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Clasp; radiology and anatomy > Chest Masterclass > Flashcards

Chest Masterclass Flashcards

1
Q

What conditions can be seen via CXR?

A 
Misplaced NG, ET and central venous catheter
Simple/ tension pneumothorax 
Pleural effusion 
Lung/ lobar collapse
Lung consolidation 
Heart failure
Foreign body 
Pneumoperitoneum
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2
Q

Common clinical scenarios in chest disease?

A 
Chest pain
Thoracic trauma
Breathlessness
Cough 
Haemoptysis
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3
Q

What are the different x-ray densities on a CXR?

A 
Air; black 
Fat; grey 
Soft tissue; grey 
Bone; white
Metal; bright white
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4
Q

What aspects determine the technical adequacy of a CXR?

A

Projection
Inspiration
Rotation
Penetration

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5
Q

What is meant by the projection of a CXR?

A

If it is PA or AP

Normal CTR of less than 0.5

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6
Q

Should the CTR be measured on an AP CXR?

A

No; can be mistaken for cardiomegaly

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7
Q

How many ribs should be seen to qualify it for adequate inspiration?

A

6 ribs anteriorly

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8
Q

How is rotation determined in a CXR?

A

Medial ends of clavicle should be equidistant from the spinous processes of the upper thoracic vertebrae

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9
Q

What mediastinal borders should be seen on a CXR?

A 
Aorta
Pulmonary artery 
Left auricle
Left ventricle
Right atrium 
Trachea
Hemidiaphragm 
Stomach bubble
Horizontal fissure
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10
Q

What are the pulmonary hila?

A

Junctions between the heart and lungs where the pulmonary arteries and bronchi enter and pulmonary veins exit the lungs

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11
Q

Which hilum tends to be higher?

A

Left

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12
Q

Which diaphragm tends to be higher?

A

Right lies about 1.5cm above

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13
Q

What are the 4 review areas?

A

Lung apices
Behind heart
Below diaphragm
Bones and soft tissues

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14
Q

What can commonly be missed in the lung apices?

A

Masses e.g. pancoast, pneumothorax

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15
Q

What can commonly be missed behind the heart on CXR?

A

Consolidation
Masses
Hiatus hernia

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16
Q

What can commonly be missed below the diaphragm on CXR?

A

Free gas
Lines and tubes
Gastric distention
Bowel obstruction

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17
Q

What can commonly be missed in terms of bones and soft tissues on CXR?

A 
Fractures
Masses
Mastectomy
Subcutaneous emphysema
Evidence of previous surgery
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18
Q

What can cause a lobar collapse?

A

Obstruction of lobar bronchus; tumours, aspirated foodstuffs, mucus impaction

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19
Q

Describe a left lower lobe collapse

A

Volume loss on left side with elevation of the hemidiaphragm, left hemithorax looks small
Increased density in left retrocardiac region
Loss of clarity medial aspect left hemidiaphragm
Left hilum downwards
CANNOT SEE LEFT HEART BORDER

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20
Q

Describe a left upper lobe collapse

A

Volume loss of left, elevation of left hemidiaphragm
Loss of clarity of heart shadow
“Veil like opacity” diffuse opacification of left hemithorax
CANNOT SEE LEFT HEMIDIAPHRAGM

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21
Q

Describe a right upper lobe collapse

A

Volume loss on right
Loss of clarity of upper right mediastinum
Density in right upper zone, elevation of horizontal fissure

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22
Q

Describe a right middle lobe collapse

A

Loss of clarity in right heart border
Density in right lower zone
Right hemidiaphragm preserved

23
Q

Describe a right lower lobe collapse

A

Volume loss on right
Loss of clarity of right hemidiaphragm
Density in right lower zone, depression of horizontal fissures

24
Q

What is the difference between pulmonary consolidation and collapse?

A

Follows same pattern but consolidation doesn’t result in the volume loss

25
Q

What will lingular consolidation result in?

A

Abut left heart border

26
Q

What is pathognomonic of consolidation?

A

Air bronchograms

27
Q

Where will pleural effusions be seen?

A

Lung bases
Forms meniscus at lung edges
Blunting of costophrenic angles

28
Q

What is a pneumothorax?

A

Rupture of visceral pleura, allowing air to rush in from the lungs every time the patient inspires
Pleural air accumulates in this way, impairing respiratory function

29
Q

Difference between pneumothorax and tension pneumothorax?

A

If pneumothorax becomes large, it will squash the lungs so that the patient cannot ventilate them

30
Q

Describe the CXR findings of heart failure

A

Dilatation of upper lobe vessels/ cardiomegaly
Interstitial opacities (peribronchovascular cuffing, kerley B lines)
Airspace opacification; filling of alveoli with fluid, batwing distribution, aric bronchograms
Pleural effusion

31
Q

Mnemonic for heart failure signs on CXR?

A 
ABCDE; 
Alveolar oedema (bat wing) 
Kerley B lines
Cardiomegaly 
Dilated upper lobe vessels
Pleural effusion
32
Q

Where should ET tubes be placed?

A

Tip 5cm above carina
Width 2/3rd tracheal diameter
Cuff not expanded the trachea

33
Q

What are common malpositions of the ET tube?

A

Tip may extend past carina
Malposition most commonly seen in tip of right main bronchus
May have entered oesophagus

34
Q

Where is the ideal position for NG tubes?

A

Subdiaphragmatic position in the stomach; identified on a plain chest radiograph as overlying the gastric bubble
Should be at least 10cm below the gastro-oesophageal junction

35
Q

Where are NG tubes commonly malpositioned?

A

Remaining in the oesophagus
Traversing into the bronchus or into lung
Coiled in upper airway
Intracranial insertion; if skull base fracture

36
Q

Through which veins can central venous catheters be entered?

A

Right and left internal jugular or subclavian veins

37
Q

Through which veins are PICC lines inserted?

A

Cephalic
Basilic
Brachial veins

38
Q

How should the position of central venous catheters be assessed?

A

Window the image to best visualise the line
Trace the line from its insertion towards the heart
Visualise the tip; in the cavoatrial junction at the 2nd intercostal space

39
Q

What are common malpositions of central venous catheters?

A

Too high in the proximal SVC (increased risk of thrombus formation)
Tip too low; distal right atrium or right ventricle (increased risk of arrhythmia)
Coiled or displaces in another vein

40
Q

How should you assess the position of PICC lines?

A

Window the image to best visualise the line
Trace line from insertion to the arm towards the axilla
Trace line under clavicle towards SVC
Trace line towards heart
Tip should be at the cavoatrial junction

41
Q

What are common malpositions of PICC lines?

A

Tip too high; superficial upper limb vein
Tip too low; distal right atrium or right ventricle
Tip in right internal jugular vein
Tip in azygos vein

42
Q

Differentiation of lung masses based on size?

A

Miliary; <2mm
Pulmonary micronodule; 2-7mm
Pulmonary nodule; 7-30mm
Mass; >30mm

43
Q

Differentiation of lung masses based on morphology?

A

Solid pulmonary nodules
Partially solid
Ground glass

44
Q

Differentiation of lung masses based on distribution?

A

Perilymphatic pulmonary nodules
Centrilobular pulmonary nodules
Random pulmonary nodules

45
Q

In what area of the lung do malignant lung tumours grow in?

A

Apices; due to smoking

46
Q

Where do lung cancers metastasize to?

A

Nodal
Liver
Adrenal
Skeletal

47
Q

How is lung cancer staged?

A

TNM
Tumour size
Intrathoracic lymph node staging
Mets

48
Q

What is a pneumoperitoneum?

A

Perforation of a hollow viscus resulting in gas in the peritoneal cavity

49
Q

How is a pneumoperitoneum diagnosed?

A

ERECT CXR to allow the gas to rise up under the diaphragm

50
Q

Presentation of a PE?

A

Dyspnoaea at rest or on exertion
Pleuritic chest pain, cough, orthopnoea, haemoptysis
Can be caused by DVT, calf/thigh pain and swelling

51
Q

Investigation of a PE?

A

Clinical scores are helpful to determine who requires investigation
D-dimers can be useful in low tirks patients
CTPA

52
Q

What are the CXR features of a PE?

A

Normal or show nonspecific findings such as a pleural effusion, cardiomegaly or atelactasis

53
Q

What are the different modes of imaging used in PE?

A

CXR
CTPA
VQ scan

Clasp; radiology and anatomy (6 decks)

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