BRANT: Chapter 10 - ANATOMY Flashcards
PA radiograph focus-to-film distance in ft or in
6 ft
PA radiograph KV potential
140 kVp
Normal CTR of PA and AP view
PA: 50%, AP: 57%
Apparent cardiac diameter increase by how much in AP view
15% to 20%
PACS stands for
Picture archiving and communicating system
In dual-energy subtraction (DES) chest radiography, what are the two sequential exposures done in rapid sequence to produce 3 frontal images?
60 kEV and 120 kEV
What are the 3 frontal images in DES chest radiography?
PA view, bone-subtracted soft tissue image and a bone image
Digital tomosynthesis (DTS) of chest
Vertical arch, 10- to 12-s breath hold, 50-60 frontal tomograms, 5 mm thick each
In lateral decubitus, as little as how much fluid or air can be demonstrated?
5 mL of fluid, 15 mL of air
Routine chest CT vs HRCT slice thickness
Routine: 2.5-3.0 mm thick
HRCT: 1.5 mm thick
Routine chest CT windows:
1. Mediastinal structures
2. Lung
- WW=400, WL=40
- WW=1500, WL=-700
Special CT technique done to assess for presence of tracheobronchomalacia
Expiratory CT scans
Minimum dimension of pulmonary nodules that which can be detected in chest CT
1 mm
T/F: Real-time sonography can also confirm phrenic nerve paralysis without the use of ionizing radiation.
True
A flat band of muscle and connective tissue of the trachea is called?
Posterior tracheal membrane
Histology of tracheal mucosa?
Pseudostratified ciliated columnar epithelium with scattered neuroendocrine cells
Normal length, coronal diameter (M vs F) of trachea
Length: 12 cm
Diameter: 25 mm (M) vs 21 mm (F)
Normal coronal-to-sagittal diameter ratio of trachea
≥0.6:1.0
Term that refers to the narrowing of the coronal diameter, producing a coronal/sagittal ratio of <0.6, and is usually seen in what condition?
Saber-sheath trachea
COPD
Superior and inferior landmarks of the trachea
Superiorly: cricoid cartilage
Inferiorly: main bronchi
Name of the pointed structure and its normal thickness
Right paratracheal stripe, 4 mm
Name of the pointed struture by the arrows and its normal width
Tracheoesophageal stripe, <5 mm
Thickening is most commonly seen with esophageal carcinoma.
Mean length of the following:
1. Right main bronchus
2. Left main bronchus
Which of the 2 forms a more obtuse angle relative to the long axis of the trachea?
- R: 2.2 cm, L: 5 cm
- Right main bronchus
Term used for (include generation) brochi without cartilaginous support
Bronchioles (at generations 12-15)
These are 1- to 3-mm airways
Term used for bronchioles bearing alveoli on their walls
Respiratory bronchioles
Term used for bronchioles just before the first respiratory bronchiole
Terminal bronchiole
Smallest bronchiole without respiratory exchange structures
Terminal bronchiole
Generation 21 to 25 between the trachea and the alveoli
Interlobar fissures are invaginations of which pleura/e?
Visceral pleura
Gas-exchanging units of the lung
Alveolar ducts and alveolar sacs
Which of the pneumocytes are flattened squamous cells covering 95% of the alveolar surface area and are incapable of mitosis or repair?
Type 1 pneumatocytes
At the level of the right ____ rib, the minor fissure projects as a thin horizontally oriented undulating line on frontal radiographs in approximately 50% of individuals.
4th (anterior)
Name the 3 pointed structures
Thin arrow: Azygos vein
Arrow head: Azygos fissure
Thick arrow: Azygos lobe
Most common accessory fissure and is found approximately 10% to 20% of individuals?
Name the pointed structure:
Inferior accessory fissure
Often incomplete
The inferior accessory fissure separates what lung segment from what other lung segments?
Medial basal segment from the remaining basal segments of the lower lobe
Responsible for the juxtaphrenic peak described in upper lobe volume loss
Inferior accessory fissure
Composed of 4 layers of pleural and represents an invagination of the right apical pleural by the azygos vein, which has incompletely migrated to its normal position at the right tracheobronchial angle.
Azygos fissure
This fissure (A) appears as a appears as a vertical curvilinear line, convex laterally, which extends inferiorly from the lung apex and ends in a teardrop (which represents B)
A. Azygos fissure, B. Azygos vein
This fissure separates the superior segment from the basal segments of the lower lobe
Superior accessory fissure
Name the pointed structure
Superior accessory fissure
This fissure separates the lingula from the remaining portions of the LUL
Left minor fissure
Contents of the inferior pulmonary ligament
Inferior pulmonary vein and lymph nodes
The inferior pulmonary ligament tethers the lower lobe to the mediastinum alongside the esophagus and is responsible for the medial location and triangular appearance of lower lobe collapse
Name the structure pointed by the straight arrow
Intersegmental septum
This structure is seen as a triangular density extending toward the lung that is seen along the posterior aspect of the right heart border on lung windows; and represents a reflection of pleura over the inferior portion of the phrenic nerve and pericardiophrenic vessels.
Pericardiophrenic ligament
Arrow heads represent the pericardiophrenic ligament containing the phrenic nerve and pericardiophrenic vessels
These are the primary nutrient vessels of the lung, supplying blood to the bronchial walls to the level of the terminal bronchioles
Bronchial arteries
The bronchial arteries usually arise from the proximal descending thoracic aorta at the level of the CARINA and show significant variability. Most commonly, there is one right-sided and two left-sided arteries. The right bronchial artery usually arises from the posterolateral wall of the aorta with an intercostal artery as an intercostobronchial trunk. The left bronchial arteries arise individually from the anterolateral aorta or, rarely, from an intercostal artery.
Term used for arteries without elastic lamina, such those seen in the distal pulmonary artery branches at the same level that the bronchi lose their cartilage and become bronchioles
Muscular arteries
Which bronchus is A) hyparterial and B) eparterial
RELY
A) Left - hyparterial
B) Right - eparterial
The left PA branches into LUL and LLL arteries within the hilum where as right PA branches into trunchus anterior and interlobar arteries within the pericardium
Bronchial arteries supply blood to the bronchial walls up to what level?
Terminal bronchioles
The right bronchial artery usually arises from the posterolateral wall of the aorta with an intercostal artery as an ___.
Intercostobronchial trunk
Landmark at which the bronchial arteries arise from the descending aorta
Carina
These pulmonary lymphatics, when distended by fluid, account for the radiographic appearance of Kerley A lines
Perivenous lymphatics
Edema involving this interstitium is recognized radiographically as peribronchial cuffing
Axial interstitium
Edema of this interstitium accounts for Kerley B lines (or interlobular [septal] lines on thin-section CT) and “thickened” fissures on chest radiographs
Peripheral and subpleural interstitium
Name the pointed sign/structure
Aortic nipple: superior intercostal vein
Normal luminal diameter of aortic nipple
<5 mm
Retrotracheal triangle is also known as
Raider triangle
This sign seen as nodularity or thickness (>2mm) along the anterior pericardial reflection suggests disease or effusion
Pericardial stripe sign
The anterior pericardial reflection can be identified separately from the myocardium on lateral radiographs in 20% of subjects. This thin line represents the pericardial layers between the epicardial and pericardial fat. Nodularity or thickness >2 mm (the “pericardial stripe sign”) suggests disease or effusion.
Diagnosis
Epipericardial fat pads
Inferiorly, the left lung may be excluded from contacting the anteromedial chest wall by a round or triangular opacity, which represents the cardiac apex and adjacent epipericardial fat. This impression on the anterior surface of the lingula has been termed as ____ (the one pointed below)
Cardiac incisura
Right or left?
Right hemidiaphragm
Several ways to distinguish the right from the left on the lateral view:
a. The right hemidiaphragm is typically higher than the left.
b. The anterior left hemidiaphragm is obscured (silhouetted) by the heart, whereas the right hemidiaphragm is seen along its entire AP course.
c. On a well-positioned left lateral chest radiograph, with the right side of the thorax farther from the recording device than the left, the right anterior and posterior costophrenic sulci should project beyond the corresponding left-sided sulci as a result of x-ray beam divergence.
d. The presence of air in the stomach or splenic flexure projecting above one hemidiaphragm and below another identifies the more cephalad diaphragm as the left.
e. Occasionally, when both major fissures are visualized, following a major fissure to its point of contact with the diaphragm allows identification of that hemidiaphragm because the left major fissure is more vertically oriented than the right.
Sign and diagnosis
Comet tail sign in round atelectasis
A well-defined, 2- to 7-cm pleural-based mass adjacent to an area of pleural thickening in the lower posterior lung. The identification of a curvilinear bronchovascular bundle or “comet tail” entering the anterior inferior margin of the mass, as seen on lateral radiographs, is characteristic.
T/F: An atelectatic lung can be seen to enhance on contrast studies
True
Sign and diagnosis
S sign of Golden with central mass and RUL atelectasis
Secondary to a central convex mass, consider bronchogenic carcinoma
Sign and diagnosis
Luftsichel sign of LUL atelectasis
Diagnosis
Pneumotoceles in Staphylococcal pneumonia
Diagnosis
Poland syndrome
Congenital absence of the pectoralis muscle
Diagnosis. 30/M with history of adenoviral infection during infancy
Swyer-James syndrome or unilateral hyperlucent lung syndrome
Most common cause of uniform mediastinal widening on frontal radiographs
Mediastinal lipomatosis
Sign and diagnosis
Continuous diaphragm sign og pneumomediastinum
Differential diagnosis: pneumopericardium
Sign and give possible diagnosis
Hilum overlay sign
Anterior mediastinal mass
60/M with congestive heart failure. On diuresis, NSCF noted. Diagnosis
Pulmonary pseudotumor or vanishing lung tumor
Sign and diagnosis
Deep sulcus sign of pneumothorax
Diagnosis
Subpulmonic pneumothoraces
Proper penetration is present when these 2 conditions are observed:
a. Faint visualization of the thoracic intervertebral disk spaces
b. Discrete branching vessels can be identified through the cardiac shadow and the diaphragm.
It is assessed by noting the relationship between a vertical line drawn midway between the medial cortical margins of the clavicular heads and one drawn vertically through the spinous processes of the thoracic vertebrae.
Rotation
An appropriate deep inspiration in a normal individual is present when the apex of the right hemidiaphragm is visible:
a. BELOW the 10th posterior rib
b. AT the level of the 6th anterior rib
On frontal radiographs obtained on deep inspiration, the apex of the right hemidiaphragm typically lies AT the level of the sixth anterior rib, approximately ½ interspace above the apex of the left hemidiaphragm
AP radiograph focus to film distance
40 in
T/F: A pneumothorax may be difficult to detect in AP supine studies because free intrapleural air rises to a nondependent position producing subtle anteromedial or inferior radiolucency
True
True about digital radiography:
a. It has increased dose efficiency and more consistent image quality
b. Contrast levels and windows can be adjusted to enhance visualization of various regions in the chest or compensate partly for suboptimal exposure.
c. Have poorer spatial resolution than their analog counterparts
d. All of the above
d. All of the above
Advantages of DES chest radiography include:
a. Improved visualization of lung nodules
b. Detection of calcification within granulomas
c. Visualizing bone islands or healing rib fractures
d. Enhanced visualization of indwelling lines and catheters
e. All of the above
e. All of the above
Uses of the DTS chest radiography include:
a. Precise localization of opacities seen on standard two-view radiography
b. Improved detection of nodules
c. Improved visualization of foreign bodies and hardware
d. Improved detection and characterization of parenchymal disease including airways and interstitial lung disease
e. A, B, and C only
f. All of the above
f. All of the above
____ is used mainly to assess for diaphragmatic paralysis
Chest fluoroscopy
The ____ is a test in which the patient undergoes chest fluoroscopy while standing and breathes quickly and deeply through the nose, shows paradoxical upward diaphragmatic movement in patients with diaphragmatic paralysis.
Sniff test
Chest CT scans without contrast are usually performed for evaluation or follow-up of the following, except:
a. Parenchymal disease
b. Solitary nodules
c. Airways disease
d. Mediastinal mass
d. Mediastinal mass
T/F: Intravenous contrast is administered for mediastinal mass evaluation, cancer staging, systemic or pulmonary arterial evaluation, and cardiac studies.
True
This is the primary modality for imaging of most congenital and acquired thoracic vascular disorders.
MRI
The ability to obtain images along the long axis of the aorta and cine-MR techniques have made MR the primary modality for imaging of most congenital and acquired thoracic vascular disorders.
Nonvascular indications of thoracic MR include the following, except:
a. Assessment of pleural and chest wall masses
b. Evaluation of mediastinal, cardiovascular and chest wall invasion by lung tumors
c. Distinguishing thymic hyperplasia from thymoma
d. Evaluation of mediastinal masses
e. Staging of lung cancer
e. Staging of lung cancer
The role of PET in the chest is mostly for:
a. Assessment of indeterminate solitary
b. Pulmonary nodules
c. Staging of lung cancer
d. Baseline assessment and follow-up of lymphoma
e. All of the above
e. All of the above
Diagnosis
Right cervical rib
Name the pointed structures
A: Anterior junction line
B. Anterior junction line
C. Arrow: Posterior junction line
C. Arrowhead: Azygoesophageal recess
D. Posterior junction line
Lateral: Frontal
a. Retrosternal space: ____
b. Retrotracheal space: ____
c. Retrocardiac space: ____
a. Anterior junction line
b. Posterior junction line
c. Inferior posterior junction line
The thickness of the right paratracheal striple is measured above the level of what structure?
Azygos vein
Normal diameter of azygos vein on frontal radiograph
10 mm
Supine positioning or performance of the Müller maneuver (forced inspiration against a closed glottis) will increase azygos venous diameter.
An increase in diameter of the azygos vein from prior comparable radiographs is more important than the absolute measurement.
When air is present in the distal portion of the esophagus and the azygoesophageal recess interfaces with the right lateral wall of the esophagus, a line called ____ rather than an edge is seen.
Right inferior esophagopleural stripe
The double density sign results from the convex rightward displacement of this line as the left atrium enlarges
Azygoesophageal recess
This line is obliquely oriented from right superior to left inferior and extends from upper sternum to base of the heart
Anterior junction line
This line is vertically oriented in the midline and extends from upper thoracic spine to level of azygos and aortic arches
Posterior junction line
The inferior vena caval interface is best visualized on lateral radiographs and is absent in patients with what condition?
Azygos continuation of the inferior vena cava
Diagnosis
Azygos continuation of the inferior vena cava
It is unusual for the LUL to interface with the left lateral wall of the trachea to form the left paratracheal stripe because of the intervening ____ and adjacent fat.
Subclavian artery
The following are right-sided on frontal radiographs, except:
a. Azygoesophageal recess
b. Anterior arch of the azygos vein
c. Lateral margin of the inferior vena cava
d. Preaortic recess
e. All of the above is right-sided
d. Preaortic recess
Abnormalities of abdominal situs may be identified by noting the location and appearance of these 3 structures:
Liver, stomach, and spleen
The thymus is a triangular or bilobed structure that is largest at ____ and then undergoes gradual fatty involution. In most individuals over the age of ____, the thymus is predominantly fatty, with little or no intermixed glandular (soft tissue) component.
Puberty, 35
The following are seen in the anterior mediastinum, except:
a. Thymus
b. Left brachiocephalic vein
c. Fat
d. Germ cell rests
e. A, C and D only
f. All of the above
f. All of the above
Posterior margin of the middle mediastinum extends to a vertical line parallel through the thoracic vertebrae ____ posterior to their anterior margins.
1 cm
T/F: The hila may be considered as lateral extensions of the middle mediastinal compartment.
True
One of the four middle mediastinal spaces which is the anatomic route used during routine transcervical mediastinoscopy
Pretracheal space
All of the following are seen in the posterior mediastinum, except:
a. Thoracic spine
b. Sympathetic ganglia and intercostal nerves
c. Azygos and hemiazygos vein
d. Thoracic duct
e. Descending aorta
E
These comprise the predominant portion of the hilar opacity.
Bilateral pulmonary arteries
The shape of the right hilum on frontal radiographs has been likened to a sideways V, with the opening pointing rightward. The upper portion of the V is composed primarily of the ____ and the posterior division of the right superior pulmonary vein.
Truncus anterior
The avascular aspect of the composite hilar shadow, inferior to the shadow of the right pulmonary artery and veins and anterior to the descending left pulmonary artery and left superior vein, is called the
Inferior hilar window
Normal thickness of posterior wall of the bronchus intermedius
<2 mm
This line, termed the ____, is seen in 95% of patients and extends inferiorly to bisect the end-on lucency of the left main/LUL bronchus on a lateral radiograph. This structure is visible because air within the intermediate bronchus anteriorly and lung within the azygoesophageal recess posteriorly outlines its posterior wall. Thickening or nodularity of this line is seen in bronchogenic carcinoma, pulmonary edema, or enlargement of azygoesophageal recess lymph nodes.
Intermediate stem line
Name the structure pointed by the arrowheads
Intermediate stem line
The LUL bronchus is seen on lateral radiographs in 75% of individuals and lies approximately ____ inferior to the RUL bronchus.
4 cm
The pleura is a serosal membrane that envelopes the lung and lines the costal surface, diaphragm, and mediastinum. It is composed of two layers (visceral and parietal) that join at the hilum. Blood supply to the parietal pleura is via the ____ circulation, while the visceral pleura is supplied by the ____ circulation.
Systemic, pulmonary
The pleural space is a potential space between the two pleural layers and normally contains a small amount of fluid (how many mL?) that reduces friction during breathing.
<5 mL
Name the structure pointed by the solid arrows
Intercostal stripe
The ____ intercostal muscle is anatomically absent in the paravertebral area, and if a thin line is visible between the lung and paravertebral fat or rib, it represents a combination of the two pleural surfaces and the endothoracic fascia.
Innermost
The following traverses the aortic hiatus, except:
a. Aorta
b. Thoracic duct
c. Azygos and hemiazygos veins
d. Vagus nerve
d. Vagus nerve
Vagus nerve joins with the esophagus through the esophageal hiatus
Potential gaps through the diaphragm:
a. Anterolateral:
b. Posterolateral:
a. Foramina of Morgagni
b. Foramina of Bochdalek
Name the following structures
See description
Name the pointed structures
a. Aortic hiatus
b. Esophageal hiatus
c. Caval hiatus
A segmental distribution of airspace disease may be seen in a process such as pneumococcal pneumonia, which begins in the terminal airspaces and spreads to other airspaces via interalveolar channels (aka a. ____) and channels bridging preterminal bronchioles with alveoli (aka b. ____). Initially, the opacity is poorly marginated because the airspace-filling process extends in an irregular fashion to inv
a. Pores of Kohn
b. Canals of Lambert
Name the pointed structure
Air bronchograms
Radiographic characteristics of airspace disease, except:
a. Poorly marginated
b. Airspace nodules, typically 8-10 mm in size
c. Tendency to coalesce
d. Air bronchograms
b. Airspace nodules, typically 8-10 mm in size
6-8 mm in size
Give the typical sizes of the following nodular densities:
a. Miliary
b. Micronodule
c. Nodules
d. Mass
See below
Most common form of atelectasis
Obstructive atelectasis
Diagnosis
Bronchopneumonia
Give the type of atelectasis associated in the following disease entities:
a. Pneumothorax
b. Bulla
c. Postprimary TB
d. RDS
a. Passive
b. Compressive
c. Cicatricial
d. Adhesive
The only direct radiographic finding of lobar atelectasis is
Displacement of interlobar fissure
Diagnosis
Subsegmental atelectasis
Subsegmental atelectasis tends to occur at the lung bases. The linear shadows are 2 to 10 cm in length and are typically oriented perpendicular to the costal pleura
Diagnosis
Rounded atelectasis
The identification of a curvilinear bronchovascular bundle or “comet tail” entering the anterior inferior margin of the mass, as seen on lateral radiographs, is characteristic.
Conventional radiographs reveal a well-defined, 2- to 7-cm pleural-based mass adjacent to an area of pleural thickening in the lower posterior lung.
Name the sign
S sign of Golden
Diagnosis
RUL atelectasis
Frontal (A) chest radiograph shows opacification of the right upper lobe with superior displacement of the minor fissure (arrowheads). Lateral (B) radiograph demonstrates anterior displacement of the major fissure (arrows) and superior displacement of the minor fissure (arrowheads).
Diagnosis
LUL atelectasis
On the frontal (C) radiograph, there is a subtle left juxtaphrenic peak (short arrow) representing an inferior accessory fissure tenting the left hemidiaphragm as a result of left upper lobe volume loss. A lucency (long arrow) outlining the aortic knob represents compensatory hyperinflation of the superior segment of the left lower lobe ( luftsichel sign).
Diagnosis
Middle lobe atelectasis
On the frontal ( E) radiograph, the right midcardiac border has an obscured contour ( asterick). The lateral ( F) radiograph shows the atelectatic middle lobe outlined by the inferiorly displaced minor fissure (arrowheads) and anterior and superiorly displaced major fissure ( arrows).
Diagnosis
Right middle lobe and RLL atelactasis
Frontal (G) and lateral (H) chest radiographs in a 14-year old male with asthma show complete middle and right lower lobe atelectasis. On the frontal ( G) view, the displaced major ( arrow) and minor ( arrowhead) fissures are visible. Note obscuration of the right heart border and right hemidiaphragm by the opacified, atelectatic lobes.
Diagnosis
LLL atelectasis
I: Left lower lobe atelectasis. Upright frontal radiograph in a patient with severe ephysema and left lower lobe atelectasis due to an obstructing lung cancer shows an opacified left lower lobe obscuring the left hemidiaphragm. Note leftward mediastinal shift and displacement of the left major fissure (arrow) outlining the atelectatic lobe.
Indicate the size of intervening lucent spaces in fine, medium and coarse reticulation:
a. Fine (GGO): 1-2 mm
b. Medium (Honeycombing): 3-10 mm
c. Coase: >10 mm
2 cancer most commonly have hematogeneous pulmonary metastases
Renal cell carcinoma
Thyroid carcinoma
All of the following may give rise to true reticulonodular opacities, except:
a. Silicosis
b. Sarcoidosis
c. Asbestosis
d. Lymphangitis carcinomatosis
c. Asbestosis
____ lines correspond to thickening of connective tissue sheets within the lung, which contain lymphatic communications between the perivenous and bronchoarterial lymphatics, while ____ lines represent thickened peripheral subpleural interlobular septa. A linear pattern of disease is seen in pulmonary edema, lymphangitic carcinomatosis, and acute vira
Kerley A, Kerley B
Thickening of the peripheral interstitium of the lung produces linear opacities that are either 2- to 6-cm long lines which are <1 mm thick and are obliquely oriented, coursing through the substance of the lung toward the hila
Kerley A lines
These are shorter (1- to 2-cm) thin lines that are peripheral and course perpendicular to and contact the pleural surface
Kerley B lines
Sign and diagnosis
Gloved finger sign seen in bronchoceles/mucoceles/mucoid impaction
A typical location—immediately distal to the expected location of the apical segmental bronchus and a hyperlucent segment or lobe distal to the bronchocele owing to collateral air drift—should suggest the diagnosis of a congenitally atretic bronchus.
True about cavities, except:
a. Form when a pulmonary mass undergoes necrosis and communicates with an airway, leading to gas within its center
b. <1 mm wall thickness with irregular or lobulated borders
c. Lung abscess and necrotic neoplasm are the most common cavitary pulmonary lesions
d. All of the above is true
b. <1 mm wall thickness with irregular or lobulated borders
The wall of a cavity is, by definition, greater than 1 mm thick and is usually irregular or lobulated.
It is a gas collection within the pulmonary parenchyma that is >1 cm in diameter and has a thin wall <1 mm thick. It represents a focal area of parenchymal destruction (emphysema) and may contain fibrous strands, residual blood vessels, or alveolar septa
Bulla
It is any well-circumscribed intrapulmonary gas collection with a smooth, thin wall >1 mm thick. While some of these lesions have a true epithelial lining and are therefore true cysts (i.e., a bronchogenic cyst that communicates with a bronchus), most are likely postinflammatory or posttraumatic lesions
Air cyst
It is a collection of gas <1 cm in size within the layers of the visceral pleura, usually found in the lung apex
Bleb
These are thin-walled, gas-containing structures that represent distended airspaces distal to a check-valve obstruction of a bronchus or bronchiole, most commonly secondary to staphylococcal pneumonia or result from pulmonary laceration following blunt or penetrating trauma.
Pneumatoceles
These are usually multiple, round, thin-walled lucencies found in clusters in the lower lobes and represent saccular dilatations of airways in varicose or cystic bronchiectasis.
Bronchiectatic cyst
Diagnosis from A to D
A. Cavity
B. Bulla
C. Bleb
D. Pneumatocele
It is a condition that follows adenoviral infection during infancy An asymmetric obliterative bronchiolitis with severe air trapping on expiration and secondary unilateral pulmonary artery hypoplasia produces the hyperlucency in this condition.
Diagnosis
Swyer–James syndrome or unilateral hyperlucent lung syndrome
This finding is virtually diagnostic of a mature teratoma
Fat-fluid level
It is the most common cause of uniform mediastinal widening on frontal radiographs.
Mediastinal lipomatosis
Give the sign and diagnosis
Continuous diaphragm sign of pneumomediastinum
Other differential: pneumopericardium
Which is nonmobile? Pneumopericardium or pneumomediastinum
Pneumomediastinum
Hence, air within the pericardium rises to a nondependent position on decubitus positioning, u
Diagnosis
Pneumopericardium + Pneumothorax (L)
Sign
Hilum overlay sign
A density through which the normal hilar vessels can be seen constitutes a “hilum overlay” sign, which indicates a mass superimposed on the hilum
Sign
Hilum convergence sign
The upper limit of normal for the transverse diameter of the proximal right interlobar artery, as measured on a PA radiograph at a level immediately lateral to the proximal portion of the bronchus intermedius, is ____ in men and ____ in women.
17 mm, 15 mm
It is the most sensitive imaging modality in detecting and localizing enlarged hilar lymph nodes and masses.
CT
Enlarged nodes are those that exceed this size
10 mm
How much pleural fluid collection is required to produce the characteristic pleural meniscus of moderate pleural effusion?
> 175 mL
It is the most sensitive technique to detect small amounts of fluid.
Lateral decubitus with the affected side down
With this technique, as small as 5 mL of pleural fluid may be seen layering between the lung and lateral chest wall.
Diagnosis (asterisk). Noted resolution upon diuresis
Pseudotumor or vanishing lung tumor
Fluid loculated between the leaves of visceral pleura within an interlobar fissure results in an elliptic opacity oriented along the length of the fissure. These loculated collections of pleural fluid are termed “pseudotumors” and are most often seen within the minor fissure on frontal radiographs in patients with congestive heart failure.
Diagnosis
Subpulmonic effusion
Clues to its presence on frontal radiographs include apparent and new elevation of the diaphragm, lateral peaking of the hemidiaphragm that is accentuated on expiration, a minor fissure that is close to the diaphragm (right-sided effusions), and an increased separation of the gastric air bubble from the base of the lung (left-sided effusions). Despite the atypical subpulmonic accumulation of fluid with the patient upright, the effusion will layer dependently on lateral decubitus radiographs
Sign and diagnosis
Deep sulcus sign in pneumothorax
The following statements about recognition of pneumothorax on supine patients are true, except:
a. In a supine patient, the most nondependent portion of the pleural space is anterior or anteromedial
b. The affected hemithorax may appear hyperlucent.
c. Signs that may suggest include deep sulcus sign and double diaphragm sign
d. All of the above
D. All of the above
Sign
Seashore sign
In normal patients, the lung is seen to slide at the interface with the pleura. This sliding is absent when a pneumothorax is present.
Sign and diagnosis
Double diaphragm sign in pneumothorax
Diagnosis
Apical cap
Curvilinear subpleural opacity, <5 mm thick, occasionally calcified, with a smooth concave inferior margin which represents nonspecific fibrosis of the apical lung and adjacent visceral pleura
Diagnosis
Superior sulcus tumor
Diagnosis
Fibrothorax
It is usually unilateral and extends over large areas of the dependent (posterior and inferior) portions of the pleural space.
These two areas are usually spared in fibrothorax
Interlobar fissures and mediastinal pleura
A mass sharply outlined by lung on one view but poorly marginated on the orthogonal view should suggest a (a) ____ process.
In contrast, (b) ____ lesions are surrounded by air and will have similar margins on both views.
a. Pleural or extrapleural
b. Intraparenchymal
T/F: Rib destruction or subcutaneous mass is the only finding that localizes an extrapulmonary lesion to the chest wall
True
