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Yr 3 - Radiology > Chest Radiography > Flashcards

Chest Radiography Flashcards

1
Q

Label 1-7

A

1 - Superior vena cava
2- Right atrium (right border of heart)
3 - Inferior vena cava
4 - Aorta
5 - Main pulmonary artery
6 - Left atrial appendage
7 - Left ventricle (left border of heart)

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2
Q

What is air space opacification? What is the diagnosis?

A

Filling of the pulmonary tree with material that attenuates x-rays more than the surrounding lung parenchyma

Pulmonary consolidation

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3
Q

What are 8 major aetiologies behind pulmonary consolidation? Give examples for each

A
  • Transudate e.g. pulmonary oedema 2ary to heart failure
  • Pus e.g. bacterial pneumonia
  • Blood e.g. pulmonary haemorrhage
  • Fat e.g. lipid pneumonia
  • Cells e.g. bronchoalveolar carcinoma
  • Water e.g. drowning
  • Protein e.g. alveolar proteinosis
  • Gastric contents e.g. aspiration pneumonia
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4
Q

General radiographic features of consolidation on CXR?

A
  1. Opacification causing obscuration of pulmonary vessels
  2. Air bronchograms
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5
Q

What are air bronchograms?

A

Air bronchogram refers to the phenomenon of air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white). It is almost always caused by a pathologic airspace/alveolar process, in which something other than air fills the alveoli.

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6
Q

Patient:

  • 70 year old female
  • Fever
  • Cough
  • Dyspnoea

What is diagnosis from CXR?

A

Right middle lobe pneumonia (consolidation in medial segment of right middle lobe)

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7
Q

Patient:

  • 70 year old female
  • Fever
  • Cough
  • Dyspnoea

What is diagnosis from CXR?

A

Right middle lobe pneumonia (consolidation in medial segment of right middle lobe)

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8
Q

Label the lobes

A

Red - Right upper lobe

Green - Right middle lobe

Purple - Right lower lobe

Yellow - Left upper lobe

Blue - Left lower lobe

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9
Q

What is lobar consolidation? What type of spread of disease does it infer?

A

Consolidation in one of the lobes of the lung (infers an alveolar spread of disease)

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10
Q

What is the most common cause of lobar consolidation? What are 2 less common cause?

A
  1. Pneumonia (most common
  2. Pulmonary malignancy (adenocarcinoma, lymphoma)
  3. Bronchial obstruction e.g. foreign body
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11
Q

What are the pores of Kohn?

A

The pores of Kohn are apertures in the alveolar septum, which allow the communication of two adjacent alveoli (i.e. holes in wall of adjacent alveoli).

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12
Q

Function of pores of Kohn?

A

Permit air flow between adjacent alveoli.

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13
Q

How are pores of Kohn involved in spread of infection?

A

The pores allow the passage of other materials such as fluid and bacteria, which is an important mechanism of spread of infection between alveoli.

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14
Q

How is infection prevented from spreading between lobes?

A

By the visceral pleura

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15
Q

What pathology is often mistaken for consolidation on CXR?

A

Lobar collapse

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16
Q

Right upper lobe consolidation PA radiography features:

A
  • Opacification of the right upper zone and/or apex, that may outline the superior margin of the horizontal fissure below (bulging fissure sign)
  • Obscuration of the right superior mediastinal contour (silhouette sign), such as the SVC, right paratracheal stripe and azygos arch
  • Obscuration of the right hilum, particularly the superior hilum
  • normal (clear and distinct) right heart border (middle lobe not involved)
  • normal right hemidiaphragm contour (lower lobe not involved)
  • air bronchograms
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17
Q

What is a bulging fissure sign?

A

The bulging fissure sign refers to lobar consolidation where the affected portion of the lung is expanded causing displacement of the adjacent fissure.

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18
Q

What is right upper lobe consolidation causing inferior bulging of major fissure typically suggestive of?

A

Klebsiella pneumoniae pneumonia

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19
Q

Radiographic features of right middle lobe pneumonia?

A
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20
Q

Radiographic features of right lower lobe consolidation?

A
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21
Q

Radiographic features of left upper lobe consolidation?

A
  • opacification of the left upper zone and/or apex
  • obscuration of the left superior mediastinal contour (silhouette sign), such as the aortic arch and left paratracheal stripe
  • obscuration of the left hilum, particularly the superior hilum
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22
Q

Radiographic features of lower lobe consolidation?

A
  • opacification of the mid and/or lower zones, and occasionally even upper zone
  • normal left superior mediastinal contour (silhouette sign), especially the aortic arch
  • obscuration of the left hilum, particularly the inferior hilum in apical segment consolidation
  • obscuration of the descending aortic contour
  • normal left heart border
  • obscuration of the left hemidiaphragm contour
  • air bronchograms
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23
Q

What is bronchopneumonia?

A

Suppurative peribronchiolar inflammation and subsequent patchy consolidation of one or more secondary lobules of a lung in response to bacterial pneumonia

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24
Q

The inhalation (or rarely hematogenous spread) of a causative organism results in peribronchiolar inflammation.

How does this spread to create consolidation in bronchopneumonia?

A

This can spread through the pore of Kohn to create consolidation throughout an entire 2ary pulmonary lobule

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25
What are the 5 most common causative organisms behind bronchopneumonia?
1. *S. aureus* 2. *Klebsiella pneumonia* 3. *Haemophilus influenzae* 4. *E. coli* 5. *Pseudomonas aeruginosa*
26
Radiographic features of bronchopneumonia? What does this represent?
Multiple small nodular opacities which tend to be patchy and/or confluent – this represents areas of the lung where there are **patches of inflammation separated by normal lung parenchyma**
27
What is a CT Pulmonary Angiogram (CTPA)? What is it a commonly performed diagnostic examination for?
* Takes pictures of pulmonary arteries - dye injected into vein in arm which travels to pulmonary arteries Commonly performed diagnostic examination to **exclude pulmonary emboli**
28
When is a CTPA indicated?
Suspected **pulmonary embolism**; acute or chronic
29
What is a saddle PE?
Commonly refers to a large PE that straddles the bifurcation of the pulmonary trunk, extending into the right and left pulmonary arteries. If large enough, it can completely obstruct both left and right pulmonary arteries, resulting in right heart failure.
30
What is an acute PE?
Embolic occlusion of the pulmonary arterial system. Can be occlusive or non-occlusive.
31
CTPA features in an acute PE?
* Filling defects within the pulmonary vasculature with acute pulmonary emboli * If emboli are non occlusive; thin stream of contrast seen adjacent to embolus
32
Which projection is the standard frontal chest projection?
PA (posteroanterior view) - x-ray beam traverses patient from posterior to anterior
33
How is the patient standing in a PA CXR?
Performed standing and in **full inspiration** with the patient hugging the detector to pull the scapulae laterally
34
Why is the patient hugging the detector in a PA CXR?
To pull the scapulae laterally
35
What are the advantages of a PA view in a CXR?
* **Scapulae abducted** so less bone is projected over lung * Chin not projected over chest * **Heart size not magnified** so can be assessed more reliably
36
Disadvantages of a PA CXR?
Patient must be able to stand erect
37
Describe an AP projection view for a CXR
Alternative frontal projection to PA with beam traversing patient from anterior to posterior
38
Position of patient during an AP CXR?
Can be performed with patient sitting up in bed and even using a portable x-ray unit
39
Advantages of an AP CXR?
More convenient for intubated and sick patients who cannot stand for PA projection
40
Disadvantages of AP CXR?
* Mediastinal structures may appear magnified as the **heart is further away from the detector** * Often poorly inspired * More likely to be rotated and create skin folds * Scapulae often cover some of lungs
41
Describe mediastinal structures and heart during AP CXR
Mediastinal structures may appear magnified as the **heart is further away from the detector**
42
Describe inspiration during AP projection CXR
Usually poorly inspired
43
What is the cardiothoracic ratio used to diagnose/detect?
The **cardiothoracic ratio** (**CTR**) aids in the detection of [enlargement of the cardiac silhouette](https://radiopaedia.org/articles/enlargement-of-the-cardiac-silhouette?lang=gb), which is most commonly from [cardiomegaly](https://radiopaedia.org/articles/cardiomegaly?lang=gb) but can be due to other processes such as a [pericardial effusion](https://radiopaedia.org/articles/pericardial-effusion?lang=gb).
44
What does the cardiothoracic ratio refer to on a PA CXR?
Rhe ratio of maximal horizontal cardiac diameter to maximal horizontal thoracic diameter (inner edge of ribs/edge of pleura).
45
On a PA CXR, what does the cardiothoracic ratio be?
0.42-0.50 (\<0.5)
46
What does a cardiothoracic ratio of \>0.5 indicate?
Cardiomegaly
47
Heart size **cannot be accurately assessed on AP. Does an AP CTR \<0.5 still exclude cardiomegaly?**
Yes
48
What are the 4 major factors that determine CXR quality?
1. Rotation 2. Inspiration 3. Penetration 4. Inclusion
49
How does rotation affect a CXR?
Changes heart contour, costophrenic angles may appear blunted, tracheal deviation, apparent mediastinal widening
50
How can you tell if rotation is present in a CXR?
The spinous processes should lie on the midline between the medial ends of the two clavicles
51
What are the costophrenic angles?
Costophrenic angles are formed by points at which the chest wall and diaphragm meet
52
What can cause blunting of the costophrenic angles?
* [pleural effusion](https://radiopaedia.org/articles/pleural-effusion?lang=gb) (most common) * [pleural thickening](https://radiopaedia.org/articles/pleural-thickening?lang=gb) * lung scarring * [atelectasis](https://radiopaedia.org/articles/lung-atelectasis?lang=gb) * [emphysema](https://radiopaedia.org/articles/pulmonary-emphysema?lang=gb)
53
How can inadequate inspiration affect a CXR? What pathologies can this mimic?
1. Inadequate inspiration will appear **denser →** can mimic consolidation. 2. Raised position of diaphragm can **obscure the lung bases** and **exaggerate heart size** → can be mistaken for pulmonary oedema
54
What does ‘penetration’ of a CXR refer to?
Refers to how well the x-rays have penetrated the body of the patient
55
How does overpenetration appear in a CXR? How about underpenetration?
Over → lung fields appear black Under → Denser structures (mediastinum, spine) appear white In both cases there will be a loss of detail
56
What does a silhouette sign refer to in a CXR?
We can see **sharp margins** when two structures of **different density** are adjacent to one another e.g. heart (soft tissue) adjacent to lung (gas). The silhouette sign refers to **the loss of normal borders between thoracic structures**. In other words, it is difficult to make out the borders of a particular structure - normal or otherwise - because it is next to another dense structure, both of which will appear white on a standard [X-ray](https://en.wikipedia.org/wiki/X-ray_computed_tomography).
57
In a lobar collapse, what is normal lung (gas density) replaced by?
Collapsed lung (soft tissue density)
58
How can a lobar collapse create a silhouette sign?
Where the lung collapses **adjacent to other soft tissue structures**, we lose the normal silhouette of that structure and see a **silhouette sign**
59
How does air density appear on CXR?
Black
60
How does subcutaneous tissue/fat appear on CXR?
Dark grey
61
How does soft tissue (e.g. heart/blood vessels) appear on CXR?
Light grey
62
How does bone appear on CXR?
Off white
63
What appear bright white on CXR?
Metal e.g. pacemaker defibrillators

Yr 3 - Radiology (1 decks)

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