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CXR - Coggle Diagram
CXR
A-H
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D- diaphragm’s - liver on the right - diaphragm is higher than the left, stomach under the right - gastric bubble
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True tracheal deviation
- Pushing of the trachea: large pleural effusion or tension pneumothorax.
- Pulling of the trachea: consolidation with associated lobar collapse.
Apparent tracheal deviation
- Rotation of the patient can give the appearance of apparent tracheal deviation (clavicle position)
field/fissures
- fields - whiter than expected- increased density of lung markings or obscured by something else
- fields darker than expected- Darker suggest air where it shouldn’t be and absent lung tissue
Horizontal fissure
- Fluid = Pleural effusion
- Opacity= infection of middle lobe
- Movement- collapsed upper lobe
Hilar
- increased density around the hilar
- bats wing pattern
- pulmonary odema/ fluid overload/ heart failiure & increased blood flow to the area
- The left hilum- slightly higher than right
- anatomically it is where the descending pulmonary artery intersects the superior pulmonary vein.
- When this is lost- lesion here (e.g. lung tumour or enlarged lymph nodes).
Hilar enlargement
- Bilateral = sarcoidosis
- Unilateral = underlying malignancy
- pushed = soft tissue mass
- pulled = lobar collapse
Pleural effusion
- Concave - meniscus
- blunting of costophrenic angles
- uniform white appearance throughout a whole lung field with a defined line and meniscus
- movement of structures away from this
Consolidation
- refers to any pathological process that fills the alveoli with e.g. pus, blood, fluid
Appearance
- patchy ocacity
- may affect one lobe up to both lungs
- silhouette sign
- Air brochiograms
- all structures in expected positions
Atelectasis
- uniform white appearance
- localised to one lobe or whole lung
- rib crowding
- reduced expansion
- movement of structures towards the area
Pulmonary Odema
- bilateral increased lung markings- perihilar and shaped like bat wings
- septal lines
- effusions may be present
Bullae- common in COPD
- areas of lung that appear more black within/adjacent to areas with lung markings in
- due to emphysematous damage of the lung
Soft tissue
- Breast shadows
- skin folds and soft tissue density
- surgical emphysema
Cardiac
Sail sign
- wedge of collapsed tissue behind the heart boarder
- left lower lung collapse
- appears like sail boat
Diaphram
- right hemidiaphram is higher than the left due to the liver
- stomach underlies left hemidiaphram
- if free gas is present (bowel perforation) air accumulates under diaphram causing it to lift and become visibly separate from the liver
- The diaphragm should be indistinguishable from the underlying liver
Expansion
- The diaphragm should be intersected by the 5th to 7th anterior ribs in the mid-clavicular line.
- Less = incomplete inspiration
- more = lung hyper-expansion
Gadgets
- Pacemaker
- ECG
- Tracheostmy
- Chest drain
- Nasogastric stomach tube
- Sternal wires
- Endotrachial tube
- Rods