Dm Ii - Cxr

Front 1

7 identifiable contours onthe frontal cxr

Back 1

Onthe right side of the heart, from top to bottom, are the ascending aorta, theindentation between the ascending aorta and the right atrium (where an enlargedleft atrium may appear), and the right atrium itself. On the left, from top tobottom, are the aortic knob, the main pulmonary artery, an indentation (wherean enlarged left atrium may appear), and the left ventricle.

Front 2

Cardiothoracic Ratio

Back 2

mediastinum <50% of widest part of lungs

Conditions that could make a heart appearenlarged when it isn’t are- pregnancy, ascites, obesity, and anatomicalconditions such as pectus excavatum

Front 3

Parameters for assessing Pulmonary vasculature

Back 3

1. diameter of Right Descending Pulmonary Artery <17mm
2. Thedistribution of flow from apex to base can be assessed by examining the size(not the number) of vessels in two imaginary circles at the right base andeither apex
3. examiningthe gradual and progressive tapering of vessels as they travel from the hilumto the periphery of the lung
   

Front 4

Pericardial Effusion: as seen on CXR

Back 4

"delta" shaped heart (looks like a hanging water balloon). Relatively symmetrical

Front 5

Interstitial Edema (4 main radiographic findings)

Back 5

1. thickening of the interlobular (intrasegmental) septa (Kerley A & Kerley B lines)
2. Peribronchial cuffing
3. Fluid in fissures (b/w lungs)
4. Pleural effusions

Front 6

Pulmonary Alveolar Edema (description of CXR findings)

Back 6

• increased pulmonary venous pressure ( >25 mmHg)
• fluffy, patchy densities
• butterfly/batwing shape (oft spares outer 1/3)

Front 7

Cephalization: definition

Back 7

increased opacification of upper vasculature

not always accurate finding

common in CHF

Front 8

Anterior Mediastinal Masses

Back 8

1. Teratoma (germ cell tumor)
2. Thyroid Goiter
3. "Terrible" Lymphoma (Hodgkin's or non-Hodgkin's)
4. Thymoma (esp in teenagers)

Front 9

Middle Mediastinal Masses

Back 9

• Vascular (aneurysms)
• Bronchopulmonary/Foregut Malformation
• Lymphadenopathy

Front 10

Posterior Mediastinal Masses

Back 10

• Neural tumors
  
• lymphadenopathy

Front 11

"ABC" Method of CXR reading

Back 11

• A: Airway & lung fields: trachea midline? lung radiopacity/radiolucency, location of fissures, air outside normal locations
• B: Bones & soft tissue: fractures, lesions and dislocations e.g. shoulder, sternoclavicular joint
• C: Cardiac contour & mediastinum: cardiomegaly, dextrocardia, mass, mediastinal width
• D: Diaphragm and costophrenic angles: distinct diaphragmatic border, elevation, air under diaphr., blunted costo angles
• E: Everything else:
  Examine technique (PA va AP, Exposure, Rotation)
• F: Foreign bodies, tubes & wires
• G: Gastric bubble(s): LUQ

Front 12

Systematic Approach to CXR

Back 12

1. Lighting
   
2. Verification of patient(Name, DOS, DOB, MRN) and L/R orientation
3. Old CXR for comparison
4. Technique (View: AP/PA/lateral, Exposure, Inspiration: 9-10 ribs, Rotation: clavicles symmetrical)
5. ABCDEFG's
6. Counting ribs for good inspiration
7. Critical Diagnoses (things you can't miss, like PTX, aneurysms, intestinal perforation, esophageal rupture, pericardial effusion/tamponade, masses, etc)

Front 13

CXR findings of CHF

Back 13

• widened mediastinum
• pleural fluid
• Kerley A & B lines
• Butterfly/Batwing
• Cephalization (superior vascularization)

Front 14

The 5 (levels of) radiographic opacities

Back 14

1. Air
   
2. Fat
3. Soft Tissue
4. Bone
5. Metal