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2B week 1 - lung infection > CXR - collapse and consolidation > Flashcards

CXR - collapse and consolidation Flashcards

1
Q

what is atelectesis

A

partial collapse or incomplete inflation of the lung; reduction in lung volume

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2
Q

what is consolidation

A

air that is normally in the lungs is replaced with something else e.g. fluid - normally an exudate, tumour, pus

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3
Q

what is (loss of) silhouette sign

A

loss of a specific contour which can help determine a disease process

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4
Q

consolidation clinical findings (examination)

A

dull to percussion; reduced breath sounds; bronchial breathing

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5
Q

what is an air bronchogram

A

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

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6
Q

examples of what might cause an air bronchogram (3)

A

pulmonary oedema; non-obstructive atelectasis; severe ILD

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7
Q

when might an air bronchogram indicate further investigation

A

if it persists for weeks despite appropriate antimicrobial - suspicion of a neoplastic process

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8
Q

5 signs of loss of volume on CXR

A

mediastinal shift; tracheal deviation; elevation of diaphragm; displacement of hilum; rib crowding

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9
Q

which hilum is normally higher than the other

A

left is higher than right

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10
Q

what are 6 patterns of consolidation

A

collapse; diffusion; multifocal; perihilar (bat’s wing); bibasal; peripheral

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11
Q

contusion CXR

A

focal haemorrhages; mediastinum widening

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12
Q

pneumonia CXR typical findings

A

dense/patchy unilateral consolidation; possible air bromchograms; silhouette sign (useful for determining which is the affected lobe);

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13
Q

what lobes boarder the diaphragm

A

L and R lower lobes

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14
Q

what lobe touches the right heart boarder

A

R middle lobe

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15
Q

what lobe touches the left heart boarder

A

Lingular (part of L upper lobe)

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16
Q

pleural effusion CXR (3)

A

blunting of costophrenic angles; homogenous opacification; meniscus sign (due to fulid pooling in lungs)

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17
Q

pulmonary oedema CXR

A

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

18
Q

tension pneumothorax CXR

A

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;

18
Q

simple pneumothorax CXR

A

air within the pleural space; loss of lung markings in the peripheral field; discrete lung edge may be identified

19
Q

tension pneumothorax diagnosis and treatment

A

medical emergency - diagnosed clinically!
Needle thoracostomy (2nd intercostal space, mid clavicular line)

20
Q

general signs to look for in lobular collapse

A

loss of volume - raised hemidiaphragm; tracheal/mediastinal shift towards collapse; displacement of hila; narrowing of rib space

21
Q

left upper lobe collapse signs (4)

A

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)

22
Q

left lower lobe collapse signs (3)

A

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;

23
Q

right upper lobe collapse signs (4)

A
  1. increased opacification in RU zone with raised horizontal fissure (usually well demarcates the abnormality);
  2. Golden’s S sign (if there is an associated hilar mass);
  3. trachea displacement to the right;
  4. reverse S shape
24
Q

right middle lobe collapse (4)

A

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

25
Q

right lower lobe collapse signs

A
  1. sail sign - similar to LLL;
  2. indistinct medial right hemidiaphragm;
  3. right hilum postitioned lower down
26
Q

what is the lung apex

A

superior end of lung that projects up from 1st rip space into floor of neck

27
Q

what is the base of the lung

A

inferior surface of lung that sits on diaphragm

28
Q

what separates the lobes of the lungs

A

oblique fissures (R and L) and horizontal fissures (R only)

29
Q

what are the 3 surfaces of the lung and what do they correspond to?

A

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.

30
Q

what are the 4 attachments of the diaphragm

A
  1. Anterior attachment: Posterior aspect of xiphoid process;
  2. Lateral attachment: costal cartilages of lower ribs from T7-T10;
  3. Posterior attachment: T11-T12;
  4. Midline attachment: Arcuate ligament and lumbar vertebrae via crura;
31
Q

what is the costodiaphragmatic recess and why is it clinically important

A

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)

32
Q

what nerve innervates the diaphragm and what nerve roots are these

A

phrenic nerve - C3,4,5

33
Q

where do the hilum correspond to anteriorly and posteriorly

A

Anteriorly - 4-5th costal
cartilages;
Posteriorly -T5-T7

34
Q

what are the hilum

A

where the bronchi, arteries, veins, and nerves enter and exit the lungs

35
Q

at what anatomical landmark does the main bronchus bifurcate

A

sternal angle

36
Q

what is the nerve and arterial supply to the bronchi

A

nerve - vagus (CNX)
artery - bronchial artery

37
Q

what do viceral afferents do in the lungs

A

conduct pain impulses to the sensory ganglion of
the vagus nerve

38
Q

where is the nerve supply for the lungs derived from

A

pulmonary plexuses

39
Q

what is the resonance change in consolidation

A

louder - dense matter conducts sound faster

40
Q

symptoms/signs of atelectasis

A

Rapid, shallow & difficulty breathing
Wheezing, Cough
Narrowing of the ipsilateral intercostal
spaces
hyperexpansion and hyperlucency of the
remaining aerated lung,

41
Q

examples of causes of consolidation (6)

A

pneumonia, atelectasis, pulmonary oedema, pulmonary
hemorrhage, aspiration, and lung cancer

2B week 1 - lung infection (6 decks)

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