chest Flashcards
1
Q
diagnostic modalities - summary
A
- in-situ X-ray: P-A, A-P, lying position, Firmann-Dahl method.
- Fluoroscopy: “motional x-ray” -> movement of the diaphragm/mediastinum (Holczknecht-Jacobson sign), pulsation of the hilum, localisation of casted shades or pathological signs.
It gives functional information. - CT (+ spiral CT, MSCT, HRCT): axial slices, with or without contrast, volume data-sampling, post-processing methods.
- PET-CT: chest deformities, paralytic thorax (tight apex, acute costovertebral angles), emphysematic thorax (apex is wide, horizontal ribs, wide intercostal spaces)
- MR: chest wall, mediastinum,, heart, major arteries.
- radioisotope examination: ventilation, perfusion.
- ultrasound: pleural fluids.
2
Q
terminology for describing x-ray of the lungs
A
- the typical discrepancies of the hilar caliber, dilated - thick hilar vessels, hypoplastic hilar vessels, centroperipheral caliber discrepancy (cpcd), apicobasal caliber discrepancy (abcd), asymmetry of hila
- vascular variances: hyper-, hypo- vascularisation, avascular regions.
- parenchymal (interstitial) linear shades, diffuse web-like image, pinstripe and atelectatic streaks
- patchy opacities: multiplex small patches (diffuse), irregularly and regularly shaped patchy opacities, blur.
- cavernous shades.
- transparential shades: less / more transparent.
3
Q
secondary lobule
A
Anatomical, pathological, physiological unit.
Well visible in case of air trapping or obstruction. Expiration: mosaic pattern - centrilobular GGO, centrilobular emphysema.
4
Q
pleural fluid
A
- large amount of pleural fluid will dislocate the midline.
- we need a Frimann-Dahl snapshot to prove subpulmonal localisation.
- if pleural adhesions are present, the encapsulated fluid & marked fluid gatherings in the small fissures, may imitate pneumonia on a P-A image.
–> hydrothorax, pneumohydrothorax
- pleural irregularities on US are called B lines!
5
Q
atelectasis
A
- deaeration of the lung tissue and consequential patchy opacities in the air-filled surroundings of the lung.
- collapse of the lung tissue.
- DDx: pneumonia.
- Local atelectasis: think of tumor (esp. if repetitive).
- empyema thoracis: compression form of atelectasis
- IRDS: micro- or adhesive atelectasis -> need aerobronchogram!
6
Q
bronchiectasis
A
- types: cystic, cylindric.
- X-ray image: summation of small, ring-like shades.
- HRCT: “signet-ring” sign -> a small artery-branch next to a wide bronchus.
7
Q
pulmonary thromboembolism - modalities
A
- lung scintigraphy -> V/Q scan
- CT angiogaphy
8
Q
pulmonary abscess on x-ray
A
Every infective, inflammatory, malignant disease can develop an abscess!
- x-ray: a cavern with ragged wall, and an air-filled fluid level inside the patchy opacity. Later the wall will become thinner and smoother.
9
Q
causes of closure of a bronchus
A
- foreign body
- bronchial cc
- benign intrabronchial tumor
- mucopurulent plug
- missed intubation
- stricture after an infection
- outer compression by tumor or lymph node
10
Q
pulmonary mycosis on x-ray
A
pneumonia, small shades, multifocal or extensive, homogenous shadow.
- aspergilloma: nestles in the cavern of another lung disease (TB, cancer, abscess) OR grows in a bronchiectasial dilation. the lumen of the cavern deforms to the form of a quarter moon (crescent).
11
Q
lung fibrosis - appearance
A
Irregular, rough/smooth linear-shade network. Covers and deforms the normal structure of the lung. in severe fibrosis, “honeycomb lung” can develop.
12
Q
bronchial carcinoma
A
- Histology: squamous cell carcinoma (-central), adenocarcinoma (-peripheral), anaplastic cc, large cell cc, small cell cc.
- X-ray: the tumor itself and/or symptoms caused by bronchostenosis.
13
Q
bronchial carcinoma
A
- central localisation, in the wall of one of the major bronchi, spreading towards the lumen.
- symptoms: int he beginning -> brnchostenosis, retentive pneumonias, obstructive emphysema, incomplete atelectasis - can be complicated by inflammation. After the extrabronchial breakthrough, unilateral widening of the hilum (the shade becomes homogenous), with irregular outline, spreading towards its environment.
14
Q
pancoast tumor (bronchial carcinoma)
A
- in the apex
- infiltrates the chest wall -> can destroy the posterior arch of the 1st and 2nd ribs & the vertebral bodies.
- symptoms: pain in the shoulder, Horner-triad, paralytic diaphragm of the affected side.
15
Q
post-operative monitoring (what to look for)
A
- localisation of central venous cannula.
- localisation of endotracheal tube -> the end should be 3-4 cm before the bifurcation.
- atelectasis: hypoventillation and/or retention of mucus. –> x-ray: homogenous shade of the deflated segment or lobe.
- aspiration pneumonia (more common in the right side)
- pulmonary edema
- pulmonary embolisation
- pneumonia
- ARDS (lung in shock) –> RTG image: negative in the beginning, moderate interstitial edema, rapid onset of extensive pulmonary edema.
- pleural fluid: check with ultrasound
16
Q
Hodgkin-lymphoma
A
- Has a pulmonary manifestation in 30-40% of cases.
- Asymmetric growth of mediastinal shadow - enlarged lymph nodes in the hilus.
- Can present as patchy opacities with or without cavity, atelectasis, multiplex hilar/subhilar/major disseminated knots, fibrosis, interstitial edema, pleural- , pericardial- fluid, or the combination of these.
- similar signs in case of leukemias: enlargement of mediastinal lymph nodes, interstitial and alveolar shades (linear and patchy).
17
Q
definition of interstitial lung diseases
A
- caused by chronic inflammation of the pulmonary interstitium, resulting in a scarred reconstruction by proliferating connective tissue.
- Mostly the alveoli and interstitium are affected.
- the airways and pulmonary vessels are secondarily affected.
18
Q
clinical signs of interstitial lung diseases
A
- non-productive cough
- stress dyspnoea
- drumstick fingers
- clubbed nails
- basal crackling
- weakness
- weight loss
19
Q
diagnostics of interstitial lung diseases
A
- (ideally) multidisciplinary ILD board: pneumonologists, rheumatologists, radiologists, pathologists
- laboratory: kidney functions, electrolytes, CRP, differential blood counts, antibodies
- lung function (restrictive ventilation fault)
- imaging: x-ray & HRCT
- bronchoscopy with transbronchial biopsy (TBB) and bronchoalveolar lavage (BAL)
- open lung biopsy (VATS)
- biopsy is not necessary in atypical interstitial pneumonia (UIA)
20
Q
typical patterns of an ILD
A
- ground glass opacities (milk glass opacity - increased parenchyma decreasement) -> partially filled and/or collapsed alveoli. Eg) active inflammation.
- consolidation: completely filled and/or collapsed alveoli (accumulation of exudate, transudate, or other tissue in the alveoli).
21
Q
idiopathic pulmonary fibrosis (heterogenous entity)
A
- AIP (acute interstitial pneumonitis)
- UIP (usual interstitial pneumonitis) - 70%
- DIP (desquamative interstitial pneumonia)
- RBILD (respiratory bronchiolitis ILD)
- NSIP (non-specific interstitial pneumonia)
- BOOP = COP (bronchiolitis obliterans organising pneumonia = cryptogenic organising pneumonia)
22
Q
interstitial lung diseases on x-ray
A
- fine-stripping-reticular pattern that is superimposed by a diffuse transparency reduction.
- increased reticulation with basal dominance.
