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Learning Radiology > Ch.6 - Recognizing a Pleural Effusion > Flashcards

Ch.6 - Recognizing a Pleural Effusion Flashcards

1
Q

Approx. …L of fluid will cause opacification of the entire hemithorax in an adult.

A

2L.

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2
Q

Subpulmonic effusions:

A

Most pleural effusions begin life collecting in the pleural space between the hemidiaphragm and the base of the lung –> These are called subpulmonic effusions.

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3
Q

As the amount of fluid increases, it forms a … shape on the upright frontal chest radiograph due to the natural elastic recoil properties of the lung.

A

Meniscus.

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4
Q

Loculated effusions:

A

With pleural adhesions (usually from old infection or hemothorax) the fluid may assume unusual appearances or occur in atypical locations. Such effusions are said to be loculated.

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5
Q

Pseudotumor:

A

It is a type of effusion that occurs in the fissures of the lung (mostly the MINOR fissure) and is most frequently 2o to CHF.
It clears when the underlying failure is treated.

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6
Q

Laminar effusions:

A

Are best recognized at the lung base just above the costophrenic angles on the frontal projection and most often occur as a result of either CHF or lymphangitic spread of malignancy.

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7
Q

A hydropneumothorax:

A

Consists of both air and increased fluid in the pleural space and is recognizable on an upright view of the chest by a straight, air-fluid interface rather than the typical meniscus shape of pleural fluid alone.

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8
Q

Pleural fluid is produced primarily at the … pleura?

A

PARIETAL

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9
Q

Pleural fluid is resorbed at the … pleura + by LYMPHATIC drainage through the … pleura.

A

visceral, parietal.

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10
Q

How can atelectasis cause a pleural effusion?

A

Via decreased pressure in the pleural space.

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11
Q

MCC of an EXUDATE pleural effusion is?

A

Malignancy

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12
Q

Hemothorax?

A

Has a fluid Ht >50% of blood Ht.

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13
Q

SLE pleural effusions - Which side?

A

Usually BILATERAL, but when UNILATERAL, the effusions are usually LEFT-SIDED.

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14
Q

3 conditions that can produce effusions on EITHER side, but are usually UNILATERAL?

A
  1. TB, and other infectious agents, including viruses.
  2. Pulmonary thromboembolic disease.
  3. Trauma.
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15
Q

Diseases that usually produce LEFT-SIDED effusions?

A
  1. Pancreatitis.
  2. Distal thoracic duct obstruction.
  3. Dressler.
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16
Q

Diseases that usually produce RIGHT-SIDED effusions?

A
  1. Abdominal disease related to the liver or ovaries (Meigs syndrome).
  2. RA - Effusion unchanged for years.
  3. Proximal thoracic duct obstruction.
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17
Q

Dressler syndrome presentation?

A

Typically occurs 2-3 weeks after a transmural MI producing:

  1. Left pleural effusion.
  2. Pericardial effusion.
  3. Patchy airspace disease at the left lung base.
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18
Q

How much pleural fluid is needed for the POSTERIOR costophrenic SULCUS to be blunted?

A

75mL.

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19
Q

When the effusion reaches about … mL in size, its blunts the lateral costophrenic angle, visible on the frontal CXR.

A

300mL.

20
Q

Pitfall about blunting of the costophrenic angles?

A

Pleural THICKENING caused by FIBROSIS can also produce blunting of the costophrenic angle.

21
Q

Solution for the pitfall about blunting of the costophrenic angle due to pleural thickening?

A
  1. Scarring sometimes produces a characteristic SKI-SLOPE appearance of blunting, UNLIKE the meniscoid appearance of a pleural effusion.
  2. Pleural thickening will NOT change in location with a change in patient position, as most effusions will.
22
Q

Right-sided subpulmonic effusion - FRONTAL view:

A
  1. Highest point of the APPARENT* hemidiaphragm is displaced more LATERALLY than the highest point of a normal hemidiaphragm would be.
  2. More difficult to recognize due to liver.
23
Q

Right-sided subpulmonic effusions - Lateral view?

A

Posteriorly, the APPARENT* hemidiaphragm has a curved arc, but as it meets the junction with the major fissure –> Assumes a flat edge that drops sharply to the anterior chest wall.

24
Q

Left-sided pleural effusions - Frontal view?

A
  1. Distance between the stomach bubble and the apparent LEFT hemidiaphragm is increased (normally only about 1cm from top of stomach bubble to bottom of aerated left lower lobe).
  2. Highest point of the apparent hemidiaphragm is displaced more LATERALLY than the highest point of a NORMAL hemidiaphragm would be.
25
Q

Left-sided effusions - Lateral view?

A

Posteriorly, the apparent hemidiaphragm has a curved arc, BUT as it meets the junction with the major fissure –> assumes a FLAT EDGE that drops sharply to the ANTERIOR chest wall.

26
Q

3 purposes of LATERAL decubitus views?

A
  1. Confirm the presence of a pleural effusion.
  2. Determine whether a pleural effusion flows freely in the pleural space or not –> IMPORTANT BEFORE ATTEMPTING TO DRAIN PLEURAL FLUID.
  3. “Uncover” a portion of the underlying lung hidden by the effusion.
27
Q

Pleural fluid may NOT flow freely if?

A

ADHESIONS ARE PRESENT, that might impede the free flow of the fluid (loculated effusions).

28
Q

Decubitus vies of the chest can demonstrate effusions as small as …-… mL.

A

15-20mL (CT have largely replace them).

29
Q

Don’t order a decubitus when?

A

If the ENTIRE hemithorax is opacified –> No change in the position of the fluid.

30
Q

When the hemithorax of an adult contains about …L of fluid, the entire hemithorax will be opacified.

A

2L.

31
Q

When we have a large effusion, what should we order in order to visualize the underlying lung?

A

CT.

32
Q

Loculated effusions can be suspected when?

A

An effusion has an unusual shape or location in the thorax.

33
Q

Is loculation of the fluid therapeutically important?

A

YES - Indicates multiple adhesions that make it difficult to drain the non communicating pockets of fluid with a single pleural drainage tube in the same way free flowing effusions can be drained.

34
Q

Pseudotumors in CXR are what?

A

Sharply marginated collection of pleural fluid contained BETWEEN the layers of an INTERLOBAR PULM. FISSURE or in a subpleural location just beneath the fissure.
TRANSUDATES that almost always occur in patients with CHF.

35
Q

Imaging findings of a pseudotumor:

A
  1. Lenticular in shape, most often occur in the MINOR fissure (75%).
  2. Pointed ends on each side where they insinuate into the fissure, much like the shape of a lemon.
  3. They do NOT tend to flow freely with a change in patient positioning.
36
Q

Recurrences of pseudotumors?

A

They disappear when the underlying condition (usually CHF) is TREATED, but they tend to recur in the same location each time the patient’s failure recurs.

37
Q

What is a LAMINAR pleural effusion?

A

A form of pleural effusion in which the fluid assumes a THIN, BANDLIKE density along the LATERAL chest wall, especially near the costophrenic angle.
–> Unlike the usual pleural effusion, the lateral costophrenic angle tends to maintain its acute angle with a laminar effusion.

38
Q

Laminar effusions are almost always the result of?

A

Elevated LA pressure, as in CHF or 2o to lymphangitic spread of malignancy. Usually NOT free-flowing.

39
Q

Hydropneumothorax?

A

Presence of BOTH air + abnormal amounts of fluid in the pleural space.

40
Q

Some of the common causes of hydropneumothorax:

A
  1. Trauma.
  2. Surgery.
  3. Recent tap to remove pleural fluid in which air enters the pleural space.
41
Q

What is a bronchopleural fistula?

A

An abnormal and relatively UNCOMMON connection between the bronchial tree and the pleural space.

42
Q

Causes of bronchopleural fistula?

A
  1. Tumor.
  2. Surgery.
  3. Infection.
43
Q

Imaging features of hydropneumothorax?

A

A hydropneumothorax produces an air-fluid level in the hemithorax marked by a STRAIGHT edge + a SHARP, air-over-fluid interface when the exposure is made with a horizontal x-ray beam.

44
Q

Why is CT frequently necessary to distinguish between some presentations of hydropneumothorax?

A

Because also a lung abscess may have a similar appearance on conventional chest radiographs.

45
Q

About …mL are required to blunt the posterior costophrenic sulcus (seen on the lateral view) and about …-…mL to blunt the lateral costophrenic sulcus (seen on frontal view).

A

75mL.

200-300mL.

Learning Radiology (32 decks)

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