CHEST Pathology Flashcards
This XRay shows enlarged heart w/ upper apical prominent pulmonary vz? What is this pathology?
CHF w/ cephalization
Intersital edema- bilateral
Alveolar-if really bad- bronchograms
This XRay has K B lines, fluid in fissures, pleural effusion, perobroncihal cuffy and cardiolmegaly? What does this indicate?
Cardiogenic Pulmonary edema
This XRay has effusion with normal size heart? What does this indicate?
NON cardiogenic pulmonary edema Drowning Fluid overload -ARF High altitude PE OD-heroin
What are sign of Late CHF?
Alveolar
Bil fluffy patchy, bat wing, pleural effusion
What are signs of early CHF?
Interstitial Fluid in fissures KBlines Pleural effusion Peribronchial cuffing, teeny donuts
What pulls structure to same side when there is volume loss in the lung?
Atelectasis
fissures displaced
Atelectasis +effusion= ominous tumor+effusion
What is discoid plate-like, elevated hemidiaphragm, seen in post op, post trauma?
Sub segmental ateltectasis
On CT may see wisp of a lung d/t effusion or penumothorax?
Compressive atelectasis
Tumor, peanuts, mucus plug, misplaced ET tube may cause this? Xray look like
OPACIFIED area
Fissure, heart, hemidiaphragm displaced
RUL- inverted triangle, d/t fissure moved up
RLL, LLL- triangle sitting on medial 1/2 of diaphragm, pulling down minor/major
Spine sign Lateral film
LUL-tenting of diaphragm, opacified hilum
Major fissure shifted forward on Lat film
RML- Triangle, silhouetting R heart
Obstructive atelectasis
Lobar collapse d/t block of bronchus
What follows a hemithorax, pseudotumor. Comet tailing on CT, sticking to pleura?
Round atelectasis
Lung cannot expand after pleural effusion
Stuck in scar tissue
What is lucent area on one side of lungs with no markings?
Complete pneumothorax
Check close to spine
Pt is afebrile with pleuritic chest pain? What should be observed carefully?
Incomplete pneumothorax
Look for thin white line paralleling thoracic curvature
Absent lung markings
SCAN peripherally and apices
What are structures not to get confused with for pneumothorax?
Ignore scapula, curves opposite of thoracic, BIL
Bullous, round, curves opposite
skin fold- lung field distal
Poss lung markings
What can be requested to see PNEumothorax?
Expiratory film
LLD
Deep sulcus sign-supine, displaces costophrenic angle superiorly
CT-small thorax
What is characteristic of meniscus sign, blunted costophrenic angles, structure move away?
Pleural effusion
What type of effusion is lemon shaped, seen in the minor fissure?
Round effusion
What is an apparent hemi diaphragm w/o meniscus?
Subpulmonic effusion
Edema- air space, infx, tissue
Effusion- between spaces
Are perfect horizontal lines normal, what do they indicate?
Hydropneumothorax
Air+fluid in pleural space-gunshot
What is lucent space btwn diaphragm and liver?
Pneumoperitoneum
bowel perforation
R side MC seen 1st
What does a ruptured trachea, alveolus, emphysema bleb, mechanical ventilation, trauma, all lead to?
Pneumomediastinum
Lucent around heart+great vessels
May see continuous diaphragm sign- lucency under heart
What cause free air post mediastinum, and push heart superiorly in CXR?
Hiatal Hernia
Painless
Superior stomach pushes through diaphragm
Pt c/c SOB, hx of smoking, w/ retractions? What would his CXR look like?
Darker, HYPERinflated Flattened diaphragm Narrow cardiac silouette Large retrosternal space-Lateral Blunted angles Bullae on CT-alien llik
What are special about pulmonary mass or nodule?
They make mediastinum and hilar region wider Cause Lobar atelectasis Mass obstructive PNA Malignant effusion exudative Chest wall mass Mets all over
Which two nodule are central and faster?
Small cell- Central ACT, SIADH
Squamous cell- central obstructive
S-speed
Which two nodules are peripheral and slower?
Adenocarcioma- solitary
Large cell- DX of exclusion
What imaging is best for staging and DX?
CT
PET, fluoroscopy
Biopsy
What conditions make a heart look bigger than 50% of thoracic cavity on PA! film only?
Magnification, AP, apical lordotic Rotation Squishing, preg, obese, expiration Pectus excavatum, kyphosis Pericardial effusion
What are Gold standard imaging for PE DX?
#1CT w/ contrast VQ if cannot do contrast Pulmonary angiogram
What are signs of PE on CXR?
Atelectasis
Effusion
Elevated Hemidiaphragm
Hamptons Hump- wedge shaped ipsilateral on pleura space
Westermarks sign- triangle like observed by vessels. CT vessels disappear
Golden S
How can you distinguish btwn diff TBs?
Primary is Upper Lobar + Ipsilateral hilar adenophathy/wide
What is MC TB in the apical upper lobes, superior LL, cavitation, hilar adenophathy, w/ effusion?
Reactivation
What is innumerable 1mm nodules on CXR and starry night on CT?
Miliary TB-primary or reactive
What are the terrible 4t of Ant. Mediastinal Mass? Restrosternal Latera?
Thyroid
Terrible Lymphoma
Thymoma
Teratoma
What is DDX C.A.L for Medial Mediastinal Mass?
Cancer
Aortic Aneurysm
Lymphadenopathy
What is DDX P.A.N for Post mediastinal Mass?
Aortic aneurysm
Neurogenic tumor
Pt hs FH of aorta ruptures. Their c/c is chest and back pain, ripping. What may be seen on Xray?
Aortic Aneurysm
Wide mediastinum
Tortuous aorta
L pleural effusion
Which ribs are commonly fractured?
Rib 4-9
Check for pneumothorax
Pulmonary contusion missed as aveloar/airspace dz
Damage to spleen is caused by which rib?
Ribs 10-12
Which ribs are uncommonly fractured and may cause other tissue damage?
Rib 1-3
