mass |
<3cm is a nodule, >3cm is a mass |
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Heteroogeneous mass |
May have cavitated |
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When giving a CXR for suspected pneumoperitoneum |
Errect posture for >10min |
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Peas in the pelvis |
Bladder calculi |
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Pelvic stones with clefts within |
Gall stones |
