What are the parts of the left upper lobe?
Apical, anterior, posterior, lingular (superior and inferior)
What are the parts of the left lower lobe?
Anterior (or anterior basal), apical (or superior), posterior (or posterior basal), lateral (or lateral basal)
What are the parts of the right upper lobe?
Apical, anterior, posterior
What are the parts of the right middle lobe?
Medial and lateral
What are the parts of the right lower lobe?
Anterior (or anterior basal), apical (or superior), posterior (or posterior basal), lateral (or lateral basal) medial (noye can’t auscultate this)
Chest x-ray
Non-invasive, commonly preformed, low radiation investigation. Used for diagnosis of conditions, for pre-op check and more. Usually a PA with lateral view. Only provides a 2D view of a complex 3D structure.
How to read a chest x-ray
- Technical details
- Quality of film such as rotation, exposure, level of inspiration
- Extra-thoracic structures
- Thoracic cage
- Intra-thoracic structures such as mediastinum, lung fields
- Attachments/foreign structures
What is a CT scan?
A form of radiography where X-rays are processed by a computer to form tomographic images (slices) and a 3 dimensional picture. Non-invasive and high degree of accuracy but is expensive
What is the silhouette sign?
The loss of a silhouette. If an area of lung becomes collapsed or consolidated it becomes denser (more white), as there is less air there. Therefore the silhouette is lost, where the lung (usually dark) abuts the heart/mediastinum/diaphragm (usually white)
What is an air bronchogram?
Where air-filled bronchi (dark) are made visible by the opacification of surrounding alveoli (white)
What does consolidation look like?
Consolidation is alveoli filled with fluid, usually indicating pneumonia. Looks opaque but no loss of volume
What does loss of volume look like?
Atelectasis or lung-collapse is the result of loss of air in a lung or part of the lung with subsequent volume loss & increased density. Features include whiteness, diaphragm moves up, mediastinum moves towards loss of volume
What does hyperinflation look like?
Increased lucency (blackness): Lung contains more air. Loss of lung tissue (less lung markings)
Increased volume: Low, flat diaphragm (loss of dome). Obtuse (less acute) costo and cardiophrenic angles. Increased rib spaces. Posterior ribs more horizontal
Elongated heart
What is acute pulmonary oedema?
Fluid accumulation in the extra-vascular spaces of the lung (ie interstitium &/or alveoli)
What is a pleural effusion and what does it look like?
Fluid in the pleural space. Shows increased opacity on the CXR, meniscus sign
What is a pneumothorax and what does it look like?
Air in the pleural space (between visceral & parietal pleura).
Features:
- Area of increased lucency (blackness)
- Absence of lung markings
- Lung edge visible (of visceral pleura)
- Usually accumulates non-dependently; apical on upright CXR if small pneumothorax
What is subcutaneous emphysema?
Air in the subcutaneous tissues (skin & muscle layers).
