wikademia>Wikademia: moved Chest X-ray to Archive:Chest X-ray

2009-06-08T03:05:53Z

moved Chest X-ray to Archive:Chest X-ray

← Older revision	Revision as of 03:05, 8 June 2009
(No difference)

wikademia>Wikademia at 01:17, 21 April 2009

2009-04-21T01:17:19Z

← Older revision		Revision as of 01:17, 21 April 2009
Line 3:		Line 3:
	*date		*date
	*modality		*modality
			{{ntnes}}
	==Marker==		==Marker==
	*Right or Left		*Right or Left

wikademia>Wikademia: 2 revisions

2009-04-21T01:15:33Z

2 revisions

← Older revision	Revision as of 01:15, 21 April 2009
(No difference)

wikademia>Donek at 00:17, 25 June 2008

2008-06-25T00:17:27Z

← Older revision		Revision as of 00:17, 25 June 2008
Line 157:		Line 157:
	==Other OSCE modules==		==Other OSCE modules==
	{{OSCE}}		{{OSCE}}
	[[Category:~~Medicine~~]][[Category:OSCE]]		[[Category: Clinical Skills]][[Category:OSCE]]

wikademia>Remi: forking from http://en.wikiversity.org/w/index.php?title=Chest_XRay_%28OSCE%29&oldid=163032

2008-04-21T08:14:14Z

forking from http://en.wikiversity.org/w/index.php?title=Chest_XRay_%28OSCE%29&oldid=163032

New page

==ID==
*name
*date
*modality

==Marker==
*Right or Left

==Position==
*Medial ends of the clavicles should be equidistant from the spinous processes at the midline to rule out rotation

==Quality==
*Penetration
**thoracic disc spaces should be just visible through the heart
***overexposure → too dark
***underexposure → too white

==Respiration==
*good inspiration → 6th anterior, 10th posterior ribs at MCL
*right hemidiaphragm at 6th anterior rib
*poor inspiration:
**poor aeration, vascular crowding, widened central shadow

==Hardware==
*Comment on any lines, lead placements, tubing, etc.

==Bones==
*C-spine, T-spine → alignment, disc space spacing, lytic or blastic lesions
*shoulder girdle, ribs, humerus, sternum → fractures, osteopenia, deformities
*vertebra OA (lateral view)
**subchondral (beneath the cartilage) sclerosis
**subchondral cysts
**narrowing of joint space
**osteophytes

==Extrathoracic soft tissue==
*breast shadow, nipple
*supra-clavicular, axillary areas → masses
*subcutaneous emphysema

==Mediastinum==
*size, shape
*mainstem and segmental bronchi, lymph nodes
*great vessles
*hila → relationship, size

==Trachea==
*position (centered, some rightward shift at level of carina)
**shift - pneumothorax, mass
**carina widened - LA enlargement, subcarinal node

==Heart Shadow==
*cardiothoracic ratio (only on full inspiration PA views)
**should be < 50%
*enlarged chambers
**LA - double shadow on right border
**RA - ↑ width of right hemidiaphragm
**LV - ↑ heart width
**RV - lateral view: retrosternal space ↓
*calcifications
*aortic knuckle - unfolded due to age

==Chest Wall==
*follow pleura for signs of pneumothorax
**loss of lung markings in the periphery
**line of visceral pleura seen on expiration view
*pleural thickening
**↑ width of white line along inside of ribcage, esp. near diaphragm
*costophrenic angles → pleural effusion
**small effusions (< 100 mL) may be only seen in the lateral view

==Diaphragms==
*compare hemidiaphragms
**obscured → lower lobe pneumonia, pleural effusion
**flattened → hyperinflation, tension pneumothorax
**elevated → phrenic nerve paralysis, hepatomegaly
**air under diaphragms → perforated GI tract

==Lung Fields==
*compare lung fields in the ICS on L vs. R, up vs. down

==Air Space Disease==
*cardinal features:
**air bronchogram
**fluffy, patchy poorly marginated appearance
**lobar or segmental distribution
*ddx:
**pus (pneumonia)
**fluid (pulmonary edema)
**blood

==Interstitial Disease==
*pathology involves the interlobular connective tissue
*cardial features:
**linear densities - Kerley B lines (< 2 cm long, 1 mm thick, reach lung edge)
**reticular pattern (thin, well defined linear densities, honeycomb arrangement)
**nodular pattern
*ddx: pulmonary edema, collagen disease (fibrosis), sarcoidosis, viral pneumonia

==Pulmonary Edema==
*edema initially collects in the interstitium
** loss of definition of pulmonary vasculature
**peribronchial cuffing
***bronchi seen end-on appear as white rings
*in CHF, the normally thin-walled bronchi become framed in interstitial fluid
** best seen in vicinity of hila
*Kerley B lines
*reticulonodular pattern
*thickening of interlobar fissures
*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
*ddx: cardiogenic, renal failure

==Atelectasis==
*cardinal signs:
**deviation of a fissure
**crowding of vessels
**hilar, mediastinum shift
*common causes: obstructive, compressive
*'''in absence of a known etiology, bronchogenic carcinoma must be ruled out'''

==Lymphadenopathy==
*lymph node groups: paratracheal, hilar, aorto-pulmonary window, subcarinal
*hilar, AP window → widen mediastinum, flatten AP window contour
**lung cancer, lymphoma, sarcoidosis, and tuberculosis
*subcarinal - ↑ angle of tracheal bifurcation to 90°

==Abdomen==
*liver size
*spleen size
*stomach (gastric bubble)
*colon (bowel gas)
- free air under diaphragm - pneumoperitoneum
==Misc==
===CHF===
*upper lobe redistribution of vessels
*Kerley B-lines (usually seen near diaphragm)
*right effusion at base
*perivascular cuffing
*pulmonary edema (interstitial, then airspace consolidation)
*venous engorgement
**normally extend 2/3 of the distance to periphery
**vessels seen to extend farther than normal

===Unilateral Left Sided Effusion===
*trauma, infection, SLE, PE, malignancy

===Mediastinal Mass===
*anterior mediastinum
**thyroid masses, thymomas, teratomas, lymphomas
*middle mediastinum
**lymphadenopathy, lymphoma, aortic aneurysm
*posterior mediastinum
**aneurysm of descending aorta, esophageal masses, hiatus hernia
*lateral view
**RVH
**effusion → accentuation of lines of major and minor fissures
==Other OSCE modules==
{{OSCE}}
[[Category:Medicine]][[Category:OSCE]]

Archive:Chest X-ray - Revision history

wikademia>Wikademia: moved Chest X-ray to Archive:Chest X-ray

wikademia>Wikademia at 01:17, 21 April 2009

wikademia>Wikademia: 2 revisions

wikademia>Donek at 00:17, 25 June 2008

wikademia>Remi: forking from http://en.wikiversity.org/w/index.php?title=Chest_XRay_%28OSCE%29&oldid=163032