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Clinical skills Yr2 > Chest x-rays and HRCT interpretation > Flashcards

Chest x-rays and HRCT interpretation Flashcards

1
Q

What is the hallmark finding on CTPA that indicates an acute pulmonary embolism?

A

Polo mint sign

Fresh thrombus (grey) located in centre of lumen (thin rim of white contrast)

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2
Q

What are the 4 hallmark findings on HRCT that can indicate bronchiectasis?

A

Signet ring sign

Tram tack sign

String of pearls sign

Bunch of grapes sign

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3
Q

What is the signet ring sign on HRCT, and what condition does it indicate?

A

Bronchus is markedly dilated (ring) compared to accompanying pulmonary artery (signet): Suggests bronchial dilation

Bronchiectasis

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4
Q

What is the tram-tack sign on HRCT, and what condition does it indicate?

A

Parallel linear opacities along the length of the bronchi show thickening

Cylindrical bronchiectasis

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5
Q

What is the string of pearls sign on HRCT, and what condition does it indicate?

A

Uneven constriction and dilation of the bronchi

Varicose bronchiectasis

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6
Q

What is the bunch of grapes sign on HRCT, and what condition does it indicate?

A

Dilation of the bronchi forms intermittent pouches

Cystic bronchiectasis

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7
Q

What are the 3 hallmark findings on HRCT that indicate early pulmonary fibrosis?

A

Interlobar septal thickening

Irregular pleural thickening

Reticular (net-like) opacities in the lobes (bilateral)

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8
Q

What are the 2 hallmark findings on HRCT that indicate advanced pulmonary fibrosis?

A

Interlobar septal thickening

Honeycombing in subpleural areas

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9
Q

What is the hallmark finding on HRCT that indicates pneumothorax?

A

Thin, sharply-defined opacity that is the visceral pleura

Grey area is compressed lung

Black area that contains no lung markings is peripheral to visceral pleura line, indicates air

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10
Q

What is the hallmark finding on HRCT that indicates pleural effusion?

A

Grey area peripheral to visceral pleura line (thin, sharply-defined opacity)

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11
Q

What is a CTPA?

A

CT pulmonary angiogram

Scan of the pulmonary arteries

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12
Q

What is a HRCT?

A

High resolution CT

Scans chest in 1mm slices (16 total) to provide detailed imaging of lung tissues

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13
Q

When is CTPA indicated?

A

Pulmonary embolism

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14
Q

When is HRCT indicated?

A

Bronchiectasis

ILD

CTD-ILDs

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15
Q

Before interpreting a scan, which patient details should you confirm?

A

Patient name

DOB

Hospital number

Date and time of scan

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16
Q

In CXR interpretation, how do you comment on the adequacy of the scan?

A

P: Projection: Is the scan PA or AP, if it doesn’t say assume PA

R: Rotation: Are the medial aspects of clavicles both equal distance from the spinous processes

I: Inspiration: Can you see 8/9 posterior ribs

M:

P: Penetration: Are the vertebrae visible behind heart

17
Q

In CXR interpretation, what order do you use to comment on the scan?

A

ABCDE

18
Q

In CXR interpretation, what does A stand for?

A

A: Airway

  1. Trachea: Should be central or slightly to right of aortic notch
  2. Carina and bronchi: Should be clear
  3. Hilar lymph nodes: Left and right should be similar size
19
Q

In CXR interpretation, what does B stand for?

A

Breathing

  1. Lung fields: Compare upper, middle, lower zones of both lungs and see if they are similar, are there any decreased/increased densities
  2. Pleura: Do lung markings extend all the way to chest wall, do pleura look thickened
20
Q

In CXR interpretation, what does C stand for?

A

Cardiac

  1. Are the heart borders clear or shaggy
  2. Is the cardiac width less than half of the thoracic width
  3. Is there heart or mediastinal shift
21
Q

In a CXR interpretation, what does D stand for?

A

Diaphragm

  1. Is the right hemidiaphragm higher than the left diaphragm
  2. Are the hemidiaphragms curved normally or abnormally flattened
  3. Are the costophrenic angles sharp or blunt
  4. Can you see the gastric bubble
22
Q

In CXR interpretation, what does E stand for?

A

Everything else

22
Q

In CXR interpretation, how can you tell where the pathology is in the lungs?

A

Silhouette sign: Normal adjacent anatomical structures of differing densities form a crisp contour or ‘silhouette’, when this is lost you can tell which lobe is affected

22
Q

In CXR interpretation, how should you point out abnormalities within the struture?

A

PRIMP

Comment on any obvious abnormalities and what pathology it could be

Go through ABCDE

Summarise findings again

22
Q

In CXR interpretation, what does silhouette sign of the left heart border suggest?

A

Pathology is in the lingula of the left upper lobe

22
Q

In CXR interpretation, what does silhouette sign of the right heart border suggest?

A

Pathology is in the right middle lobe

23
Q

In CXR interpretation, what does silhouette sign of the left hemidiaphragm suggest?

A

Pathology is in the left lower lobe

24
Q

In CXR interpretation, what does silhouette sign of the right hemidiaphragm suggest?

A

Pathology is in the right lower lobe

25
Q

In CXR interpretation, what does silhouette sign of the aortic notch suggest?

A

Pathology is in the left upper lobe or middle mediastinum

26
Q

In CXR interpretation, what does the pathology being above the right heart border suggest?

A

Pathology is in the right upper lobe

27
Q

What are the main CXR findings of a tension pneumothorax?

A
  1. A: Tracheal deviation away from the air
  2. B: Loss of lung markings on affected side, can see the lung edge
  3. C: Mediastinal shift and heart shift
  4. D: Depressed diaphragm on side of air entry
  5. E: Could be fractures, iatrogenic trauma
28
Q

What are the main CXR findings of a simple pneumothorax?

A
  1. A: Trachea is central
  2. B: Loss of lung markings on affected side, can see lung edge
  3. C: Mediastinum isn’t shifted, heart isn’t shifted
  4. D: Depressed diaphragm
  5. E: Could be fractures, iatrogenic trauma

Clinical skills Yr2 (18 decks)

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