19 Radiology 2 Flashcards

1
Q

What do you need for a chest x-ray to be adequate?

A
  • 1st rib
  • Lateral margin of ribs
  • Costophrenic angle
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2
Q

What indicates cardiomegaly on a chest x ray?

A
  • Over 50% cardiac thoracic ratio
  • Only on PA film
  • Think about situs invertus
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3
Q

What are the A and B of the ABCDE approach of looking at a CXR?

A

A: airway for central trachea and hila

B: breathing: lungs, pleural spaces, lung interfaces (silhouette sign)

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4
Q

What are the C and D of the ABCD approach of looking at a CXR?

A

C: circulation: mediastinum, aortic arch, pulmonary vessels, borders of the heart

D: diaphragm/dem bones: free gas under diaphragm, nodules, fractures, mass

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5
Q

Where are some of the important review areas on a CXR and what pathology might we be looking for?

A
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6
Q

What is the silhouette sign?

A

Structures of differing density eg heart muscle and air in lung form a crisp silhouette so when this is lost there is pathology in an area

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7
Q

How can you tell on a CXR if there is mediastinal shift?

A
  • Check the trachea and the cardiac shadow
  • Pushed if there is an increase in volume or pressure (pleural effusion)
  • Pulled if decrease (consolidation with lung collapse)
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8
Q

What are some causes of costophrenic blunting on a CXR? (3)

A
    • Consolidation
    • Fluid
    • Hyperinflation of lung
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9
Q

How do you identify a pneumothorax on a CXR?

A
  • Lung edge more than 2cm from chest wall
  • Tracheal or mediastinal shift away from pneumothorax is tension

- Visible pleural edge

-No lung markings beyond this point. Side effected is blacker

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10
Q

How do you identify a pleural effusion on a CXR?

A
  • Collection of fluid so uniform white area
  • Loss of costophrenic angle
  • Hemidiaphragm obscured
  • Meniscus at upper border (not when supine)
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11
Q

How does a lobar lung collapse look on a CXR?

A
  • Elevation of ipsilateral hemidiaphragm
  • Crowding of ipsilateral ribs
  • Crowding of pulmonary vessels
  • Shift of mediastinum towards atelectasis
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12
Q

What are some things that can cause consolidation on a CXR?

A

Always reassess in 6 weeks to think about cancer

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13
Q

How do you spot consolidation on a CXR?

A
  • Increased opacity
  • Air bronchograms (pattern of air-filled bronchi on a background of airless lung)
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14
Q

What is being shown on this CXR? What could have caused the pathology?

A

Cavitation

Which could be due to infarction, abscess, TB, malignancy, septic microthrombi

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15
Q

What are some causes of a space occupying lesion on a CXR?

A

Vertebral body height is about 3cm (use as reference)

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16
Q

What is being shown on this CXR?

A

Milliary TB until proven otherwise

(massive lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli)

17
Q

Apart from x-rays, how else can we image the lungs?

A
  • CT angiogram low dose
  • Ultrasound for guiding aspiration and biopsy
  • Nuclear medicine CTPA (computed tomographic pulmonary angiography)
18
Q

What is the best way to treat small cell lung carcinoma?

A

Chemo and radiotherapy

19
Q

Identify the abnormalities on this x-ray.

A
  • Space occupying lesion in upper left zone probably due to bronchial carcinoma
  • Elevation of right hemidiaphragm due to mass causing a phrenic nerve palsy
20
Q

Which lung cancer is most likely to cause paraneoplastic syndromes and give some examples of the syndromes it can cause?

A
  • Small cell
  • Cushings
  • SIADH
21
Q

Small cell lung carcinoma is also the most likely to cause SVC obstruction, what are some signs of this?

A
  • Raised JVP
  • Oedema
  • Feeling dizzy
  • Change in eye sight
22
Q

What is the diagnosis and how would you treat this to test for malignancy?

A
  • Right sided pleural effusion
  • Aspirate and do cytology to look for malignancy
23
Q

What is the difference between a pleural effusion and lung consolidation?

A

A pleural effusion is a collection of fluid in the space between your chest wall and lungs. A lung consolidation may also be fluid, but it’s inside your lung, so it can’t move when you change positions.