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Imaging > Chest imaging > Flashcards

Chest imaging Flashcards

1
Q

Checking for good film: is it an adequate breath?

A

Too shallow–>”crowded” lung…looks pathologic

Should have 10-11 ribs visible

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2
Q

Checking for good film: is it over/under penetrated?

A

Burns through lungs…can’t see vessels

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3
Q

Checking for good film: is anything cut off?

A

That’d be bad

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4
Q

Checking for good film: is the patient rotated?

A

Can distort some anatomy

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5
Q

What is the progression in reading a CXR?

A

Review bones
Evaluate mediastinum
Diaphragm
Lungs

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6
Q

How big should the heart appear?

A

Half of the chest

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7
Q

What can make the heart look bigger than it actually is?

A

Supine view
AP view
Cardiac tamponade–globular shape caused by fluid

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8
Q

What can enlarge the heart?

A

Hypertrophy due to overuse
Cardiomyopathy–CV disease, drugs, infection
Fluid around the heart

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9
Q

Why should the contour of the heart be observed?

A

Massive left atrial enlargement

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10
Q

What can be seen of the aorta?

A

Aneurysm
Aortic dissection
Post traumatic injury with hematoma

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11
Q

What can be seen of pulmonary vessels?

A

Lymph node enlargement–cancer, infection, granulomatous disease (sarcoid)

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12
Q

What can be seen of the trachea?

A

Tracheal deviation

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13
Q

What normally causes tracheal deviation?

A

Enlarged thyroid

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14
Q

What can be seen of the diaphragm?

A

Air in the abdomen
Paralysis (need inspiration and expiration views…also need Sniff test)
Air trapping due to COPD (flat diaphragm and barrel chest)

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15
Q

What would interstitial infiltrates look like on CXR?

A

Lacy

Reticular pattern

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16
Q

What do interstitial infiltrates indicate?

A

Atypical pneumonia
Early CHF
Fibrosis

17
Q

What would alveolar infiltrates look like on CXR?

A

Fluffy
Consolidating pattern
Air bronchograms present

18
Q

What do alveolar infiltrates indicate?

A

Bacterial pneumonia
Late CHF
ARDS

19
Q

Lung nodules less than 3cm?

A

Incidental nodules

20
Q

What are the Fleischner Society Recommendations for incidental nodules based on?

A

Size
Number
Risk factors

21
Q

Lung nodules greater than 3cm?

A

Rule out cancer (calcification suggests benign)

22
Q

Multiple lung nodules diagnostic?

A 
Metastatic disease
Infection
Granulomatous disease (sarcoid, Wegner Granulomatosis)
23
Q

Single lung nodule diagnostic?

A 
Lung cancer
Abscess
Infection (TB, blasto)
Benign granuloma
AV malformation
Granulomatous disease
24
Q

What would a CXR of CHF look like?

A 
Interstitial edema if early
Alveolar edema if late
Pleural effusions are common
Cardiomegaly is common
Kerley's B lines or septal lines are strongly suggestive
25
Q

What is the diagnostic of patient presenting with chest pain?

A

Acute Coronary Syndrome
Pneumothorax (PTX)
Pulmonary Embolus
Aortic Dissection

26
Q

What are examples of Acute Coronary Syndrome?

A

MI

Angina

27
Q

What tests/labs should be done for ACS?

A

EKG

Enzymes

28
Q

What is PTX?

A

Air between parietal and visceral pleura

29
Q

What causes PTX?

A

30-40% causes by chest trauma (rib fx)

Can be spontaneous or iatrogenic

30
Q

What should be done for PTX?

A

> 20% will need chest tube placement…can be life threatening–one-way valve mechanism leads to impaired venous return

31
Q

What would be found on a CXR of PTX?

A

Sharp line = visceral pleura
No lung markings lateral
Mimics: large bullae, skin folds, bedding, tubes

32
Q

Pulmonary Embolus

A

Really bad…usually diagnosed in autopsy

Often thought…rarely had

33
Q

Non-specific findings of a PE on a CXR?

A

Hampton’s Hump: wedge-shaped opacity corresponding to lung infarct
Westermark’s sign: relative oligemia

34
Q

Other tests for a PE

A

VQ scan: nuclear medicine scan with both ventilation and perfusion components

35
Q

What is an aortic dissection?

A

Tear in intimal layer of vessel separates intima from media or adventia, causing a false channel

36
Q

Is an aortic dissection bad?

A

YES

Requires immediate surger

37
Q

What are the risk factors for an aortic dissection?

A

Hypertension
Marfans or Ehler-Danlos
Cocaine use
Pregnancy

38
Q

What would an aortic dissection look like on a CXR?

A

Wide mediastinum
Abnormal arch configuration
L>R pleural effusion

39
Q

CT can be used to determine treatment for an aortic dissection

A

If ascending aorta is involved, it is a surgical case

If descending aorta is involved, patient can be treated medically

Imaging (1 decks)

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