W3 - Ribs and Chests

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22 Terms

1
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AP vs. PA ribs

  • AP = posterior upper and lower ribs

  • PA = anterior upper ribs (only upper bc there are no lower anterior ribs)

2
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Structures Included - AP Ribs

  • upper = post. ribs 1-10

  • lower = post. ribs 8-12

3
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Critique - AP Ribs

Rot’n:

  • SP midline

  • medial clav equidistant

  • scap off lung field

4
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Positioning - AP Upper/Lower Ribs

  • CP

  • CR

  • PT Position

  • Respiration

  • upper = T7, lower = between xiphi and LCM

  • perp

  • erect, roll shoulders to remove scapulae off lung field

  • upper = insp, lower = exp

5
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Respiration - AP Ribs

  • upper: full inspiration shows 1-10 post. ribs seen above diaphragm

  • lower: full expiration shows 8-12 post. ribs below diaphragm

6
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deep insp vs. exp 

  • deep insp = ribs flatten out → reduced OBL

  • deep exp = ribs become more angled 

7
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IQ - AP Ribs

  • ribs visible thru lung markings

  • bony trabs, cortical outline and ST seen

  • no noise

8
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Structures Included - PA Ribs

post ribs 1-9

9
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Structures Included - AP OBL Ribs

  • upper: 1-10 post. ribs, seen above diaphragm

  • lower: 8-12 post. ribs, seen below diaphragm

10
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Critique Rotation - AP Upper/Lower OBL Ribs

  • upper:

    • axillary ribs free of SI indicated by ant. ribs at lateral edge of rib cage (just SI lat. ribcage)

    • sternum approx. halfway between vertebral column and ant. ribs

  • lower:

    • axillary ribs free of Si indicated by ant. ribs at lateral edge of rib cage (just SI lat. ribcage)

    • scottie dogs (pedicles mid VB)

11
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AP vs. PA Rib OBLs

  • AP = affected side is in contact

  • PA = affected side is raised

12
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Positioning - AP/PA OBL Ribs

  • upper = T7, lower = midway xiphi and LCM

  • perp

  • erect, obl = 45, abduct and roll affected arm 

13
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Structures Included - Lordotic Chest

  • entire lung field including clavs

  • apical view: apices only

14
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Critique - Lordotic Chest

  • Tilt/BTB:

    • clavs are nearly horizontal and superior to the apices (acceptable to SI ribs 1-2)

    • post. ribs nearly horizontal and SI ant. ribs

  • Rot’n:

    • medial clavs equidistant

    • SP midline

    • lung fields equal width

  • Tilt:

    • ribs and clavs on the same transverse plane

    • spine // LA

15
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Positioning - Lordotic Chest

  • CP

  • CR

  • SID

  • PT Position

  • Respiration

  • depends

  • 15-20 ceph, or pt leans back

  • 180cm

  • pt is 30cm away from the board before leaning back

  • inspiration

16
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IQ - Lordotic Chest

  • no motion

  • sharp outlines of diaphragm, heart and ribs

  • visible lung markings, esp in the upper/apical region

17
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Structures Included - Decub Chest

  • entire lung fields

  • both lat. margins

18
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Critique - Decub Chest

  • Free of SI

    • arms flexed and abducted sup,

    • chin lifted

    • scaps rolled forward

  • Rot’n:

    • clavs equidistant to spine

    • SP midline

  • Good Inspiration:ribs 9-10 above diaphragm

19
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Positioning - Decub Chest

  • T7

  • HB

  • 180cm

  • pt lies on side for 5-8mins, torso elevated on sponge, arms raised and knees flexed

20
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IQ - Decub Chest

  • appropriate density diff to see air/fluid

  • cortical outline, ST vs. bone, lung markings

21
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Purpose of Lordotic Chest

  • to demonstrate the apices of the lungs

  • to see some pathologies such as miliary TB, calcifications/masses beneath the clavicles

22
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Purpose of LAT Decub Chest

to demonstrate air and/or fluid in the pleural cavity