Cardiopoulm Test 2 Part 1: Chest X rays

air shows up as what color on x rays

black

what are the 3 basic views for chest xrays

• PA

• AP

• Lateral

Differentiate which is PA vs AP view. Why

Left PA:

• clavicles ELEVATED

• medial border of scap NOT in center of lung fields

• heart NOT magnified and enlarged

Right: AP

• clavicles HORIZONTAL

• scapulae in lung fields

• heart appears magnified/elarged

labeled PA view 

first rib attaches to

T1

3 ways x rays can be unreliable

1. rotation

2. exposure

3. inspiration vs. expiration

look at the distance btwn ___ and ___ to tell if pt was rotated during x ray

spinous process and medial clavicles

which was was this pt rotated when getting imaging?

R line is larger so it means R side was farther away. meaning pt was rotated R. whichever line is longer means pt was rotated that way (this info might be wrong. check w ahmed!!!)

if you cannot see the thoracic vertebrae behind the heart in a a CXR, the xray is _____________

underexposed

if u can clearly see the thoracic vertebrae behind the heart, your x ray might be ______

overexposed

in an (over/under)exposed x ray, people might think that there is too much air and pt has pneumothorax

overexposed

which is inspiration vs expiration. how do u know?

Pic 1: inspiration (inhale —> diaphragm goes down. you can see 9-10 ribs in full inspiration)

• u want pt in full inspiration to see how much air lungs can hold. u want to see if there are issues w lung getting air

Pic 2 expiration: u see less than 9 ribs

What do u term each of these pics in terms of opacity?

Pic 1: homogenous opacity - area of opacity with UNIFORM DENSITY throughout, appearing evenly white or grey

Pic 2: heterogenous opacity: area of opacity with NON-uniform density, appearing as a mix of lighter and darker regions

How will a pt with COPD present in a radiograph?

1. (Hypo/hyper)inflation

2. (increased/decreased) bronchovascular markings

3. (Inflated/flat) diaphragms

4. ________ heart shape

1. hyperinflation

2. decreased bronchovascular markings

3. flat diaphragms

4. tubular heart shape

What is the hallmark pathophysiologic finding in COPD? How will this show up on an xray?

• air trapped in lungs, resulting in HYPERinflation

• reflects as more BLACK on xray

  • more air = decreased bronchiovascular markings

What is going on in these pictures. Whats the dx?

Left pic: normal

Right pic: COPD

whats the dx for these pics?

Left: normal

Right: pneumonia

1. pneumonia has ________ opacity

2. It is (localized/general)

pneumonia

1. heterogenous

2. localized

whats the dx?

pulmonary edemap

pulmonary edema has

1. ________ consolidation

2. _______ pattern

pulmonary edema:

1. bilateral consolidation

2. butterfly pattern

whats the dx

pulmonary edema

pleural effusion has

1. _______ opacity

2. blunted _____________

3. min _____ mL fluid needed to detect

4. potential mediastinal shift to (same/opposite) side

pleural effusion:

1. homogenous opacity

2. blunted costophrenic angles (bc

3. min of 200 ml fluid needed detect

4. potential mediastinal shift to OPPOSITE side

why does the mediastinum get shifted to the OPPOSITE side in pleural effusion?

Fluid buildup in the pleura increases pressure and pushes the heart to the other side

whats the dx

left: normal

right: atelectasis

atelactasis has

1. _______ opacity

2. costophrenic angles _____

3. ________ of ribs

4. potential mediastinal shift to ____ side

atelactasis:

1. homogenous opacity

2. costrophrenic angles blunted

3. crowding of ribs

4. potential mediastinal shift to SAME side

the mediastinum shifts to the (same/opposite) side in atelectasis. why?

same; when the lung collapses, it acts as a vacuum and sucks everything to the same side

whats the dx

pneumothorax

what is pneumothroax?

air in the pleural cavity (thorax)

• there should not be air in the pleural cavity. There should be fluid there

pneumothorax has

1. __________ bronchovascular markings

2. affected side appears what color?

3. can see borders of _________

4. potential mediastinal shift to _____ side

pneumothorax:

1. ABSENT bronchovascular markings

2. affected side appears black

3. can see borders of affected lung

4. potential mediastinal shift to OPPOSITE side

The mediastinum moves to (same/opposite) side in pneumothorax. Why

opposite; the excess air causes a buildup of pressure, pushing everything to the opposite side (like an inflating balloon crowding everything out)

what lung condition may occur if a PT accidentally dry needles too deep?

pneumothorax (air in the pleura)

whats the dx

tumor

whats the dx

hydropneumothorax (air AND water in pleural space)

hydropneumothroax has:

1. _______ opacity on the same side

2. bronchovascular markings are ___

3. mediastinum pushed to (opp/same) side

hydropneumothorax:

1. homogenous opacity on same side

2. bronchovascular markings absent on same side

   1. mediastinum goes to opp side

where is the endotracheal tube supposed to end and why

above the “carina” (bifurcation of the lungs)

If not, it tends to move when the pt flexes/extends neck and has a tendency to slip into the R mainstem bronchus. This leads to only ONE lung getting air and may lead to collapse of the other (u will not hear the other lung when u auscultate)

whats the dx

pneumonia (R side?)

• consolidation, heterogenous opacity, localized

whats the dx

massive pneumothorax L side

(L side dark no bronchovascular markings)

whats the dx?

pleural effusion

a 65 y/o male, 2 days post abdominal surgery reports SOB. He’s been lying supine most of the time and has shallow breathing due to pain. Whats your dx?

atelectasis

whats the dx?

pleural effusion

whats the dx?

COPD