CXR normal anatomy
- PA view
- 1. trachea
- 2. R main bronchus
- 3. L main bronchus
- 4. Aortic arch
- 5. Azygous vein
- 6. R pulmonary artery
- 7. L pulmonary artery
- 10. R atrium
- 11. L ventricle
If it the projection is not written on the xray what way do you assume it is?
- - PA- heart appears normal size
- - if mobile xray take to them- done in AP
When is a lateral CXR taken?
- - not in ICU
- - done when pt is mobile
What are posible pt positions for CXR?
- - erect
- - supine
- - lateral decubitis
- - clavicles centred?
Expousre of the CXR?
- - white- high density- underexposed
- - black low density- overexposed
Where does the first rib sit?
- - CXR take on inspiratory effort
- - normal 6th rib ant
- - 9th rib post
- - they discet the diaphragm in the mid clavicular line
- - inspiratory film when trying to determine pneuothorax
On CXR what do we look for when we look at soft tissue?
- - breast tissue
- - swelling
- - subcutaneous emphseama(air under the skin)
- - air under the diaphragm- be black but not in a circle
What parts to we look for to ensure they are in the right place?
- - mediastinum- heart should be less than 1/2 diameter of chect, SVC, R atrium, L ventricle, aorta
- - hilum- bronchi, arteries, veins, lymph nodes
- - trachea- midline, bifurcation should be visible
What do we look at on the bones of a CXR?
- - #
- - Jts
- - Thoracic shape
- - vertebral column
- - osteoporosis
What do we look for with the CXR diaphragm?
- - outline should be clear
- - right higher than left= about 2.5cm = liver
- - costophrenic angle and cardiophrenic angle
- - elevated (collapse pulls it up), flattened (something in chest pushing down- eg air when you are hyper inflated)
What are we looking for with CXR lung fields?
- - transluency symmetrical
- - lung markings are evenly spaced and all the way out to the edge of the flim (eg pneumothorax)
- - pleura should not be thickened eg pleural effusion
- - horizontal fissue approx 4th IC space
Where abouts do you want the ETT/ trache should sit?
- Ta or 3-4cm about the carina
What does the central venous catheter go into?
- just above RA in SVC (superior vena cava)
Swan Ganz Catheter goes into?
- - in PA (pulmonary artery) outside RV
- - also know as PAC
Where does an ICC go?
- - drain
- - top lung for air
- - bottom lung for fluid
Where does a NGT go?
What are opacity- interstitual space?
- - finger like projections
- - peribroncial suffing
- - kerly B lines
- - Upper lobe vascular distension
What can cause opacity in the interstitual space?
- - cardiogenic
- - ARDS- leaky capillaries
- - hypervolaemia
What does peribroncial cuffing look like?
- donut- white fluid around
How can you tell the opacity is from the pleural space?
- - veil like
- - uniform in composition
- - dependent if pt is mobile (at bottom of lung if upright)
- - veil over entire lung if supone
What can cause pleural effusion?
- - exudate (irritaion- causing puss etc)
- - transudate- fluid overload
- - blood
- - pus
- - water
On a chest XR how can u tell it is a pleural effusion?
- has a menisucs
How can you tell if the opacity is alveolar space?
- - air bronchograms (go airway black- surrounded by consolidation)
- - patchy opacity
- - limited by major fissures
What are the 5 substances that cause opacity in the alveolar space?
- - pus- infection
- - blood- pulmonary contusion
- - protein- alveolar proteinosos
- - water- fluid overload
- - cells- neoplastic
- To tell look at distribution
Alveolar opacity- consolidation v colapse
- - often occurs simultaneously
- - pure consolidation = signs of alveolar opacity, no loss of volume- eg rib and diaphragm are fine
- - pure collapse = signs of alveolar opacity, loss of volume and movement of fissures or diaphragm
- - any borders hazzy = part of lung is collapsed and consolidated
Right Ul atelectasis
- - can see horizontal fissue moved up too high
Left UL ateletasis
- tell by the diaphragm being moved up
Right middle lobe collapse
Lower lobe collapse and consolidation
Structured approach to looking at CXR what does this involve?
- LABELS name, date, MRN , time
- ORIENTATION is the film the right way round
- PROJECTION how is the film taken eg AP vs PA
- EXPOSURE underexposed, over exposed, normal
- PATIENT POSITION sitting, upright, supine, rotated
- SOFT TISSUE amount, air in soft tissues
- BONY STRUCTURES ribs, vertebral column
- MEDIASTINUM size, position
- DIAPHRAGM clarity, position
- SILHOUETTE SIGN borders of heart, diaphragm
- LUNG FIELDS translucency, lung markings
- LINES/ATTACHMENTS what and are they in the right place
What are the signs of hyperinflation?
- - flattened ribs
- - elongated mediastinum
- - blackened lung fields
- - increased number of ribs visible above the diaphragm
- - flattened diaphragm
Think of common findings on CXR
- - boobs
- - bra underwires
- - buttons
What is sinus inversus?
- where heart etc in flippe around the wrong way
Right lung collapse
- If you lok you can see trachea has been pulled across
Aspiration pneumonia LL Right