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PEGGYS POINTS

12/10/07

Is the heart larger


on a PA or AP chest
film?

PA

AP Due to
magnification
AP

Why do we say cardiac


silhouette instead of heart size?

Pericardial effusion can enlarge the


silhouette but not the heart itself.

Note the large effusion

What are the 3 radiographic stages of CHF ?

1. Pulmonary venous hypertension

2. Interstitial edema 3. Alveolar edema

Normal vascularity

Pulmonary venous hypertension

Interstitial edema

Alveolar edema

COMPARE THE STAGES

Normal
vascularity

Plumonary
venous
hypertension

Interstitial
edema

Alveolar
edema

Where is the earliest


sign of pleural effusion
seen on a PA/Lat chest
film?

Blunted posterior costophrenic angle

What is a subpulmonic effusion ?

Fluid between the lung and diaphragm

How do you determine if a


pleural effusion is free
flowing?

A decubitus chest film

How do you determine if a right


sided effusion is free flowing?

Order a right lateral decubitus-(right side down) chest xray.

What distinguishes atelectasis from


consolidation?

Volume loss

What are the 2


considerations for an
opacified hemi thorax?
1-Obstructed bronchus
2-Large pleural effusion

How do you tell the difference?


Mediastinum shifts
Towards the side of a bronchial
obstruction.
Away from a large pleural effusion.

What distinguishes a
pneumothorax from a skin
fold ?

Pneumothorax will show a


white line at the border.

A skin fold typically shows a


black line at the border.

Cause of a spontaneous pneumothorax

Rupture of a sub pleural bleb typically in the upper lobe.

What radiograph is used to evaluate for


possible pneumothorax ?

Expiratory chest x-ray

Expiratory CXR will show a


pneumothorax more easily as
relative volume will be larger
and more easily seen.

inspiration

expiration

What is the silhouette sign ?

Silhouette sign indicates loss of visualization of an


edge, as density difference between lung and heart
is lost.

What is an air bronchogram ?

Air filled bronchi surrounded by opacified lung.

What does a Hamptons hump signify ?

Hamptons hump is a triangular lung infarct on a


CXR in patients with a pulmonary embolus.

What is a pseudotumor ?

A Pseudotumor is loculated pleural fluid that


simulates a lung mass.

More examples
of
pseudotumors

What is the AP window?

It is the potential space between the aortic arch and


the left pulmonary artery.

Do you see the mass?

Correlate the CT biopsy with


the film above.

Why is an x-ray made in the x-ray


department of better quality than a
portable x-ray ?

An X-ray in the department can be made with a


more powerful generator (3phase vs single phase
for portable).
This allows for a shorter exposure time resulting in
decreased patient motion. A film in the department
also allows for easier use of an xray grid which can
absorb scatter and improve the contrast of the film
for better detail.

ABDOMEN

What is the exam to


evaluate for
pneumoperitoneum?

Upright abdomen film

If a patient can not stand what radiograph can be


substituted?
pneumoperitoneum

Liver side UP

Left lateral Decubitus

==

Patient lying on their LEFT


side.

Why is an upright chest film included in a


acute abdomen series?

Lower lobe pulmonary disease can sometimes


present with abdominal symptoms.
Pneumoperitoneum can sometimes be more
easily visualized on an upright chest xray.

What is the significance of curvilinear calcifications


along the spine?

You have to consider an abdominal aortic aneurysm.

Large aortic
aneurysm

What separates an
illeus from a small
bowel obstruction?

An illeus should involve large


and small bowel
symmetrically vs SBO which
will have little to absent colon
gas.

IODINATED CONTRAST is used for patients at risk


of GI tract perforation. It is also of value in patients
with fecal impaction to draw fluid into colon to help
evacuation.
Studies on patients for pending GI surgery are
sometimes requested using iodinated contrast.
Barium from GI studies can limit future CT scans due
to artifact from retained barium.
****
Barium contrast is used for all other patients
especially if there is the risk of aspiration. The
osmotic effect can promote pneumonitis in lungs with
aspiration.

If in doubt --- CALL XRAY AND ASK.

Why is a non contrast CT preformed for


possible urolithiasis?

The contrast being excreted by the


kidney can obscure a calcified
calculus.