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Respiratory > Chest Radiography II > Flashcards

Chest Radiography II Flashcards

1
Q

What is the silhouette sign?

A

An intrathoracic lesion touching the border of the heart, aorta, or diaphragm will obliterate that border on an x-ray

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2
Q

Why is the term airspace disease more appropriate than pneumonia when looking at a CXR?

A

opacity may not be pneumonia; could be hemorrhage for example.

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3
Q

A radiopacity which overlaps but does not obliterate the heart border is where in the thoracic cavity?

A

Posteriorly

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4
Q

What is the air bronchogram sign?

A

The phenomenon of air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white)

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5
Q

True or false: intrapulmonary bronchi are not usually visualized on CXR. Why or why not?

A

True–since they are filled with air, and are surrounded by alveolar air

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6
Q

When are air bronchograms usually seen?

A

Pneumonia
Pulmonary edema
Bronchoalveolar cell CA

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7
Q

An air bronchogram indicates that the pathology is where?

A

It indicates that the lesion in within the lung parenchyma, rather than in the pleura or mediastinum

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8
Q

What are the five things that can fill the alveoli to cause the bronchogram sign?

A 
Blood
Pus
Water
Proteinaceous fluid
Tumor
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9
Q

What does an air bronchogram sign indicate?

A

It indicates that the airway is open–unlikely that the lung disease is due to an obstructive tumor

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10
Q

What are the three scenarios in which the air bronchogram sign may not be present?

A
  • bronchi are full of secretions
  • Bronchus is obstructed by a FB or tumor
  • Incomplete lung consolidation
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11
Q

What are the five mechanisms that cause lung volume loss?

A
  • resorption of air as a result of obstruction of a bronchus
  • relaxation of the lung as a result of air or fluid in the pleural space
  • Scarring causing lung contraction
  • Decreased surfactant
  • Hypoventilation
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12
Q

What is atelectasis?

A

Less severe changes of volume loss than complete collapse

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13
Q

What are the direct signs of lobar collapse? (3)

A
  • Displacement of the interlobar fissure
  • Loss of aeration of the involved lobe
  • Crowding of the bronchovascular markings
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14
Q

What are the two things on CXR that produce straight lines?

A

Fissures and air fluid levels

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15
Q

Triangular shaped area behind the lung = ?

A

Left lower lobe collapse

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16
Q

What are the indirect signs of lobar collapse? (5)

A
  • Elevation of the ipsilateral diaphragm
  • Deviation of the trachea to the side of collapse
  • Cardiac displacement toward side of collapse
  • Narrowing of the rib cage on the side of collapse
  • Compensatory overaeration of the adjacent normal lung
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17
Q

What happens to the hemidiaphragm with lobar collapse?

A

Elevation of the ipsilateral diaphragm

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18
Q

What happens to the hilum with lobe collapse?

A

If higher lobe, then elevation

If lower lobe, then depression

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19
Q

What happens to the trachea with lobe collapse?

A

Deviate toward affected side

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20
Q

What happens to the heart with lobar collapse?

A

Displacement toward the side of the collapse

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21
Q

What happens to the rib cage with lobar collapse?

A

Narrowing on the side of collapse

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22
Q

What happens to the adjacent, normal lung with lobar collapse?

A

Overaeration

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23
Q

What happens to the minor fissure with RUL collapse?

A

Horizontal fissure goes superiorly

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24
Q

What are the radiographic findings of a RML collapse (PA and lateral)?

A

Ill defined shadowing obscuring the right heart border on PA film.

Lateral film shows thin wedge between the major and minor fissures

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25
Q

What are the radiological findings with a RLL collapse (PA and lateral views)?

A 
PA = obliteration of the right hemidiaphragm, but normal heart border
Lat = Abnormally increased density over the lower thoracic spine d/t the triangular shaped density of the collapsed lobe. The major fissure is displaced downward
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26
Q

What are the radiological findings with LUL collapse (PA and lateral views)?

A 
PA = LUL collapses forward and thus presents no sharp margins
Lat = The collapsed lobe is visible as a band of soft tissue retrosternally
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27
Q

What happens to the major fissure with LUL collapse?

A

Major fissure is pulled anteriorly

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28
Q

What are the radiological findings with LLL collapse (PA and lateral views)?

A 
PA = triangular retrocardiac opacity with major fissure pulled medially
Lat = Increased opacity over the lower thoracic spine
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29
Q

What is the most common cause of a central airway obstruction in children?

A

Mucous plug or aspirated foreign body

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30
Q

What is the most common cause of a central airway obstruction in adults younger than 40?

A

Mucous plug

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31
Q

What is the most common cause of a central airway obstruction in adults over 40?

A

bronchogenic CA

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32
Q

Why is lobar collapse common with ventilator use?

A

Increased mucus secretion

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33
Q

What are the two major structures of the lungs?

A

Interstitium

Alveoli

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34
Q

Multiple alveoli form what? Several of these form what?

A

Acini

Secondary pulmonary lobule

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35
Q

What are the two major ways that the lung can respond to disease?

A

Thicken or thin

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36
Q

Most interstitial lung disease is acute or chronic? What about airspace disease?

A 
Interstitial = Chronic
Airspace = acute
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37
Q

What are the four variables of lung disease?

A

Interstitium (thicken/thin)
Alveoli (fluid/air)
Location (focal/diffuse)
Time (acute/chronic)

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38
Q

Why do the pulmonary vessels disappear on CXR are you move peripherally? What happens if there is thickening?

A

They are beyond the resolution of the x-ray

Thickening will increase the distance at which you are able to see them

39
Q

What are the three generalized patterns of lung disease?

A
  • Generalized (linear)
  • discrete (nodular)
  • comimation
40
Q

How do you differentiate between acute and chronic patterns of lung disease?

A 
Acute = interstitial markings are ill defined and not distorted
Chronic = sharp and distorted markings
41
Q

What is the most reliable way to differentiate between acute vs chronic pattern of lung disease?

A

Compare to old films

42
Q

Most diffuse interstitial lung disease is chronic, and usually caused by what?

A

Fibrosis

43
Q

Acute interstitial lung disease is usually due to what?

A

Pulmonary edema or viral/mycoplasma pneumonia

44
Q

What is alveolar disease?

A

airspace consolidation d/t fluid, pus etc

45
Q

How does a lung with alveolar disease look on CXR?

A

Appears airless

46
Q

True or false: most airspace disease is acute

A

True

47
Q

With airspace disease, a bronchogram sign may be present depending on what?

A

Depending on whether the associated bronchus is patent or occluded

48
Q

What is the difference between a mass and a nodule in a lung?

A

Nodule is less than 3 cm, mass is greater

49
Q

What are the general causes of focal alveolar consolidation?

A

Pulmonary mass or nodule

50
Q

What is the most frequent cause of acute diffuse alveolar disease?

A

Bacterial pneumonia and pulmonary edema

51
Q

In young patients, what are nodules/mass usually due to? What about patients over 40?

A 
Young = indolent infx or inflammation
Old = CA
52
Q

Which has sensory innervation: the visceral or parietal pleura?

A

Parietal

53
Q

Which pleura has lymphatic: visceral or parietal? What are the openings to these vessels called?

A

Parietal

Stoma

54
Q

The pleural space extends to which rib posteriorly? Laterally?

A

12th rib poasteriorly

10th rib laterally

55
Q

What is the costophranic sulcus (angle)?

A

The deep gutter around the dome of each hemidiaphragm

56
Q

What view of the chest can you see the posterior costophrenic sulcus? Lateral costophrenic?

A

Posterior sulcus = lateral view

Lateral sulcus = PA view

57
Q

What is the meniscus sign?

A

Rounding of the costophrenic angle d/t accumulation of fluid

58
Q

Which view is more sensitive for detecting pleural effusions? Why?

A

Lateral, since you can see the posterior costophrenic sulcus better, and that is the lowest area of the diaphragm

59
Q

If a hemithorax is totally opaque, it is usually due to what?

A

Consolidation and/or atelectasis or a large pleural effusion

60
Q

If an opaque hemithorax is due to atelectasis, which way will the mediastinum shift?

A

Toward the involved hemithorax

61
Q

If an opaque hemithorax is due to a large pleural effusion, which way will the mediastinum shift?

A

Shift away from the involved hemithorax

62
Q

If there is an opaque hemithorax without shifting of the mediastinum, then what is it likely due to?

A

Both atelectasis and pleural fluid or a tumor

63
Q

How much fluid does it take to visualize on a PA CXR?

A

More than 175 mL

64
Q

How much fluid does it take to visualize on a lateral upright CXR?

A

More than 75 mL

65
Q

How much fluid does it take to visualize on a decubitus CXR?

A

Greater than 5 mL

66
Q

How much fluid does it take to visualize on a supine CXR?

A

Several hundred mL

67
Q

Where are most pneumothoraces most commonly seen?

A

Apex of the lung

68
Q

What is a tension pneumothorax?

A

When air enters the pleural space with each breath, but cannot escape, thus increasing the intrapleural pressure

69
Q

What are the CXR findings with a tension pneumothorax?

A

Depressed hemidiaphragm

Mediastinal shift away from the pneumothorax

70
Q

Review the labeled lateral CXR. What is A?

A

Ascending aorta

71
Q

Review the labeled lateral CXR. What is B?

A

Aortic knob

72
Q

Review the labeled lateral CXR. What is C?

A

descending aorta

73
Q

Review the labeled lateral CXR. What is D?

A

right heart border

74
Q

Review the labeled lateral CXR. What is E?

A

left heart border

75
Q

Review the labeled lateral CXR. What is F?

A

right pulmonary artery

76
Q

Review the labeled lateral CXR. What is G?

A

left pulmonary artery

77
Q

Review the labeled lateral CXR. What is H?

A

Retrosternal clear space

78
Q

Masses in the mediastinum cause what kind of widening?

A

Focal

79
Q

Hemorrhage/fat or infiltrating diseases in the mediastinum cause what kind of widening?

A

Generalized

80
Q

What are the radiological findings of LV enlargement on a PA CXR?

A

Left heart border moves laterally, and the cardiac apex moves anterolaterally

81
Q

What are the radiological findings of LV enlargement on a lateral CXR?

A

The left heart border moves inferoposteriorly

82
Q

In a normal, erect state, how do the upper and lower lobe pulmonary arteries compare? What happens in CHF?

A

Upper are thinner and more delicate
Lower and thicker

CHF will cause equalization between the two in the erect state

83
Q

What is the most frequent cause of pulmonary redistribution (cephalization)?

A

Left heart failure and mitral valve stenosis

84
Q

Pulmonary redistribution without pulmonary edema = ?

A

Mild CHF

85
Q

What are Kerly B lines, and what causes them?

A

Fluid in the interlobular septa d/t increased LA pressure increases interstitial edema, causing the vessel margins to become less distinct, and peripheral interstitial markings to becomes more prominent.

86
Q

Which is worse: interstitial edema, or alveolar edema?

A

Alveolar edema

87
Q

What are the radiological findings of alveolar edema?

A

Diffuse, patchy infiltrate

88
Q

The sensitivity for a first or second order pulmonary embolus is close to 100%, but drops markedly for further branching. How clinically significant is this? Why?

A

Not very, since low incidence of complications from these

89
Q

What is a V/Q scan?

A

Compare V with Xe gas, and Q with Tc

90
Q

How do you grade V/Q scans?

A

Based on pretest probability and results

91
Q

What are the three outcomes of a V/Q scan?

A

High probability
Non-diagnostic
Low probability/normal

92
Q

What are the indications for a V/Q scan over a pulmonary angiography?

A
  • pt with renal failure
  • allergy to contrast
  • Young women (?)
93
Q

What type of imaging modality should be used to test for a PE in a pregnant woman?

A

CT pulmonary angiogram d/t the low dose of contrast

Respiratory (34 decks)

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