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Chest X-Ray for Medical Student OSCE

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1. Identify

2. Describe film

   1. PA / AP (falsely magnifies heart shadow)

   2. Rotation

   3. Inspiration – 6 anterior ribs. More than 10 posterior ribs = hyperinflation

   4. Penetration

   5. Artefacts

3. Interpretation

   1. Trachea

   2. Mediastinum

   3. Left and Right hilum (enlarged – lymph nodes due to TB, mets, lymphoma, Sarcoidosis; pulmonary artery hypertension; bronchial carcinoma)

   4. Heart – cardiothoracic ratio >50% suggestive of congestive heart failure; shape (globular – pericardial effusion). Double left heart border – left lower lobe collapse. Right heart border – right atrium.

   5. Diaphragm – presence, level. Raised hemidiaphragm: reduced lung volume, phrenic nerve paralysis, subphrenic abscess, hepatomegaly. Costophrenic and cardiophrenic angle blunting – effusion. Air under hemidiaphragms (perforated viscus); free air in stomach.

   6. Lung fields: describe shadowing as nodular, reticular (crisscross lines – fibrosis), reticulo-nodular, alveolar (fluffy appearance – pulmonary oedema). Ring shadows – abscess / bronchus

   7. Soft tissue – breast shadow (mastectomy), supraclavicular area and axillae for lesions.

   8. Bones – fractures, lesions (abscess, mets), rib notching (coarction of aorta)

About the Author

by: Admin
Total views: 0
Word Count: 283
Date: Fri, 22 Jan 2010 Time: 4:12 PM
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