Chest Disorders Flashcards
1
Q
Identify the structures shown here
A
1 - Aortic Arch (should be ~4 cm)
2 - Pulmonary Trunk
3 - Left ventricle
2
Q
What is demonstrated by the yellow lines?
A
3
Q
What structures are represented by the blue & purple markings?
A
Blue
4
Q
What condition is likely the cause of these findings?
A
Pneumonia/Tuberculosis
5
Q
Identify the structure shown here
A
Horizontal fissure
6
Q
What pattern of pneumonia is shown here?
A
- Bilateral, perihilar area, Irregular
- Bronchopneumonia
- Pink circle = cavitation •associated w/ Infection ie. TB & Tumor)
7
Q
This appearance is associated with what condition
A
Interstitial/Nodular
“Milliary pattern”
Associated with TB or fungal infection
(Differential = metastasis/tumor)
8
Q
- Opacities frequently desribed as ill-defined, hazy or fluffy
- Margins of opacities are poorly defined & indistinct
- May demonstrate air bronchograms & silhouette signs
A
Air space disease (aka consolidation)
9
Q
In air space disease, air is replaced with what 4 things
A
Blood (pulmonary hemorrage)
Pus (exudate assoc. w/ infection)
Water (aspiration)
Cells (tumor)
10
Q
What findings are demonstrated here?
A
11
Q
What findings are shown here?
A
12
Q
____ pattern in interstitial disease that appears as lines
A
Reticular
13
Q
____ pattern in interstitial disease that appears as small numerous discrete opacities separated from one another by normal lung
A
Nodular
14
Q
_____ pattern in interstitial disease that is a combo of lines & opacities
A
Reticulonodular
15
Q
What findings are shown here?
A
16
Q
What findings are shown here?
A
17
Q
What findings are shown here?
A
18
Q
When two similar radiographic densities are in anatomical contact with one another, the visible border between the two structures is lost
A
Silhouette sign
19
Q
Involvement of RUL → what structure silhouetted
A
Ascending aorta
20
Q
Involvement of RML → what structure silhouetted
A
Right heart border
21
Q
Involvement of RLL → what structure silhouetted
A
Right hemidiaphragm
22
Q
Involvement of LUL → what structures silhouetted
A
Aortic knob
Pulmonary trunk
Left heart border
23
Q
Involvement of LLL → what structures silhouetted
A
Descending aorta
Left hemidiaphragm
24
Q
What findings are shown here?
A
Silhouette Sign - Increased density in RML which obscures right heart border
25
What findings are shown here?
Silhouette Sign - LUL density is obscuring left heart border
26
What findings are shown here?
Silhouette sign - LLL density obscuring left hemidiaphragm
27
- Visualization of air in bronchi due to surrounding lung tissue (alveoli) filling w/ fluid or cells
- Bronchi should not normally be seen
Air bronchogram
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Air bronchogram sign is primarily associated with
Consolidation/Air space disease
29
What findings are shown here?
30
What findings are shown here?
\*right
31
What findings are shown here in this chest CT?
\*right
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- Used to determine if a mass is outisde the lung parenchyma or inside
- Assess angle the mass forms w/ the chest wall
Extra-pleural sign
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If the angle of a mass with the chest wall forms an obtuse \> 90o = \_\_\_\_
If the edges form an acute \< 90o = \_\_\_\_\_
= Extra-pleural sign
= Inside lung parenchyma
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Extra pleural sign or Not extra pleural sign
Not
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Extra pleural sign or not extra pleural sign
Extra pleural sign
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- Hilar mass causes compresion of right upper lobe bronchus
- Results in atelectasis of right upper lobe
- Superior migration of lateral minor fissure
- The medial minor fissure however remains lower because of hilar mass
Golden S sign
37
What findings are shown here?
38
Incomplete air filling and under expansion of pulmonary tissue =
Atelectasis
39
When lung tissue collapses, soft tissues will shift ____ (towards/away from) the side of collapse
Towards
40
- MC atelectasis
- Intrinsic or extrinsic blockage of airway
Obstructive/Resorptive
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Type of atelectasis involving external space occupying lesion to the lung, like fluid or a chest wall mass
Passive (relaxation)
42
Type of passive atelectasis but internal to the lung like a lung tumor, abscess or bullae causing compression
Compressive
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Type of atelectasis involving scarring and retraction of pulmonary tissue
- Infection common cause
Cicatrization/scarring
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- Type of atelectasis usually due to a lack of surfactant
- Seen in ischemic issues, radiation damage, general anesthesia, neonates w/ hyaline membrane disease
Adhesive
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- Patients who are not taking deep breaths for long periods of time such as post-op patient or patient w/ pleuritic chest pain
- Form of adhesive atelectasis
- Does not result in shifting of structures
Subsegmental atelectasis (discoid atelectasis or plate-like)
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- Occurs in association w/ pleueral thickening
- Form of compressive atelectasis
- Always in subpleural location
Round atelectasis
47
What findings are shown here?
(minor fissure being pulled towards area of increased density)
48
What findings are shown here?
49
Term used to describe fluid collection in the pleural space first between the hemidiaphragm and lung base
Subpulmonic effusion
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- Large collection of transudate, exudate, blood or chyle in pleural space
- Nonspecific sign of underlying pathology
- Can cause passive atelectasis
Pleural effusion
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- Costophrenic blunting (posterior costophrenic angle is initial location)
- Opacifed hemithorax in severe cases
- Diaphragms will be silhouetted eventually
= associated w/ what condition
Pleural effusion
52
What findings are shown here?
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What findings are shown here?
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What findings are shown here?
55
What findings are shown here?
Deviation of structures away (therefore not atelectasis)
56
What findings are shown here?
Fluid trapped in places = loculated
57
- Collection of air in pleural space
- A rupture of either the parietal or visceral pleural permits air into pleural space
- Results in loss of negative pressure within pleural space
Pneumothorax
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Radiographic features of ____ include:
- - Thin pleural line represents the visceral pleural separated from chest wall; called **Visceral Pleral line**
- Crescent-shaped radiolucent shadown between lung & chest wall (absence of lung markings in crescent shaped radiolucent region)
- Best seen on full expiration/standing x-ray
- CT & US more sensitive
Pneumothorax
59
What findings are shown here?
60
What findings are shown here?
61
What findings are shown here?
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What findings are shown here in this axial CT?
63
Community acquired pneumonia MC demonstrates a ____ pattern due to Strep. pneumoniae
Lobar (MC pattern, involves majority or entire love)
64
Interstial patterns MC demonstrate a ____ pattern
Atypical
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\_\_\_\_\_ pattern of pneumonia is very patchy & follows the branching of bronchial tree
Bronchopneumonia
66
Air bronchograms MC seen with with ____ & can be seen w/ ____ pneumonia
Lobar & bronchopneumonia
67
T/F: In pneumonia, there is typicall no deviation towards or away from strucutres
T
68
What findings are shown here?
Lobar pneumonia
69
What findings are shown here?
Opacified hemithorax = Pneumonia, Pleural Effusion, Atelectasis
70
What findings are shown here?
Lobar pneumonia
Also blunting of costophrenic angles → pleural effusion
71
What findings are shown here?
72
What pattern of pneumonia is demonstrated here?
Atypical
73
Calcific nodule in lung tissue that represents old focus of infection associated with TB =
Ghon tubercle
74
Combination of granuloma in lung tissue (Ghon tubercle) and lymph node calcification =
Ranke complex
75
Hilar lympadenopathy & miliary pattern due to hematogenous spread are common characteristics of what condition
TB
76
What findings are shown here?
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What findings are shown here?
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What findings are shown here?
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What findings are shown here?
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What findings are shown here?
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What findings are shown here?
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Radiopacities greater than 3cm =
Radiopacities less than 3cm =
= Mass
= Nodule
83
DDX for _____ are:
- Granuloma
- Hamartoma
- Arteriovenous malformation
- Round atelectasis
- Round pneumonia
- Bronchogenic carcinoma
- Metastasis
Solitary pulmonary nodule/mass
84
DDX for _____ are:
- Metastasis
- Granuloma
- Lymphoma
- Sarcoidosis
- Wegener's granulomatosis
Multiple pulmonary nodules/masses
85
What findings are shown here?
86
What findings are shown here?
87
- Tumor in upper lung region seen in bronchogenic carcinoma
- Usually squamous cell type
- Nerve compression symptoms (Horner's) can occur
Pancoast tumor
88
What findings are shown here?
Red = rib involvement
89
What findings are shown here?
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What findings are shown here?
91
What findings are shown here?
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What findings are shown here?
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What findings are shown here?
94
- Abnormal permenant enlargement of airspaces distal to terminal bronchiole accompanied by destruction of acinar walls w/ little or no fibrosis
- Expansion of air cells occurs to form blebs & bulla
Emphysema
95
- Upper lobes zones predominate
- Assocaited w/ cigarette smoking
= ____ emphysema
Centrilobular (aka centriacinar)
96
- Lower lobes
- Associated with a-antitrypsin deficiency
- Can also be seen in smokers
= ____ emphysema
Panacinar (aka panlobular)
97
Radiographic findings of ____ include:
- Hyperlucency of lung
- Flattened & depressed hemidiaphragms (below 10th post. rib)
- Often results in costophrenic angles blunting
- Increased retrosternal clear space (resulting in barrel chest appearance)
- Prominent interstital markings
- - Bulla (lack of interstitial markings)
- Bleb (less than 1cm lucency seen peripherally)
Emphysema
98
What findings are shown here?
Yellow = bulla
99
What findings are shown here?
100
Radiographic findings of ____ include:
- Enlarged heart shadow (chamber enlargement)
- Cephalization of blood flow - increased vascular markings in upper lung fields
- Plerual effusion
- Pulmonary edema
Congestive Heart Failure
101
What findings are shown here?
102
What findings are shown here?
103
What findings are shown here?
104
What findings are shown here?
105
What findings are shown here?
106
What findings are shown here?
Aortic calcifications
107
- Aortic shadow "pulled away" from midline
- Usually seen in older individuals
- Results from longstanding hypertension
Aortic uncoiling
(AKA aortic tortuosity or aorta ectasia)
108
What findings are shown here?
109
What findings are shown here?
110
Dilation of greater than ___ cm for ascending aorta (MC); greater than ___ cm for descending aorta
5 cm; 4 cm
111
MC cause of aneurysm =
Atherosclerosis
112
What findings are shown here?
113
What findings are shown here on this CT?
114
What findings are shown here?
115
What findings are shown here?
116
- Herniation of abdominal contents through esophageal hiatus of diaphagm
- Can be assocaited with GERD
Hiatal Hernia
117
- MC type of hiatal hernia
- Gastroesophageal junction moves up past diaphragmatic hiatus
Type I (sliding or axial)
118
Type of hiatal hernia where fundus of stomach herniates through the diaphragmatic hiatus alongside the esophagus
Type II (paraesophageal)
119
What findings are shown here?
120
What findings are shown here?
121
What findings are shown here?
122
- MC type of congenital diaphragmatic hernia
- Posterior and to the left
- Allows herniation of retroperitoneal structures
Bochdalek
123
- Less common type of congenetical diaphragmatic hernia
- Anterior and to the right allowing liver & intestine to migrate into chest cavity
Morgagni
124
What findings are shown here?
125
What findings are shown here?
126
What structures do you evaluate in a chest x-ray?
Abdomen (below hemidiaphrams)
Thorax (osseus thorax, clavicles, ribs, etc.)
Mediastinum (heart, etc.)
Lungs
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