CXR - collapse and consolidation Flashcards
what is atelectesis
partial collapse or incomplete inflation of the lung; reduction in lung volume
what is consolidation
air that is normally in the lungs is replaced with something else e.g. fluid - normally an exudate, tumour, pus
what is (loss of) silhouette sign
loss of a specific contour which can help determine a disease process
consolidation clinical findings (examination)
dull to percussion; reduced breath sounds; bronchial breathing
what is an air bronchogram
the phenomenon of air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white);
examples of what might cause an air bronchogram (3)
pulmonary oedema; non-obstructive atelectasis; severe ILD
when might an air bronchogram indicate further investigation
if it persists for weeks despite appropriate antimicrobial - suspicion of a neoplastic process
5 signs of loss of volume on CXR
mediastinal shift; tracheal deviation; elevation of diaphragm; displacement of hilum; rib crowding
which hilum is normally higher than the other
left is higher than right
what are 6 patterns of consolidation
collapse; diffusion; multifocal; perihilar (bat’s wing); bibasal; peripheral
contusion CXR
focal haemorrhages; mediastinum widening
pneumonia CXR typical findings
dense/patchy unilateral consolidation; possible air bromchograms; silhouette sign (useful for determining which is the affected lobe);
what lobes boarder the diaphragm
L and R lower lobes
what lobe touches the right heart boarder
R middle lobe
what lobe touches the left heart boarder
Lingular (part of L upper lobe)
pleural effusion CXR (3)
blunting of costophrenic angles; homogenous opacification; meniscus sign (due to fulid pooling in lungs)
pulmonary oedema CXR
A - alveolar and interstitial shadowing;
B - kerly B lines (horizontal lines usually on lateral edges)
C - cardiomegaly
D - upper lobe venous blood diversion
E - effusion
F - fluid in horizontal fissure
tension pneumothorax CXR
air within the pleural space; loss of lung markings in the peripheral field; discrete lung edge may be identified; tracheal/mediastinal deviation away from pneumothorax; flattening of ipsilateral dome of diaphragm;
simple pneumothorax CXR
air within the pleural space; loss of lung markings in the peripheral field; discrete lung edge may be identified
tension pneumothorax diagnosis and treatment
medical emergency - diagnosed clinically!
Needle thoracostomy (2nd intercostal space, mid clavicular line)
general signs to look for in lobular collapse
loss of volume - raised hemidiaphragm; tracheal/mediastinal shift towards collapse; displacement of hila; narrowing of rib space
left upper lobe collapse signs (4)
1.veil sign - whole lung field looks like its been covered by a veil
2.Luftsichel sign - occasionally seen, radiolucency in the left upper zone, aound the aroitc arch, due to compensatory hyperinflation of the left lower lobe
3.treacheal deviation to left and left hemidiaphragm elevation (volume loss indicators)
left lower lobe collapse signs (3)
sail sign - triangle similar to the shape of sail, sharp edge is the same angle as the LH;
double heart boarder is seen (due to sail sign);
Indistinct medial aspect of the L hemidiaphragm;
right upper lobe collapse signs (4)
- increased opacification in RU zone with raised horizontal fissure (usually well demarcates the abnormality);
- Golden’s S sign (if there is an associated hilar mass);
- trachea displacement to the right;
- reverse S shape
right middle lobe collapse (4)
hard to detect on CXR
1. depression of horizontal fissure
2. indistinct right heart boarder
3. possible opacification in right lower zone
4. on lateral CXR may see small band of hyperdensity that is the lobe collapsed to a very small volume
right lower lobe collapse signs
- sail sign - similar to LLL;
- indistinct medial right hemidiaphragm;
- right hilum postitioned lower down
what is the lung apex
superior end of lung that projects up from 1st rip space into floor of neck
what is the base of the lung
inferior surface of lung that sits on diaphragm
what separates the lobes of the lungs
oblique fissures (R and L) and horizontal fissures (R only)
what are the 3 surfaces of the lung and what do they correspond to?
Mediastinal surface: faces lateral aspect of middle mediastinum;
Diaphragmatic surface: Lines base of lung. Concavity is deeper in right
lung, due to liver;
Costal surface: faces internal chest wall. Smooth and convex- costal pleura separates it from ribs and innermost intercostal muscles.
what are the 4 attachments of the diaphragm
- Anterior attachment: Posterior aspect of xiphoid process;
- Lateral attachment: costal cartilages of lower ribs from T7-T10;
- Posterior attachment: T11-T12;
- Midline attachment: Arcuate ligament and lumbar vertebrae via crura;
what is the costodiaphragmatic recess and why is it clinically important
sharp gutter at the junction of costal and diaphragmatic pleurae in each pleural cavity;
important - if there is fluid in the lungs it will pool here as this is the most distal aspect (costophrenic angle blunted)
what nerve innervates the diaphragm and what nerve roots are these
phrenic nerve - C3,4,5
where do the hilum correspond to anteriorly and posteriorly
Anteriorly - 4-5th costal
cartilages;
Posteriorly -T5-T7
what are the hilum
where the bronchi, arteries, veins, and nerves enter and exit the lungs
at what anatomical landmark does the main bronchus bifurcate
sternal angle
what is the nerve and arterial supply to the bronchi
nerve - vagus (CNX)
artery - bronchial artery
what do viceral afferents do in the lungs
conduct pain impulses to the sensory ganglion of
the vagus nerve
where is the nerve supply for the lungs derived from
pulmonary plexuses
what is the resonance change in consolidation
louder - dense matter conducts sound faster
symptoms/signs of atelectasis
Rapid, shallow & difficulty breathing
Wheezing, Cough
Narrowing of the ipsilateral intercostal
spaces
hyperexpansion and hyperlucency of the
remaining aerated lung,
examples of causes of consolidation (6)
pneumonia, atelectasis, pulmonary oedema, pulmonary
hemorrhage, aspiration, and lung cancer
