Chest Radiology Flashcards
What is X-ray?
The thorax is the most imaged body part using x-rays The 3D structure of the thorax is capture on a 2D image A frontline source of imaging utilised in most areas of healthcare
What is CT?
High radiation dose image acquisition Best combined with intravenous contrast for best results Higher sensitivity and specificity than x-ray
What is US?
Rapid and accessible for trained ED practitioners Ideal for excluding some life-threatening pathologies No radiation or powerful magnet
What is MRI?
No ionizing radiation but has the complication of the magnet Can be a long turn around time from request to scan Dynamic scans and can demonstrate great soft tissue detail
Label the lobes of the lung through an X-ray
On image - page 2
Describe the position of the lung hilum
What length represents volume loss?
- The right hilum is usually lower than the left but can be the same height
- Any greater than 2cm apart and this could represent volume loss
Identify the normal variants of a x-ray
- Left hand side image – Azygos lope (tadpole sign) seen in the right apical zone medially
- Right hand side image – Dextracardia but best described as Situs inversus, not isolated dextracardia
Page 4
Identtify the cervical rib
On image
What is a Silhouette Sign?
Identify a left lower and right lower lobe collapse
• This requires a comfortable knowledge of anatomical relationships with the thorax
• Structures are visible on x-rays due to the differential absorption of tissues by x-rays
• Loss of a normal air-tissue interface produces a continuous border with an abnormality highlighting its presence
An air-soft tissue interface creates a sharp line demonstrated the anatomy. I.e. in a normal CXR the left heart border is sign where as:
Left hand side image – has upper lobe consolidation which effaces the left heart border obliterating it.
Right hand side image – has lower lobe consolidation which does not efface the left heart
Identify a left lower lobe collapse
Page 5
Identify a Left upper lobe consolidation
Page 5
Identify Right middle lope consolidation/collapse
Page 6
Identify Some examples of tubes lines and drains
Page 6
When is US useful?
- Limited use in thoracic imaging
- FAST or eFAST in Emergency Care setting
- Fastest possible images to obtain with a trained member of staff performing
- Echocardiogram is used cardiology to exclude
Identify an US of the heart and lungs
Page 7
Label the echocardiogram of the heart
Left hand side image is a labelled image of the heart
Right hand side image has a circled area demonstrating vegetation at the end of the cusp of the mitral valve from infective endocarditis
Page 8
Label the CT of the chest
Page 8
Identify a double aortic arch
page 8 and 9
Identify MRI of the great vessels at different phases
Page 9
What is Ventilation Perfusion?
Left hand side image is a V/Q scan (Ventilation Perfusion) which is inhaled gas into the lungs that emits radiation. This is best used as a lower radiation dose than CT to investigate for pulmonary embolism.
Right hand side image is Myocardial Perfusion scan (MIBI or sestamibi)
Page 9
Identify the coronary arteries
Page 10
What is Right sided apical bullae?
Page 10
Right sided apical bullae –pockets of air in the right upper zone with thin-walled hyperdense line surrounding them
Also note, the patient is still wearing a bra and there is a symmetrical increased density in the lower zones of the chest demonstrating the effect of breast shadows. It is important to understand this for CXR evaluation and factor in situations of unilateral mastectomies. Also consider someone with very large pectoralis major muscles will have similar increased density
Identify a thoracoplasty
Page 11
