7a. Trauma Evaluation - Chest

Question 1

how many anterior ribs is good inspiration for PA chest

Answer 1

5 ant ribs

Question 2

what shows good positioning for PA chest in terms of rotation

Answer 2

medial clavicles equidistant to spinous processes

Question 3

what shows good positioning for PA chest in terms of lordosis/kyphosis

Answer 3

clavicles should be projected over the 3/4th post ribs

Question 4

what are the 5 common densities on a CXR

Answer 4

bone
soft tissue
fat
air
iatrogenic

Question 5

what does iatrogenic

Answer 5

placed in by doctor

Question 6

what are the 4 locations of interest for evaluation in a CXR

Answer 6

mediastinum
lungs
pleura
chest wall

Question 7

what 4 things create densities

Answer 7

water
pus
blood
cells

Question 8

what creates lucencies

Answer 8

air

Question 9

what are 2 common pathologies of the lung

Answer 9

consolidation

tumors

Question 10

what are 2 common pathologies of the pleura

Answer 10

pleural effusion

pneumothorax

Question 11

what are 2 common pathologies of the mediastinum

Answer 11

enlarged heart

mediastinal nodes

Question 12

what are 2 common lung densities

Answer 12

consolidations and masses/nodes

Question 13

what is an example of what a consolidation can be in the chest

Answer 13

infection

Question 14

what is an example of what masses and nodes can be in the chest

Answer 14

cancer

Question 15

what is a silhouette sign

Answer 15

loss of normal borders between 2 adjacent soft tissue structures (eg losing the heart border)

Question 16

what is the silhouette sign used for

Answer 16

locating area of consolidation

Question 17

if there is a right paratracheal stripe in the xray which lobe of the lung is the consolidation in

Answer 17

right upper lobe

Question 18

if the right heart border is obscured in the xray which lobe of the lung is the consolidation in

Answer 18

right middle lobe

Question 19

if the right hemi diaphragm is obscured in the xray which lobe of the lung is the consolidation in

Answer 19

right lower lobe

Question 20

if the aortic knuckle is obscured in the xray which lobe of the lung is the consolidation in

Answer 20

left upper lobe

Question 21

if the left heart border is obscured in the xray which lobe of the lung is the consolidation in

Answer 21

lingula segments of the left upper lobe

Question 22

if the left hemi diaphragm or descending is obscured in the xray which lobe of the lung is the consolidation in

Answer 22

left lower lobe

Question 23

can you tell the difference on images between blood, pus, water and tumor cells from an xray

Answer 23

no you need clinical history

Question 24

what is the air bronchogram sign

Answer 24

air filled bronchi remain patent and visible on image as there is contrast between the air in the bronchi and the fluid in the alveoli

sign of bronchi that are not filled with fluid and are filled with air and run through infection

Question 25

what is the air bronchogram used for

Answer 25

occur with conditions such as cancers but are most commonly associated with infective consolidations such as pneumonia shows its not a solid mass so likely to be a infection

Question 26

what is the bulging lobar margin sign due to

Answer 26

formation of large amounts of inflammatory exudate (pus/fluid) results in local expansion of lung

Question 27

what does bulging lobar margin indicate

Answer 27

infection or inflammation

Question 28

what are 2 common mediastinal pathologies

Answer 28

enlarged glands and heart

Question 29

what is the definition of an enlarged heart

Answer 29

heart size is usually less than 50% of the thoracic diameter

Question 30

when does upper lobe diversion happen

Answer 30

early heart failure

Question 31

what is upper lobe blood diversion

Answer 31

incompetence of heart forces blood to go to upper lobes

Question 32

what does the batwing presentation indicate

Answer 32

cardiac infarct

Question 33

what does the batwing presentation look like

Answer 33

edges/corners of lung near diaphragm are blackened

Question 34

what is a pleural effusion

Answer 34

fluid in pleural cavity

Question 35

what is pneumothorax

Answer 35

air in the pleural cavity

Question 36

what does the deep sulcus sign indicate

Answer 36

supine pneumothorax

Question 37

besides all normal chest checks what are the 4 things needed to be checked

Answer 37

deep sulcus sign pneumothorax on patient with shoulder and rib # check for other bony # widened mediastinum

Question 38

in a supine patient with normal lungs the distribtution of blood would be

Answer 38

equal throughout the lungs due to gravity

Question 39

what is a flail chest

Answer 39

2 or more ribs fractured in 2 or more places

Question 40

in the normal chest the left hilum lies where relative to the right hilum

Answer 40

1-2cm above the right

Question 41

the medial ends of the clavicles should be equidistant to what in an unrotated image

Answer 41

spinous proceses of the vertebra

Question 42

a good inspiration should have how many anterior ribs

Answer 42

5-6

Question 43

what does the silhouette sign indicate

Answer 43

loss of normal borders between 2 adjacent structures because of consolidation in the lung which appears white the whiter lung area alongside the white solid organ outline means that the borders cannot be distinguished

Question 44

what is the apical zone

Answer 44

above the clavicles

Question 45

what is the upper zone

Answer 45

below the clavicles and above the cardiac silhouette

Question 46

what is the mid zone

Answer 46

level of hilar structures

Question 47

what is the lower zone

Answer 47

bases of the lung

Question 48

what is the air bronchogram sign

Answer 48

fluid/consolidation present in air spaces/alveoli, it appears white on radiograph, any fluid in alveoli appears white on radiograph bronchi is visible in abnormal case as branching black lines the air filled bronchi remain patent and visible as there is contrast between the air in the bronchi and the fluid in the alveoli

Question 49

what are air bronchograms most commonly associated with

Answer 49

infective consolidations such as pneumonia

Question 50

what are the 2 types of pneumonia

Answer 50

bronchopneumonia and lobar pneumonia

Question 51

what is bronchopneumonia

Answer 51

initially inflammation of the bronchioles and bronchi later affecting the alveoli resulting in a more patchy appearance

Question 52

what is lobar pneumonia

Answer 52

a part or whole of one lobe is affected

Question 53

what are the 2 types of lung cancers

Answer 53

metastases or primaries

Question 54

what is the most common type of lung cancer

Answer 54

metastatic

Question 55

what are the 2 main types of primary lung cancers

Answer 55

small cell | non small cell

Question 56

what are the 3 most common non small cell primary lung cancers

Answer 56

adenocarcinomas squamous cell carcinomas large cell carcinomas

Question 57

what are the 4 things to look for in terms of lung nodules and masses

Answer 57

tracheal shift smooth outlines popcorn lesions lack of air bronchograms

Question 58

what is tracheal shift in context of nodules and masses

Answer 58

trachea is often pushed or pulled by a neoplasm usually a primary lesion

Question 59

what happens with mild pulmonary edema

Answer 59

upper lobe blood diversion

Question 60

what 4 things happens with moderate pulmonary edema

Answer 60

upper lobe blood diversion bronchial wall thickening blurring of bronchovascular densities due to fluid in supporting tissues blunting of costophrenic angles

Question 61

what happens with severe pulmonary edema

Answer 61

edema fills alveoli and results in air space opacification

Question 62

what is interstitial edema

Answer 62

increased interstitial densities including septal lines/interlobular septa are visible

Question 63

what is the batwing distribution indicate and what part of the lung is not affected

Answer 63

severe pulmonary edema - myocardial infarct outer 3rd of lungs commonly spared