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[PBR] Pediatric Imaging > Chest > Flashcards

Chest Flashcards

1
Q

Cardiothoracic ratio decreases as the child grows older and should be less than 50%, with the heart appearing similar to an adult by what decade

A

Second decade

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2
Q

A guide for normal heart is that a line drawn along the posterior tracheal wall on the lateral CXR should pass _______ to the heart

A

Posterior

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3
Q

True cardiomegaly in children is seen usually in what view of chest xray

A

Lateral

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4
Q

Thymus is proportionately largest at _____

A

Birth

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5
Q

It is the primary finding in asthma

A

Hyperinflation

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6
Q

Hyperinflation in asthma is much more common in viral or bacterial pneumonia?

A

Viral

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7
Q

What is the rib that should be the first to cross the diaphragm to know if the chest is adequately aerated

A

6th anterior rib

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8
Q

If expiratory CXR for evaluating air trapping cannot be obtained due to an uncooperative child, what technique should be done

A

Bilateral decubitus radiographs

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9
Q

Syndrome that presents one lung to be hyperlucent

A

Obliterative bronchiolitis, also called Swyer-James-Macleod syndrome

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10
Q

A decrease in the AP size of the trachea otherwise suggests a

A

Tracheomalacia or extrinsic compression

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11
Q

On frontal expiratory CXR, the trachea often buckles, at times dramatically. The trachea always buckles in what direction

A

Opposite to the location of the aortic arch

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12
Q

Normal trachea lies slightly to the ____ of the midline, due to the position of the aortic arch

A

Slightly to the right of the midline

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13
Q

True or false: a true midline trachea is abnormal, and it is a sign of ____

A

True.

Sign of double aortic arch

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14
Q

A focal right-sided impression on the trachea is almost always due to a

A

Right arch

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15
Q

True or false: lung volume can be increased, normal or decreased in Swyer-james syndrome

A

True

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16
Q

True or false: air trapping due to a foreign body will usually have increased lung volume, and should not have decreased lung volume in the absence of atelectasis

A

True

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17
Q

Normal tracheal buckling has _____ angles compared with the more ______ displacement seen with masses

A

Normal: sharp angles

With mass: rounded displacement

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18
Q

with surfactant deficiency disease, there should be no finding suggesting______ or ______

A

Pleural fluid or asymmetry of opacities

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19
Q

Bilaterally symmetrical coarse linear and branching opacities suggest

  • cause obstruction of small peripheral bronchioles, resulting in unevenly distributed areas of subsegmental atelectasis with alternating areas of overdistension.

This creates a coarse reticulonodular or nodular appearance of the lungs (Fig. 50.40).

A

Meconium aspiration

Aspirated meconium particles

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20
Q

Aspirated meconium-stained fluid causes mechanical and chemical airway trauma due to its ______

A

Particulate nature and the presence of irritants including bile

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21
Q

Meconium aspiration pneumonia appears as

A

Areas of atelectasis and inflammation alternating with areas of hyperinflation

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22
Q

Features of SDD that distinguishes it from other causes of diffuse opacity

A

Low lung volumes with granular diffusely increased attenuation that is evenly distributed, without pleural effusion

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23
Q

Linear opacities, central greater than peripheral particularly when radiating from the hila, suggest

A

Retained lung fluid, aka transient tachypnea of the newborn

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24
Q

Retained lung fluid resolves both clinically and radiographically by ____ hours and should not be suggested in older infants

A

72 hours

24-48 hours

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25
Q

A pneumonia that simulate SDD which presents as diffuse ground glass opacities is mainly caused by what organism

A

group B streptococcus

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26
Q

In the immediate neonatal period, GBS usually cause ____

A

Pneumonia

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27
Q

Later in early infancy, GBS is more likely to cause _____

A

Meningitis

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28
Q

Most common cause of lung abnormalities in older infants in the neonatal ICU

  • common complication of preterm birth, the manifestations of which are changing slightly in the postsurfactant therapy era.
A

Bronchopulmonary dysplasia or chronic lung disease

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29
Q

Suggested pathophysiology of BPD

A

Diffuse capillary leak

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30
Q

More common area of pneumothorax in neonates

A

Basal pneumothoraces, particularly medially located

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31
Q

These area of pneumothorax are seen as lucency adjacent to the cardiomediastinal silhouette with a sharply defined cardiac or diaphragmatic margin much more often than with a pleural line

A

Basal pneumothoraces

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32
Q

True or false: lungs are usually very stiff in infants with neonatal lung disease

A

True

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33
Q

What is the highest point in a supine patient

A

Lung base

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34
Q

Best sign of pneumonediastinum in a neonate

A

Elevation of thymus from rest of mediastinum

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35
Q

In a neonate with pneumodiastinum, its extension is more common in the

A

Peritoneum, rather than in the neck as subcutaneous emphysema

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36
Q

True or false, isolated pneumomediastinum almost never require drainage

A

True

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37
Q

Pneumopericardium is best distinguished from pneumomediastinum by air surrounding the entire cardiac silhouette, particularly where

A

Superiorly

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38
Q

When in doubt if a supine baby has pneumothorax, what radiograph should be added

A

Decubitus view

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39
Q

Radiograph that would make the distinction of pneumopericardium over pneumomediastinum

A

Lateral radiograph

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40
Q

A complication of barotrauma that occurs when alveolar tears allow air to enter the pulmonary interstitium and lymphatics

A

Pulmonary interstitial emphysema

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41
Q

Development of pneumomediastinum or pneumothorax in patients with PIE is often due to

A

The extra-alveolar air that stiffens the lung

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42
Q

CXR appearance of PIE

A

Small round and rod-like lucencies superimposed on a background of higher attenuation lung

Air dissects through the interstitium and lymphatics (pulmonary interstitial emphysema), creating a radiographic pattern of serpiginous bubbles that can extend well into the lung periphery.

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43
Q

True or false: PIE usually resolves quickly, but there us an entity of persistent PIE than can persist fo months

A

True

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44
Q

Tip positioning of ET tube in neonates and infants can be considered satisfactory in all neonates and infants

A

Tip positioning midway between thoracic inlet and carina

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45
Q

Type of umbilical catheter that extends cephalad from the umbilicus with a straight or gently curve course

A

Venous

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46
Q

Type of umbilical catheter that first extends caudad and then turns and extends cephalad. The turning point forms an acute angle that usually lies close to the bottom of the sacroiliac joint

A

Arterial

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47
Q

Type of umbilical catheter that remains anterior

A

Venous

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48
Q

Type of umbilical catheter that passes posteriorly to the posteriorly located aorta and overlies the spine

A

Arterial

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49
Q

Incorrectly positioned UACs are almost always within the ______, with the catheter tip either too high or too low

A

Aorta

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50
Q

Two accepted placements of umbilical arterial catheter

A

High placement- between T6 and T9 and low placement- with the catheter tip ideally at the bottom of L3

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51
Q

True or false, course of UVC is more complex, and there are multiple opportunities for malposition

A

True

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52
Q

Course of the umbilical vein

A

Umbilical vein—> left portal vein —> ductus venosus —> IVC just below the hepatic veins

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53
Q

Course of the umbilical artery

A

Umbilical artery —> internal iliac artery —> aorta

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54
Q

Risk of important complications if the UV catheter tip is where?

A

Within the liver, “slightly low” position

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55
Q

Single catheter extracorporeal membrane oxygenation (venous) usually ends in the

A

Low Right atrium

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56
Q

What type of ECMO allows full bypass of the heart

A

2 catheter

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57
Q

Position tip of UVC

A

Diaphragm

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58
Q

Arterial ECMO catheter proper placement site

A

Above aortic arch

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59
Q

Upper extremity PICC position

A

Carina to 2 vertebral bodies (including interspaces) below carina

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60
Q

Lower extremity PICC position

A

Diaphragm

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61
Q

Most common type of CPAM (congenital pulmonary airway malformation) that contain one or more cysts greater than 2cm and make up about half of CPAMs

A

Type 1

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62
Q

Single most important feature to identify on imaging of congenital lung malformations is the presence or absence of

A

A feeding vessel. A feeding vessel identifies the lesion as a sequestration

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63
Q

Most common congenital lung malformation, making up about 1/4 to 1/2 of lung lesions diagnosed prenatally

A

Congenital pulmonary airway malformation

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64
Q

Type of CPAM with multiple smaller cysts

A

Type 2

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65
Q

Type of CPAM wherein the cysts are <5mm, larger than type 2, affecting the entire lobe. It is associated with hydrops and a poor prognosis

A

Type 3

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66
Q

It is a mass of nonfunctioning lung tissue that does not connect to the rest of the tracheobronchial tree

A

Pulmonary sequestration

67
Q

Type of sequestration within the visceral pleura and aerate from the collateral ventilation

A

Intralobar sequestration

68
Q

Type of sequestration that have their own pleura and cannot become aerated

A

Extralobar sequestration

69
Q

Type of sequestration that can be solid or cystic, and usually contain both components

A

Intralobar

70
Q

Arterial and venous drainage in pulmonary sequestration is variable, but is most commonly from the

A

Aorta and to a pulmonary vein

71
Q

Both types of pulmonary sequestration can be seen at what part of the lung

A

Lower lobes, left more common than right

72
Q

Foregut duplication cysts include (3)

A

Bronchogenic cysts,
esophageal duplication cysts and
neuroenteric cysts

73
Q

They are round, well- defined masses that can occur in mediastinum or in the lung, usually centrally

A

Bronchogenic cysts

74
Q

Aberrant budding of the bronchopulmonary foregut is thought to result from

A

Cyst lined with respiratory epithelium and filled with fluid or mucus

75
Q

What feature of bronchogenic cyst distinguishes it from an infection

A

BCs do not communicate with the tracheobronchial tree

Bronchogenic cysts
• are lined with respiratory epithelium and filled with mucoid liquid
• They occur in the lung parenchyma or in the mediastinum
• A subcarinal location is very common.
• Some are connected to the bronchial tree and are air-filled
• The cystic nature of these lesions is readily demonstrable with CT or MR (Fig. 50.47).

76
Q

Foregut duplication cyst that occur adjacent to the esophagus and appear similar to mediastinal bronchogenic cyst

A

Esophageal duplication cysts

77
Q

Neuroenteric cysts appear where

A

Posterior mediastinum, and can be associated with vertebral body anomalies

78
Q

A developmental abnormality that results in overinflation of a lobe. An airway abnormality, particularly abnormal cartilage and airway malacia resulting in a check-valve mechanism

A

Congenital lobar overinflation

79
Q

Congenital lobar overinflation occurs most commonly in the (3)

A

Left upper, right upper and middle lobes

80
Q

Abnormality affecting the entire lung lobe with no bronchus present

A

Pulmonary agenesis

81
Q

Lung malformation affecting the entire lobe where a short, blind-ending bronchus is present

  • rudimentary bronchus but lack of lung tissue and pulmonary artery
A

Pulmonary atresia

Pulmonary aplasia

82
Q

Lung malformation affecting an entire lobe wherein the size of the lung and/or the number of bronchopulmonary segments are decreased

A

Pulmonary hypoplasia

83
Q

There is abnormal drainage of a lung lobe. The configuration of the abnormal vein has been linked to a scimitar sword. The affected lobe is small.

A

Pulmonary venolobar or scimitar syndrome

84
Q

The abnormal drainage of a lobe in scimitar syndrome is usually connected to (3)

A
  • IVC,
  • hepatic vein or
  • left atrium.

The abnormal arterial supply is from the aorta

85
Q

Occurs when there is focal interruption of a bronchus during lung development. The cause is unknown, but there is normal development of the bronchial distal to the interruption suggesting a prenatal traumatic event

A

Bronchial atresia

86
Q

A soft tissue nodule associated with focal air trapping will almost always be due to a

A

Bronchial atresia

87
Q

In bronchial atresia, there would always be these things present

A

Mucocele or mucus collection distal to the occlusion, and air trapping

88
Q

Best way to defined pulmonary situs

A

Defining the relationship of the main bronchi (right and left) to the pulmonary arteries

89
Q

Eparterial

A

Right upper lobe bronchus

E.R.

90
Q

Type of tracheal stenosis from airway trauma such ad from repeated suctioning, or prolonged intubation

A

Focal tracheal stensosis

91
Q

Type of tracheal stenosis that is congenital

A

Diffuse stenosis

92
Q

Tracheal stenosis associated with congenital heart disease is often due to

A

Complete tracheal rings

93
Q

Most common infectious disease of children

A

Infection of lower respiratory tract

94
Q

Most common response to lower respiratory tract infection of any etiology is

A

Inflammation of the airways and increased mucus production

95
Q

Best predictor for a bacterial lung infection

A

Pleural effusion

96
Q

2 most common causes (pathogens) of pneumonia in the first month of life

A

GBS and gram-negative enteric bacteria

97
Q

Viral-like appearance of pneumonia in 6-12 week old infant is usually caused by

A

Chlamydia trachomatis

98
Q

Most common etiology of pneumonia in 1-3 months infant

A

Streptococcus pneumoniae

99
Q

From a few months of age to a few years, what is the most common etiology of pneumonia

A

Viral

100
Q

Older children pneumonia

A

Bacterial

101
Q

Most common etiology of pulmonary infection in infants and young children

A

Respiratory syncytial virus

102
Q

Most common cause of bronchiolitis in infants and young children

A

Respiratory Syncytial virus

103
Q

Clinically defined as a disease of wheezing and respiratory distress in children less than 2 years old

A

Bronchiolitis

104
Q

“Wandering” or “shifting” atelectasis

A

Bronchiolitis

105
Q

Most common cause of pneumonia in children, responsible for 40% or more of pediatric pneumonia. Affects children from school age through adolescence

A

Mycoplasma pneumonia

106
Q

Bacterial pneumonia that appears as a “viral” pattern with hilar adenopathy and small pleural effusions seen in some cases

A

Mycoplasma pneumonia

107
Q

Mycoplasma can occur in a mixed infection, particularly with

A

Pneumococcus

108
Q

Common cause of pneumonia in premature infants

A

Listeria

109
Q

Most common cause of bacterial pneumonia in children after neonatal period

A

S. Pneumoniae

110
Q

It is a manifestation of streptococc al pneumonia with a strikingly mass-like appearance.

A

Round pneumonia

111
Q

Round pneumonia is usually seen in

A

Lower lobe of children less than 8 y.o

112
Q

Most often pulmonary primary disease until the age of puberty, after which adult type reactivation disease becomes more common

A

Childhood TB

113
Q

The primary focus and lymphadenopathy from the primary TB is calles

A

Ghon complex

114
Q

Most common finding in primary TB is

A

Adenopathy

115
Q

Parenchymal disease appearance of TB

A

Nonspecific infilrate associated with hilar or mediastinal lymphadenopathy

116
Q

Infiltrates of primary TB can occur in any location, but is most often where

A

Peripheral and in the mid or lower lung

117
Q

Most common lung mass in child

A

Pseudomass, most commonly a round pneumonia

118
Q

most common malignant neoplasm in the lung during childhood

A

Metastases

119
Q

Most common true lung mass in children

A

Inflammatory myofibroblastic tumor/ plasma cell granuloma ans xanthogranuloma

Postinflammatory granulomas caused by tuberculosis or fungal infections are the most common true lung masses - Brant.

Plasma cell granuloma is the most common tumorlike abnormality in the lungs of children. - Caffey

120
Q

Most common primary benign neoplasm of pediatric chest

A

Pulmonary hamartoma

121
Q

Pulmonary hamartoma usually presents as

A

Solitary, noncalcified lobular mass

122
Q

Most common primary malignant lesion in pediatric chest

A

Endobronchial carcinoid and pleuropulmonary blastoma

123
Q

Pleuropulmonary blastoma usually occurs in children of what age

A

Younger than 6 years old

124
Q

CPAM can be distinguished from PPB in a neonate with

A

Pneumothorax, multiple lesions and a family history (DICER 1)

125
Q

Very rare in children, but can be a cause of thin-walled cysts

A

Lymphangioleiomyomatosis

126
Q

Appears as irregurly shaped cysts

A

Langerhans cell histiocytosis

127
Q

When lung nodules are associated with cysts, pulmonary involvement by _____ and _____ should be considered

A

Papillomatosis and langerhans cell histiocytosis

128
Q

Largest normal structure in the anterior mediastinum

A

Thymus

129
Q

Thymic contour in infants are in what shape

A

Rounded or rectangular

130
Q

By school age, the shape of the thymus becomes

A

Triangular

131
Q

Appearance of thymus in ultrasound that can be used to confirm the presence of normal thymus and so exclude other causes of an anterior mediastinal process

A

“Dot-dash” appearance

132
Q

Most common anterior mediastinal mass in children

A

Lymphoma

thymus gland
• is the primary normal structure in the anterior mediastinum
• the most common cause of an apparent anterior mediastinal mass.

133
Q

True mass such as lymphoma can be distinguished from thymus with these features

A

Irregular contour, heterogeneous attenuation, mass effect

134
Q

Most common neurogenic tumor in children

A

Neuroblastomas

135
Q

Relatively common form of ILD that has a classic imaging appearance of ground-glass opacities most marked in the right middle lobe and lingula and otherwise distributed predominantly in a perimediastinal location

A

Neuroendocrine hyperplasia

136
Q

Crazy paving pattern of ILD in children

A

Surfactant protein mutations

137
Q

Common form of ILD in infants from a prenatal or perinatal lung insult. Seen in infants with BPD, pulmonary hypoplasia due to oligohydramnios and in association with cardiac and chromosomal abnormalities such as trisomy 21

A

Alveolar growth abnormality

138
Q

ILD that appears as ground glass opacity, cysts and distorted secondary pulmonary lobular architecture with the secondary lobules varying in size and attenuation

A

Alveolar growth abnormality

139
Q

Bacterial infections are more common in humoral or cellular immunodeficiency?

A

Humoral

140
Q

Viral and opportunistic infection more common in humoral or cellular immunodeficiency?

A

Cellular

141
Q

Features of several primary immunodeficiencies

A

Small or absent thymus, adenoids or tonsils

142
Q

Caused by a defect in a cell membrane chloride channel called the cystic fibrosis transmembrane regulator

A

Cystic fibrosis

143
Q

Most common chest finding in children with sickle cell disease

A

Mild cardiomegaly

144
Q

Most common pulmonary manifestation of sickle cell disease

A

Acute chest syndrome

characterized by fever, pleuritic chest pain, dyspnea, leukocytosis,and new lung opacities on radiographs

145
Q

2 suggested common etiology in sickle cell disease

A

Rib infarcts and associated pain

146
Q

Common pulmonary manifestation of rheumatoid/collagen vascular disease

A

Diffuse lung disease, with band-like or focal peripheral areas of “reticular ground-glass”

147
Q

Commonly found in patients with spontaneous pneumothorax

A

Apical blebs

148
Q

Spontaneous pneumothorax occurs primarily in what gender

A

Teenage boys

149
Q

Common etiology of spontaneous pneumothorax

A

Abnormal collagen

150
Q

Type of spontaneous pneumothorax without associated respiratory disease

A

Primary

151
Q

Type of spontaneous pneumothorax in which respiratory disease such as asthma is present

A

Secondary

152
Q

Usually, pneumomediastinum in children has unknown etiology, but may be seen mostly in patients with

A

Asthma

153
Q

A sign that may distinguish contusion from atelectasis is the presence of

A

Subpleural sparing

154
Q

Viral infection that affects the upper and lower airways, particularly the subglottic trachea

A

Croup or laryngotracheobronchitis

155
Q

Most common infectious disease of the upper airway

A

Croup

156
Q

Most common pathogen of croup

A

Parainfluenza

157
Q

Croup commonly affects what age group

A

6 months to 3 years of age

158
Q

Appears on imaging as symmetrical narrowing of the subglottic airway with a configuration that is describes as a pencil point or church steeple. The epiglottis and aryepoglottic folds are normal

A

Croup

159
Q

Most common pathogens of bacterial tracheitis aka bacterial croup or membranous croup

A

Moraxella catarrhalis and Staphylococcus aureus

160
Q

Identification of an intraluminal defect, representing a sloughed membrane is a specific but not sensitive sign on airway radiographs of what disease

A

Bacterial tracheitis

161
Q

Swelling involves the aryepiglottic fold as well as epiglottis caused by haemophilus influenza

A

Epiglotittis or supraglottitis

162
Q

Most common single organism of retropharyngeal abscess

A

Group A strep

163
Q

Congenital softening of the soft tissues of the pharynx that leads to airway collapse with inspiration. Most common cause of noisy breathing in infants and is the most common congenital abnormality of the larynx

A

Laryngomalacia

[PBR] Pediatric Imaging (5 decks)

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