CHEST X-RAYSUBJECT CODE : CCCD 6112(CRITICAL CARE NURSING OF CLIENTS WITH

CARDIOVASCULAR DISORDERS)

NURULFAHANA BINTI SENINUDIN CCC/037/11

Identify cardiothoracic anatomical structures demonstrable on a chest film.

Recognize a normal chest radiograph.Recognize and name the radiographic signs

of any abnormalities in CVSCorrelate physical signs and symptoms of

cardiopulmonary disease with chest radiographic findings.

Learning objective

What is Chest X-ray?

Is a painless and noninvasive procedure used to evaluate organs and structures within the chest for

symptoms of disease.

Indication

People who have symptoms such as shortness of breath, chest pain, chronic cough (a cough that lasts a long time), or fever

Conditions such as pneumonia, heart failure, lung cancer, lung tissue scarring, or sarcoidosis.

line and tube placement. Preoperative/Postoperative Severe trauma Cardiopulmonary disease Possible primary or secondary malignancy Immigrants from countries

Indication

After intubation. After the insertion of any central line in the neck or

chest, or after repositioning a line. After the insertion of a chest tube.

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To evaluate the lungs, as well as the chest cage, for the presence of abnormalities.

To evaluate the size of the heart. To establish the size and location of an

abnormality prior to performing other tests, such as a biopsy.

To screen for lung disease in people who have occupational exposure to potentially toxic substances such as asbestos.

Purpose

Method of CXR

AP (anterior)PA stretcher/stool Supine/ semi-erect Lateral Decubitus AP Lordotic

LateralLateral (stretcher/stool) oblique (LOA/RAO)

Nursing Management

No special preparation for this procedure. Important to tell doctor before the Chest X-ray

• If you are or may be pregnant. • If you have difficulty taking a deep breath and holding your breath.

Wear gown that easy for take off Remove jewelry Remove dental appliances, eye glasses and any

metal objects or clothing that might interfere with the x-ray images.

Preparation

Pt’s can go back to normal routine. Radiologist will analyze and sent the report to

the ward. Nurses should inform the doctor for any

abnormalities.

After CXR

Localized of the heart

To assess any abnormalities of the shape of the heart, important to know composition of the heart shadow.

i. Look at the Rt heart border and follow it up from the diaphragm. From the diaphragm to the hilum, the heart border formed by the edge of the right atrium (1)

ii. From the hilum upwards it is formed by the superior vena cava(2).

iii. Follow the heart border up from the diaphragm. From the diaphragm up to the hilum it consist of the left ventricle(3).

iv. The left border is then concave at the lower left level of the left hilum and here it is made up the left atria appendage(4)

Localized the heart

v. At the level of the hilum the border is made up of the pulmonary artery (5) and above this then aortic knuckle(6)

vi. The posterior border of the heart shadow is made up of the left ventricle and the anterior border the right ventricle

Continue :-

(3) Lt ventricle

(2) SVC

(1)right atrium

aortic knuckle(6)

(4) Atria appendage

pulmonary artery (5)

Vascular hilum

Anatomy of Lung

The right upper lobe (RUL) occupies the upper 1/3 of the right lung.

Posterior, the RUL is adjacent to the first three to five ribs.

Anteriorly, the RUL extends inferiorly as far as the 4th right anterior rib

The right middle lobe is typically the smallest of the three, and appears triangular in shape, being narrowest near the hilum

The right lower lobe is the largest of all three lobes, separated from the others by the major fissure.

Posterior, the RLL extend as far superiorly as the 6th thoracic vertebral body, and extends inferiorly to the diaphragm.

Review of the lateral plain film surprisingly shows the superior extent of the RLL.

The lobar architecture of the left lung is slightly different than the right.

Because there is no defined left minor fissure, there are only two lobes on the left; the left upper

Normal CXR

Normal CXR

Inspiration and Expiration

CVL and ETT Placement

This AP chest radiograph shows a left-sided central line that has crossed midline and is likely within the right subclavian vein (arrows). An endotracheal tube is also noted.

Abnormal finding

CXR interpretation it is simply a black and white film and any abnormalities can be classified into:-

Too white Too black Too large In the wrong place

Most majority of abnormalities in the area are too white and the common causes are

Collape or atelectasis Consodilation Pleural effusion Pulmonary edema

When are the area which appear too black, most important causes are

Pneumothorax COPD

Heart failure with atria enlarged

X-ray chest PA view in heart failure, showing cardiomegaly with right atria enlargement (shift of the right border to the right with a prominent bulge) and a prominent superior vena cava shadow upwards from the right atrial contour, along the right border of the spine. There is also an unfolding of the arch of aorta, which together with the superior vena caval shadow causes an appearance of superior mediastinal widening. The haziness of the lung fields are partly due to the pulmonary congestion and also contributed to by the overlapping mammary shadow.

Lt ventricular aneurysm

The boot –shape with enlargement and elevation of the venticular is clearly evident.

Aortic aneurysm

The mediastinal shadow is dominated by the dilation of the aorta. Note that as the descending aorta on the left approaches the diaphragm, it begins to lie more centrally.

Aortic regurgitation

Forty-eight year-old male with longstanding moderately severe aortic insufficiency due to past endocarditis. When the volume of the regurgitant fraction is significant, there is enlargement of the left ventricle and, therefore, a globular widening of the cardiac silhouette.

Pulmonary hypertension

The radiograph demonstrates a convex portion of the left cardiac border just below the aortic knob and a very prominent lower right pulmonary artery segment at the hilum. The pulmonary vessels particularly of the left thorax show an abrupt tapering with much smaller distal vessels particularly visible in the left upper lobe.

Precardial effusion

pericardial effusion will show apparent cardiomegaly when the effusion is large enough. Since the pericardial fluid is roughly the same radiographic density as blood in myocardium, it may be impossible to confirm whether the cardiomegaly is due to enlargement of the ventricular chambers or whether the fluid is located in the pericardial space.

Patent Arteriosus Ductus

Dextrocardia

Dextrocardia is a condition where the heart is located on the right side instead of the left chest. This can occur at birth (congenital)

Chest x-ray Made Easy 3rd Edition [Book] / auth. Jonathan Corne Kate Pointon. - [s.l.] : Elsevier, 2010.

http://www.imagingpathways.health.wa.gov.au/includes/pdf/consumer/cxr.pdf

http://medical dictionary.thefreedictionary.com/Chest+X+Ray

http://mymoldtreatment.com/x-rays/ http://www.yale.edu/imaging/cases/aortic_aneury

sm/index.html http://www.yale.edu/imaging/cases/aortic_regurgi

tation/index.html http://www.yale.edu/imaging/cases/pericardial_eff

usion/index.html

References

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