imaging

notes from RespiratoryCram

radiolucent?

normal lungs

hyperlucent?

pneumothorax etc.

radiopaque/radiodense?

hemothorax, penomia, etc.

PA projection?

• from back to front

• better quality than AP

• for healthy pts able to stand

AP projection?

• from front to back

• lower quality than PA

• for pts unable to stand

what are lateral decubitus projections used for?

for pleural effusions

what are inspiratory/expiratory projections used for?

for small pneumo and foreign body aspiration

how should a correctly exposed c x-ray look?

vertebrae and lung markings are clearly visible

how do overexposed c x-rays look?

too dark with poorly seen vascular markings

how do underexposed c x-rays look?

excessively white

when should c x-ray be taken in pts breathing pattern?

on full inspiration

on c x-ray where should diaphragm be seen in relation to anterior and posterior ribs?

diaphragm should be seen ta 6th anterior rib or between 8th-6th posterior rib

where are the costophrenic angles?

the areas where the diaphragm meets the ribs (outer lower corners)

what does it mean if more than 7 anterior ribs are visible above diaphragm?

hyperinflation

what does it mean if clavicles are not at the same level?

probably because the pt is rotated and not correctly positioned

coarctation of the aorta?

constriction of the aorta

transposition of the great vessels?

• aorta connects to right ventricle

• pulmonary artery connects to left ventricle

tetralogy of fallot?

• ventricular septal defect

• pulmonary stenosis

• overriding aorta

• right ventricular hypertrophy

air bronchograms?

patent bronchial tubes surrounded by consolidation

how big should normal heart shadow be?

less than half the width of the lungs

what is cardiomegaly and what is it associated with?

• when the heart shadow is greater than half the width of the lungs

• associated with chf

what is in the mediastinum?

the heart and great vessels

what is consolidation?

poorly defined, solid white (opaque) segments or lobe

most common causes of pleural effusion?

• chf

• pneumonia

• malignancy

• pulmonary embolism

what projection is ideal for identifying small pleural effusions?

lateral decubitus

what can ct scans identify?

• small pleural effusions

• differentiate pleural effusions vs. empyema

• cause of effusion

empyema?

collection of pus in pleural space?

how is pulmonary edema described and appear on x-ray?

• appears as diffuse whiteness throughout lungs

• described as batwing or butterfly pattern

• may have increased interstitial markings

• kerley B lines may develop

how is ards described?

• ground glass

• honeycombing

• reticulogranular appearance

how is atelectasis described?

• plate-like infiltrates

• densities

atelectasis treatment?

more peep

what is epiglottitis?

supraglottic swelling

what usually cause epiglottitis?

bacterial infection

what x-ray is used for epiglottitis and how does it appear?

• lateral neck x-ray

• thumb sign

who is epiglottitis common in?

children up to 3 yrs old

what is croup?

subglottic swelling

what is croup usually caused by?

viral infection

what does croup look like on x-ray?

steeple sign

what is croup often accompanied by?

barking, seal like cough

who is croup common in?

common in children 6 months to 6 yrs

copd key words?

• hyperinflation

• flattened diaphragms

pneumothorax key words?

hyperlucent

hemothorax key words?

• similar to pleural effusion

• associated with trauma to chest wall

pleural effusion key words?

• dependent consolidation

• density

pulmonary edema key words?

• batwing butterfly pattern

ards key words?

• honeycombing

• ground glass

• reticulogranular

atelectasis key words?

• platelike infiltrates

• densities

epiglottis key words?

• thumb sign on lateral neck x-ray

croup key words?

• church steeple sign

what level should the ett be at?

• 2-6 cm above carina

• at the level of the aortic knob

what should you do if trach tube is dislodged?

remove tube and manually ventilate with bag and mask if necessary

where should chest tube be placed for a pneumo?

5th intercostal space, mid-axillary

where should nasogastric tube be placed?

• 2-5 cm below diaphragm

where should a pacemaker appear?

over right ventricle

where should pulmonary artery catheter be located?

over right lower lung field

how does ct scan with contrast work?

iodine contrast is given to pt through iv

what does ct scan with contrast help identify?

• blood vessels

• organs

• other structures

what to recommend if decreased lung perfusion and a pulmonary embolism are suspected?

anticoagulants

what does a v/q scan identify?

regions of the lung that lack perfusion

what is the most common cause of poor perfusion?

pulmonary embolism

when is an angiogram indicated?

if the v/q scan is inconclusive

what causes a reduction in both the ventilation and perfusion in v/q scan?

atelectasis

how do pet scans work?

uses radioactive tracer injected into pt’s vein to reveal metabolic activity inside tissues and organs

how does a pulmonary angiography work?

contrast dye is injected through a catheter to assess the pulmonary vessels

list of radiation free imaging tests?

• mri

• unltrasonography

• echocardiogram

what do mri’s detect?

• masses

• lesions

• nodules

what is ultrasonography used for?

• identify deep vein thrombosis

• helpful in identifying pleural effusions

what can echocardiograms be used to identify?

• structures of the heart

• presence of pulmonary hypertension

• the need for nitric oxide