Card Set Information
Anatomy of the lungs
CXR normal anatomy
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?
- 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
- 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?
- Thoracic shape
- vertebral column
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?
- 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?
- ARDS- leaky capillaries
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
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
- bra underwires
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