Chest Radiology

Question 1

assessing inspiration in CXR?

Answer 1

> 6 ribs visible

Question 2

assessing rotation in CXR

Answer 2

medial ends of clavicle should be equidistant from spinous processes

Question 3

what projection should a CXR be in generally and why is this best

Answer 3

standing PA

allows measurement of CTR and prevents unwanted enlargement of organs due to xray beam projection

Question 4

what lung hila sits higher

Answer 4

left generally

Question 5

what hemidiaphragm sits higher

Answer 5

right

Question 6

review areas for CXR?

Answer 6

apices
retrocardiac
beneath diaphragm
edges of radiograph

Question 7

what possible missed findings may be seen at lung apices

Answer 7

pancoast tumour

PTX

Question 8

what possible missed findings may be seen at edges of radiograph and others

Answer 8

fracture
subcut emphysema
soft tissue injury
past surgery

Question 9

what possible missed findings may be seen behind heart

Answer 9

consolidation
hiatus hernia
mass

Question 10

what possible missed findings may be seen beneath diaphragm

Answer 10

pneumoperitoneum
NG placement
bowel obstruction

Question 11

cause of lung lobe collapse

Answer 11

tumour
aspiration
mucus impaction
foreign body

Question 12

features of LL lobe collapse

Answer 12

increased density in retrocardiac region
loss of clarity of left medial hemidiaphragm
left hila displaced down
triangle of opacity

Question 13

features of LU lobe collapse

Answer 13

elevation of left hemidiaphragm

veil like opacity with difficulty finding left heart border

Question 14

features of RU lobe collapse

Answer 14

increased density in upper zone of right lung with demarcation by horizontal fissure
volume loss
golden S sign
density in RU zone and elevated horizontal fissure

Question 15

features of RM lobe collapse

Answer 15

loss of right heart border
visible right hemidiaphragm
right lower zone density

Question 16

features of RL lobe collapse

Answer 16

sparing of right heart border but loss of right hemidiaphragm
increased lower zone density

Question 17

features of RM and RL lobe collapse

Answer 17

volume loss and loss of right heart border and hemidiaphragm
depression of horizontal and oblique fissure

Question 18

describe why collapse of RM and RL lobe commonly occur together

Answer 18

obstruction of the middle and lower bronchi is possible more commonly due to blockage of bronchus intermedius

Question 19

how can consolidation be differentiated from collapse

Answer 19

generally not as much volume loss

Question 20

what does consolidation of the lingula lead to radiologically

Answer 20

loss of left heart border

Question 21

what is an air bronchogram

Answer 21

bronchus contains air but lung does not

Question 22

where would you be likely to find a small PTX

Answer 22

lung apex

Question 23

escess fluid in the pleural space may be seen by what radiologically?

Answer 23

blunting of costophrenic angles

Question 24

ABCDE features of heart failure on CXR

Answer 24

Alveolar oedema - bat wing 
Kerley B lines 
Cardiomegaly 
Dilated upper lobe vessels 
Pleural Effusion

Question 25

normal placement features of ETT

Answer 25

5cm above carina 2/3rd tracheal diameter cuff not expanding trachea

Question 26

normal placement features of NG tube

Answer 26

subdiaphragmatic, overlying gastric bubble and should pass about 10cm past gastro-oesophageal junction

Question 27

possible areas of malposition of ETT

Answer 27

extension past carina extension to right main bronchus oesophagus

Question 28

possible areas of malposition of NG tube

Answer 28

coiled in upper airway stuck in oesophagus trachea or R/L main bronchus Intracranial

Question 29

where are central venous catheters inserted and what is their correct placement?

Answer 29

subclavian or internal jugular | cavoatrial junction, roughly anterior end of right 2nd rib

Question 30

possible areas of malpiosition of central line

Answer 30

tip too high in prox SVC tip too low in RA/RV displacement into another vein

Question 31

how may a mass appear on CXR

Answer 31

discrete mass/masses or secondary features like collapse

Question 32

use of contrast CT in masses?

Answer 32

tumour size biopsy metastasis

Question 33

use of FDG-PET CT in masses

Answer 33

nodal, distant mets or finding mass in an area of collapse

Question 34

what may be the cause of pneumoperitoneum

Answer 34

perforation of stomach, colon, duodenum, small intestine

Question 35

features of PE on CXR

Answer 35

normal/non specific | usually to exclude other causes

Question 36

gold standard for PE

Answer 36

CTPA

Question 37

Indication for V/Q scan?

Answer 37

defects caused by clot very mild ambulatory pt pt not suited to CTPA