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Radiology > Chest > Flashcards

Chest Flashcards

1
Q

What is the ABC approach to examining the chest?

A 
airway and abdomen
bones
cardiac
diaphragm
effusions
Fields (lung)

LOOK AT EVERYTHING AND NOT JUST LUNG PATHOLOGY

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2
Q

On the PA film what chambers of the heart are not visible edges?

A

RV and LA

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3
Q

On lateral CXR- what 3 things make up the posterior border?

A

IVC, LV, LA

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4
Q

What is the hoffman Rigler’s sign?

A

assess LV enlargement- 2cm up from IVC,heart junction and 2 cm back. If heart past this then it is enlarged.

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5
Q

How can we tell if RV is enlarged on lateral film?

A

> 1/3 sternal length is abutted by the RV

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6
Q

What are the 3 knobs of the left heart

A

aorta, pulmonary trunk, LV

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7
Q

if there is a 4th mogul, what is the problem?

A

LA enlargement

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8
Q

If you see a prominent bulge in 3rd mogul…?

A

LV aneurysm

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9
Q

How many anterior ribs should we see in adequate inspiration/

A

6 ant. ribs

8 or more suggests hyperinflation

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10
Q

For adequate penetration- what should be seen thru cardiac shadow…

A

intervertebral disks and pulmonary vessels

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11
Q

What false signs are seen in AP portable technique?

A

cardiac enlargement and vascular crowding

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12
Q

Pathology in the anterior mediastinum is most likely what 4 things?

A

thymoma
teratoma
thyroid
terrible lymphoma

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13
Q

Pathology in the middle mediastinum is most likely what?

A 
heart- pericardial cyst
asc. aorta- dissection TAA
esophagus- mass duplication cyst
bronchus: mass duplication cyst
lymph nodes- lymphoma, TB, sarcoid, etc.
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14
Q

Posterior mediastinum problems include?

A

neural tumors- schwannomas, neurofibroma, neuroblastoma, ganglioneuroma
spine malignancy

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15
Q

What two things help us work up nodules?

A

determine age (>2 years stable = benign)

evaluate qualities

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16
Q

If nodule is soft tissue in density, what does it mean?

A

probably malignancy

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17
Q

If nodule is fat, what is it probably?

A

hamartoma

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18
Q

What is the size difference between mass and nodule?

A

3cm

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19
Q

How do we know that a hamartoma is what we are looking at…

A

compare density to subQ fat

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20
Q

Is contrast enhancement of nodules predictive of malignancy?

A

No- it is suggestive- it is difficult with small nodules, cavitary lesions, central necrosis

21
Q

What is so good about PET, what is the size limit, when is the False +

A

sensitivity and spec >90

difficult if

22
Q

What are the 2 stages of pulm edema?

A

congestion, interstitial and frank

23
Q

What are the 4 signs of congestion?

A

-loss of 1:1 arterial-bronchial ratio
- development of peribronchial cuffing
- cephalization
loss of vascular border

24
Q

What are the 2 big signs for interstitial edema?

A

Kerley B lines

Bat wing

25
Q

What is different about frank edema?

A

air space component–> spilling into alveoli

symmetric bilateral

pleural effusions

26
Q

How big is azygos in upright PA normally?

A
27
Q

If it is air-space what should we be thinking?

A

cotton, fluffy

blood, pus, tumor, water

infection, pulmonary edema, hemorrhage

28
Q

If it is interstitial what should we be thinking?

A

linear, lacey

fibrosis, pulmonary edema early, scarring, viral infection

29
Q

What lobe abuts the left heart border?

A

LUL- lingular

30
Q

what lobe abuts ascending aorta?

A

RUL

31
Q

Main difference between abscess and empyema?

A

abscess- cavitary, usually round, airfluid level

Empyema- loculated, lentiform, in the plearual space

32
Q

In a contrast study differentiating abscess from loculated empyema what is the diffence in shape? margin? angle with chest wall? effect on lung?

A

Shape: E = oval; A = round
Margin: E = thin, smooth; A = thick, irregular
Angle with chest wall: E = obtuse; A = acute
Effect on lung: E = compression; A = consumption

33
Q

What way does atelectasis shift mediastinum?

A

toward side of collapse

obliteration of heart or diaphragm borders with lobar collapse

34
Q

What can we see on lateral CXR for RML collapse?

A

shift of the minor fissure downward- on pa we saw loss of right heart border

35
Q

Increased retrocardiac density suggests what?

A

LLL problems- possibly collapse

36
Q

Wat is virchow’s triad?

A

venous stasis
intimal injury
hypercoaguable state

37
Q

What are the 3 major/classic symptoms of PE?

A

dyspnea
pleuritic pain
cough

However,

38
Q

What are the embolic origins of PE?

A

lower extremetiy DVT»»>iliac vein thrombosis, IVC thrombosis

39
Q

What is hampton’s hump?

A

Lung infarct, loss of alveolar integrity collapse

=infarct- rate of resolution of these densities is the best way to judge if lung tissue has been infarcted

40
Q

What is westermark’s sign?

A

area of decreased vascularity and perfusion distal to a large PE

Presumed to be secondary to near complete loss of blood flow

41
Q

T-F- hampton’s hump and westermarks sign are sensitive for PE

A

FAlse- neither are- infarcts may have not had time to evolve, blood supply may not be completely compromised

42
Q

What is used for perfusion in the V/Q scan? what is used for ventilation?

A

Perfusion- TC-99m macroaggregated albumin

Ventilation Tc99M DTPA aerosol or xenon 133 gas

43
Q

Ona V/Q scan, what is seen on mismatch?

A

lung is ventilated but not perfused

44
Q

What are the 4 probabilites of V/Q results?

A

high probability- 87
intermediate probability- 30
low probability- 14
Normal- 0%

High prob with high clinical suspicion=95%
low prob+ low suspicion= 4%

45
Q

In PE is VQ very specific?

A

no like 10%, CT is sens and specific

46
Q

If CT is better than V/Q…why use V/Q?

A
  • CT contraindicated in pregnancy
  • contrast load has potential for renal failure
  • patients with contrast allergy
47
Q

What is the pressure in the pleural space normally?

A

5 cm of water below atmospheric

48
Q

What is sometimes the only clue to a pneumothorax that we should not forget?

A

deep sulcus sign

Radiology (8 decks)

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