Cardiovascular and Respiratory Systems Flashcards
What are some risk factors for tumours?
Age
Smoking (previous history)
What are the clinical presentation of tumours?
Symptoms are vague and increases with time
Affects breathing
Unexplained haemoptysis
Unexplained weight loss
What imaging modality is used first to rule out a tumour in the cardiovascular and respiratory region?
CXR - be referred to from GP
What imaging modality is used for diagnosis and prognosis?
CT after getting a biopsy
What is Bronchial adenoma?
Umbrella term for neoplams that can lead to obstruction
What does bronchial adenoma lead to?
Cough
Haemoptysis
Atelectasis (collapse of lung) or Pneumonia
What modality is most useful for bronchoscopy and biopsy?
CT. MRI is used when CT is unclear
What are the treatment options for bronchial?
Radiotherapy (if confined)
Chemo and/or RT (small cell lung carcinoma)
Stent (bronchial)
Excision (complexity and vascular involvement)
Radiofrequency Ablation (RFA) Lung - certain areas
Why is MRI not the 1st modality used for Bronchial?
Long scan time
Lungs not well visualised due to breathing and heart movement
What type of tumour is MRI good to visualise?
Pancoast (Apical) Tumour
What is a pancoast (apical) tumour?
A type of lung cancer that invades the apical chest wall
What is bronchoscopy?
A procedure to look directly at the airways in the lungs using a thin, lighted tube (bronchoscope)
What kind of cancer is the leading cause of death for both men and women?
Lung carcinoma
What imaging modality is used to diagnose primary and any liver mets?
CT chest and liver with IV contrast
What is PECT/CT used to assess?
Benign or malignant lesion(s)
What imaging modality is best used to assess chest wall invasion?
MRI
What is MRI used to assess?
Location
Size of primary tumour
Assists with staging by identifying any liver mets
What are the advantages of PET/CT?
- More accurate than CT for staging lung cancer
- Highly sensitive (small metastatic deposits)
- Determines the extent of disease (good for surgical/treatment planning for any spread of disease)
- Cost-effective tool for differentiating operable from inoperable disease
- Ascertaining lung tumour response to therapy and detecting recurrence in successfully treated lesions
What are the disadvantages of PET/CT?
Not readily available
Time consuming
Expensive (compared to CT)
Higher radiation dose then CT
Slower throughput
Why is CT guidied biopsy used?
For locolisation and pinpointing
Higher accuracy of sample
To avoid vital anatomical structures (major blood vessels, nerves, peritoneal cavity, spinal canal and its contents)
Why is fine needle aspiration (FNA) used?
Less invasive than core biopsy
Less tissue damage
Smaller tissue damage
Rapid-firing mechanism
What is the risk associated with CT lung biopsy?
Small risk of bleeding or pneumothorax
Why is lung radiofrequency ablation (RFA) used?
For inoperable early stage lung cancer
For controlled burning
Contraindications in patients with tumour that are close to the mediastinum and the airways in the oesophagus and large blood vessels including the aorta
What imaging modality is used for lung radiofrequency ablation?
CT
What are the preliminary images in lung radiofrequency ablation used for?
To determine the best access route to the tumour and avoid structures such as:
- ribs
- fissures
- central bronchi
- large blood vessels
- brachial plexus
What kind of tumours are common in lungs and rib cage?
Metastatic disease
How does metastatic disease spread?
Usually via a haematogenous route
What are some common primary tumours?
Breast
Renal tract
Testis
GI tract
Thyroid
Bone
What can cause cardiac disturbances?
Medication
Congenital abnormalities
Aetiology unknown
What are the two different types of arrhythmias?
Tachycardia
Bradycardia
Where does supraventricular tachycardia take places?
From or above the atrioventricular node
Where does Atrial fibrillation (AF) happen?
Signal comes from multiple sites which causes confusion
What is heart block?
Electrical pathways are interrupted which leads to bradycardia and can result in fainting, dizziness and SOB
Can be congenitial or develop w/ age
Can result from cardiac arrest, infections, post CABG, and medication
What treatment method isused for a mild heart block?
Temporary pacing wires
What are some treatment options for cardiac arrythmias?
- Artirial fibrillation (cardioversion)
- Electrodes on chest and administered a controlled shock to the heart
- Under sedation
Under what imaging modality are pacemakers inserted?
Fluoroscopy
What are pacemakers used to treat?
Bradycardia
Cardiac arrest
Heart block
What is implantable cardioverter defibrillator (ICD) used for?
Prevent sudden death syndrome
What are the futrue trends associated with cardiac arrythmias?
No leads ICD within the heart via femoral access
Why is RFA in cardiac used for?
A nonsurgical procedure to treat arrythimia
Creates an accessory pathway
Why is a femoral access required?
To place a catheter in the heart which is ECG monitored and helps identify the areas of arrythmias occurring
What are some symptoms of lung infections?
Affects respirations
Raised tempreature
What imaging modality is best used for lung infection visualisation?
CXR
Why is US used of lung infections?
To differentiate between consolidation and pleural effusion
What can pneumonia result to?
Lung abscess
What are antibiotics used for?
Bacterial infections
What is bronchiectasis?
Dilation of bronchioles which leads to an increase in mucus which then results in a higher risk of lung infection
Causes permanent damage
What are some symptooms of bronchiectasis?
SOB
Presistent productive cough
What are some treatment options for bronchiectasis?
Medication - keeps airways as patent as possible
This is done via: -
- Nebulisers
- Oxygen
- Respiratory exercises
- Postural drainage
What is lung abscess?
Necrosis of the lung tissue and development of cavity which fills with necrotic debris or fluid from microbial infection
What is pericarditis?
An inflammation of the membrane that surrounds the heart
What is complication can pericarditis lead to?
Restrictive pericarditis
What pathologies are caused by abnormal fluid/air collections?
Pleural effusion
Cardiac tamponade
Haemo/pneumo thorax
What is pleural effusion?
Abnormal fluid collection within the pleural space
Moves with different positions
What causes pleural effusion?
Benign and malignant disease
Cardiopulmonary disorders
Inflammatory diseases
What imaging modality is good for detecting a pleural effusion?
X-ray
CXR - Good for decting but not caracterising
What modality is used for further definition?
CT, US, and MRI
CT and US - assess the underlying condition
MRI - if CT is unclear
How is US useful in pleural effusion?
It is helpful to locate small or large amounts of pleural fluid or isolated pockets of fluid
This is good as it can be marked on the patient to be followed up on and drained if deemed necessary
S can also be used to assess effusions in a foetus
How is pleural effusion visualised on US?
It’s seen as an echo-free space between the visceral and parietal pleurae
What are the sonographic characteristics of a pleural effusion dependant on?
Aetiology and type : -
- Fluid
- Pus
- Solid
- Chronicity of the collection
What is the shape of a pleural effusion dependent on?
Respiration and position
What is a treatment option for pleural effusion?
Chest drainage
Percutaneous abscess drainage (CT/US/Fluoroscopy guidance)
What is cardiac tamponade?
Blood or fluid accumulation in the space between the myocardium (the muscle of the heart) and pericardium
This causes the heart to be compressed and the great vessels enlarge
What is cardiac tamponade caused by?
Trauma
Bleeding after heart surgery
Pericarditis
Hypothyroidism
What other pathology is cardiac tamponade associated with?
Pleural effusion
What imaging modality is best used for cardiac tamponade?
US (echocardiography): demonstrates fluid levels and their location
What are some treatment options for cardiac tamponade?
Needle aspiration under image guidance: echocardiography +/- fluoroscopy
Drainage of the fluid via catheter (might be kept in situ for 1-2 days)
What is pericarditis caused by?
Infection
Mestastatic disease
Kidney disease
Radiation therapy
Recent heart attack
What are some clinical indication of pericarditis?
Chest pain
High temperature
What imaging modalities is used for pericarditis and why?
CT, MRI and US
CT and MRI - demonstrate the pericardium surrounding the heart
CT will demonstarte any calcifications of the pericardium
US will sdemonstarte the fluid
What is pulmonary oedema?
Fluid builds up in alveoli and then leaks into the lungs
What is a clinical presentation of pulmonary oedema?
SOB
Tiredness
Coughing
Swelling in the abdomen (ascites)
Swelling in the ankles and legs
What can pulmonary oedema be caused by?
Heart failure: poor circulation and changes in pressures
What imaging modality is used to assess pulmonary oedema?
X-ray
CXR
What is the imaging pathway for a non-trauma haemo/pnuemo throax?
Initial: CXR and follow-up
Follow up - CT to assess extent (immobility in spine)
What is haemo/pnuemo thorax?
Air and/or blood in the pleural space
How does a haemo/pnuemo thorax occur?
Trauma related and/or post procedure
Could also be spontaneous
Haemo - blunt of penetrating trauma
What can happen to a small pneumothorax?
May self-resolve - may not be detectable on imaging
What is the imaging pathway for a trauma haemo/pnuemo throax?
CT and/or FAST (Focused assessment sonography)
What is a tension pneumothorax caused by?
Trauma
What is a tension pneumothorax?
Increase in the pleural air pressure with no wound to escape from
What does a tension pneumothorax cause?
Shift of the mediastinum
Deviation of the trachea (away from the tension side)
Depression of the hemi-diaphragm
What are some treatment options for a haemo/pneumo thorax?
Chest drain
Thoracotomy: 10% of thoracic traumas - used to drain larger volumes but also to locate the stem origin of the bleed
What is the imaging pathway for covid?
It depends on the symptoms: cough to assess pneumonia, chest pain
What imaging modalities are used for covid?
CXR initially
CT, if more complex, to assess respiratory
What is emphysema?
An increase in size of air space, with dilatation and destruction of the lung tissue distal to the terminal bronchiole
What does emphysema cause?
Impair lung function as the walls cannot expand and contract properly
What other pathologies is emphysema associated with?
COPD
COAD (A= Airways)
What is Pulmonary fibrosis?
It is the scarring of the lung as the air sacs of the lungs gradually becomes replaced by fibrotic tissue.
What happens when the scar forms in the lung due to the fibrosis?
The tissue becomes thicker, causing an irreversible loss of the tissue’s ability to transfer oxygen into the bloodstream
What is the radiological appearance of pulmonary fibrosis?
Honeycomb
What imaging modality is best used to visualise the honeycombing in pulmonary fibrosis?
CT - HRCT
What is the treatment for chronic asthma?
Steroid inhalers - prevention and ablation
What is functional MRI (fMRI)
MRI looking specifically at moment-to-moment changes to function
What ia a treatment option for DVT?
Blood thinning drugs:
- Intravenous heparin
- Oral warfin
What are some reasons blood thinning drugs won’t work for some patients?
High risk: -
- Haemorrhage
- Risk of falling
- Stroke
- Acute bleeding (haemophilia, GI bleed)
- Recent major surgery
Why is IVC used?
It has a clot-trapping qualities
Ability to preserve flow in the IVC
Easy to place
Durable material
Non corrosive
What are the treatment options for patients unable to take blood thinning drugs for DVT?
Inferior vena cava (IVC)
IVC filter to catch and trap clots
Some can be temporary and easy to remove and some can be permanent
What imaging modalities are well used for IVC placement?
CT and MRI: configuration and anatomical variants of the IVC and to montior
What are the imaging pathways for pulmonary embolism?
Chest X-ray - Consolidation or pleural effusion
VQ scan - PE, COPD
CTPA - PE, VQ scan inconclusive
How is a VQ scan useful for finding pulmonary embolus?
Via the mismatch between the two phases ventilation and perfusion. If the radiation is shown on one phase and not the other phase/scan then a pulmonary embolus is present in the lung
Ventilation phase: inhaling the radioactive gas (Tc)
Perfusion phase: injection of the radiation (Tc) into the vein
How does vascular dissection of the aorta occur?
When the blood enters the wall of the artery (tear) between layers, it creates a cavity or false lumen in the vessel wall
What is the incidence and risk factor of vascular dissection of the aorta?
1-10 : 100.000
Mostly men
Hypertension > 70%
What imaging modality is used for vascular dissection of the aorta?
CT initially
US may also be used
In trauma what scan is required if stable and unsure of arterial bleed?
CTA
If vascular injury is highly likely what treatment is better to regain vascular flow?
Interventional over surgical
What is the treatment for patients with a polytrauma pelvic ring injury?
Selective angiography and embolisation of active arterial bleeding
What are the interventional treatments for pelvic complex fractures?
Bone management intervention - ex fix
Vascular trauma management - embolisation
What is CT virtual imaging?
Computer software program
Create virtual 3D environment from 2D CT scans
To aid detection, diagnosis and surgical planning
Very detailed (high res)
Narrow collimated width; increased dose
Overlapping reconstructed slices
What is endovascular US?
Evaluation of normal and abnormal vascular anatomy from an endoluminal position
What other imaging modalities are used in conjunction with endovascular US?
CT and MRI: Increase the accuracy of selecting patients for the endovascular procedures
What is an endovascular repair?
Placing a stent and complete IVUS exam
What is 3D fluoroscopic arteriography?
Use of FAST
Specific C-arm movements during image acquisition to produce 3D images from 2D
Costly
Increased dose
Good range (carotid, cerebral, cardiac, pelvic)
CVA ‘time is brain’ impact with 3D
What is therapeutic hypothermia with coronary angioplasty?
Induced internally via a cooling catheter in the vena cava whilst externally temperature is maintained
Why is interventional image guied mechanical thrombectomy used?
An alternative to sugery mechanical thrombectomy
CVA (ischaemic) intervention
Time sensitive - reversal of CVA
Severe CVA and thrombolysis ineffective
Why is cardiac CTA used?
Fast
Allows for 3D recon and MIPs (Using raw data) to visualise arterial structures and contrast flow (pelvis to toeas)
Less invasive, shorter prep than interventional
CT is used for follow up post stent
Why is MRI used?
Assess valves
Dynamic studies to demonstrate blood flow through the heart
Gated techniques for combat movement artefacts
What are the advantages and disadavantages of CTA?
AD: Multiclice CT can trigger image acquisition to an ECG and can ‘freeze’ cardiac motion
- Recon allows for visulisation of vascular function in 4 cardiac cycles
- High negative predictive value
Disadvantages: High heart rate and calcification
- use of beta blockers
If there’s high suspicions of stenosis interventional angiography should be used
What is myocardial perfusion imagining (MPI)?
Mapping the extent of blood supply to the myocardium
Why is nuclear medicine used for cardio-vascular disease?
- Diagnosing anf assessing coronary artery diseas such as ischaemia
- Evaluate cardiomyopathy and damages to the heart and if the ischaemia is reversible
- Visualise blood flow and patterns to the heart walls (myocardial perfusion scan)
- Presence and extent of (sus or known) coronary artery disease to determine extent of injury to the heart after a heart attack or myocardial infarction
- Evaluates the results of bypass surgery or other procedures designed to restore blood supply to the heart
- Used alongside an ECG to evaluate heart wall movement and overall heart function
How are the tracers used in a MPI?
They are trapped by well-perfused myocardium but less well by acutely ischaemic or infracted cardiac muscle
What is the advantages to MPI?
- Diagnosis and assessment of the extent of coronary artery disease
- Evaluates the effects of operative procedures such as angioplasty or bypass surgery on myocardial perfusion
- Confirmation or exclusion of old myocardial infract
- Diagnosis of hibernating myocardium/reversible ischaemic damage
What is multiple gated acquisition (MUGA) used for?
To assess left ventricular ejection fraction rate as preassessment to chemo (where chemo is known to affect this rate)
During an MPI what states are the cardiac muscle imaged?
Rest
Stressed (perfomed first)
(normally two day study but one day study is better for the patients)
Why is rubidium PET/CT used?
- PET for cardiac function
- More sensitive and specific for myocardial viability and calcium scoring pre-intervention
- Still stress and rest, same day
- Very short half life (75secs)
- Very expensive
What is echocardiography used for?
- Cardiac US
- Used to image the heart and surrounding structures
- Evaluate chamber size, wall thickness, motion, proximal vessels, pumping capacity, and location and extent of any tissue damage
- Diagnosis
- Management and follow-up (sus or known heart disease)
- Looks for abnormalities (eddy currents and regurgitation)
In echocardiography, what is the function of the doppler US?
To study the heart flow and valve efficiency
What are some advantages to echocardiography?
- Helps in detecting cardiomyopathies such as hypertonic cardiomyopathy and dilated cardiomyopathy
- Gives estimates of heart function such as a calculation of the cardiac output, ejection fraction and diastolic function (how well the heart relaxes)
- Stress echocardiography (chest pain or symptoms relating to heart disease)
- Non-invasive has no known risk or side effects
What type of echocardiography is more invasive?
Oesophageal echocardiography: passing the transducer down the oesophagus
Used when echo is inconclusive and more detailed is required
How is 3D echocardiography possible?
Using a matrix array US probe and a processing system
Enables detailed anatomical assessment of cardiac pathology, valvular defects and cardiomyopathies
What are complications of angioplasty?
Perforation of the artery
Occlusion of artery
Occlusion of collaterals
Haematoma formations
Aneurysm risk increased
What are some treatment options for vascular and peripheral vascular?
- Balloon angioplasty for stenosis (or multiple) to re-establish flow
- Tailored to each lesion
- For coronary also use stent
- Drug eluting stents being used more in coronary (targeted therapy - prevents scar tissue (can lead to thrombis formation))
- If angioplasty not successful, will involve surgical interventional – mechanical removal of plaque (peripheral) or CABG for coronary
Why is CO2 used in angiography?
- For those who have a contra indication to the iodinated contrast
- It is used specifically below the diaphragm as there is an increased risk of embolism to the spinal, coronary and cerebral arteries
- It is less viscous then iodinated CM and lighter than blood plasma. (larger vessels it doesn’t disperse evenly)
What is the future trend for vascular?
Assessment of perivascular adipose tissue
CTAs to assess inflammation changes on the fat around coronary arteries
CT fat attenuation index
Aim is to correlate and ‘predict’ heart attacks
What imaging modalities are used for aortitis?
PET/CT - positron detection of inflammation
What are some symptoms of aortitis?
Unexplained aetiology of pyrexia, elevated WBC
Funtional inflammation would be assessed
What are some treatment options and disadvantages for thrombus in the femoral artery?
Surgical alternative peripheral vascular - endarterctomy (pelvic - bypass graft)
CABG (coronary artery bypass graft)
Invasive
More risks
Longer recovery time
What is a vascular aortic aneurysm?
Ballooning of the aortic wall
Gradually grows in size and can rupture
‘Silent killer’
Targeted screening program for AAA is US
Immediate surgery is need if ruptured
What is the treatment option for aortic aneurysm?
Stent to reinforce and support the vessel wall - EVAR (endovascular aneurysm repair)
Vascular and interventional joint team response
Vascular theatre or interventional suite
