X-ray interpretation NICU - Kelsie

Graduate Nursing 569 with York-hernandez at Emory University

About this deck

By: Kelsie MacKenzie
Created: 2012-02-24
Size: 72 flashcards
Views: 14

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X-ray

A high energy electromagnetic wave used to bombard a target with high velocity electrons

Radiopaque

Structures or disease processes that absorb most of the x-rays appear white or whiter on the film

True or False.
Less dense structures absorb fewer x-rays allowing more to reach and develop on the film.

True

Radiolucent

If a structure or pathological condition appears dark on a film

AP view

Anteroposterior
Infant is lying on back

PA view

Posteroanterior
Infant lying prone

Left lateral view

Cross table lateral
Infant lying on back and cassette is against infant's left side

Left lateral decubitus

Infant lying on left side, with cassette underneath left side

Which view helps to displace air?

Left lateral view

True or False.
Correct exposure for AP view of the chest and abdomen on the SAME film can only be done on full term infants.

False. Correct exposure for AP view of chest and abdomen on the SAME film can only be done on preterm infants. Two separate films must be used on full term infants for chest and abdomen.

Why do two separate films need to be ordered for a full term infant's chest and abdomen?

The abdomen requires slightly more exposure than the chest

What needs to be done with the film of a suspected pneunothorax?

Lateral chest films need less exposure in order to view the anterior chest wall clearly

What needs to be done with the film of pneumoperitoneum?

The horizontal lateral view needs less exposure to visualize the anterior abdominal wall clearly

What should be done with a film to see a NG tube curled in a blind esophageal pouch (EA)?

There's a need to increase exposure to penetrate soft tissues of the shoulder

Penetration

The type of exposure

Overexposure appears

Dark

Underexposure appears

White

4 radiographic densities

Air
Fat
Water
Bone

How does air/gas appear on an x-ray?

Air/gas does not absorb much x-ray beams and appears black or dark gray

True or False.
Fat is denser than water, which produces a gray image on x-ray.

False. Fat is not as dense as water. Fat will produce a gray image on x-ray.

How does water appear on an x-ray?

Water is more dense than fat and blocks a significant amount of x-ray beam, producing a lighter gray appearance

Out of the 4 radiographic images, which is the most dense?

Bone has the greatest density and appears the whitest on film

Liver, heart, aorta, spleen, blood, and most muscle are ...

Water density

True or False.
When two structures are of the same density, they cannot be differentiated on film.

True.

With lung pathology that produces densities similar to water (RDS, TTN, pneumonia, atelectasis), what disappears on x-ray?

The heart borders disappear

True or False.
Air filled bronchogram will appear less dense than diseased lung.

True.

Air bronchograms are usually seen ...

Over the heart, but not in the lung in non-disease state

What does ABCDE stand for when evaluating an x-ray?

Airway: ETT, air bronchograms, midline trachea
Bones: Trachea
Cardiac: Abnormal heart shape and size
Diaphragm: Signs of over- or under-distention
Everything else: Lines and tubes, infiltrates, pneumothorax, masses

Aortic arch and ascending aorta

Appear at the level of the second rib anterior to the junction between the manubrium and the body of the sternum

Where is the carina located at?

Approximately at the level where the second rib joins the sternum (anterior)

Where is the inferior angle of the scapulae located?

Located approximately at the 8th rib posteriorly

Where should the ET tube be placed?

T2 - T3
Right above the carina

What is consider abnormal with heart size?

Measure the heart at the widest point then compare to the thorax
The heart should be no more than half the width of the thorax

What may excessive markings on the lung fields indicate?

Atelectasis, interstitial/alveolar edema, fibrosis, or other pathologies

What may absence of tissue markings indicate on lung fields?

Pneumothorax or pneumonectomy

What does flattening or tenting a characteristic of with the diaphragm?

Chronic obstructive pulmonary disease or hyperinflation

Pleural space

Includes the area between the visceral pleura and the parietal pleura

True or False.
The costophrenic angle should come to a sharp point.

True.

What is represented as radiolucent streaks in the soft tissue spaces?

Subcutaneous emphysema, which may be seen with patients with chest tubes or tracheostomy

UVC high placement

Above the diaphragm at the RA junction

UVC low placement

Below the liver
Appropriate for emergencies until other access established

UAC high placement

Tip located between T6 and T9

UAC low placement

Tip located between L3 and L4

Direct signs of atelectasis

Displaced fissures, crowded blood vessels, and an increased radiopacity

Indirect signs of atelectasis

Tracheal shift toward the affected side, diaphragmatic elevation, and crowded ribs on the affected side

HMD

The term for histologic appearance of the alveolar space lined by eosinophilic membrane formed by cellular debris

What is HMD caused by?

Surfactant deficiency --> atelectasis --> intrapulmonary shunting --> hypoxemia

How does an x-ray appear with HMD?

Ground glass appearance with bronchograms
Homogenous, diffuse, bilateral reticulogranular pattern
Air bronchograms with aerated bronchioles superimposed on non-aerated alveoli
Volume loss
Normal heart size
Similar to GBS pneumonia

Causes pulmonary interstitial emphysema (PIE)

Inadequate surfactant secondary to prematurity --> atelectasis --> uneven distribution of pressure/gas to alveoli

What population does this normally occur in?

Long-term ventilator patients with uneven aeration and CLD

Transient tachypnea of the newborn (TTN)

Occurs when the lung fluid is retained; correlates with a decreased thoracic birth squeeze or diminished respiratory effort in the newborn

X-ray findings of TTN

Prominent perihilar streaking due to engorgement of blood vessels
Hyperventilation caused by partial airway obstruction from mediastinal fluids
* Fluid in the fissure especially fissure on the right that separates the lower/upper lobes (becomes more prominent with retained fluid present)

What is the hallmark of TTN?

Fluid in the fissure

What is the hallmark of sepsis over TTN?

Tachypnea

Meconium aspiration x-ray findings

Snowstorm appearance
Patchy and non-homogenous
Prone to pneunothorax
Increase in AP diameter
Hyperventilation
Atelectasis

Pneunomia/sepsis x-ray findings

Patchy infiltrates (aspiration)
Bilateral diffuse granular pattern
Streaky
Loss of volume

What are the different kinds of air leaks?

Pnemomediastinum
Pneumothorax
Pneumopericardium
Pneumoperitoneum

What appears on transillumination of pneumothorax?

Positive transillumination with high intensity light

Congenital diaphragmatic hernia (CDH)

A condition of the displacement of the abdominal viscera into the thoracic activity

Why does CDH normally occur on the left?

80% involve the left hemidiaphragm through failure of the closure of the pleuroperitoneal canal during the 8th week of gestation

True or False.
The earlier the onset of CDH the worse the outcome.

True.

Respiratory distress in CDH is related to ...

The size of the defect and accompanying degree of pulmonary hyoplasia and pulmonary hypertension

CPAP belly

Abdominal distention due to high pressure from CPAP

Treatment of CPAP

Gastric vented tube
Time off CPAP
Passage of stool

Bowel obstruction is most commonly seen where?

Small intestine

Bowel obstruction presents with

Bilious vomiting and abdominal distention

Duodenal atresia presents with

Non-bilious vomiting +/- distention

What is the hallmark of duodenal atresia?

Double bubble

What is duodenal atresia associated with?

Trisomy 21

True or False.
Surgery is required for duodenal atresia.

True.

What is signs of Hirschsprung's disease?

Failure to pass meconium in first 24 hours
Vomiting and abdominal distention
Dilated loops of bowel and air fluid levels
Absence of ganglion cells in nerve plexus in colon
Rectosigmoid junction but may involve entire colon

How is the diagnosis made for Hirschsprung's disease?

Rectal biopsy

About this deck

By: Kelsie MacKenzie
Created: 2012-02-24
Size: 72 flashcards
Views: 14

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis