Abnormal Chest X-rays

Question 1

What can increased translucency be due to?

Answer 1

• Air (gas)

- Loss of tissue density

Question 2

What can too white or white in the wrong place be due to?

Answer 2

• Fluid

- Increased tissue e.g lymphadenopathy

Question 3

What devices could appear as very white or very radio opaque on a CXR?

Answer 3

• Pacemaker
• ETT
• NG tube
• Sternal wiring
• Prosthetic heart valves
• CVP line
• Chest drain

Question 4

What does a chest x-ray that is too white with the trachea pushed away indicate?

Answer 4

Pleural effusion

Question 5

What ‘too white’ conditions can pull the mediastinum towards the pathology?

Answer 5

• Collapse/atelectasis

- Fibrosis

Question 6

What 4 things should you consider on clinical examination?

Answer 6

• Inspection
• Palpatation
• Percussion
• Auscultation

Question 7

What differentiates a tension pneumothorax from a simple?

Answer 7

Tension have mediastinal shift

Question 8

What conditions cause a deviated trachea away from the pathology?

Answer 8

• Tension pneumothorax

- Massive pleural effusion, or any mass effect

Question 9

What conditions cause mediastinal shift towards the pathology?

Answer 9

• Pneumonectomy / lobectomy

- Lobar collapse atelectasis

Question 10

What is a pneumonectomy?

Answer 10

surgical removal of a lung or part of a lung.

Question 11

What does blurring of the heart shadow indicate?

Answer 11

Opacification is in lingula

Question 12

What 5 substances and subsequent conditions can cause consolidation?

Answer 12

• Pus - pneumonia
• Blood - pulmonary haemorrhage
• Fluid - pulmonary oedema
• Cells - lung cancer
• Protein - alveolar proteinosis

Question 13

What is an air bronchogram?

Answer 13

• Large airways are spared so become visible (black) against a white background
• Like branches of tree with snow
• Pus blood or oedema fluid sit in alveoli
• No loss of volume

Question 14

What condition is there a loss of volume atelectasis or consolidation?

Answer 14

Atelectasis

Question 15

What differentiates pleural effusion from pulmonary consolidation upon clinical examination?

Answer 15

Increased vocal resonance in consolidation decreased in pleural effusion.

Question 16

What is atelectasis caused by?

Answer 16

When a main bronchus has been blocked

Question 17

What is the normal level of the horizontal fissure?

Answer 17

Anterior 4th rib

Question 18

What is atelectasis?

Answer 18

Reduction in inflation of all or part of the lung

Question 19

What would you see on an X-ray if an individual has an atelectasis?

Answer 19

• Volume loss
• Displacement of trachea
• Displacement of diaphragm
• Displacement of lung fissures
• Compensatory over inflation of non collapsed lung
• Crowding of vessels & bronchi
• Loss of cardio mediastinal contour
• “Veil like” opacification of left lung field

Question 20

What is seen on an x-ray with pleural effusion?

Answer 20

• Trachea is pushed away
• Uniformly white
• Concave upper border (meniscus)

Question 21

What is pleural effusion?

Answer 21

Fluid collecting within the pleural cavity

Question 22

What does a large (50% of hemithorax), unilateral pleural effusion usually indicate?

Answer 22

Lung cancer

Question 23

What is the cause of an exudate pleural effusion?

Answer 23

• Malignancy
• Infection
• Rheumatoid

Question 24

What is usually the cause of a transudate pleural effusion?

Answer 24

Congestive Heart Failure

Question 25

What does asbestos exposure look like on a CXR?

Answer 25

- Can see pleura - Holly leaf? - Whispy calcified white - If malignant (mesothelioma) unilateral fluffy opacification

Question 26

What are the signs of acute pulmonary oedema from congestive heart failure on a CXR?

Answer 26

- A: batwing shadowing - alveolar oedema coming out from the hilum - B: Kerley B lines - little straight lines perpendicular to the thorax interstitial septa - C: cardiomegaly - D: upper lobe diversion - E: pleural effusion - blunting of costophrenic angles

Question 27

What does sternal wiring indicate?

Answer 27

Sternotomy for cardiac surgery

Question 28

What can free gas under the diaphragm indicate?

Answer 28

- Laperoscopy (from up to 2 weeks) - Post abdominal surgery (from up to 2 weeks) - Perforated abdominal viscus most likely

Question 29

What can a bright white structure in the trachea be?

Answer 29

Tracheostomy tube

Question 30

What can the hidden areas be?

Answer 30

- Neck - Apices - Mediastinum - Behind the heart - Costophrenic angles - Behind / below diaphragm - Soft tissues - Bones

Question 31

What can bilateral hilar lymphadenopathy indicate?

Answer 31

- Lymphoma (hodgkins) | - Sarcoid

Question 32

What can unilateral lymphadenopathy be?

Answer 32

- TB | - Metastic spread