Sharp Costophrenic Angles
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Describe the appearance of the normal chest on an X-ray
- both hemidiaphragms are Round (dome-shaped) - the right hemidiaphragm is slightly higher than the left - the right hemidiaphragm is at the level of the sixth anterior rib - Trachea is midline, bilateral radiolucent appearance of lungs, with sharp costophrenic angles.
Describe the following terms in relation to the quality of a radiologic image Exposure/Penetration
Will show the intervertebral disc spaces thru the shadow of the mediastinum (vertebrae are just visible behind the heart)
Describe the following terms in relation to the quality of a radiologic image Under- penetration
Image does not allow visualization of the intervertebral discs thru the heart shadow. (all kinds of white)
Describe the following terms in relation to the quality of a radiologic image Over- penetration
Image will show black lung parenchyma without blood vessels.
What condition causes obliteration of the costophrenic angles ?
Pleura Effusion
In what pathology is the diaphragm flattened ?
COPD
What pathology would cause crowding of the ribs ?
Atelectasis (straight or horizontal ribs = Air trapping)
Describe each of the following positions used for chest X-rays and what pathology each can identify. Lateral decubitus position
Patient lying on the affected side Detects small pleural effusion
Describe each of the following positions used for chest X-rays and what pathology each can identify. End expiratory image
Taken when the patient is at the end exhalation Detects -Small pneumothorax -diaphragmatic excursion
Where should the tip of the endotracheal tube be positioned when viewed on a chest roentgenogram ?
-Below the vocal cords - Approximately 2 - 6 cm above the carina - At the level of the aortic knob or aortic arch
What is the quickest way to determine adequate ventilation following endotracheal intubation ?
- Inspection and auscultation
Proper position for Chest tube
Should be located in the pleural space surrounding the lung.
Proper position for Nasogastric and Feeding tube
Should be positioned in the stomach 2 - 6 cm below the diaphragm
Proper position for Pulmonary artery catheter
Should appear in the right lower lung field.
Proper position for Pacemaker
should be normally positioned in the right ventricle
Proper position Central venous catheter
Inserted through the subclavian or jugular vein and should rest in the superior vena cava or right atrium of the heart (4th intercostal space, right of sternum)
Briefly describe how each of the following conditions would be represented on a lateral neck X-ray Croup
Narrowing with subglottic swelling -Steeple sign -Picket fence sign -Pencil point sign -Hourglass sign
Briefly describe how each of the following conditions would be represented on a lateral neck X-ray Epiglottitis
Supraglottic narrowing with an enlarged and flattened epiglottis and swollen aryepiglottic folds -Thumb sign
What type of radiographs are helpful in locating areas of air trapping?
Inspiratory and Expiratory radiographs
Radiolucent a) Description b) Diagnosis
Dark pattern, air Normal
Radiodense/ Opacity a) Description b) Diagnosis
White pattern, solid, fluid Normal for bone, organs
Infiltrate a) Description b) Diagnosis
Any ill-defined radiodensity Atelectasis
Consolidation a) Description b) Diagnosis
Solid white area Pneumonia/ Pleural effusion
Hyperlucency a) Description b) Diagnosis
Extra pulmonary air (Air trapping) COPD, Asthma attack, Pneumothorax
Vascular markings a) Description b) Diagnosis
Lymphatics, vessels, lung tissue Increased with CHF absent with Pneumothorax
Diffuse a) Description b) Diagnosis
Spread throughout Atelectasis/ Pneumonia
Opaque a) Description b) Diagnosis
Fluid, solid
Pulmonary Edema a) Terminology b) Description c) Treatment
a) Fluffy infiltrates, butterfly pattern, batwing pattern b) Diffuse whiteness, infiltrate in shape of butterfly c) Diuretics, Digitalis, Digoxin
Atelectasis a) Terminology b) Description c) Treatment
a) Patchy infiltrates, platelike infiltrates, crowded pulmonary vessels, crowded air bronchograms b) Scattered densities, thin layered densities c) Lung Expansion Therapy, SMI/IS, IPPB, CPAP, PEEP
ARDS or IRDS a) Terminology b) Description c) Treatment
a) Ground glass appearance, honeycomb pattern, diffuse bilateral radiopacity b) Reticulogranular (glass), Reticulonodular c) O2 (recruit) Low VT or PIP (alveoli) , CPAP, PEEP
Pleural effusion a) Terminology b) Description c) Treatment
a) Blunting/ obliteration of the costophrenic angle, Basilar infiltrates with meniscus (curving) Concave superior interface/ border b) Fluid level on affected side, possible mediastinal shift to unaffected side c) Thoracentesis , Chest tube , antibiotics, steroids
Pneumonia a) Terminology b) Description c) Treatment
a) air bronchogram b) increased density from consolidation and atelectasis c) antibiotics
Pulmonary Embolism a) Terminology b) Description c) Treatment
a) Peripheral wedge- shape b) may be normal c) heparin, Streptokinase
Tuberculosis
a) Cavity formation b) Often in upper lobe c) Antitubercular agents
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