Chest imaging Flashcards
What symptoms indicate CXR?
- Acute SOB
- Chronic cough >3w
- haemoptysis
- Sudden onset pleuritic chest pain
- chronic chest pain
- peripheral oedema
- productive cough
- sx’s of infection in someone immunocomp. / requires abx (homeless, elderly, IVDU, RIB FRACTURE…)
What signs indicate CXR?
- decreased or absent breath sounds
- added sounds: creps or crackles
- hyper/hyporesonant percussion
- respiratory distress
- tracheal tug / deviation (TREAT FIRST)
How might someone present w/ lung malignancy?
Acute: sudden onset SOB, pneumonia, dramatic haemoptysis
chronic: cough, small haemoptysis, hoarse voice, gradually ^ SOB/decreased exercise tolerance, gradual weight loss
Give some CXR features of lung malignancy
opaque lesion!!
other: pleural effusion, consolidation (secondary), collapse, satellite mets, cavitation, rib lesions, pleural plaques, hilar lymphadenopathy
How might someone with tension pneumothorax present?
ACUTELY UNWELL
signs of chest trauma (penetrating)
deviated trachea, Sudden SOB, respiratory distress (tachypnoeic, hypotensive, bradycardic [decreased CO + venous return])
What CXR signs would you see in tension pneumothorax?
Trachea deviated, absent lung markings, mediastinal shift (E.g. cardiac nuchal)
What CXR signs would you see in tension pneumothorax?
Trachea deviated, absent lung markings, mediastinal shift (E.g. aortic nuchal, shifted heart borders)
When would you request further imaging if you suspect lung malignancy?
- If CXR equivocal
- CXR shows lesion
- CXR shows no improvement after Abx
what is High resolution CT good for?
Bronchiectasis and pulmonary fribrosis
What are the different types of CT (not including normal CT)?
CTPA
HRCT
What further imaging would you do in CONFIRMED lung malignancy?
CT chest (furtehr evaluate + guide Rx)
CT abdomen (staging)
What are the symptomatic indications for imaging heart (echo)?
SYMPTOMS:
- breathless
- forthy sputum
- chest pain
- syncope
- palpitations
- Uncontrolled HTN
- Post-MI!!!!!!!!!!!!!
Signs:
palpitations O/E or ecg, heart murmur, signs of HF
What are the imaging modalities of choice for the heart and lungs?
Heart: CXR + ECHO (1st line)
Lungs: CXR + CT
When is CXR used to image the heart?
ONLY when HF suspected (ECHO is 1st line)
What 5 signs do you see on CXR of heart failure?
Cardiomegaly Kerley B lines (interstitial oedema) pleural effusion Prominent upper lobe vessels Alveolar oedema (pulmonary oedema) = bat wings
What are the advantages of ECHO?
Non-invasive, cheap, non-ionising, REAL TIME FUNCTIONAL imaging, portable
what are the disadvantages of ECHO?
poorer resolution than other modalities, obese, requires skilled person/intepretor
What are some symptoms of HF?
Orthopnoea, paroxysmal nocturnal dyspnoea, peripheral swelling, SOB, decreased exercise, ascites
Why would you CT the heart?
- Coronary artery disease (CT angiography) or just XR coronary angiography
- Assess masses picked up on ECHO
- Assess pericardium
- If MRI contraindicated
Why would you use MRI to image the heart?
- assess cardiac function
- MR angiography
- gadolinium enhanced MR (ischaemic damage)
What are 3 ways you can image the heart using nuclear medicine?
(((Gadolinium MRI –> ischaemic damage (SMALLER AREAS PICKED UP) –> GADOLINIUM ISN’T NUCLEAR/))))
- gated cardiac blood pool imaging (RBCs labelled w/ T99 –> assess LV function more accurately)
- SPECT: single photon emission CT (heart - T99 attached sestemibe) –> assess blood flow / myocardial perfusion in the heart
- FDG-PET –> ischaemic damage
What information can you get from echocardiography?
wall thickness, valve function, masses, structural wall defects, wall abnormalities (post-mi), valve function, ejection fractions
What can you use gadolinium MRI for?
Heart - ischaemia
Brain - SOL
How can contrast be used to image the heart?
Gadolinium MRI
