abnormal chest Flashcards
consolidation
infiltrate or solid engorgement
congestive heart failure
hilar engorgement and increase heart size
pneumothorax
air in the pleural cavity
atelectasis
collapse of the lung due to obstruction
alveolar
air sacs
interstitial
spaces within a lung or tissue/spaces between alveoli
pleural effusion
fluid in the pleural cavity
patterns of disease
- diffuse
- focal
- lung volume
- pleural disease
- lymphadenopathy
two divisions of diffuse disease pattern
airspace disease and interstitial opacity
two divisions of focal disease patterns
nodules/masses
blebs/bullae/cysts/cavities
what will airspace disease look like
is it focal or diffuse
a confluent fluffy or hazy opacity resulting from fluid density in the alveoli
it is diffuse and can involve part or the whole lung
what is air bronchogram sign
what is it indicative of
indication of airspace disease
an air filled bronchus surrounded by an airless lung
if air bronchogram sign is present where is the lesion causing the issue
in the lung
describe what the airspace disease will look like on xray
hazy, fluffy, confluent opacities with indistinct margins and airbronchogram or silhouette sign
what is the acute DDx for air space opacity
- pneumonia
- pulmonary alveolar edema
- hemorrhage
- aspiration
- near-drowning
what is the DDx for chronic air space opacity
- bronchoalveolar cell carcinoma
- alveolar cell proteinosis
- sarcoidosis
- lymphoma
interstitial lung disease
development of particles in the interstitium
interstitium
connective tissue, lymphatics, blood vessels, and bronchi that surround and support airspaces
three characteristics of interstitial lung disease
- reticular, nodular, or reticulonodular pattern
- packets of disease surrounded by normal lung
- can be focal of diffuse
define the reticular/nodular pattern found in interstitual lung disease
small, well defined white nodules and lines that cna be fine, thin, lacy densities
description of interstitial opacities based on pattern
- reticular (too many lines)
- nodular (too many dots)
- reticulonodular (too many lines and dots)
DDx for interstitial opacities
- idiopathic interstitial pnemonia
- infection
- pulmonary edema from CHF
- idiopathic pulmonary fibrosis
- environmental factors
- hemorrhage
- sarcoidosis
- tumor/metastases
in what disease would a miliary pattern appear on xray
tuberculosis
distinguish between a nodule and mass
nodule is any pulmonary radiographic lesion that is sharply defined, discrete, nearly circular, and less that 3cm
a mass is larger than 3cm
descriptive terms for a nodule or mass
- single vs multiple
- size
- border defintion
- calcification
- location
characteristics of benign nodules
- can be slow or fast growing
- usually round and less than 4cm
- usually found in non smokers under 35
- can be calcified
- well definded edges
characteristics of malignant nodules
- steady, predictable growth
- larger than 5cm
- can be smooth round or ill defined depending on source
how will primary lung cancer look on xray
ill defined, speculated, lobulation
how will hematologic mets look on x ray
multiple smooth round lung nodules often variable in size
how will lymphatic mets look on xray
more like interstitial lung disease
what is snowball sign used to do
elaborate on how
determine if a mass or nodule comes from the lung or surrounding tissue
if the snow ball is round, it is in the lung, if the snow ball is flat it is in the surrounding tissue
atelecatsis
three types
collapse or volume loss
obstructuve, compressive, subsegmental
what will atelectasis look on xray
white tissue due to lack of air volume
obstructuve ateleactasis
blocked bronchus causes reabsorption of air in the alveoli distal to the obstruction leading to collapse
compressive atelectasis
passive compression of the lung due to pleural effusion, pneumothorax, or space occupying mass
subsegmental atelectasis
lung collapse of part of a lung usually caused by patients not taking deep breaths, often related to surgery or pleuritic chest pain
signs of atelectatsis
- displacement of the interlobar fissure toward the collapsed lobe
- increased density of the affected lung
- shift of mobile structures in the thorax
- overinflation of the ipsilateral lobes and/or contralateral lung
what three structures in the thorax can shift due to atelectasis
trachea, heart, lungs
why can the ipsilateral lobes/contralateral lungs overinflate due to atelecatsis
there will be an attempt to overcompensate due to volume loss
what is the most common mediastinal mass
lymphadenopathy
four common causes of lymphadenopathy
- lymphoma
- metastatic carcinoma
- sarcoidosis
- TB
how will lymphadenopathy present on xray
medialstinal widening and hilar prominence
commonalities between blebs, bullae, cysts, and cavities
four points of variation between them
all air and or fluid containing lesions in the lung
- size
- location
- wall composition
- fluid content
blebs
very small blister like lesions that form in the visceral pleura, usually in the apices
can blebs always be seen on CXR?
what sequla is associated with blebs
not usually
spontaenous pneumo
bullae
less than 1cm cavitys associated with emphysema, only partially visable on CXR
where are bullae found?
why are they only partiall visable on CXR
lung parechyma
very thin wall
cysts
location
defining characteristic
cavities that can be congential or acquired through infection
occur in the lung parenchyma and mediastinum
thin walled but larger than bullae (<3mm)
cavity
location
wall characteristic
description
often includes what
variable in size and shape
lung parenchyma
wall greater than 3mm
white soft tissue density ring with an air density center
air fluid level
causes of lung cysts
abscesses, TB, carcinoma
signs to look for to indicate pneumothorax
- symmetrical
- lung markings to periphery
- white visceral lines and bones
signs to look for in pleural effusion
blunting of the costophrenic angle
movement of opacity
what should you do if you suspect pleural effusion or lung infiltrate
move the patient effusion will move in response to gravity infiltrate wont
signs of COPD or emphysema
- hyperinflation
- flattened diaphragm
- heart appears smaller
why are lungs hyper inflated in COPD/Emphysema
air trapping due to incomplete expiration
barrel chest is a sign of what
COPD emphysema
what usually causes pneumopericardium
direct wound
air bronchogram
air bronchogram
normal vs alveolar opacity
right upper lung opacity
right middle lobe opacity
interstitial lung disease vs normal lung
linear interstitial disease
nodular interstitial disease
reticular interstitial disease
reticulonodular interstitial disease
interstitial lung disease from advanced pulmonary fibrosis
reticular intestitial disease
milliary intertstitial disease
differentiate between air space disease and interstitial lung disease in term of location in the lung
there is no difference both diesease can be in any zone
differentiate between air space disease and interstitial lung disease in term of appearance on CXR
ASD: confluent shadows with air bronchogram
ILD: linear/reticular/nodular shadows
differentiate between conditions that will cause air space disease and interstitial lung disease to show up on CXR
ASD: fluid, pus, blood, tumors
ILD: fluid or inflammation leading to fibrosis
what are four examples of disease that can lead to fibrosis/interstitial lung disease
- industrial lung disease
- inflammation
- sarcoidosis
what is the probability of malignancy if a malignant lung nodule is larger that 5cm
95%
calcified nodules
nodule
nodule
how will subsegmental atelectasis look different from other atelectasis on CXR
linear densities parallel to diaphragm seen at the lung bases
what is a common cause of subsegmental atelecatasis
two conditions that would lead to this
patients who arent taking deep breaths
post-op patients or patients with pleuritic chest pain
T/F a small, acute atelectasis will create a larger overinflation of the the contralateral lung
false, a large or chronic atelectasis will produce a larger compensation
atelectasis
lymphadenopathy
lymphadenopathy
cyst with an air fluid level
cyst
what will definitely be visable on CXR in the case of pneumothorax
a white viseceral line at the periphery
what are two structures that can mimic pneumothorax
how can they be differientated from pneumo
overlapping skin folds
scapular border
follow the lung markings
what should be ordered if you are unsure if there is a pneumo but have high clinical suspicion
get an expiratory film
pneumothorax on expiration
pneumothorax on inspiration
tension pneumo
tension pneumo
pleural effusion
pleural effusion
pleural effusion
COPD
COPD
COPD
COPD
pneumopericardium
pericardial effusion
mediastinal widening
