Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Introduction
- Acknowledgments
- List of abbreviations
- Section 1 Principles of surgery
- Section 2 General surgery
- Section 3 Breast surgery
- Section 4 Pelvis and perineum
- Section 5 Orthopaedic surgery
- Section 6 Vascular surgery
- Section 7 Heart and thorax
- Section 8 Head and neck surgery
- Section 9 Neurosurgery
- Section 10 Plastic surgery
- Section 11 Surgical radiology
- 44 Principles of plain film
- 45 Chest x-ray
- 46 Abdominal x-ray
- 47 Mammogram
- 48 Facial x-ray
- 49 Cervical spine x-ray
- 50 Shoulder x-ray
- 51 Elbow x-ray
- 52 Wrist and distal forearm x-ray
- 53 Pelvis and hip x-ray
- 54 Knee x-ray
- 55 Foot and ankle x-ray
- 56 Principles of CT
- 57 Head CT
- 58 Chest CT
- 59 Abdomen CT
- 60 Aorta CT
- 61 Kidneys, ureter and bladder CT
- 62 Lower limb CT angiogram
- Section 12 Airway, trauma and critical care
- Index
45 - Chest x-ray
from Section 11 - Surgical radiology
Published online by Cambridge University Press: 05 July 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Introduction
- Acknowledgments
- List of abbreviations
- Section 1 Principles of surgery
- Section 2 General surgery
- Section 3 Breast surgery
- Section 4 Pelvis and perineum
- Section 5 Orthopaedic surgery
- Section 6 Vascular surgery
- Section 7 Heart and thorax
- Section 8 Head and neck surgery
- Section 9 Neurosurgery
- Section 10 Plastic surgery
- Section 11 Surgical radiology
- 44 Principles of plain film
- 45 Chest x-ray
- 46 Abdominal x-ray
- 47 Mammogram
- 48 Facial x-ray
- 49 Cervical spine x-ray
- 50 Shoulder x-ray
- 51 Elbow x-ray
- 52 Wrist and distal forearm x-ray
- 53 Pelvis and hip x-ray
- 54 Knee x-ray
- 55 Foot and ankle x-ray
- 56 Principles of CT
- 57 Head CT
- 58 Chest CT
- 59 Abdomen CT
- 60 Aorta CT
- 61 Kidneys, ureter and bladder CT
- 62 Lower limb CT angiogram
- Section 12 Airway, trauma and critical care
- Index
Summary
Introduction
‘This is a chest radiograph in AP/PA erect/supine view with no/some rotation. It is (is not) adequate.’
Summary
Examination sequence ABCDEF:
A Address
A Adequacy of film
A Airway
B Breathing
B Bones
B Breasts
C Circulation
D Diaphragm
D Danger areas
E Everything else
F Foreign objects
Checklist
Address
• Name and date of birth of patient
Adequacy
RIPO:
• Rotation – symmetrical distances between spinous processes and clavicular heads
• Inspiration – 5–6 anterior ribs cross the mid-clavicular line and diaphragm
• Penetration – vertebral bodies seen behind heart
• Orientation – PA usual, AP if patient is unwell
Airway
• Trachea:
• central or deviated
• carina: position and angle (widened by malignant carinal lymphadenopathy)
• endotracheal tube: tip should be 2 cm above carina
• Branches:
• inhaled foreign body: commonly right lower lobe, although may affect any lobe
Breathing (lung fields)
• Mediastinal shift: tension pneumothorax
• Lung parenchyma:
• increased lucency (black): pneumothorax (absent lung markings), bullae, COPD
• increased opacity (white): consolidation, pulmonary oedema, collapse, effusion, haemothorax, empyema
• Lobar involvement: ill-defined edges:
• right middle lobe: poor definition of right heart border
• right lower lobe: poor definition of right hemi-diaphragm
• left upper lobe/lingual lobe: poor definition of left heart border
• left lower lobe: poor definition of left hemi-diaphragm
• Hila: position (usually left higher than right), size, masses
Bones
• Fractures: ribs, sternum, clavicles, humerus, scapulae, vertebrae
• Dislocations: humerus, clavicles
Breast (in women)
• Present/absent (only relevant if at least one breast is seen)
• Breast implants
Circulation
• Mediastinum: pericardial effusion, pneumopericardium, left lower lobe collapse, hiatal hernia
• Heart size > 50% of thoracic diameter on PA radiograph = cardiomegaly
• Aorta: widened (aneurysm, dissection, unfolded)
Diaphragm
• Above diaphragm: loss of costophrenic angle (effusion, consolidation, lower lobe collapse)
• Below diaphragm:
• air below diaphragm: hollow viscus perforation, Chilaiditi's sign
• air below the diaphragm is physiological if on the left side and part of gastric bubble (air in fundus of stomach).
- Type
- Chapter
- Information
- Physical Examination for SurgeonsAn Aid to the MRCS OSCE, pp. 386 - 395Publisher: Cambridge University PressPrint publication year: 2015