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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
What will lingular consolidation result in?
Abut left heart border
26
What is pathognomonic of consolidation?
Air bronchograms
27
Where will pleural effusions be seen?
Lung bases Forms meniscus at lung edges Blunting of costophrenic angles
28
What is a pneumothorax?
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
Difference between pneumothorax and tension pneumothorax?
If pneumothorax becomes large, it will squash the lungs so that the patient cannot ventilate them
30
Describe the CXR findings of heart failure
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
Mnemonic for heart failure signs on CXR?
``` ABCDE; Alveolar oedema (bat wing) Kerley B lines Cardiomegaly Dilated upper lobe vessels Pleural effusion ```
32
Where should ET tubes be placed?
Tip 5cm above carina Width 2/3rd tracheal diameter Cuff not expanded the trachea
33
What are common malpositions of the ET tube?
Tip may extend past carina Malposition most commonly seen in tip of right main bronchus May have entered oesophagus
34
Where is the ideal position for NG tubes?
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
Where are NG tubes commonly malpositioned?
Remaining in the oesophagus Traversing into the bronchus or into lung Coiled in upper airway Intracranial insertion; if skull base fracture
36
Through which veins can central venous catheters be entered?
Right and left internal jugular or subclavian veins
37
Through which veins are PICC lines inserted?
Cephalic Basilic Brachial veins
38
How should the position of central venous catheters be assessed?
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
What are common malpositions of central venous catheters?
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
How should you assess the position of PICC lines?
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
What are common malpositions of PICC lines?
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
Differentiation of lung masses based on size?
Miliary; <2mm Pulmonary micronodule; 2-7mm Pulmonary nodule; 7-30mm Mass; >30mm
43
Differentiation of lung masses based on morphology?
Solid pulmonary nodules Partially solid Ground glass
44
Differentiation of lung masses based on distribution?
Perilymphatic pulmonary nodules Centrilobular pulmonary nodules Random pulmonary nodules
45
In what area of the lung do malignant lung tumours grow in?
Apices; due to smoking
46
Where do lung cancers metastasize to?
Nodal Liver Adrenal Skeletal
47
How is lung cancer staged?
TNM Tumour size Intrathoracic lymph node staging Mets
48
What is a pneumoperitoneum?
Perforation of a hollow viscus resulting in gas in the peritoneal cavity
49
How is a pneumoperitoneum diagnosed?
ERECT CXR to allow the gas to rise up under the diaphragm
50
Presentation of a PE?
Dyspnoaea at rest or on exertion Pleuritic chest pain, cough, orthopnoea, haemoptysis Can be caused by DVT, calf/thigh pain and swelling
51
Investigation of a PE?
Clinical scores are helpful to determine who requires investigation D-dimers can be useful in low tirks patients CTPA
52
What are the CXR features of a PE?
Normal or show nonspecific findings such as a pleural effusion, cardiomegaly or atelactasis
53
What are the different modes of imaging used in PE?
CXR CTPA VQ scan

Clasp; radiology and anatomy (6 decks)

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