Chest X-rays

Question 1

where is the left lingula?

Answer 1

Question 2

which ribs do the lungs & pleura go down to

• on the mid clavicular line?
• on the mid axillary line?

Answer 2

• *lungs:**
• mid clavicular line: 6th rib
• mid axillary line: 8th rib
• *pleura:**
• mid clavicular line: 8th rib
• mid axillary line: 10th rib

Question 3

where are the costophrenic and cardio-phrenic angles?

Answer 3

Question 4

what is the neuronal control of breathing from?

Answer 4

central respiratory control: brainstem - pons & medulla

communicated to the thorax via the phrenic nerve (visceral c3-5) & intercostal nerves

Question 5

what do dense substances appear as on the x-ray?

Answer 5

white :)

Question 6

what is this?

Answer 6

costophrenic angle

Question 7

what is this ?

Answer 7

cardio-phrenic angle

Question 8

label this bestie xox

Answer 8

Question 9

how you approach a chest x-ray? (explain 1 & 2)

Answer 9

• *1. Patient details: (normally in top corners)**
• name
• age / dob
• image type
• date
• previous imaging (for comparison)
• *RIPE**
• Rotation: the medial aspect of each clavicle should be equidistant from spinous process
• Inspiration: (patient should take deep breath in, you see:) 5-6 anterior ribs (or 8-10 posterior ribs), costo-phrenic angles and lateral rib edges should be present
• *- Projection:** AP or PA (standard)
• Exposure: (of the film). left hemi-diaphragm should be visible to the spine and verterbrae behind the heart

then,

Question 10

how do u approach an x-ray? (overview)

Answer 10

• *1. Patient details: (normally in top corners)**
• name
• age / dob
• image type
• date
• previous imaging (for comparison)
• *RIPE**
• Rotation
• Inspiration
• Projection
• Exposure
• *ABCDE:
  i) AIRWAY**
• Trachea
• Carina
• Bronchi
• Hilar Structures
• *ii) BREATHING**
• Lung fields
• Pleural Space
• *iii) Circulation**
• Heart Size
• Heart Borders
• Mediastinum
• *iv) Diaphragm**
• Curvature
• Elevation
• Beneath diaphragm
• *v) Everythng else**
• Bones
• Soft tissue
• Other objects

Question 11

what are the main things that could cause airways to not be correct? (4)

Answer 11

• non-central trachea
• airway obstructions
• foreign bodies
• englargement of hilar regions

Question 12

how do you tell if an x-ray is PA or AP?

who is more likely to have an PA or AP x-ray?

Answer 12

• *PA**
• The standard / default
• Patient must be able to stand
• Can comment on cardiac size
• *AP**
• The ill / recumbent patient
• Scapulae in lung field
• anterior ribs more prominant
• Can’t comment on cardiac size

Question 13

whats wrong here?

Answer 13

• tracheal deviation (to right)

Question 14

whats up here?

Answer 14

hilum enlarged

Question 15

what would you look for ABCDE BREATHING?
what look for that could go wrong? (3)

Answer 15

ii) BREATHING
- Lung fields
- Pleural Space

• *look for:
• opacification / whitening of lungs: infection :(
• collapse of lung
• air of fluid in pleural space**

Question 16

whats wrong here?

Answer 16

whitening of the lung - in the right middle zone of the lung

Question 17

whats wrong here?

how can you tell?

Answer 17

pneumothorax

• A pneumothorax is, when looked for, usually easily appreciated on erect chest radiographs. Typically they demonstrate:*
• • visible visceral pleural edge is seen as a very thin, sharp white line*
• • no lung markings are seen peripheral to this line*
• • peripheral space is radiolucent compared to the adjacent lung*
• • lung may completely collapse*
• • mediastinum should not shift away from the pneumothorax unless a tension pneumothorax is present (discussed separately)*

Question 18

• which areas do you look for with ABCDE CIRCULATION? (3)
• what things do you loo

Answer 18

ABCDE CIRCULATION:

• Heart size (width of the heart should be less than half the size of width of thorax)
• *- Heart borders
• Mediastinum**

Look for:

• Englarged heart - PA view only
• Loss of heart borders

Question 19

what is a cardiomegaly?

Answer 19

• *normal**: width of the heart should be less than half the size of width of thorax
• *cardiomegaly:** width of the heart is more than half the size of width of thorax on PA film

Question 20

whats wrong here?

Answer 20

loss of heart border !

Question 21

what do you look for in ABCDE Diaphragm? (5)

things that might be wrong? (3)

Answer 21

• *Look for:**
• Curvature
• Elevation
• Beneath diaphragm
• Costophrenic and cardiophrenic angles
• *Wrong:**
• Blunted costophrenic and cardiophrenic angles
• Flattened diaphragm
• Sub-diaphragmatic air / gas (dont want !! )

Question 22

whats wrong here?

Answer 22

blunted cardiophrenic and costophrenic angles

Question 23

what do u look for ABCDE Everything else? (3)

what can go wrong?

Answer 23

v) Everythng else
- Bones
- Soft tissue
​- Other objects

• *Wrong:**
• fractures
• discolations
• pacemakers
• inserted lines

Question 24

whats this?

Answer 24

cardiopacemaker

Question 24

whats wrong here?

Answer 24

**air under the right diaphragm**

Question 25

what is dextrocardia?

Answer 25

condition in which the heart is pointed toward the right side of the chest.

Question 26

whats up here? (2)

Answer 26

- trachea is non-central - left lung is completely white (due to fluid build up)

Question 27

whats up here xo

Answer 27

inhaled foreign bodies (dentures)