Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonary system > Approach to chest radiographs and computed tomography > Flashcards

Approach to chest radiographs and computed tomography Flashcards

1
Q

Suggested order of interpreting chest radiograph

A
  1. Technique
  2. Written data
  3. Chest wall/soft tissues
  4. Abdomen
  5. Diaphragm
  6. Pleura
  7. Heart
  8. Mediastinum
  9. Hila
  10. Lung parenchyma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Technical factors to look for

A

1) Rotation
2) Inspiration
3) Exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Rotation

A

Spinous processes should
project midway between
medial heads of clavicles
-i.e. clavicles are equidistant from the spinous processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Inspiration

A 
Dome of right 
hemidiaphragm projects 
over the anterior 6th /7th 
interspace and posterior 
right 10th interspace
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Exposure

A 
The lower thoracic disc 
spaces should be seen 
through the cardiac 
silhouette , and left 
diaphragm (i.e. disk spaces seen behind heart but should not see bony details of the spine + should visualize the left diaphragm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When are posterior ribs more apparent

A

-on PA film (anterior ribs less visible on this film)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many posterior ribs are visible

A

-up to 10 visible ribs on full inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Importance of proper inspiration

A

-poor inspiration results in simulation of an enlarged heart and increased density of lower lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Consequences of improper exposure

A

1) increased density - under exposed/penetrated - appears white because too little contrast
2) decreased density - over exposed/penetrated -appears lucent/dark - too much contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Written data -things you should check

A
  • the patients right side is on your left (i.e. view images as through you are standing in front of the patient)
  • patients name may give clue to ethnic group (certain diseases are more prevalent in some groups)
  • may state hospital ward patient is on
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Things to check when looking at the chest wall/soft tissues

A

1) Check each rib individually
2) Check the clavicles
3) Check for the presence or absence of breastss
4) Check for the presence of soft tissue masses
5) Check the vertebra (body, pedicles, spinous process, disc space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Things to check when looking at the abdomen

A

Looking for intrraperitoneal air (indicates perforated ulcer?
I.e. air rising above diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Things to check when looking at the diaphragm

A
  1. Point where diaphragm meets chest wall forms a shart acute angle (the lateral and posterior costophrenic angles)
  2. Right hemidiaphragm normally about 2cm higher than the left
  3. Normal diaphragm is convex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What flat diaphragms can indicate

A

-emphysema -due to hyperinflated lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Things to check when looking at pleura

A
  1. Are costophrenic angles blunted?
  2. Scrutinize perimeter of lung laterally and medially
    3 Pleural calcifications?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cause of blunting costophrenic angles

A
  • pleural effusion

- thickening

17
Q

Minimum amount of fluid needed to detect a pleural effusion on a lateral and frontal film

A

-75-200 cc

18
Q

Apperance of pneumothorax

A

thin white line representing the visceral pleura separated from the chest wall

19
Q

Meniscus sign

A
  • aka air crescent sign
  • the result of air accumulation between a mass or nodule and normal lung parenchyma
  • most frequently encountered in patients with aspergillosis
  • we saw it in case of effusion
20
Q

Assessing heart size

A

Cardiothoracic (CT) ratio = maximum transverse diameter of heart/maximum transverse diameter of rib cage

21
Q

Normal CT ratios

A

> 0.5 on PA view
0.6 on AP view
suggestive of cardiomegaly

22
Q

Composition of hila

A
  • lobar bronchi
  • pulmonary arteries/veins
  • lymph nodes
23
Q

Position left and right hilum

A

-left hilum is slightly higher than right

24
Q

What may cause hila enlargement

A
  • arteries
  • masses
  • enlarged lymph nodes
25
Q

What checking hila for

A
  • nodules or masses

- seen as enlarged hilum

26
Q

Radiographic appearance of lung parenchyma

A
  • gas filled alveoli = black
  • pulmonary vessels = white
  • bronchi don’t normally contriute to radiographic density
27
Q

How to recognize vessels in the lung parenchyma

A

They have a tapering and branching pattern

28
Q

Views of computed tomorgraphy

A
  • saggital
  • coronal
  • transverse/axial
29
Q

Checking for nodules in CT - meaning of random distribution

A
  • TB

- Mets

30
Q

Checking for nodules in CT- meaning of centrilobar distribution

A
  • disease that enter lung through airways
  • hypersensitivity pneumonitis
  • respiratory bronchiolitis
  • centrilobular emphysema
31
Q

Checking for nodules in CT -meaning of perilymphatic distribution

A
  • diseases that enter via lymphatics
  • sarcoidosis (classic)
  • silicosis
  • lymphangitic carcinomatosis
  • pulmonary edema
32
Q

Approach to disease patterns on CT

A
  1. Identify the pattern:
  2. Distribution and content
  3. upper or lower lobes
  4. Central or peripheral
  5. Associated findings- pleural effusion, lymphadenopathy, enlarged heart and pulmonary vasculature, calcification
33
Q

Identify the pattern algorithm

A 
1. Increased or decrease opacity/attenuation
A. increased opacity/attenuation/density
-consolidation?
-interstitial?
-nodular/mass?
-Atelectasis?
B. Decreased opacity/attenuation/lucent
-pneumothorax
-emphysema
-bronchiectasis
34
Q

Different contents

A
  1. Water
  2. Pus
  3. Blood
  4. Cells
35
Q

Different distributions and what they could indicate

A

1) Lobar
2) Diffuse
3) Multi-focal

36
Q

Differential diagnosis water consolidation

A
  • heart failure
  • ards
  • low albumin
  • renal failure
37
Q

Differential diagnosis pus consolidation

A

-pneumonia

38
Q

Differential diagnosis blood consolidation

A
  • trauma
  • goodpasture
  • henoch schonlein
  • SLE
39
Q

Differential diagnosis cell consolidation

A
  • BAC
  • organizing pneum
  • chron eosin pneum
  • sarcoid

Pulmonary system (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions