Abnormal Breath Sounds; Intro to Chest Imaging Flashcards
What is the lowest lobe you can hear in each lung in the front?
Right: Right Middle Lobe
Left: Lingula of Left Upper Lobe
What lobe can not be heard in each lung on the back?
Right: RML
Left: Lingula of Left Upper Lobe
What do bronchial breath sounds sound like?
Amplified normal (vesicular) breathing sound
What creates crackles generally and where are they typically heard?
Re-opening of sick alveoli
Typically heart best at lung bases
What causes fine vs coarse crackles?
Fine - Interstitial lung disease (pulmonary fibrosis)
Coarse - Pulmonary edema, pneumonia (can easily be heard without a quiet room)
What are rhonci / what causes them?
Whistlelike noise lower pitch than a wheeze
Caused by mucus or secretions obstructing large airways
What causes wheezes?
Narrowing of the airways (as in asthma) -> high pitched expiration / inspiration sound
What are stridor?
High pitch inspiratory wheeze caused by upper airway disease (as in croup)
How are wheezes told apart from stridor?
Stridor are heard higher up, in the upper airways
-> closer to neck level
What does a pleural rub sound like? What causes it?
Low pitched sound continuous over inspiration / expiration
-> caused by pleuritis
What are the four regions which radiologists divide the mediastinum into for CT scanning?
1 - supra-aortic
2 - Aortic arch w/ aortopulmonary window (APW)
3 - pulmonary artery and azygo-esophageal recess
4 - Pericardium / cardiac level
Where is the aortopulmonary window (APW)?
The space between the pulmonary artery and aortic arch
What is it called in radiology when you cant see the vessels in the lung because everything is white?
Homogenous opacity obscuring vessels
What is a contrast sign in lung CT and what causes it?
Very white vessels, due to perfusion of lung with blood with contract
What is an air bronchogram and why is it caused?
The phenomenon of air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white). It is almost always caused by a pathologic airspace/alveolar process, in which something other than air fills the alveoli. Air bronchograms will not be visible if the bronchi themselves are opacified (e.g. by fluid) and thus indicate patent proximal airways.
What is it called when a section of lung has ill-defined borders, and an irregular, moddled appearance to it? What causes it?
Air alveologram
Contrast in density between some alveoli being filled with fluid or cellular material and others filled with air.
What is most likely to cause a patchy infiltrate?
A bronchopneumonia, especially S. aureus
spreading via blood stream
What are very tiny opacities on CXR called and why?
Acinar Nodular Opacity - smaller inspiratory unit
What is it called when everything appears slightly more white in the lung tissue and it reaches the pleura? When might this occur?
Preserved lung volume (replacement of air with fluid) and extension to pleural surface
Might occur in lobar pneumonia
What does the bat wing sign on chest-ray mean and what things typically cause it?
Diffuse white infiltrate inside (closer to center) and black outside (towards periphery)
Caused by pulmonary edema (especially cardiogenic / HF), pneumonia (viral or atypical), and inhalational injury
What is the reversed bat wing sign on chest-ray, and what things typically cause it?
Peripheral opacities of the lungs, sparing the perihilar region.
Eosinophilic pneumonitis, sarcoidosis, and cryptogenic organizing pneumonia (COP) are near the top of the DDx
What causes diffuse patchy infiltrate?
ARDS, inhalational injury, hemorrhage
What types of things cause diffuse airspace nodules?
Mycobacterium, cancer, and spreading pneumonia
What causes segmental vs lobar consolidation?
Lobar - along with spherical, typical bacterial pneumonias are most common, sometimes cancer. The bacteria invade via pores of Kohn the entire airspace
Segmental - typically a vascular or bronchiole obstruction (mucous plug, pulmonary embolus, tumor)
What lobes obscure the aortic arch on the right and left (Silhouette sign)
Right - RUL
Left - LUL
What lobes obstruct the right heart border and left hemidiaphragm (Silhouette sign)
Right heart border - Right middle lobe
Left hemidiaphragm - Left lower lobe
What obscures the left heart border and right hemidiaphragm (silhouette sign)?
Left heart border - Lingula (LUL)
Right hemidiaphragm - Right lower lobe
What obscures the descending aorta (silhouette sign)?
Left lower lobe
