Radiology review

II. Adequate CXR

1. Penetration: see spine through heart
2. Inspiration: at least 8-9 posterior ribs
3. Rotation: spinous process between clavicles
4. Angulation: clavicle over 3rd rib
-PA: heart is closer to film = less magnified. AP = heart is farther away =
more magnified.
III. Cardiomegaly
1. CT ratio < 50% EXCEPT:
-portable AP film, obesity, pregnant, ascites, straight back
syndrome, pectus
excavatum. May also appear larger with
expiration.
-if the heart touches the lateral chest wall, it is enlarged
IV. Causes of an Opacified Hemithorax
1. Atelectasis: lose volume, therefore heart and hemidiaphragm shift
toward side of
opacification.
2. Large pleural effusion: acts like a mass, therefore heart and trachea
get pushed away from the affected side.
3. Pneumonia of an entire lung: no shift. may have air bronchogram.
4. Post-pneumonectomy: volume loss but fills with fibrosis. Look for
clips +/- loss of 5th rib.
V. Pleural Effusion
-Normal = 2-10cc fluid in pleural space produced at parietal pleura and
removed via
lymphatics by visceral pleura.
-Transudate vs exudate
Transudate: increased capillary hydrostatic pressure or
decreased osmotic
pressure.
Exudate: neoplasm or inflammatory disease
-[fluid protein]/[serum protein] > 0.5
-[fluid LDH]/[serum LDH] > 0.6
-fluid LDH > 2/3 highest normal serum LDH
-Left vs right side
Left side: pancreatitis, Dresslers syndrome, distal thoracic duct
obstruction
Right side: heart failure, abdominal disease, proximal thoracic
duct
obstruction
VI. Congestive Heart Failure
-Pulmonary interstitial edema: kerley B lines (distended interlobular
septa),
peribronchial cuffings (distal to hilar area), thickening of the
fissures (fluid in subpleural space), pleural effusions. Need LA pressure 2025 mmHg.

-Pulmonary alveolar edema: butterfly configuration. Clears up in <3

days with resolution starting peripheral.
VII. Airspace vs Interstitial Disease
-Airspace: soft tissue opacities that may contain air bronchograms (can
see the
bronchus because it becomes surrounded with fluid). Fluffy and
indistinct margins.
-ex: pneumonia. pulmonary edema, pulmonary hemorrhage,
aspiration
-Interstitial: discrete spots of disease that are not homogenous without
air
bronchograms. Reticular, nodular, or reticulonodular.
-ex: cancer, sarcoidosis, cystic fibrosis, asbestosis
-nodular: metastatic disease, silicosis, miliary tuberculosis
-reticular: idiopathic pulmonary fibrosis and eosinophilic
granuloma
-Honeycomb pattern: coarse, criss-crossing pattern.
Bronchiectasis and
eosinophilic granuloma.
VIII. Pneumothorax
-Visceral pleura white line: when air enters the pleural space, separate
the visceral
and parietal pleura.
-May or may not have absence of lung markings
-Skin folds (fat people who lost weight) can mimic a ptx. Skin fold has a
density/lucency edge while ptx has a line within lucency.
-Simple ptx: no shift
-Tension ptx: shift away from ptx and compress opposite side.
Compromise
respiratory fxn. Air enters on inspiration but hole closes on
expiration and air cant
leave.
-Causes: spontaneous (rupture of apical bleb), traumatic, decreased
lung compliance, rupture alveolus (asthma)
IX. Pneumomediastinum, pneumopericardium and subcutaneous
emphysema
Tube or Line
ETT
Tracheostomy
Central venous catheter
PICC
Swann-Ganz
Pleural drainage
Pacemaker
AICD
NG tube

Desired position
>5 cm from carina
way between stoma and carina
SVC
SVC
Proximal R or L pulmonary artery
Anterosuperior for ptx; posteroinferior for effusion
Apex of RV, others in RA and/or coronary sinus
One lead in SVC, other in RV
Stomach

XIII. SBO, LBO and ileus

Local ileus
General ileus
SBO
LBO

Air in rectum/Air in small bowel

sigmoid
Yes
2-3 distended loops
Yes
Many distended loops
Yes
Many dilated loops
Yes
None unless incompetent
ileocecal valve

Air in large bowel

Rectum or sigmoid
Yes- distended
No
Yes- dilated

-Localized ileus: sentinel loops.

-Generalized ileus: postop pts. Bowel sounds absent or hypoactive.
XIV. Free air
-3 major findings: air beneath the diaphragm, falciform ligament sign,
air on both sides of bowel.
-MCC: perforated ulcer
XV. Abdominal calcifications
-Patterns
-Rim-like: wall of a hollow viscus
-Linear or track: walls of a tube
-Lamellar: lumen of hollow viscus
-Cloudlike: solid organ or tumor
XVI. Abdominal soft tissue masses
-Bowel displacement: paucity of gas in an area or abdomen normally
containing bowel.
-Pad sign: extrinsic impression on a loop of bowel
-Edge of a soft tissue mass
XVIII. Disclocations and fractures