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33 Cards in this Set
- Front
- Back
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Indications for CXR
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Acute respiratory illness or dyspnea.
Changing chronic disease ICU/ER setting Suspected pneumothorax Hemoptysis Rib fractures |
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CXR in ICU/ER setting
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Acute trauma
Decomposition of patient Confirm placement of: - Lines - Tubes - Catheters |
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Plain film relies on contrast of 4 radiographic densities
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Air
Soft tissue (water) fat Bone |
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CXR for hemoptysis
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Massive
Recurrent R/F: >40 years +40 pack year |
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CXR not indicated
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Screening
- preoperative exam - carcinoma Nonspecific chest pain Asthma - unless suspected pneumonia, pneumothorax Pregnancy |
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Attenuation
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Intensity of x-ray beam decreases as it passes through matter
- ↑density = ↑attenuation - ↓density = ↓attenuation |
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Radiolucent
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Penetrable to x-ray
Appears black on the film ↓density *example: air |
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Radiopaque
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Impenetrable to x-ray
Appears white on x-ray ↑density *example: lead |
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AP view
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Usually portable
Used when patient is unable to stand Not optimal |
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PA view
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Most common view
Chest against the film Heart closer to film - less magnified - less distorted |
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Chest x-ray views
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PA - posteroanterior
AP - anteroposterior LAT - lateral lateral decubitus oblique |
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Radiographic contrast
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Structures of the same density merge on x-ray
Structures of different densities contrast from one another on x-ray |
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Clinical data for plain films
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Name, date, age, gender, comparison films, clinical problem
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Technical data for plain films
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Completeness: adequate aspiration, four corners
Exposure: is film over or under penetrate? Position: is the patient rotated |
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How to assess for adequate inspiration
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Counting ribs: requires 9 posterior or 6 anterior ribs for adequate inspiration
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4 corner visualization
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Costophrenic angle visible
Apices visible Diaphragm Shoulders |
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Systemic approach for the lungs
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Evaluate density
vascular pattern hilum position of fissures costophrenic angles abnormal opacities silhouette sign |
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Systemic approach for the mediastinum
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Look for the trachea position
Is there widening Assess aorta, heart size, shape, and position |
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Foreign bodies on x-ray
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Make sure you have two views
Mark the nipples Inspect the body for external objects |
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Pneumonia on chest x-ray
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Nonuniform patchy whiteness
Poorly demarcated borders Febrile, coughing Signs of infection |
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Fibrosis on chest x-ray
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Nonuniform/patchy whiteness
Poorly demarcated borders |
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Pleural effusion/lung collapse on chest x-ray
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Uniform whiteness
Well demarcated borders |
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Air bronchogram etiology
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Usually means alveolar disease
- blood, plus, mucus, cells, protein |
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+ silhouette sign
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Loss of cardiac borders
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Pneumocystis jiroveci pneumonia on chest x-ray
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Bilateral infiltrates
- atypical patterns with cavitation lobar infiltrates Nodules Pneumothorax |
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Congestive heart failure on x-ray
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Cephalization of flow
Kerley lines = interstitial edema Cardiomegaly Intra alveolar pulmonary edema |
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Intra alveolar pulmonary edema on chest x-ray
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Patchy ill-defined coalescent densities radiating outward from the hilum
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Pneumothorax on chest x-ray
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Tracheal deviation
Atelectasis of affected lung Shift of heart and great vessels away from affected lung Loss of vascular markings on side of affected lung Visible border of the affected lung |
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Differential diagnosis of hilar adenopathy
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Sarcoidosis
TB Lymphoma Bronchogenic cancer Mets |
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Vascular cavities
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Septic emboli
Tumor emboli Infarct |
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Bronchial cavities
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Aspiration
Lung abscess TB coccidiomycosis |
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Expansion rib lesion
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Plasmacytoma of the rib
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Emphysema with bullae
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Decrease vascularity (most reliable sign for emphysema)
Hyperlucency Increased retrosternal airspace Increased lung volume Bullae: large cavity of captured air |
