1. Chest p40-46 (Anatomy, Localisation)

Question 1

Position for lateral CXR

Answer 1

Left lateral (i.e. left side against the film)

Question 2

Right vs Left ribs on lateral CXR

Answer 2

Right ribs are magnified and more posterior

Question 3

Right vs Left diaphragm on lateral CXR

Answer 3

Left diaphragm is above stomach bubble

Question 4

Normal hilum on lateral CXR (4)

Answer 4

Central dark hole is left upper lobe bronchus,
Right PA infront of black hole,
Left PA over top of black hole,
Posterior wall of bronchus intermedius (normally <3mm) runs down through black hole

Question 5

Raider’s triangle (4)

Answer 5

a.k.a. Retrotracheal triangle,
On lateral CXR,
Lucent triangle bordered by:
- Aortic arch inferiorly
- Upper thoracic vertberal bodies posteriorly
- Trachea anteriorly

Question 6

Obliteration of Raider’s triangle (definition, cause) (2)

Answer 6

Opacity within (usually lucent)
Usually caused by aberrant right subclavian arterty.

Question 7

Right hilar angle made up of (frontal CXR)

Answer 7

Superior pulmonary vein (above) and right interlobar artery (below)

Question 8

Normal width between right interlobar artery and right bronchus intermedius

Answer 8

<15-16mm

Question 9

Most superior heart valve

Answer 9

Pulmonary valve

Question 10

Most anterior heart valve

Answer 10

Tricuspid valve

Question 11

Most posterior valve

Answer 11

Pulmonary valve

Question 12

Mitral valve vs aortic valve

Answer 12

Mitral valve is larger

Question 13

Pacemaker wire going through valve? (which valve)

Answer 13

Tricuspid valve

Question 14

Right vs left oblique fissures

Answer 14

Right is anterior and superior to left

Question 15

Golden S sign imaging/cause (2)

Answer 15

Right upper lobe collapse.
Inverted S sign at right upper zone.

Question 16

Flat waist sign imaging/cause (2)

Answer 16

Left lower lobe collapse.
Straight, diagonal left heart border.

Question 17

Luftsichel sign imaging/cause (2)

Answer 17

Left upper lobe collapse.
Hyperinflation of superior segment of left lower lobe. Inflated segment takes shape of a sickle beside the left upper mediastinum.

Question 18

Right upper lobe segments

Answer 18

Three:
Apical,
Posterior,
Anterior

Question 19

Right middle lobe segments

Answer 19

Two:
Medial,
Lateral

Question 20

Right lower lobe segments

Answer 20

Five:
Superior,
Posterior,
Lateral,
Anterior-basal,
Medial-basal

Question 21

Left upper lobe segments

Answer 21

Two:
Anterior,
Apical-posterior

Question 22

Left lingula segments

Answer 22

Two:
Superior,
Inferior

Question 23

Left lower lobe segments

Answer 23

Four:
Superior,
Anterior-medial basal,
Lateral,
Posterior

Question 24

Mediastinum sections

Answer 24

Four:
Superior,
Anterior,
Middle,
Posterior

Question 25

Superior segment of mediastinum (border)

Answer 25

Inferior border is oblique plane from sterno-manubrial junction

Question 26

Anterior segment of mediastinum (border)

Answer 26

Posterior border is pericardium

Question 27

Middle segment of mediastinum (anatomy)

Answer 27

Contains heart, pericardium and bifurcation of trachea.

Question 28

Posterior segment of mediastinum (anatomy)

Answer 28

From back of heart to spine.
Contains oesophagus, thoracic duct and descending aorta

Question 29

Cervicothoracic sign

Answer 29

Demonstrates that things above the clavicles are in the posterior mediastinum.

Question 30

Posterior junction line (2)

Answer 30

Formed by apposition of posterio-medial pleura of both upper lobes, posterior to oesophagus but anterior to thoracic spine.
Is above the clavicles.

Question 31

Hilum overlay sign (2)

Answer 31

Masses of the hilum will obliterate the sillhouette of the pulmonary vessels.
If you can see the edge of the pulmonary vessels, the mass isn’t hilar (either anterior or posterior)

Question 32

Pulmonary vs Mediastinal mass (2)

Answer 32

Only pulmonary will have air bronchograms.
Pulmonary mass will make an acute angle with the lung edge, mediastinal will be obtuse.

Question 33

Azygous lobe (cause) (2)

Answer 33

Azygous vein displaced laterally during development.
Results in deep fissure in the right upper lobe.

Question 34

Azygous lobe (trivia) (2)

Answer 34

Not actually an accessory lobe, but a normal variant of right upper lobe.
“How many layers of pleura…?” - answer is 4

Question 35

Pig bronchus/tracheal bronchus (anatomy)

Answer 35

Tracheal bronchus is a bronchus coming off the trachea, before the bifurcation into right/left main bronchi.
Pig bronchus is when this supplies the entire right upper lobe

Question 36

Pig bronchus (clinical)

Answer 36

Usually nothing, but can cause air trapping or recurrent infections.

Question 37

Commonest anatomic variant of pulmonary veins (2)

Answer 37

Separate vein draining right middle lobe (30% prevalence)
Of importance to electrophysiologists prior to ablation.

Question 38

Proximal interruption of pulmonary artery (anatomy) (2)

Answer 38

Congenital absence of right (or left) PA with distal vasculature present.
Also called unilateral absence of PA (confusing, as distal vasculature is there)

Question 39

Proximal interruption of pulmonary artery (imaging) (2)

Answer 39

Volume loss on one hemi-thorax,
Then contrast shot of heart with just one PA

Question 40

Proximal interruption of pulmonary artery (trivia) (3)

Answer 40

Seen on opposite side to aortic arch.
Associated with PDA.
Interrupted left PA associated with TOF and Truncus.