Term
| What is the time frame for cxr and bacterial pneumonia? |
|
Definition
| cxr will lag for 2/3 days after onset of bacterial pneumonia |
|
|
Term
| How sensitive are plain films? |
|
Definition
| plain films are not very sensitive. a great deal of pathology is missed |
|
|
Term
| How specific are plain films? |
|
Definition
| They are also not very specific since the majority of possible pathology falls under the category of fluid or soft tissue density making it difficult to differentiate |
|
|
Term
| How effective are plain films in screening? |
|
Definition
| Plain films are poor screening exams. Studies looked at pts w/documented lung disease and found that approximately 10% of the pts had normal looking plain films. |
|
|
Term
| How frequently do radiologists agree about the interpretation of cxr? |
|
Definition
| Inter-observer error- Radiologists will disagree among themselves 24% of the time. |
|
|
Term
| How frequently will radiologists agree with the original dx they made? |
|
Definition
| Intra-observer error- a radiologist may not agree w/the original dx he or she made on the same film 31% of the time. |
|
|
Term
| What kind of cxrs are standard? |
|
Definition
| The standard cxr consists of PA and lateral views. The films are read together. |
|
|
Term
| How are cxrs viewed in the PA and lateral view? |
|
Definition
| the PA exam is viewed as if the pt is standing in front of you w/their right side on your left. The pt is facing towards the left on the lateral view. |
|
|
Term
| What is useful in comparing new cxr's? |
|
Definition
| comparing previous "old" films to new ones |
|
|
Term
| In a true lateral position, are the right or left ribs larger? |
|
Definition
| The right ribs are larger due to magnification and usually project posterior to the left ribs if the pt was examined in a true lateral position |
|
|
Term
| Is the right or the left hemidiaphragm usually lower? Why does this occur? |
|
Definition
| The left hemidiaphragm is usually lower than the right. The heart lies predominantly on the left hemidiaphragm. The result on a lateral film is a silhouetting out of the anterior portion of the hemidiaphragm, whereas the anterior right hemidiaphragm remains visible. The right diaphragm continues anteriorly while the left diaphragm disappears b/c of the silhouetting caused by the heart. |
|
|
Term
| In the superior AP position, how far from the pt is the x-ray tube? |
|
Definition
|
|
Term
| How is the pt positioned for the PA film? How far from the pt is the x-ray tube? How does this position effect the film? |
|
Definition
| The PA film is obtained w/the pt facing the cassette and the x-ray tube 6 ft away. This distance diminishes the effect of beam divergence and magnification of structures closer to the x-ray tube. |
|
|
Term
| Which heart chamber is seen on the right cardiac border? |
|
Definition
|
|
Term
| Which heart chamber is seen on the left cardiac border? |
|
Definition
|
|
Term
| Which heart chambers are superimposed? |
|
Definition
| r. ventricle and l. atrium |
|
|
Term
| Which view is better: PA or AP? |
|
Definition
|
|
Term
| Most AP views are shot with what kind of machine? |
|
Definition
|
|
Term
| Will a magnified cardiac border occur in and AP or PA view? |
|
Definition
| note the magnified cardiac border in the ap view in comparison to the pa view overlay |
|
|
Term
| What view could be helpful to assess the volume of pleural effusion and demonstrate whether a pleural effusion is mobile or loculated? |
|
Definition
| lateral decubitus position |
|
|
Term
| Why might you order a lateral decubitus position? |
|
Definition
| This view could be helpful to assess the volume of pleural effusion and demonstrate whether a pleural effusion is mobile or loculated |
|
|
Term
| When you order an AP view, do you typically get a lateral as well? |
|
Definition
| no. you typically get a lateral with a PA view. |
|
|
Term
| In a PA view, how large should the heart be? |
|
Definition
| less than 50% of thoracic diameter. otherwise, you have an "enlarged cardiac silhouette" |
|
|
Term
| On a lateral view, do you position the pt with the healthy or pathological side down on the table? |
|
Definition
| bad side down good side up (liquid will pool down with gravity) |
|
|
Term
| What aspect of radiation is necessary for a good film? Which anatomical landmarks should be barely visible and which are not usually seen? |
|
Definition
| adequate penetration of the pt by xrt is also required for a good film. on a good PA film, the thoracic spine disc spaces should be barely visible thorugh the heart but bony detalis of the spine are not usually seen. |
|
|
Term
| If bronchovasucular structures can be seen through the heart, was penetration sufficient? |
|
Definition
|
|
Term
| How should the pt inhale for a cxr? Why? |
|
Definition
| the pt should be examined in full inspiration. this greatly helps to determine if there are intrapulmonary abnormalities. |
|
|
Term
| With good inspiration, at what rib level can the diaphragm be found? |
|
Definition
| The diaphragm should be found at about the level of the 8th to 10th posterior rib or 5th to 6th anterior rib on good inspiration |
|
|
Term
| What can make a cxr appear falsely abnormal? |
|
Definition
| a pt can appear to have a very abnormal chest if the film is taken during expiration |
|
|
Term
| How can you look for proper penetration and inspiration on the lateral view? |
|
Definition
| by observing that the spine appears to darken as you move caudally |
|
|
Term
| What might look abnormal if there is rotation of the pt? |
|
Definition
| the mediastinum may look very unusual |
|
|
Term
| How might one assess pt rotation? |
|
Definition
| by observing the clavicular heads and determining whether they are equal distance from the spinous process of the thoracic vertebral bodies |
|
|
Term
| What is the pulmonary hilum? |
|
Definition
| a depression on the mediastinal surface of the lung where the bronchus, blood vessels, and nn enter |
|
|
Term
| For what might a rotated film be mistaken? |
|
Definition
| This rotated film skin folds can be mistaken for a tension pneumothorax. Notice the skewed positioning of the heads of the clavicles and the spinous processes |
|
|
Term
| On the lateral view, both lungs are superimposed. Which fissures can be seen? |
|
Definition
| The left lung has only a major fissure and right lung will have both the major and minor fissure |
|
|
Term
| Normally is the right or left half of the diaphragm higher on a pa view |
|
Definition
| normally right's a little higher than the left |
|
|
Term
| Is the left pulmonary artery above or below the left main bronchus? |
|
Definition
| left: Artery above Bronchus |
|
|
Term
| Do you typically pick up the right minor fissure on the right lung on a pa view? |
|
Definition
| not typically- you'll see it in pleural effusion |
|
|
Term
| Retrocardiac processes are best seen in which view? |
|
Definition
| lateral view- the heart isn't obstructing your view |
|
|
Term
|
Definition
|
|
Term
| What are 5 steps in reading a cxr? |
|
Definition
1. optimize room lighting, view images in order.
2. pt's data (name, h/x, MR#, age, sex, old films)
3. routine technique: ap/pa, exposure, rotation, supine or erect. 4. trachea: midline or deviated, caliber, mass. 5. lungs: abnormal shadowing or lucency. |
|
|
Term
| Where is the gastric air bubble positioned? |
|
Definition
| can move but should never be above the diphragm |
|
|
Term
| Are the following frequently seen on cxr: pulmonary vasculature and bronchial structures? |
|
Definition
| Bronchial structures can frequently be seen on cxr however pulmonary vasculature are commonly not recognized |
|
|
Term
| On a cxr, what abnormalities should you look for in pulmonary vessels? |
|
Definition
|
|
Term
| On a cxr, what abnormalities should you look for in the hilum? |
|
Definition
|
|
Term
| On a cxr, what abnormalities should you look for in the heart: thorax? |
|
Definition
| heart width >2:1? cardiac configuration |
|
|
Term
| On a cxr, what abnormalities should you look for in mediastinal contour? |
|
Definition
|
|
Term
| On a cxr, what abnormalities should you look for in pleura? |
|
Definition
| effusion, thickening, calcification |
|
|
Term
| On a cxr, what abnormalities should you look for in bones? |
|
Definition
|
|
Term
| On a cxr, what abnormalities should you look for in soft tissues? |
|
Definition
|
|
Term
| On a cxr, what abnormalities should you look for in other therepeutic presences? |
|
Definition
|
|
Term
| When looking for abnormalities, should you gaze at film or do a directed search? |
|
Definition
| It is best to do a directed search of cxr rather than simply gazing at the film. an abnormality will not likely hit you over the head. |
|
|
Term
| How should your eyes travel when looking for abnormalities in a cxr? |
|
Definition
| look for abnormalities and have a planned search in mind. your eye gaze should scan all portions of the film, follow lung/mediastinal interfaces and look again carefully in areas where you know that mistakes are easily made. |
|
|
Term
| What is the order for a plan or specific method when looking for abnormalities in a cxr? |
|
Definition
| Airway. Bone. Cardiac. Diaphragm. Everything else. |
|
|
Term
| What is the silhouette sign? What can the location help determine? |
|
Definition
| elimination of the silhouette or loss of lung/soft tissue interface caused by a mass or fluid in the normally air filled lung. The location of this abnormality can help determine the location anatomically |
|
|
Term
| On a cxr, how might you see an intrathoracic opacity in anatomic contact with the heart border? |
|
Definition
| the opacity will obscure that border. |
|
|
Term
| What is an air bronchogram? |
|
Definition
| an air bronchogram is a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates |
|
|
Term
| What are 6 potential causes of an air bronchogram? |
|
Definition
| 1. lung consolidation. 2. pulmonary edema. 3. nonobstructive pulmonary atelectasis. 4. severe interstitial disease. 5 neoplasm. 6. normal expiration. |
|
|
Term
| What can be indicated by a solitary pulmonary nodule? |
|
Definition
| a solitary nodule in the lung can be totally innocuous or potentially a fatal lung cancer. |
|
|
Term
| What is the initial step after detection of a solitary pulmonary nodule? |
|
Definition
| after detection the initial step in analysis is to compare the film w/prior films if available. |
|
|
Term
| Is a nodule that is unchanged for 2 years likely benign or malignant? |
|
Definition
|
|
Term
| Is a nodule that is completely calcified or has central or stippled calcium likely malignant or benign? |
|
Definition
| If the nodule is completely calcified or has central or stippled Ca2+ it is most likely benign |
|
|
Term
| Is a nodule that has irregular calcifications or those that are off center likely malignant or benign? |
|
Definition
| should be considere suspicious, and need to be worked up further |
|
|
Term
| What is known as collapse or incomplete expansion of the lung or part of the lung? |
|
Definition
|
|
Term
| What is the most frequent cause of atelectasis? |
|
Definition
| most often caused by an endobronchial lesion, such as mucus plug or tumor |
|
|
Term
| With what cxr finding and pathology is atelectasis almost always associated? |
|
Definition
| with a linear increased density on a cxr and is associated with loss of volume in that lung |
|
|
Term
| Is a rib f/x best viewed with cxr? |
|
Definition
| no. order CT or rib series unless you think underlying pathology is a pneumothorax. |
|
|
Term
| What are 6 cxr findings for pulmonary edema? |
|
Definition
| 1. cephalization of the pulmonary vessels. 2. kerley B lines or septal lines. 3. peribronchial cuffing. 4. "bat wing" pattern. 5. patchy shadowing w/air bronchograms. 6. an increased cardiac size. |
|
|
Term
| What are 2 basic types of pulmonary edema? |
|
Definition
| cardiogenic edema. noncardiogenic pulmonary edema. |
|
|
Term
| If you have a normal cxr is everything OK? |
|
Definition
| no. low index of specificity and sensitivity. |
|
|
Term
| What type of edema is caused by increased hydrostatic pulmnoary capillary pressure? |
|
Definition
|
|
Term
| What type of pulmonary edema is caused by either altered capillary memrane permeability or decreased plasma oncotic pressure? |
|
Definition
| noncardiogenic pulmonary edema |
|
|
Term
| The following circumstances might cause what kind of pulmonary edema: near drowning. o2 tx. transfusion or trauma. CNS disorder. ARDS. aspiration. altitude sickness. renal disorder or resuscitation. drugs. inhaled toxins. allergic alveolitis. contrast or contusion? |
|
Definition
| noncardiogenic pulmonary edema |
|
|
Term
|
Definition
| an airspae disease w/consolidation caused by bacteria, viruses, mycoplasma, and fungi: space occupying lesion w/o volume loss |
|
|
Term
| What are 3 radiographic findings of opacity? |
|
Definition
| airspace opacity. lobar consolidation. interstitial opacities. |
|
|
Term
| Generally speaking, how might you know an etiology of pneumonia? |
|
Definition
| certain etiologies of pneumonia have characteristic radiographic patterns |
|
|
Term
| What are horizontal lines less than 2cm long, commonly found in the lower zone periphery? |
|
Definition
|
|
Term
| What lines are thickened, edematous interlobar septa? |
|
Definition
|
|
Term
| The following circumstances cause what abnormal cxr finding: pulmonary edema, lymphangitis, carcinomatosa and malignant lymphoma, viral and mycoplasmal pneumonia, interstitial pulmonary fibrosis, pneumonoconiosis, sarcoidosis? |
|
Definition
|
|
Term
| What is commonly caused by CHF, infection, trauma, PE, and tumors? |
|
Definition
|
|
Term
| What amount of fluid is necessary to detect an effusion in frontal vs. lateral films? |
|
Definition
| 200mL for frontal (ap/pa) vs. 75 mL for lateral |
|
|
Term
| What film view is helpful in confirming an effusion in a bedridden pt as the fluid will layer out on the affected side (unless the fluid is loculated) |
|
Definition
|
|
Term
| *How is a pneumothorax defined?* |
|
Definition
| air inside the thoracic cavity but outside the lung (this is one of Yate's favorites- definition is very important) |
|
|
Term
| How is a spontaneous pneumothorax (PTX) defined? |
|
Definition
| air inside the thoracic cavity but outside the lungs that occur w/o obvious inciting incident |
|
|
Term
| How is a tension PTX defined? |
|
Definition
| a type of PTX in which air enters the pleural cavity and is trapped during experiation usually by some type of ball valve-like mechanism. This leads to a buildup of air increasing intrathoracic pressure |
|
|
Term
| What cxr abnormality appears as air w/o lung markings in the least dependent part of the chest? |
|
Definition
|
|
Term
| Where is PTX most commonly found? Where is this most commonly seen in an upright film? |
|
Definition
| the lung is displaced by air in the pleural cavity. most commonly the air is found peripheral to the white line of the pleura. in an upright film this is most likely seen in the apices. |
|
|
Term
| How is a hydropneumothorax (hemopneumothorax) defined? |
|
Definition
| both air and fluid in the pleural space. |
|
|
Term
| What is characterized by an air-fluid level on an pright or decubitus film in a pt w/a pneumothorax? |
|
Definition
| hydropneumothorax (hemopneumothorax) |
|
|
Term
| How is emphysema defined? |
|
Definition
| loss of elastic recoil of the lung w/destruction of pulmonary capillary bed and alveolar septa. |
|
|
Term
| What is the most likley cuase of emphysema? |
|
Definition
|
|
Term
| What is commonly described on CXR as diffuse hyperinflation w/flattening of diaphragms? |
|
Definition
|
|
Term
| What commonly occurs in pts w/emphysema and is associated w/bronchial wall thickening? |
|
Definition
|
|
Term
| How do rib f/x appear in cxr? |
|
Definition
| abrupt discontinuity in th esmooth outline of the rib |
|
|
Term
| When ordering cxr/pcxr to evaluate for pneumothorax, will rib f/x have been visualized? |
|
Definition
| rib f/x may or may not have been visualize |
|
|
Term
| What cxr view is more helpful to ID rib f/xs? |
|
Definition
| specialized, oblique views |
|
|
Term
| What causes an enlarged heart shadow that is often globular shaped? |
|
Definition
|
|
Term
| What is the "fat pad" sign? |
|
Definition
| a soft tissue stripe wider than 2mm btwn the epicardial fat and the anterior mediastinal fat |
|
|
Term
| On what view can the "fat pad" sign be seen? |
|
Definition
| anterior to heart on lateral view |
|
|
Term
| Pt a few days post-surgery, develops fever 100/101. What abnormality would you expect the pt to show? How should it be tx? |
|
Definition
| atelectasis. tx w/IS (spirometry) |
|
|
Term
| How much fluid is necessary in pericardium to show detectable change in the size of the heart shadow on PA CXR? |
|
Definition
| 400-500 mL of fluid in pericardium |
|
|
Term
| What cxr abnormality looks like lungs lightly packed full of cotton balls with cephalization (pulmonary vasculature goes toward head) of pulmonary vasculature? |
|
Definition
|
|
Term
| What abnormality will show streaky lucencies over the mediastinum that extend into the neck on cxr? |
|
Definition
|
|
Term
| cxr shows diffuse bilateral interstital infiltrate. how do you tell this from pulmonary edema? |
|
Definition
| h&p points to pneumonia vs. chf. when ordering the cxr, you can indicate clinically what you think you're looking for |
|
|
Term
| What cxr abnormality shows elevation of the parietal pleura along the mediastinal borders? |
|
Definition
|
|
Term
| How is pneumomediastinum different from pneumothorax and pneumopericardium? |
|
Definition
| pneumopericardium: air can be present underneath the heart, but does not enter the neck. pneumothorax: loss of lung markings |
|
|
Term
| What abnormality is potentially caused by asthma, surgery (post-op complication), traumatic tracheobronchial rupture, abrupt changes in intrathoracic pressure (vomiting, coughing, and strenuous exercise), ruptured esophagus, barotrauma, smoking crack cocaine? |
|
Definition
|
|
Term
| Should you use cxr do determine whether a pt should be intubated? |
|
Definition
| no. that decision is based on clinical findings. |
|
|
Term
| A cxr shows enlarged cardiac sillhouette and big fluffy cotton balls- what might be the pathology? |
|
Definition
|
|
Term
|
Definition
| no. it is a clinical finding. you need to find out what the cause of pulmonary edema might be. |
|
|
Term
| How do you distinguish R upper from R middle pneumonia? |
|
Definition
| look for the right heart border. present? R upper. absent? R middle. |
|
|
Term
| How can pneumonia progress? |
|
Definition
| it can become loculated, firm and stiff, or become an abscess |
|
|
Term
| When should you take an xray of a tension PTX? |
|
Definition
| never. it's a clinical dx that needs immediate tx. |
|
|
Term
|
Definition
| when it's over 15%. Smaller ones often resolve by themselves as long as you're tx underlying etiology. |
|
|
Term
| Highest mortality is in which rib fx? |
|
Definition
| 1st, b/c of vascular structures present in that region |
|
|
Term
| What common mistakes involve light versus dark colors in cxr. |
|
Definition
| your eyes go to what is lighter first, so you might think this is worse, when the real pathology might be the dark side. |
|
|
Term
| Elongation of pulmonary anatomy with flattened diaphragm are common with what pathology? |
|
Definition
|
|
Term
| Why would you take a cxr of a pt w/rib fx? |
|
Definition
| to ID presence/abscence of pneumothorax |
|
|
Term
| What's the best test to order just to find a pericardial effusion? |
|
Definition
|
|
Term
| What might a rice crispies sound indicate? |
|
Definition
|
|
Term
| What occurs when the stomach slips through the esophageal hiatus into the chest? |
|
Definition
|
|
Term
| What is caused by a weakness in the diaphragm and usually occurs on the left posterior side? |
|
Definition
|
|
Term
| What typically occurs medially secondary to a weakness of the diaphragm. How can this occur? |
|
Definition
| Morgagni hernia- can occur without frank herniation of abdominal contents (eventration) |
|
|
Term
| How would normal tracheal findings on cxr be reported? |
|
Definition
| trachea is midline, mediastinum is not displaced, and the mediastinal contours and hila appear normal |
|
|
Term
| How are normal lung findings reported on a cxr? |
|
Definition
| lungs are clear, w/no infiltrate, fluid collection, or pneumothorax |
|
|
Term
| How is a normal diaphragm reported in a cxr report? |
|
Definition
| there is no evidence of free air under the diaphragm |
|
|
Term
| How are normal bones and soft tissues reported in a cxr report? |
|
Definition
| the bones and soft tissues appear normal: "no acute CV changes, obvious fx or abnormalities" |
|
|
Term
| What is one of the poorest indicators of ET tube placement? |
|
Definition
| cxr. endotrachial tube placement is a clinical skill. |
|
|
Term
| What is the most common finding on a cxr from a pulmonary embolis? |
|
Definition
|
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