https://ideawaza.com/api.php?action=feedcontributions&feedformat=atom&user=129.106.197.75 2026-09-29T20:01:11Z User contributions MediaWiki 1.46.0 https://ideawaza.com/index.php?title=Chest_x-ray&diff=44638 2007-09-23T17:50:39Z

<p>129.106.197.75: /* Lymphadenopathy */</p> <hr /> <div>==ID==<br /> *name<br /> *date<br /> *modality<br /> <br /> ==Marker==<br /> *Right or Left<br /> <br /> ==Position==<br /> *Medial ends of the clavicles should be equidistant from the spinous processes at the midline to rule out rotation<br /> <br /> ==Quality==<br /> *Penetration<br /> **thoracic disc spaces should be just visible through the heart<br /> ***overexposure → too dark<br /> ***underexposure → too white<br /> <br /> ==Respiration==<br /> *good inspiration → 6th anterior, 10th posterior ribs at MCL<br /> *right hemidiaphragm at 6th anterior rib<br /> *poor inspiration:<br /> **poor aeration, vascular crowding, widened central shadow<br /> <br /> ==Hardware==<br /> *Comment on any lines, lead placements, tubing, etc.<br /> <br /> ==Bones==<br /> *C-spine, T-spine → alignment, disc space spacing, lytic or blastic lesions<br /> *shoulder girdle, ribs, humerus, sternum → fractures, osteopenia, deformities<br /> *vertebra OA (lateral view)<br /> **subchondral (beneath the cartilage) sclerosis<br /> **subchondral cysts<br /> **narrowing of joint space<br /> **osteophytes<br /> <br /> ==Extrathoracic soft tissue==<br /> *breast shadow, nipple<br /> *supra-clavicular, axillary areas → masses<br /> *subcutaneous emphysema<br /> <br /> ==Mediastinum==<br /> *size, shape<br /> *mainstem and segmental bronchi, lymph nodes<br /> *great vessles<br /> *hila → relationship, size<br /> <br /> ==Trachea==<br /> *position (centered, some rightward shift at level of carina)<br /> **shift - pneumothorax, mass<br /> **carina widened - LA enlargement, subcarinal node<br /> <br /> ==Heart Shadow==<br /> *cardiothoracic ratio (only on full inspiration PA views)<br /> **should be &lt; 50%<br /> *enlarged chambers<br /> **LA - double shadow on right border<br /> **RA - ↑ width of right hemidiaphragm<br /> **LV - ↑ heart width<br /> **RV - lateral view: retrosternal space ↓<br /> *calcifications<br /> *aortic knuckle - unfolded due to age <br /> <br /> ==Chest Wall==<br /> *follow pleura for signs of pneumothorax<br /> **loss of lung markings in the periphery<br /> **line of visceral pleura seen on expiration view<br /> *pleural thickening<br /> **↑ width of white line along inside of ribcage, esp. near diaphragm<br /> *costophrenic angles → pleural effusion<br /> **small effusions (&lt; 100 mL) may be only seen in the lateral view<br /> <br /> ==Diaphragms==<br /> *compare hemidiaphragms<br /> **obscured → lower lobe pneumonia, pleural effusion<br /> **flattened → hyperinflation, tension pneumothorax<br /> **elevated → phrenic nerve paralysis, hepatomegaly<br /> **air under diaphragms → perforated GI tract<br /> <br /> ==Lung Fields==<br /> *compare lung fields in the ICS on L vs. R, up vs. down<br /> <br /> ==Air Space Disease==<br /> *cardinal features:<br /> **air bronchogram<br /> **fluffy, patchy poorly marginated appearance<br /> **lobar or segmental distribution<br /> *ddx:<br /> **pus (pneumonia)<br /> **fluid (pulmonary edema)<br /> **blood<br /> <br /> ==Interstitial Disease==<br /> *pathology involves the interlobular connective tissue<br /> *cardial features:<br /> **linear densities - Kerley B lines (&lt; 2 cm long, 1 mm thick, reach lung edge)<br /> **reticular pattern (thin, well defined linear densities, honeycomb arrangement)<br /> **nodular pattern<br /> *ddx: pulmonary edema, collagen disease (fibrosis), sarcoidosis, viral pneumonia<br /> <br /> ==Pulmonary Edema==<br /> *edema initially collects in the interstitium<br /> ** loss of definition of pulmonary vasculature<br /> **peribronchial cuffing<br /> ***bronchi seen end-on appear as white rings<br /> *in CHF, the normally thin-walled bronchi become framed in interstitial fluid <br /> ** best seen in vicinity of hila<br /> *Kerley B lines<br /> *reticulonodular pattern<br /> *thickening of interlobar fissures<br /> *with progression, fluid begins to collect in the alveoli, causing diffuse air space disease (bat wing or butterfly pattern), tend to spare the intermost lung fields<br /> *ddx: cardiogenic, renal failure<br /> <br /> ==Atelectasis==<br /> *cardinal signs:<br /> **deviation of a fissure<br /> **crowding of vessels<br /> **hilar, mediastinum shift<br /> *common causes: obstructive, compressive<br /> *'''in absence of a known etiology, bronchogenic carcinoma must be ruled out'''<br /> <br /> ==Lymphadenopathy==<br /> *lymph node groups: paratracheal, hilar, aorto-pulmonary window, subcarinal<br /> *hilar, AP window → widen mediastinum, flatten AP window contour<br /> **lung cancer, lymphoma, sarcoidosis, and tuberculosis<br /> *subcarinal - ↑ angle of tracheal bifurcation to 90°<br /> <br /> ==Abdomen==<br /> *liver size<br /> *spleen size<br /> *stomach (gastric bubble)<br /> *colon (bowel gas)<br /> - free air under diaphragm - pneumoperitoneum<br /> ==Misc==<br /> ===CHF===<br /> *upper lobe redistribution of vessels<br /> *Kerley B-lines (usually seen near diaphragm)<br /> *right effusion at base<br /> *perivascular cuffing<br /> *pulmonary edema (interstitial, then airspace consolidation)<br /> *venous engorgement<br /> **normally extend 2/3 of the distance to periphery<br /> **vessels seen to extend farther than normal<br /> <br /> ===Unilateral Left Sided Effusion===<br /> *trauma, infection, SLE, PE, malignancy<br /> <br /> ===Mediastinal Mass===<br /> *anterior mediastinum<br /> **thyroid masses, thymomas, teratomas, lymphomas<br /> *middle mediastinum<br /> **lymphadenopathy, lymphoma, aortic aneurysm<br /> *posterior mediastinum<br /> **aneurysm of descending aorta, esophageal masses, hiatus hernia<br /> *lateral view<br /> **RVH<br /> **effusion → accentuation of lines of major and minor fissures<br /> ==Other OSCE modules==<br /> {{OSCE}}<br /> [[Category:Medicine]][[Category:OSCE]]</div>

129.106.197.75