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Definition
| is the property of relative transparency to the passage of X-rays through a material |
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Definition
indicates greater transparencyto X-ray photons
i.e. Air/Fat |
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Definition
indicates greater opacity to X-ray photons.
Greatest radiodensity appears white i.e. bone, barium |
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Definition
Slants slightly to right
Bifurcates at Carina
level of sternal angle anteriorly and
fourth thoracic spinous process posteriorly |
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Definition
•Identify first rib by finding its anterior junction with the manubrium and following this rib backward to the spine
•Then count down the posterior ribs
•Begin at the origin of the first rib at its junction with the first thoracic vertebra and trace each rib as far anteriorly as you can to the beginning of the radiolucent (and hence invisible) costal cartilage
•If you can count 9 or more ribs àgood inflation |
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Definition
•Upper zone veins dilate and are equal in size or larger
(Cephalization, The antigravitational redistribution of pulmonary blood flow that occurs with heart failure, caused by increased vascular resistance in the dependent part of the lung, a consequence of pulmonary venous hypertension; usually described on the basis of relative vascular size on chest radiography.)
1st sign of early CHF, pulmonary edema |
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Term
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Definition
•Interstitial edema occurs with the appearance of Kerley B lines
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Term
| Posterioranterior (PA) and Lateral Chest X-ray |
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Definition
Standard CXR. The films are read together. The PA exam is viewed as if the patient is standing in front of you with their right side on your left.
The patient is facing towards the left on the lateral view. Comparison films can be invaluable - Old Gold!
If you have comparison films, the old PA film is displayed adjacent to the new PA film and the old lateral is displayed adjacent to the new lateral.
Old PA, New PA New LA, Old LA |
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Term
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Definition
The PA film is obtained with the patient facing the cassette and the x-ray 6 feet away. AP laying flat.
AP, Magnification of the heart and widening of the mediastinum The pulmonary vasculature is altered. Equalization of the pulmonary vasculature when the size of the lower lobe vessels are compared to the upper.
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Term
| Lateral decubitus position |
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Definition
Helpful to assess the volume of pleural effusion and if its mobile or loculated.
Dependant lung should increase in density d/t atelectasis from the weight of the mediastinum. Failure to do so indicates air trapping.
You could also look at the nondependent hemithorax to confirm a pneumothorax in a patient who could not be examined erect.
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Term
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Definition
CXR should be examined in full inspiration. Helps the radiologist to determine if there are intrapulmonary abnormalities.
The diaphragm should be found at about the level of the 8th - 10th posterior rib or 5th - 6th
anterior rib on good inspiration
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Term
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Definition
Thoracic spine disc spaces barely visible through the heart bony details of the spine are not usually seen
bronchovascular structures can usually be seen through the heart
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Term
Underpenetrated
Vs.
Overpenetrated
PA film |
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Definition
underpenetrated not enough photons
ovepenetrated too many photons |
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Definition
Assess rotation by observing clavicular heads
equal distance from the spinous process of the thoracic vertebral bodies
Magnification of clavicular head and spinous process alignment demonstrating a straight film |
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| Three locations that a mass can exist in the thoracic cavity |
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Definition
Intraparenchymal (part of the lung)
Pleural
Extrapleural
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Term
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Definition
PA & LA CXR, Right lung has 1 minor fissure dividing the right middle lobe from the right upper lobe. Also 1 major fissure dividing lower lobe from upper and middle lobes.
Left lung has 1 major fissure and no minor.
The major fissures are usually not well seen on the PA view because you are looking through them obliquely. If there is fluid in the fissure, it is occasionally manifested as a density at the lower lateral margin. |
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Term
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Definition
Left Pulmonary artery passes over the left mainstem bronchus to descend behind it
Right Pulmonary artery passes behind the ascending aorta |
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How to Read a
Chest X-Ray |
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Definition
•Turn off stray lights,
▫optimize room lighting, view images in order
•Patient Data:(name history #, age, sex, old films)
•Routine Technique: (Under/over, see spinal process)
▫AP/PA, exposure, rotation, supine or erect
•Trachea:midline or deviated, caliber, mass
•Lungs:abnormal shadowing or lucency
•Pulmonary vessels:artery or vein enlargement
•Hila:masses, lymphadenopathy
•Hear:thorax: heart width>2:1? Cardiac configuration?
•Mediastinal contour:width? mass?
•Pleura:effusion, thickening, calcification
•Bones:lesions or fractures
•Soft tissues:(Unilateral breast looks like Plural effusion)
▫don’t miss a mastectomy
•Identify tubes
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Term
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Definition
| Elimination of the silhouette or loss of lung/soft tissue interface caused by a mass or fluid in the normally air filled lung |
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Definition
alveoli are filled with fluid making the bronchi visible
i.e. pulmonary edema |
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Definition
| almost always associated with a linear density with volume loss (Lobe will concortract) |
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Definition
Alveolar edema, often in a classic perihilar bat wing pattern of density.
Pleural effusions also often occur. |
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Definition
| Earliest CXR finding of CHF is cardiomegaly (cardiothoracic ratio >50%), alveolar edema, and haziness of vascular margins |
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Term
| Cardogenic Pulmonary Edema |
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Definition
Increased hydrostatic pulmonary capillary pressure
Cephalization of pulmonary veins, Kerley B lines or septal lines
Peribronchial cuffing, “bat wing” pattern
Patchy shadowing with air bronchograms
Indistinct vascular margins
Enlarged heart |
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Term
| Noncardogenic Pulmonary Edema |
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Definition
▫altered capillary membrane permeability or
▫decreased plasma oncotic pressure
▫NOT CARDIAC
–near-drowning, oxygen therapy, transfusion or trauma, CNS disorder, ARDS, aspiration, or altitude sickness, renal disorder or resuscitation, drugs, inhaled toxins, allergic alveolitis, contrast or contusion. |
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Term
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Definition
| horizontal lines less than 2cm long, commonly found in the lower zone periphery (thickened, edematous interlobular septa) |
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| Atelectasis vs. Pneumonia |
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Definition
Atelectasis vs. Pneumonia
•Vol Loss Associated •Normal or Increased Vol
Ipsilateral Shift •No Shift, or if Present then
(toward atl lobe) Contralateral
•Linear, Wedge-Shaped •Consolidation
•Apex at Hilum Air Space opacity
•Not Centered at Hilum
Air bronchograms can occur in both.
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Term
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Definition
Air inside the thoracic cavity but outside of the lung,
appears as air w/out lung markings in the least dependant part of the chest
•Generally found peripheral to the white line of the pleura
•upright film→ most likely seen in the apices
•best demonstrated by an expiration film
•difficult to see when the patient is in a supine position
▫air rises to the medial aspect of the lung
▫may be seen as a lucency along the mediastinum
▫may also collect in the inferior sulci (deep sulcus sign)
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Definition
This is a medical emergency → decreased venous return and death without immediate CT placement
Right sided tension pneumothorax=leftward mediastinal shift. |
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Term
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Definition
loss of elastic recoil of the lung with destruction of the pulmonary capillary bed and alveolar septa, bullae (lucent, air-containing spaces), diffuse hyperinflation with flattening of diaphragms, increased retrosternal space
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Definition
| Abrupt discontinuity in the smooth outline of the rib; a lucent fracture line may be seen |
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Definition
| enlarged heart shadow (globular, transverse diameter disproportionately increased) |
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Term
Positioning of Endotracheal Tubes
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Definition
The ideal position for endotracheal tubes:
▫Midtrachea
▫5 cm from the carina, when the head is neither flexed nor extended
▫minimal safe distance from the carina is 2 cm. |
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| Method For Locating Carina |
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Definition
T4-T5 interspace
(95% project over T5, T6, or T7 vertebral bodies)
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Term
| Pulmonary Artery Catheter |
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Definition
PAC tip in the right pulmonary artery (rule of thumb à tip should be within the mediastinal shadow)
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