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