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MS2 Respiratory > 9/8- Chest Imaging in Lung Disease > Flashcards

9/8- Chest Imaging in Lung Disease Flashcards

1
Q

What is the reference substance for x-ray?

A

Water

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2
Q

Describe relative absorption of x-rays by different tissues:

  • Bone
  • Tissue (fluid, muscle)
  • Air
A
  • Bone: high absorption (white)
  • Tissue (fluid, muscle): grey
  • Air: low absorption (black)
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3
Q

What is silhouette sign in x-ray?

A

Tissues or structures with similar density, adjacent to each other, cannot be differentiated (e.g. blood filled heart) If fluid is obscuring heart/aorta, it’s in the same plane as what is no longer seen

(B- see aorta outline but not heart; in plane of heart. C- see heart border but not aorta; in plan of aorta)

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4
Q

Under what position/conditions is a CXR taken?

A
  • Upright
  • Full inspiration
  • 72” from x-ray source
  • Plate in front of patient
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5
Q

Characteristics of a normal CXR (postero-anterior)?

  • Stomach
  • Scapula
  • Clavicles
  • Vertebral bodies
  • Lung lobes
A

Postero-anterior film

  • Air in stomach
  • Scapulae at edge of thorax
  • Well centered – clavicles equidistant from spinous processes
  • Lower vertebral bodies barely visible
  • LLL visible (behind heart
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6
Q

What is different in antero-posterior view as opposed to postero-anterior?

A
  • Opposite
  • Anterior structure magnified: heart, mediastinum
  • Scapula in thorax
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7
Q

Features of lateral CXR?

A
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8
Q

What is abnormal?

A

Elevated diaphragm

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9
Q

What can cause an elevated diaphragm?

A
  • Collapse/ volume loss of lung
  • Subpulmonic effusion
  • Subphrenic abscess
  • Herniation/eventration
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10
Q

What are diseases of increased radiographic density?

A
  • Alveolar filling (blood, fluid, cellular components in pneumonia)
  • Atelectasis/Volume loss
  • Interstitial infiltrates
  • Masses
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11
Q

What is seen here?

A

Silhouette Sign: RML pneumonia

  • We are missing the right heart border
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12
Q

What is seen here?

A

Infiltrate in upper lobe

  • Opacity above minor fissure (separating upper lobe from middle lobe)
  • Possibly additional infiltrate in left lower lobe
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13
Q

Which lobes correspond to:

  • Right heart border
  • Left heart border
A

- Right heart border: right lower lobe

- Left heart border: left lingula

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14
Q

What is seen here?

A

Uremic lung disease (not a specific finding)

  • Diffuse increase in density; bilateral
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15
Q

What is seen here?

A

Collapsed left lung (due to tumor)

  • Ipsilateral pulling of midline structures due to collapse
  • Heart, diaphragm, aorta/midline structures are all silhouetted out
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16
Q

What is seen here?

A

Pulmonary vascular congestion (turns out he had mitral stenosis)

  • Predominant upper lobe density
  • Bilateral
17
Q

What does the meniscus sign suggest?

A

Presence of pleural fluid

18
Q

What is seen here?

A

Tumor causing obstruction of right main bronchus

  • Trachea and heart deviated to the right
  • Right lung is smaller and more opaque
19
Q

What are diseases of decreased radiographic density?

A
  • Air trapping: asthma, emphysema, foreign body
  • Pneumothorax
  • Cysts/bullae
  • Loss of soft tissue (e.g. mastectomy pts)
20
Q

What is seen here

A

Overinflation- severe bullous emphysema

  • Diaphragm low and flat
  • Streaks are due to upper lung tissue being pulled down (bullae); crowding of lung markings in lower thorax; absence of lung markings (upper)
  • Hilum has been pushed down (below aortic knob)
21
Q

What is seen here?

A

Overinflation- severe bullous emphysema

  • Increased retrosternal air space
  • Flat diaphragms
22
Q

What is seen here?

A

Pneumothorax- compression atalectasis of the lung

  • Right apex might be considered normal (no markings, but mostly collapsed/compressed lung
  • See pneumonic infiltrates on right
23
Q

What is seen here?

A

Pneumothorax

  • Can see pleura line on the lower right with effusion just external
24
Q

What is seen here?

A

Cavitation of the lung (lucency within density)

  • Commonly from infection (also, sometimes from cancers)
25
Q

What is seen here?

A

Cavity with development of air-fluid level… this is an ABSCESS

26
Q

When would you want decubitus film?

A
  • Demonstrate pleural effusion fluid layers/air rises
  • Sub-pulmonic effusion
  • Air/fluid levels
  • Subtle pneumothorax
27
Q

If there is a pleural effusion on the right, which side do you want down?

A

Want pneumothorax side DOWN

28
Q

When would inspiratory/expiratory films be helpful?

A
  • Small/subtle pneumothorax
  • Unilateral air trapping
29
Q

CT is test of choice for what?

A
  • Pulmonary embolism
  • Vascular malformations

Also:

  • Evaluation of hilar and mediastinal structures: LNs, tumors, central airways
  • Radiologic diagnosis of bronchiectasis
30
Q

What is seen here?

A
  • “Generous” hilum
31
Q

What is seen here?

A

Large homogeneous density of a mass/LN

32
Q

Angiography of the chest shows what vessels?

A

Contrast studies help diagnose vascular diseases such as pulmonary embolism

  • Pulmonary
  • Bronchial
33
Q
  • A 41 yo presents with dyspnea for 3 weeks-
  • On physical exam there are decreased breath sound, decreased tactile fremitus, and dullness to percussion on the right lower lung field
  • Chest x-ray show increased radiographic density and obliterated costophrenic angle.
  • You suspect pleural effusion.
  • What radiographic test would you order next to confirm the diagnosis?
A

Pleural diseases, pneumothorax and pleural effusion are better assessed by decubitus films

  • For a pneumothorax: air rises when lying on unaffected side, fluid layers when lying on the affected side
34
Q

How does pneumothorax affect absorption of X-ray photons and what is the resulting effect on the X ray density on the affected side?

A

Air rises when lying on unaffected side, fluid layers when lying on the affected side

35
Q

Name 3 respiratory conditions associated with increased and 3 associated with decreased radiographic density.

A

Increased radiographic density:

  • Alveolar filling
  • Atalectasis/volume loss
  • Interstitial infiltrates
  • Masses

Decreased radiographic density:

  • Air trapping: asthma, emphysema, foreign body
  • Pneumothorax
  • Cysts/bullae
  • Loss of soft tissue

MS2 Respiratory (26 decks)

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