1. Chest p40-46 (Anatomy, Localisation) Flashcards
Position for lateral CXR
Left lateral (i.e. left side against the film)
Right vs Left ribs on lateral CXR
Right ribs are magnified and more posterior
Right vs Left diaphragm on lateral CXR
Left diaphragm is above stomach bubble
Normal hilum on lateral CXR (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
Raider’s triangle (4)
a.k.a. Retrotracheal triangle,
On lateral CXR,
Lucent triangle bordered by:
- Aortic arch inferiorly
- Upper thoracic vertberal bodies posteriorly
- Trachea anteriorly
Obliteration of Raider’s triangle (definition, cause) (2)
Opacity within (usually lucent)
Usually caused by aberrant right subclavian arterty.
Right hilar angle made up of (frontal CXR)
Superior pulmonary vein (above) and right interlobar artery (below)
Normal width between right interlobar artery and right bronchus intermedius
<15-16mm
Most superior heart valve
Pulmonary valve
Most anterior heart valve
Tricuspid valve
Most posterior valve
Pulmonary valve
Mitral valve vs aortic valve
Mitral valve is larger
Pacemaker wire going through valve? (which valve)
Tricuspid valve (lead terminates in RV)
Right vs left oblique fissures
Right is anterior and superior to left
Golden S sign imaging/cause (2)
Right upper lobe collapse (caused by central mass).
Inverted S sign at right upper zone.
Flat waist sign imaging/cause (2)
Left lower lobe collapse.
Straight, diagonal left heart border.
Luftsichel sign imaging/cause (2)
Left upper lobe collapse.
Hyperinflation of superior segment of left lower lobe. Inflated segment takes shape of a sickle beside the left upper mediastinum.
Right upper lobe segments
Three:
Apical,
Posterior,
Anterior
Right middle lobe segments
Two:
Medial,
Lateral
Right lower lobe segments
Five:
Superior,
Posterior,
Lateral,
Anterior-basal,
Medial-basal
Left upper lobe segments
Two:
Anterior,
Apical-posterior
Left lingula segments
Two:
Superior,
Inferior
Left lower lobe segments
Four:
Superior,
Anterior-medial basal,
Lateral,
Posterior
Mediastinum sections
Four:
Superior,
Anterior,
Middle,
Posterior
Superior segment of mediastinum (border)
Inferior border is oblique plane from sterno-manubrial junction
Anterior segment of mediastinum (border)
Posterior border is pericardium
Middle segment of mediastinum (anatomy)
Contains heart, pericardium and bifurcation of trachea.
Posterior segment of mediastinum (anatomy)
From back of heart to spine.
Contains oesophagus, thoracic duct and descending aorta
Cervicothoracic sign
Demonstrates that things above the clavicles are in the posterior mediastinum.
Posterior junction line (2)
Formed by apposition of posterio-medial pleura of both upper lobes, posterior to oesophagus but anterior to thoracic spine.
Is above the clavicles.
Hilum overlay sign (2)
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)
Pulmonary vs Mediastinal mass (2)
Only pulmonary will have air bronchograms.
Pulmonary mass will make an acute angle with the lung edge, mediastinal will be obtuse.
Azygous lobe (cause) (2)
Azygous vein displaced laterally during development.
Results in deep fissure in the right upper lobe.
Azygous lobe (trivia) (2)
Not actually an accessory lobe, but a normal variant of right upper lobe.
“How many layers of pleura…?” - answer is 4
Pig bronchus/tracheal bronchus (anatomy)
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
Pig bronchus (clinical)
Usually nothing, but can cause air trapping or recurrent infections.
Commonest anatomic variant of pulmonary veins (2)
Separate vein draining right middle lobe (30% prevalence)
Of importance to electrophysiologists prior to ablation.
Proximal interruption of pulmonary artery (anatomy) (2)
Congenital absence of right (or left) PA with distal vasculature present.
Also called unilateral absence of PA (confusing, as distal vasculature is there)
Proximal interruption of pulmonary artery (imaging) (2)
Volume loss on one hemi-thorax,
Then contrast shot of heart with just one PA
Proximal interruption of pulmonary artery (trivia) (3)
Seen on opposite side to aortic arch.
Associated with PDA.
Interrupted left PA associated with TOF and Truncus.
