Podcast
Questions and Answers
A central venous catheter (CVC) is ideally positioned with its tip within which vessel?
A central venous catheter (CVC) is ideally positioned with its tip within which vessel?
- Inferior vena cava (IVC)
- Pulmonary artery
- Superior vena cava (SVC) (correct)
- Azygos vein
What is the recommended distance above the carina for the distal tip of a correctly positioned endotracheal tube (ET tube) on a chest radiograph?
What is the recommended distance above the carina for the distal tip of a correctly positioned endotracheal tube (ET tube) on a chest radiograph?
- 1-3 cm
- 5-7 cm (correct)
- 8-10 cm
- 10-12 cm
A tracheostomy tube on a chest radiograph should be positioned at the level of which anatomical structure?
A tracheostomy tube on a chest radiograph should be positioned at the level of which anatomical structure?
- Carina
- Thyroid cartilage
- Suprasternal notch
- Clavicles (correct)
When evaluating a nasogastric tube (NG tube) on a chest radiograph, what anatomical landmarks should be assessed to confirm correct placement?
When evaluating a nasogastric tube (NG tube) on a chest radiograph, what anatomical landmarks should be assessed to confirm correct placement?
In a patient with a right-sided pacemaker, through which vein is the lead typically advanced to reach the superior vena cava (SVC)?
In a patient with a right-sided pacemaker, through which vein is the lead typically advanced to reach the superior vena cava (SVC)?
Following a median sternotomy, what radiographic finding is expected to be observed in the anterior chest?
Following a median sternotomy, what radiographic finding is expected to be observed in the anterior chest?
When assessing a chest radiograph for post-surgical changes following a CABG, what specific findings might indicate the use of surgical clips?
When assessing a chest radiograph for post-surgical changes following a CABG, what specific findings might indicate the use of surgical clips?
Which of the following findings on a chest radiograph is most indicative of a hair braid artifact?
Which of the following findings on a chest radiograph is most indicative of a hair braid artifact?
What radiographic technique is considered the gold standard for both diagnosing and removing a foreign body in the airway?
What radiographic technique is considered the gold standard for both diagnosing and removing a foreign body in the airway?
Which indirect radiographic sign is most suggestive of foreign body aspiration in a child?
Which indirect radiographic sign is most suggestive of foreign body aspiration in a child?
What is the normal range of retrosternal space as measured on a lateral chest radiograph?
What is the normal range of retrosternal space as measured on a lateral chest radiograph?
A premature neonate is diagnosed with respiratory distress syndrome (RDS) and a left-sided pneumothorax. Following treatment, a chest x-ray reveals a peripherally inserted central catheter (PICC) line that is malpositioned. Which of the following best describes the correct positioning of a PICC line?
A premature neonate is diagnosed with respiratory distress syndrome (RDS) and a left-sided pneumothorax. Following treatment, a chest x-ray reveals a peripherally inserted central catheter (PICC) line that is malpositioned. Which of the following best describes the correct positioning of a PICC line?
A patient has a mass in the anterior mediastinum. The retrosternal clear space is effaced on the radiograph. This finding helps localize the mass in which mediastinal compartment?
A patient has a mass in the anterior mediastinum. The retrosternal clear space is effaced on the radiograph. This finding helps localize the mass in which mediastinal compartment?
A patient presents with suspected foreign body aspiration. The initial chest radiograph is inconclusive. Which additional radiographic view or technique is most useful for detecting air trapping?
A patient presents with suspected foreign body aspiration. The initial chest radiograph is inconclusive. Which additional radiographic view or technique is most useful for detecting air trapping?
Which of the following findings on a chest radiograph would suggest malposition of a central venous catheter (CVC)?
Which of the following findings on a chest radiograph would suggest malposition of a central venous catheter (CVC)?
A patient who underwent aortic valve replacement presents for a follow-up chest radiograph. Where would you typically expect to see the prosthetic valve?
A patient who underwent aortic valve replacement presents for a follow-up chest radiograph. Where would you typically expect to see the prosthetic valve?
A patient with a history of CABG has a chest radiograph. What radiographic finding would strongly suggest the use of sternotomy wires?
A patient with a history of CABG has a chest radiograph. What radiographic finding would strongly suggest the use of sternotomy wires?
In the context of chest radiography, how would you differentiate between a foreign body and an artifact?
In the context of chest radiography, how would you differentiate between a foreign body and an artifact?
Assessing the position of medical support lines in chest radiographs is crucial. What is a potential consequence of a nasogastric tube (NG tube) not descending past the left hemidiaphragm?
Assessing the position of medical support lines in chest radiographs is crucial. What is a potential consequence of a nasogastric tube (NG tube) not descending past the left hemidiaphragm?
What could be the most severe outcome of placing an endotracheal tube too far down the mainstem bronchus?
What could be the most severe outcome of placing an endotracheal tube too far down the mainstem bronchus?
How does hyperinflation manifest on a chest radiograph in the context of foreign body aspiration?
How does hyperinflation manifest on a chest radiograph in the context of foreign body aspiration?
Distinguishing foreign body aspiration from other respiratory conditions on a chest radiograph can be challenging. Which indirect sign is most reliably associated with foreign body aspiration in children?
Distinguishing foreign body aspiration from other respiratory conditions on a chest radiograph can be challenging. Which indirect sign is most reliably associated with foreign body aspiration in children?
In a trauma patient, rapid assessment of the proper placement of medical support lines is critical. What is the most concerning malposition of a chest tube?
In a trauma patient, rapid assessment of the proper placement of medical support lines is critical. What is the most concerning malposition of a chest tube?
When evaluating a lateral chest radiograph for cardiac size, what upper limit of normal measurement helps determine if the retrosternal clear space is being encroached upon by an enlarged heart?
When evaluating a lateral chest radiograph for cardiac size, what upper limit of normal measurement helps determine if the retrosternal clear space is being encroached upon by an enlarged heart?
How does the radiographic appearance of interstitial lung disease differ from airspace disease on a chest x-ray?
How does the radiographic appearance of interstitial lung disease differ from airspace disease on a chest x-ray?
In neonatal chest radiography, what specific characteristic of the thymus gland’s appearance can help differentiate it from other mediastinal masses?
In neonatal chest radiography, what specific characteristic of the thymus gland’s appearance can help differentiate it from other mediastinal masses?
Flashcards
Central Venous Catheters (CVC)
Central Venous Catheters (CVC)
Tip of CVC within the SVC at or just above the level of the carina.
Endotracheal tube (ET tube)
Endotracheal tube (ET tube)
Tube inserted into the trachea to provide oxygen.
Tracheostomy tube
Tracheostomy tube
Tube inserted into the trachea to provide an airway.
Nasogastric tube (NG tube)
Nasogastric tube (NG tube)
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Pacemaker placement
Pacemaker placement
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Sternotomy wires
Sternotomy wires
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Aortic valve replacement
Aortic valve replacement
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Surgical clips
Surgical clips
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Artifacts on chest imaging
Artifacts on chest imaging
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Foreign body aspiration (FBA) diagnosis
Foreign body aspiration (FBA) diagnosis
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Bronchoscopy
Bronchoscopy
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Radiolucent foreign body
Radiolucent foreign body
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Airspaces
Airspaces
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Retrosternal space
Retrosternal space
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Interstitium
Interstitium
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Study Notes
- General Radiology PHA-649P covers Chest Radiograph - 2
Objectives
- Evaluate the placement of support lines, cardiac support devices, post-surgical changes, and artifacts on chest imaging
- Identify foreign body aspiration of the respiratory system
- Explain the radiographic appearance of air space and interstitial
Common Support Lines
- Central Venous Catheters (CVC) have their tip within the SVC at or just above the level of the carina
Endotracheal Tube (ET tube)
- Should ideally be positioned 5-7 cm above the carina
- If positioned too deep, pull it back so air goes to only one lung
Tracheostomy Tube
- Tracheostomy tubes should be at the level of the clavicles
Nasogastric Tube (NG Tube)
- Look for midline descent, carina bisection, diaphragm crossing, left hemidiaphragm
Cardiac Support Devices
- Pacemakers have a pulse generator in the right pectoral region and a lead through the right subclavian vein into the superior vena cava
- Pacemakers have two electrodes in the right ventricle
Post-Surgical Changes
- Sternotomy wires are midline
- Aortic valve replacements are somewhat medially over the spine
- Surgical clips are typically placed post left surgery like CABG
- A patient who had a CABG has their sternum cut and opened, then held back together with wires after the procedure
Artifact
- Artifacts on chest radiographs can be caused by motion, external objects, hair, or skin folds
- Hair braids can cause opacifications in the superior mediastinum
Foreign Body Aspiration (FBA)
- Studies for FBA include Inspiratory and Expiratory Films to visualize hyperinflation
- A CT Scan is used if there is high clinical suspicion but the CXR is inconclusive
- Bronchoscopy is the gold standard for diagnosis and removal
- A direct sign is a radiopaque foreign body such as metal objects
- Indirect signs of radiolucent foreign body i.e., food include hyperinflation, mediastinal shift away from the affected lung, and atelectasis or lobar consolidation
Normal Air Space and Interstitium
- Airspaces consist of respiratory bronchioles, alveolar ducts, and alveoli (dark areas)
- Retrosternal space is the area between the sternum and ascending aorta, and should be <2.5cm (radiolucent)
- Interstitium is the tissue surrounding the airspaces, appearing as thin, faint lines
Practice Questions
- A peripherally inserted central catheter (PICC) line that is arching backwards and peripherally is malpositioned
- The retrosternal clear space or retrosternal airspace is seen posterior to the sternum on lateral chest radiographs and should appear radiolucent
- Increased soft tissue density posterior to the sternum may signify the presence of an anterior mediastinal mass
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