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12. Respiratory > 8. Radiology of the Chest and Pleura, Chest Wall and Interstitial Lung Disease > Flashcards

8. Radiology of the Chest and Pleura, Chest Wall and Interstitial Lung Disease Flashcards

1
Q

Describe how to identify the trachea on a plain film radiograph of the chest.

A

It is between the two medial edges of the clavicles.

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2
Q

Describe how to identify the hila on a plain film radiograph of the chest.

A

They are faint just coming lateral to where the heart starts, about 5 ribs down.

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3
Q

Describe how to identify the lungs on a plain film radiograph of the chest.

A

They are dark due to lots of air, don’t absorb much.

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4
Q

Describe how to identify the diaphragm on a plain film radiograph of the chest.

A

It is rounded on both sides, should be able to trace left side behind the heart.

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5
Q

Describe how to identify the heart on a plain film radiograph of the chest.

A

It is slightly to the left and goes from about rib 5 to the diaphragm.

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6
Q

Describe how to identify the aortic knuckle on a plain film radiograph of the chest.

A

On the left side of the patient and stick out from the sternum a bit.

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7
Q

Describe how to identify the ribs on a plain film radiograph of the chest.

A

Curve outwards across the whole length of the chest.

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8
Q

Describe how to identify the scapulae on a plain film radiograph of the chest.

A

The scapulae are on the lateral edges of the radiograph image, they are behind the shoulder joint.

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9
Q

Describe how to identify the breasts on a plain film radiograph of the chest.

A

The breast may look like some consolidation around the level of the diaphragm.

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10
Q

What is the costophrenic recess/angle?

A

The potential space in the pleural cavity at the posterior-most tips of the cavity, the junction of the costal pleura and diaphragmatic pleura.

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11
Q

What is the costocardiac angle?

A

The angle at the joining of the lungs and the heart.

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12
Q

What is a radiological indicator of lobar collapse?

A

Displacement of the horizontal fissure.

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13
Q

When does the horizontal fissure get dispaced upwards?

A

With lobar collapse of the right upper lobe.

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14
Q

When does the horizontal fissure get displaced downwards?

A

If there is volume loss of the right lower lobe, in collapse.

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15
Q

What is consolidation?

A

If alveoli and small airways fill with dense material.

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16
Q

What can cause consolidation?

A

Infection, fluid, blood, or cells.

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17
Q

How does a space occupying lesion appear in the lung?

A

A large, round, thick-walled lung cavity.

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18
Q

What is a common cause of space occupying lesions in the lung?

A

Squamous cell lung carcinoma.

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19
Q

What is pleural effusion?

A

A collection of fluid in the pleural space.

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20
Q

How will pleural effusion present on X rays of an upright patient?

A

It obscures the costophrenic angle/ hemidiaphragm.

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21
Q

How will pleural effusion present on X rays of a supine patient?

A

The pleural effusion layers along the posterior aspect of the chest cavity and is difficult to see on an X ray.

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22
Q

What is the meniscus sign?

A

Pleural effusion on an X ray appear as uniformly white, with a concave area at the top.

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23
Q

What is a pneumothorax?

A

Air trapped in the pleural space.

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24
Q

What is the X ray change seen with tension pneumothoraces?

A

Tracheal or mediastinal shift away from the pneumothorax. It is pushed away by the air in the pleural cavity.

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25
Q

What decided if a disease pulls or pushes the trachea in tracheal displacement?

A

Anything that increases pressure or volume in one hemithorax will push the trachea and mediastinum away from that side. Any disease that causes volume loss in one hemithorax will pull the trachea over towards that side.

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26
Q

What is the X ray appearance of asbestos plaques?

A

Irregular, well defined, and classically like holly leaves.

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27
Q

What can cause hyperinflation of the lungs?

A

COPD.

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28
Q

How does hyperinflation present on X rays?

A

Blunting of the costophrenic angles and flattened hemidiaphragms.

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29
Q

How does bowel perforation appear on X rays?

A

Lungs are normal but air is under the diaphragm.

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30
Q

What should the cardiothoracic ratio be?

A

The widest part of the heart should be less than 50% of the width of the thorax.

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31
Q

What is the interstitial space?

A

A potential space between alveolar cells and the capillary basement membrane.

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32
Q

What is the pathophysiology of interstitial lung disease?

A

The development of fibrous tissue in the intersticium, making lungs less compliant and have a restrictive ventilatory defect.

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33
Q

How does interstitial lung disease affect FVC and FEV1/FVC ratio?

A

FVC is reduced but FEV1/FVC is normaly.

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34
Q

How is gas exchange impaired in interstitial lung disease?

A

The diffusion path is lengthened between alveolar air and blood. Oxygen uptake is affected more than CO2.

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35
Q

What are the symptoms of interstitial lung disease?

A

Shortness of breath, reduced exercise tolerance, dry cough.

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36
Q

What are the signs of interstitial lung disease?

A

Tachypnoea, tachycardia, reduced chest movement and coarse crackles. Cyanosis and signs of right heart failure. Clubbing in cryptogenic fibrosing alveolitis.

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37
Q

What are the five categories of causes of interstitial lung disease?

A

Occupational, treatment related, connective tissue disease, immunological, and idiopathic.

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38
Q

What occupational linked factors can cause interstitial lung disease?

A

Asbestos, silicosis, coal workers pneumoconiosis.

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39
Q

What treatments related factors can cause interstitial lung disease?

A

Radiation, methotrexate, nitrofurantoin, amiodarone, chemotherapy.

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40
Q

What connective tissue disease factors can cause interstitial lung disease?

A

Rheumatoid arthritis, systemic lupus erythematosus, polymyositis, schleroderma, Sjogren’s.

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41
Q

What immunological factors can cause interstitial lung disease?

A

Sarcoidosis, hypersensitivity pneumonitis.

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42
Q

What idiopathic factors can cause interstitial lung disease?

A

CFA/IPF, UIP/NSIP, DIP, LIP, RB-ILD, COP.

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43
Q

What is fibrosing alveolitis?

A

Progressive inflammatory condition.

44
Q

What causes fibrosing alveolitis?

A

Unknown cause.

45
Q

What is the incidence of fibrosing alveolitis?

A

3-5 cases per 100000, twice as common in males.

46
Q

What are the histological changes of fibrosing alveolitis?

A

Increased activated alveolar macrophages. Attract neutrophils and eosinophils, local lung damage from reactive oxygen species and proteases, tissue destruction and fibrosis.

47
Q

What are the symptoms of fibrosing alveolitis?

A

Progressive shortness of breath on exercise, often with non-productive cough.

48
Q

What are the chest X ray features of fibrosing alveolitis?

A

Small lungs with micro-nodular shadowing predominating in the lower lobes with ragged heart borders.

49
Q

How is fibrosing alveolitis treated?

A

High dose oral steroids in the early stages, uneffective as fibrosis develops.

50
Q

What is extrinsic allergic alveolitis?

A

Inhalation of organic material triggers an allergic reaction in alveoli and bronchioles.

51
Q

What is acute extrinsic allergic alveolitis also called?

A

Farmer’s lung.

52
Q

What is Farmer’s lung caused by?

A

Antigen termophilic actinomycetes found in mouldy hay.

53
Q

What are the symptoms of Farmer’s lung?

A

Influenza like illness after 4-9 hours with dry cough and breathlessness on exertion. Fine mid and late inspiratory crackles, may have a wheeze.

54
Q

What is chronic extrinsic allergic alveolitis also called?

A

Bird fancier’s lung.

55
Q

What is bird fancier’s lung caused by?

A

Long term antigen exposure to pigeons/ budgerigars.

56
Q

What are the symptoms of bird fancier’s lung?

A

Insidious malaise, dry cough with breathlessness over months and years. Inspiratory crackle.

57
Q

What are the X ray findings of bird fancier’s lung?

A

Acute disease has diffuce mirco-nodular infiltrate denser towards the hilar. Chronic may have almost normal X ray but progressive fibrosis late in the disease.

58
Q

What are the lung function results for bird fancier’s lung?

A

Reduced compliance and reduced gas transfer.

59
Q

What is asbestosis inhalation associated with?

A

Benign pleural plaques, asbestosis, mesothelioma.

60
Q

How does asbestos fibres cause fibrosis?

A

They penetrate to the alveoli so there is influx of macrophages to cause alveolitis that progresses to fibrosis.

61
Q

What are the symptoms with asbestosis?

A

Breathless on exertion and a dry cough. Inspiratory crackles at lung bases.

62
Q

How can asbestosis be treated?

A

It can’t.

63
Q

What do lung function tests show in asbestosis?

A

Small lungs, reduced compliance, and impaired gas transfer.

64
Q

What is sarcoidosis?

A

A disease of unknown cause that is characterised by non-caseating granulomas in multiple organs and body sites.

65
Q

What do the alveoli contain lots of in sarcoidosis?

A

Cells like macrophages and lymphocytes.

66
Q

Which ethnicities are more at risk of sarcoidosis?

A

Afro-Caribbeans and Asians.

67
Q

What is the highest incidence age of sarcoidosis?

A

30s and 40s.

68
Q

What are the symptoms of sarcoidosis?

A

Often asymptomatic but can have cough and breathlessness.

69
Q

What do X rays in sarcoidosis show?

A

Miliary and nodular shadowing and diffuse fibrosis.

70
Q

How can sarcoidosis be treated?

A

In stages 1-3, steroids can suppress the disease.

71
Q

What do lung function tests of sarcoidosis show?

A

Small lungs, reduced compliance, and impaired gas transfer. May have air flow obstruction.

72
Q

Which occupations cause increased susceptibility to asthma?

A

Lab workers.

73
Q

Which occupations cause increased susceptibility to diffuse fibrosis?

A

Boiler/ pipe laggers, railway or construction.

74
Q

Which occupations cause increased susceptibility to nodular fibrosis?

A

Coal miner, miner, demolition workers.

75
Q

Which occupations cause increased susceptibility to alveolitis?

A

Farmer, pigeon fancier.

76
Q

What exposure leads to asthma in lab workers?

A

Rat urine.

77
Q

What exposure leads to diffuse fibrosis in boiler/ pipe laggers and railway/construction workers?

A

Asbestos.

78
Q

What exposure leads to nodular fibrosis in coal miners, miners, and demolition workers?

A

Coal dust, silica and asbestos.

79
Q

What exposures lead to alveolitis in farmers and pigeon fanciers?

A

Fungal spores in hay, avian antigen respectively.

80
Q

What is the pleura?

A

A serous membrane consisting of a single layer of mesothelial cells with a thing layer of underlying connective tissue.

81
Q

What does the parietal pleura line?

A

The inside of each hemithorax.

82
Q

What does the visceral pleura line?

A

The outside of the lung, extends between lobes of the lung into the oblique and horizontal fissures.

83
Q

What is the pleural cavity?

A

A potential space between the two layers of pleura.

84
Q

What is the purpose of the pleural fluid in the pleural space?

A

It allows the two pleural layers to slide over each other. The surface tension also provides cohesion to keep the lung surface in contact with the thoracic wall for breathing.

85
Q

How much pleural fluid is made a day?

A

15ml.

86
Q

What produces pleural fluid?

A

The capillary filtration at the parietal pleura.

87
Q

How is the amount of pleural fluid produced affected?

A

Increased in lung interstitial fluid increase, hydrostatic pressure, permeability. Decreased in oncotic pressure rise.

88
Q

How is the pleural fluid absorbed?

A

Via lymphatic drainage.

89
Q

What affect pleural fluid absorption?

A

Decreased with lymphatic blockage, increase in systemic venous pressure increase.

90
Q

How can pleural effusions be characterised?

A

By protein content: exudate or transudate.

91
Q

How do transudate and exudate effusions differ?

A

Transudates have low protein content, exudates have high protein content.

92
Q

How do transudates affect hydrostatic and oncotic pressures?

A

Increase hydrostatic pressure, decrease capillary oncotic pressure.

93
Q

What can cause exudate pleural effusion?

A

Neoplasms, infection, immune disease, abdominal disease.

94
Q

What is pleuritis?

A

Inflammation of the pleura.

95
Q

What are the symptoms of pleuritis?

A

Sharp pain on inspiration, worse with coughing, sneezing, laughing etc.

96
Q

Why is there referred pain in pleuritis?

A

Involvement of the diaphragmatic pleura so pain in shoulder on same side.

97
Q

What is a characteristic physical sign of pleuritis?

A

Pleural rub - creaking noise heard through the stethoscope with respiratory movements.

98
Q

What causes pleuritis?

A

Infection most commonly, autoimmune, lung cancer, pneumothorax, pulmonary embolism.

99
Q

What is pleural fibrosis caused by?

A

Unabsorbed pleural effusion leading to fibrosis.

100
Q

What is the effect of pleural fibrosis?

A

Wide spread fibrosis restricts expansion, so measurable reduction in lung volumes and compliance.

101
Q

What is the commonest primary pleural tumour?

A

Malignant mesothelioma.

102
Q

What are the symptoms and signs of primary pleural tumour?

A

Early symptoms are loss of pleural effusion, with duller pain. Or of that of a large pleural effusion.

103
Q

What impairment to respiration can scoliosis and kyphosis produce?

A

Functional to thoracic cage.

104
Q

What acquired abnormalities can impair the thoracic cage?

A

Trauma producing broken ribs, possible pneumothorax. Surgery from TB to collapse lungs.

105
Q

How can muscle and neurological disease affect respiration?

A

Muscles involved in breathing might be affected by generalised muscular disease like muscular dystrophy, or by neurological disease like motor neurone disease or polio.

106
Q

How can muscle weakness lead to respiratory tract infections?

A

Respiratory failure and poor clearance of secretions so infection.

12. Respiratory (10 decks)

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