Sharp Costophrenic Sulci

Airways Bones/soft tissue Cardiac silhouette/mediastinum Diaphragm and pleura Everything else (effusions) Fields (lung fields)

which side of the body the xray was taken

White lines

No - they're filled with air and have thin walls

No

No

greater - due to gravity

bigger

"Ryan Has Found The Diaphragm" The retrosternal space Hilar region Fissures Thoracic spine Diaphragm and posterior costophrenic sulci

Lucent crescent between sternum and ascending aorta

no discrete mass present

Major and minor fissures should be pencil point thin, if even seen

Rectangular vertebral bodies with parallel end plates, disk spacecs maintain height

Right hemidiaphragm slightly higher than the left, sharp posterior costophrenic sulci

Acute and sharply outlined

pleural effusion

100 mL

300 mL

<50% - heart is less than 1/2 of internal diameter of thoracic cage

<65%

Opacities described as fluffy, cloudlike, and hazy Bronchograms may be present

Series of black, branching tubular structures - sign of airspace disease

Discrete, reticular, nodular, or reticulonodular patterns "Pockets" of disesae are separated by normal appearing aerated lung

Lower lobe process such as pneumonia

Two substances of the same density touch each other and blur the edges between them - can't tell where one object begins and other ends

pneumonia

Discrete reticular, nodular, or reticulonodular patterns "Packets" of disease are separated by normal aerated lung No air bronchograms present

Connective tissue Lymphatics Blood vessels Bronchi

Lots of lines

Lots of dots

Lines and dots

Thickening of bronchovascular/axial interstitium - sign of pulmonary edema

Thickening of the peripheral interstitium near the costophrenic angle - sign of pulmonary edema

Cavitary lesion in upper lobe is pathogneumonic for TB

Cavitary lesion in upper lobe

1. Atelectasis of the entire lung - complete obstruction of L or R bronchus

air Opaque

Shift of the heart and trachea towards side of atelectasis

Visible in airspace disease Visibility of air in bronchus because of surrounding airspace disease

compressing push away from the side of opacification

opaque - since it no longer contains air

pneumonia

firbous tissue opaque toward side of opacification

Complete or partial collapse of a lung or lobe of a lung, alveoli become deflated Appears white when fluid/soft tissue is substituted for air or when air is reabsorbed No new air can enter the portion of lung distal to collapse/obstruction

1. Displacement of the major/minor fissure toward the atelectasis 2. Increased density of the atelectatic portion of the lung 3. Shift of the mobile structures in the throax (heart, trachea, hemidiaphragms) 4. Compensatory overinflation of the unaffected segments, lobes or lungs

1. Mucus plug 2. Tumors 3. Foreign body aspiration 4. inflammation

Build up of excess fluid between the visceral and parietal pleura

Blunting of the posterior costophrenic sulcus (lateral view)

blunting of the lateral costophrenic sulcus (frontal view)

Opacification of the entire hemithorax in an adult

fluffy, indistinct, usually homogenous in density

will cause prominence of the interstitial tissues (areas outside of the airspace) of the lung in the affected area

Lobar Segmental Interstitial Round Cavitary

Homogenous consolidation of affected lung with air bronchogram

Patchy airspace disease, no air bronchogram, atelectasis can be present

Most often in right lower lobe

1. Parietal pleura remains adjacent to the inner surface of the chest wall, but the visceral pleura retracts toward hilum w/ collapsed lung 2. Visceral pleura becomes a visible thin white line

Visceral pleural line

visceral pleural line

Leakage of air in the pleural space, and there is no shift in mediastinal structures

Progressively large amount of air gets trapped in the potential space between parietal and visceral layers Occurs when there's a one-way valve allowing air into, but not out of, the pleural space shift in mediastinal structures to opposite side CANNOT MISS

Bullae Skinfolds Medial border of scapula

Subcutaneous air on x ray

3-5cm

Right main or right lower lobe bronchi bc it's the path of least resistance

chronic inflammatory disease in which small nodules (granulomas) develop in lungs, lymph nodes, and other organs

Hyperinflation of lungs Dark lung fields Low set diaphragm in 11th or 12th posterior ribs Heart is vertical and narrow Flattened diaphragms in lateral chest Retrosternal air is increased Increased AP diameter

1. Kerley B lines (usually at lung bases near the costophrenic angle. Kerley A lines extend from the hila but do not reach the periphery of lung 2. Peribronchial cuffing (interstitial fluid accumulates around bronchi) 3. Fluid in fissures 4. Pleural effusion

1. Fluffy, indistinct airspace disease 2. Batwing configuration 3. Pleural effusion if edema is cardiogenic

Air in the pleural space separates the visceral from parietal pleura

The pneumothorax itself will appear "black" (air density). The hemithorax may appear more lucent than normal

There is NEVER a shift of theheart or trachea toward TOWARD the side of a pneumothorax

Visceral and parietal pleura do not separate

Atelectasis is the absence of air in the lung. The hemithorax will appear more oqauque

There is almost always a shift of the heart and trachea TOWARD the side of atelectasis

Left hemidiaphragm moves upward and may disappear (silhouette sign)

contact between the parietal pleura and visceral pleura is disruted

Pleural effusion Pneumothrorax

The increased pressure on the great vessels causes a decrease in venous return, reduced CO, decreased BP, hyoxia, and eventual shock

TB

bronchograms

asthma emphysema chornic bronchitis (COPD)

there's an obstruction of an airway

Pleural effusion Pneumothorax

airspace disease