Revision 3 for 'Assessment of lungs, pleura and airways on chest x-ray (approach)'All Revisions - View changeset
Assessment of airways, lung parenchyma, pleura on CXR
Described below are points on the systematic assessment of airways, lung parenchyma, pleura on chest radiographs.
- pneumothorax: visceral pleural line parallel to the thoracic cavity, the absence of lung markings (vessels)
- views to exaggerate pneumothorax: erect CXR in full expiration, lateral decubitus with the suspect side up
- on supine film: deep sulcus sign, sharply outlined diaphragm, hyperlucent upper abdomen
- imposters: scapula margin, clothes, wrinkles, lines/tubing, bullous disease
- management: < 2cm - observe, > 2cm - aspirate.
- hemo-pneumothorax: air-fluid level, no meniscus visible
- tension pneumothorax: ipsilateral diaphragm depressed, mediastinal contents pushed contralaterally
- pleural effusion: look for the meniscus sign. Collects in the costophrenic angles. If supine - veiling opacity. Empyema can organize into loculations
- apical pleural thickening: focal area of thickening over the apex, can be heavily calcified
- pleural plaques: similar to the density of bone. Common posteriorly & laterally & inferior 1/3 of the thorax. Metastasis - less dense than bone
- lung collapse: opacity with no air bronchograms, negative mass effect (displacement of fissure, hilum, mediastinum, elevation of hemidiaphragm, the decrease in spacing between the ribs)
- central bronchogenic carcinoma and lobar collapse: "golden sign of S"
2. Lung parenchyma
- lobar collapse: opacity with no air bronchogram, negative mass effect with shift of a lung fissure, hilum, hemidiaphragm
- lung collapse: opacity with whiteout, negative mass effect with mediastinal shift to the contralateral side
- increased interstitial marking vs. airspace opacification
- consolidation: alveolar pathology (cloud-like/cotton-candy shadowing); no volume loss, air bronchogram, homogeneous airspace opacity. Clears by 6 weeks, if not suspect malignancy
- pulmonary edema: interstitial opacities (too many squiggly lines); airspace opacification
- emphysema: 1. pulmonary hyperinflation, 2. narrowed mediastinum, 3. prominant pulmonary vessels, 4. Reduced peripheral pulmonary vessels, 5. distance to hila/base
- left ventricular failure: 1. increased interstitial marking, 2. Airspace opacification, 3. bilateral pleural effusions