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Radiologic Examination of the Chest > chapter 7 > Flashcards

chapter 7 Flashcards

1
Q

what is an air cyst?

A

A thin walled radiolucent area surrounded by normal lung tissue

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2
Q

What is a Bleb?

A

A superficial air cyst protruding into the pleura: also called bulla

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3
Q

What is a Bronchogram?

A

An outline of air-containing bronchi beyond the normal point of visibility. An air Bronchogram develops as a result of an infiltration or consolidation that surrounds the bronchi, producing a contrasting air column on the radiograph-that is , the bronchi appear as dark tubes surrounded by a white area produced by the infiltration or consolidation.

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4
Q

What is a Bulla?

A

A large, thin walled radiolucent area surrounded by normal lung tissue.

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5
Q

What is the cavity?

A

A radiolucent (dark) area surrounded by dense tissue (white). A cavity is the hallmark of a lung abscess. A fluid level may be seen inside a cavity.

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6
Q

What is Consolidation?

A

The act of becoming solid; commonly used to describe the solidification of the lung caused by a pathologic engorgement of the alveoli, as occurs in acute pneumonia.

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7
Q

What is homogenous densiity?

A

Refers to a uniformly dense lesion (white area); commonly used to describe solid tumors, fluid-containing cavities, or fluid in the pleural space.

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8
Q

Describe Honeycombing?

A

A coarse reticular (netlike) density commonly seen in pneumoconiosis.

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9
Q

What does infiltrate mean?

A

A poorly defined radio density (white area); commonly used tto describe an inflammatory lesion.

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10
Q

What is interstitial density?

A

A density caused by interstitial thickening.

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11
Q

What is a lesion?

A

Any pathologic or traumatic alteration of tissue or loss of function of a part.

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12
Q

What does opacity mean?

A

State of being opaque (white); an opaque area or spot; impervious to light rays, or by extension, x-rays; opposite of translucent or radiolucent.

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13
Q

What is pleural density?

A

A radio-density caused by fluid, tumor, inflammation, or scarring.

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14
Q

What is pulmonary mass?

A

A lesion in the lung that is 6 cm or more in diameter; commonly used to describe a pulmonary tumor.

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15
Q

What is a pulmonary nodule?

A

A lesion in the lung that is less than 6 cm in diameter and composed of dense tissue called a solitary pulmonary nodule or “coin” lesion because of its rounded, coin-like appearance.

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16
Q

What is radioidensity?

A

Dense areas that appear white on the radiograph; the opposite of radiolucency.

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17
Q

what is radiolucency?

A

The state of being radiolucent; the property of being partly or wholly permeable to x-rays; commonly used to describe darker areas on a radiograph such as an emphysematous lung or a pneumothorax.

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18
Q

What is Translucent mean?

A

Permitting the passage of light; commonly used to describe darker areas of the radiograph.

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19
Q

What is radiography?

A

The making of a photographic image of the internal structures of the body by passing x-rays through the body by passing x-rays through the body to an x-ray film, or radiograph.

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20
Q

How are x-rays formed?

A

When electrons with sufficient energy collide with matter in any form.

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21
Q

How are x-rays produced?

A

With an X-ray tube

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22
Q

List the the components used to make an x-ray.

A
  • Vacuum-sealed glass tube that has a cathode an anode.
  • 1/2 inch tungsten square plate (target) is fixed to the end of the rotating anode in the center of the tube.
  • When the cathode is heated, electrons “boil off”
  • High voltage is applied and electron are driven into the rotating plate
  • the sudden deceleration converts energy into x-rays
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23
Q

The ability of the x-ray to penetrate matter depends on?

A

the density of the matter.

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24
Q

Dense objects absorb?

A

more x-ray’s and will be more opaque (white or gray) on the film.

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25
Q

Les dense objects will not absorb?

A

as many x-rays, the x-rays will penetrate the film and appear more radiolucent (black).

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26
Q

What are the 5 densities seen in thee chest?

A
  1. Air
  2. Water
  3. Fat
  4. Bone
  5. Metal ( contrast material)
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27
Q

Standard radiograph of the chest includes two views, while standing. Name the two.

A
  1. Postero-anterior (PA) projection

2. Lateral Projection

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28
Q

If the patient is seriously ill or immobile, a PA film may not bee possible. What would you do instead?

A

Anteroposterior (AP) projection

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29
Q

Explain how the Posteroanterior (PA) radiograph is taken.

A
  • Patient is in a upright position, standing or sitting
  • Anterior of patient’s chest against film plate with shoulders rotated forward.
  • distance between X-ray tube and film is 6 feet
  • x-ray taken during a full inspiration
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30
Q

Describe how a lateral projection is taken?

A
  • side of the patient’s chest is against cassette
  • arms raised and resting on head
  • taken on inspiration
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31
Q

Explain how to take a anteroposterior (AP) radiograph?

A
  • Usually taken by a portable x-ray machine

- Film is placed behind the patient’s back and the x-ray machine is about 48 inches from the film.

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32
Q

What are the disadvantages to the anteroposterior radiograph?

A
  • heart and superior portion of the mediastinum is magnified
  • less resolution and more distortion
  • lower lobes may appear hazy
  • often have extraneous shadows from ventilator tubing, indwelling catheters and ECG lines
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33
Q

What is lateral Decubitus Radiograph?

A
  • x-ray is obtained with patient lying on right or left side
  • named for the side the patient is laying on
  • useful in diagnosing accumulation of fluid in the pleural space (pleural effusion)
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34
Q

When inspecting the chest radiograph what must you check?

A

_ be sure you have the correct patient

  • Check positioning
  • Check exposure quality
  • Check level of inspiration
  • Identify normal landmarks
35
Q

Check your positioning. What should you look for?

A
  • Vertebral column should be precisely in the center between the medial ends of the clavicles
  • Distance between the right and left costophrenic angle and the spine should be even
  • small rotations can create a false image
36
Q

What should the exposure quality be?

A
  • Normal exposure verified by determining visibility of spinal processes behind the heart
37
Q

What does it look like if the exposure quality is overexposed?

A

Heart and lungs become more radiolucent (darker)

  • heavily penetrated
  • burned out
38
Q

What if the exposure quality is unerexposed?

A
  • heart and lungs become more dense or whiter
39
Q

A CXR should be taken on?

A

full inspiration

40
Q

The diaphragmatic domes should be at?

A

The level of the 9th and 111th rib posteriorly

41
Q

When x-ray is taken on expiration lungs will appear?

A

denser and heart larger

42
Q

List the sequence of the examination.

A
  • Mediastinum
    - Trachea
    - heart
    - hilar region
  • lung parenchyma
  • pleura
  • diaphragm
  • gastric air bubble
  • bony thorax
  • extrathoracic soft tissue
43
Q

When checking the mediastinum . What should you check?

A

-check for width, contour and shift from midline

44
Q

The trachea should always be?

A

Midline

45
Q

If the trachea is shifted away from affected area it indicates?

A

Fluid or gas inn pleural space

46
Q

if the trachea is shifted toward the affected area, it means?

A

Lung collapse or fibrosis

47
Q

The heart on the PA film the cardio-thoracic ratio should be?

A

<1:2

48
Q

On the x-ray a small portion of the heart should be seen on the right side of the vertebral column. Two bulges seen on the right heart border is?

A
  • superior vena cava

- right atrium

49
Q

There is three bulges on the left side of he heart.What are they?

A
  • Aorta
  • Main pulmonary artery
  • left ventricle
50
Q

Is the left hilum about to 2 cm higher than the right?

A

Yes

51
Q

What can increased densities on the hilum indicate?

A

Signify vascular engorgement

52
Q

Vertical displacement of the hilum suggests?

A

volumes loss in the corresponding upper lobes

53
Q

Why look for the lymph nodes when looking at the hilum region?

A

Enlarged lymph nodes may push or pull the hilar region out of its normal area

54
Q

When looking at the lung parenchyma look at the lung systematically from top to bottom comparing one lung with the other. What should you see?

A

Tissue markings throughout the lungs

55
Q

If there is loss of tissue markings in the lung parenchyma, what does it mean?

A

-pneumothorax, air-trapping,pneumonectomy, and overexposure.

56
Q

What does it mean when there is excessive marking in the tissue on the lung parenchyma?

A

fibrosis, edema, lung, compression, underexposure

57
Q

When looking at the pleura, examine for?

A

pleural thickening, presence of fluid or air, or the mass lesions

58
Q

When inspecting the pleura, inspect the costophrenic angle look for?

A

Blunting of this angle may signify a pleural effusion

59
Q

Diaphragms should have what kind of shape?

A
  • upwardly convex, domed shaped contour

- Right and left costophrenic angles should be clear

60
Q

Right diaphragm is how much higher than the left?

what causes the right diaphragm to be higher than the left?

A
  • the right is approx. 2 cm higher than the left

- Due to the position of the liver

61
Q

if the diaphragm is depressed, what does that indicate?

A

Air trapping

62
Q

If the diaphragm is elevated, what does it indicate?

A
  • Lung collapse
  • Nerve Damage
  • Spinal Curvature
63
Q

What is the gastric bubble?

A

A stomach bubble commonly seen under the left hemi-diaphragm
When looking at the gastric bubble look for indications of excessive free air.

64
Q

When inspecting the bony thorax, inspect the?

A

Inspect the ribs, vertebrae, clavicles, sternum, and scapulae.

65
Q

When looking at the intercostal spaces, what should you look for?

A

Look for intercostal spaces to be symmetrical and equal over each lung field.

66
Q

If the intercostal spaces are too close together, what does that indicate?

A
  • Loss of muscle tone
67
Q

If the intercostal spaces are too far apart, what does that indicate?

A
  • alveolar hyperinflation
68
Q

When looking at the bony thorax look at the ribs for what?

A

Rib fractures and deformities

69
Q

When looking at extra-thoracic soft tissue, what will it indicate?

A
  • When looking at it, it will indicate the gender the patient.
  • look for free air it will indicate subcutaneous emphysema.
70
Q

List the other Radiologic Tecchniques.

A
  • Computed tomography (CT)
  • Positron Emission Tomography (PET)
  • Magnetic Resonance Imaging (MRI)
  • Pulmonary Angiography
  • Ventilated/Perfusion scan
  • Fluoroscopy
  • Bronchography
71
Q

What is computed tomography?

A

provides a series of cross-sectional (transverse ) picture of the structures within the body at numerous levels

72
Q

Why is the computed tomography useful supplement to the CXR?

A
  • detects lesions
  • detects masses and nodules
  • cavities
  • small pneumothorax
73
Q

What is Positron Emission Tomography?

A
  • Shows both the anatomic structures and the metabolic activity of the tissues and organs scanned.
  • Used to detect early cancerous lesions
74
Q

How does Positron Emission Tomography work?

A
  • The patient is injected with glucose, tagged with a radioactive isotope.
  • Cancer cells metabolize glucose at an extremely high rate.
  • Glucose breaks don and produce positrons
  • Positrons produce gamma rays
  • Gamma rays are converted to dark spots to the PET scans
75
Q

What is Magnetic Resonance Imaging?

A
  • Uses magnetic resonance as its source of energy to take cross-sectional (Transverse, sagittal, or coronal) images of the body.
  • Used as a supplemental to CT to study the mediastinum and hilar region.
76
Q

What is pulmonary angiogaphy?

A
  • Injection of radiopaque contrast medium through a catheter that has been passed though the right side of the heart and into the pulmonary artery.
  • rapid serial pulmonary angiograms
  • shows abnormalities in pulmonary circulation
77
Q

Describe the perfusion scan.

A

Radioactive material injected into blood stream an is distributed into pulmonary circulation.
-lungs then scanned with a gamma camera that produces a picture.

78
Q

Describe the ventilation scan.

A
  • Patient breathes a radioactive gas from a closed circuit spirometer .
  • gamma produces a picture
79
Q

A ventilation/perfusion scan can detect?

A

Pulmonary emboli

80
Q

What is a Fluoroscopy?

A
  • Technique by which x-ray motion pictures of the chest are taken.
  • uses larger doses of x-rays than standard radiography.
81
Q

What is an example of the use of a fluoroscopy?

A
  • Assessment o abnormal diaphragmatic movement

- Localization of lesions to be biopsied during fiberoptic bronchoscopy.

82
Q

What is bronchography?

A
  • Instillation of a radiopaque material into the lumen of the tracheobronchial tree
  • CXR is then taken
83
Q

When would you use a bronchography?

A
  • Diagnosis of bronchogenic carcinoma

- determine presence or extent of bronchiectasis

Radiologic Examination of the Chest (1 decks)

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