248 Final

Which routine chest x-ray places the film (image receptor) on the patients’ anterior chest?

• PA

• x

Which view is RA enlargement best visualized?

• Lateral

• x

How are the following X-rays performed?

PA - taken with the x-ray film placed against the patient's anterior chest

Left Lateral -taken with the left side of the chest adjacent to the film cassette.

AP -with a portable x-ray machine and the film behind the patient

• x

• y

What is RA enlargement and what x-ray view is this best visualized?

May be seen in tricuspid valve disease, right atrial tumor, pulmonary hypertension, and cardiomyopathy.

May be present when the right-sided heart border bulges toward the right.

Best visualized from lateral view.

• x

• y

Know the clues on a CRX (chest x-ray) that suggests left atrial enlargement.

May be seen in mitral valve disease, left atrial tumor, and cardiomyopathy.

May be present when the left-sided heart border bulges toward the left.

• Increased cardiothoracic ratio: Left atrial enlargement can cause an overall increase in the size of the heart, leading to an increased cardiothoracic ratio. This is measured by comparing the width of the heart to the width of the thoracic cage. A value above the normal range may suggest cardiac enlargement.

• Straightening of the left heart border: The left atrium, when enlarged, can push against the left lung, causing a straightening of the left heart border on the CRX. This can be seen as a loss of the normal convexity of the left heart border.

• Double density shadow: In some cases, a chest X-ray may reveal a double density shadow behind the heart, known as the "double density sign." This occurs when an enlarged left atrium partially obscures the pulmonary vessels behind it.

• Left atrial appendage: The left atrial appendage, which is a small pouch-like structure connected to the left atrium, may become more prominent on a CRX in cases of left atrial enlargement. It can appear as a bulge or an increased density near the left atrium.

What can LV enlargement tell you about the patient and how is it visualized?

May provide a clue to the presence of chronic volume overload (e.g., AR, MR) or dilated cardiomyopathy. Lateral view is best.

• x

• y

Answer explanation

AR = aortic regurgitation

MR = mitral regurgitation

Know how much pericardial fluid represents enlargement on a CRX (chest x-ray).

• 200-250 cc

• x

Know what you would see on a CRX that would suggest CHF.

• increased vascular markings, vascular redistribution (upper lobe blood diversion), or perihilar haziness due to interstitial edema.Alveolar edema-bilateral hilar clouding. "butterfly" or "bats wing" appearance

• increased vascular markings, vascular redistribution

• Alveolar edema-bilateral hilar clouding. "butterfly" or "bats wing" appearance

• thickening of the interstitium, most commonly observed as Kerley B lines, which are short horizontal lines seen in the periphery of the lung fields.

Know standard paper speed of an EKG

• 25 millimeters per second (mm/s)

• X

What plane are the 6 limb leads and what do they represent?

3 bipolar leads (I, II, and Ill)

3 unipolar augmented leads (aVR, aVL, and aVF)

• register the direction, amplitude and duration of the heart's electrical activity, as seen from 6 different positions in the frontal plane

• x

Answer explanation