DI midterm 3 Flashcards
Describe the appearance Right lung on chest films
Right lung: ( 3 lobes- upper, middle, and lower) Oblique fissure:
- Superior and middle lobes above fissure
- Inferior lobe below fissure
- Visible on LATERAL film ( not seen on PA)
- Identify side O.F. by which diaphragm it intersects with
- Horizontal fissure will run into O.F. but will not cross it
Right horizontal ( minor ) fissure:
- Anterior portion of superior lobe above fissure
- Middle lobe below fissure
- Separates right anterior segment of right upper lobe from right middle lobe
- Begins at right oblique fissure at mid-axillary line
- Runs horizontally anterior to sternal end of 4th costal cartilage
- Absent or incomplete in 25%
- Seen in 54% of PA
Describe the appearance of oblique ( minor) fissures on chest films
Left oblique fissure:
- Separates left upper lobe from left lower lobe
- Begins @ T5
- Extends obliquely down and forward
- Ends at anterior plural gutter of diaphragm
Right oblique fissure:
- Separates right upper and middle lobes from right lower lobe
- Begins @ T5
- Extends down and forward
- Ends at anterior pleural gutter of diaphragm
Less vertical than left oblique fissure
Describe the appearance of horizontal ( minor) fissures on chest films
Right horizontal fissure:
- Separates anterior segment of the RUL from the RML
- Begins at the oblique fissure at mid-axillary line
- Runs horizontally anterior to the sternal end of 4th costal cartilage
Locate the lobes of the left and right lungs.
- RUL: apical, anterior, & posterior
- RML: lateral & medial
- RLL: superior, medial basal, anterior basal, lateral basal, & posterior basal
- LUL: apical-posterior, anterior, superior lingular, & inferior lingular
- corresponds to RML
- LUL is analogous to RUL and RML combined
- LLL: superior, medial basal, anterior basal, lateral basal, posterior basal
- LLL is the same as LRL
What anatomical parts are responsible for the cardiac contours on the PA and lateral chest films? - anterior
- Right heart border, left heart border, ascending aorta
- Right medial segment of right medial lobe lies in anatomic contact with all but the uppermost portion of the right heart border
- Uppermost portion of the heart border and ascending aorta are in anatomic contact with the anterior segment of the RUL
- Lingual ( left side) is in contact with the left heart border
- Anterior segment of LUL-upper portion of left heart border
- Anterior part of left hemidiaphram is usually obliterated by the bottom of the heart bec they are in anatomic contact ( physiological silhouette)
- Anterior mediastinal tissue and plural fluid
What anatomical parts are responsible for the cardiac contours on the PA and lateral chest films? - posterior
- Descending thoracic aorta, aortic knob (posterior portion of aortic arch)
- Apical posterior segment of the LUL lies in contact w/ aortic knob
- RLL and LLL are not in contact with the heart borders. Therefore, disease in the RLL and LLL will NOT obliterate heart borders
- LLL and RLL overlaps middle portion of the heart border, but will not obliterate borders ( if it lies behind the aortic knob is could be in LLL but would still see the knob)
- Posterior pleural cavity
- Posterior mediastinum
- Basal segments of the RLL and LLL lies in anatomic contact with the hemidiaphragms
What anatomical parts are responsible for the cardiac contours on the PA and lateral chest films?
- basal segments
- All basal segments contact the diaphragm
- water density in the basal segments can cause a silhouette sign of a portion of the diaphragm
Which views are included in routine plain film examination of the chest?
PA and left lateral……..full inspiration
What condition or anatomical region is best demonstrated by the apical lordotic view?
See apices of the lung, can dx a pancoast tumor ( or anything in the apices of the lung)
Is the routine chest x-ray taken with inspiration or expiration?
Full inspiration Breath held on inspiration Expands lung fields depresses diaphragm Provides contrast (air vs. tissue)
Describe the difference in appearance between inspiration and expiration.
Need good inspiration, should see first 10 ribs posteriorly, lowers the diaphragm
What condition is better demonstrated upon expiration than inspiration?
Pneumothorax: upright expiration more sensitive
What is the appearance of interstitial disease?
- Thickened alveolar septa, alveolar walls; interstitial lymph, veins, cells
- Usually a diffuse pattern of involvement
- Often combined with consolidation
- Pattern: reticular, nodular, honeycomb, or any combo/ combo—acinar shadow
- Ground glass: hazy inc density, vasculature clearly visible ( use acute, some chronic fibrosis)
- Linear ( reticular): thickened septa, fibrosis, Kerley B lines
What is the appearance of alveolar disease?
- Silhouette sign, air bronchogram, pattern—diffuse, lobar/localized, solitary nodule/mass, multiple nodule/mass, atelectasis
- Represents filling of the pulmonary acini, the 8mm respiratory units composed of respiratory bronchioles, alveolar ducts, and alveoli
- Opacities appear fluffy and ill-defined and often become confluent to form larger regions of opacity. Other findings are air-bronchograms (lucent tubular and branching structures representing aerated bronchi surrounded by opaque acini), absence of volume loss (the acini remain filled, with replacement of air by fluid or tissue), and a non-segmental distribution.
- 5 substances fill air space: pus, tumor, water, protein, blood
- Pneumococcal pneumonia, TB, fungal pneumonia, bronchoalveolar carcinoma, lymphyoma, ARDS, pulmonary edema ( including cardiogenic) ( essential radiology p. 117)
What are the x-ray findings of lobar consolidation?
- Lobar density
- Air bronchogram
- No significant loss of lung volume
White arrows are pointing to transverse fissure which is in normal location
List the 4 patterns of “white lung” disease (lung opacification on chest films) and a differential list for each?
• Diffuse Usually bilaterally symmetric Suggest more systemic/widespread disease DDX: Pulmonary Edema (CHF) Unusual infections pneumocysitis carinii, opportunistic, immune compromised Sarcoidosis Histopasmosis, TB Bronchiolaveolar carcinoma Idiopathic pulmonary hemorrhage • Localized Lobar Usually only a portion of one lung Most common presentation of infection DDX: Acute bacterial pneumonia Pulmonary TB Pulmonary infarct Bronchopulmonary sequestration Pancoast Tumor Atypical pneumonia (viral, mycoplasma) • Solitary mass/nodule Smaller, fairly well defined area Common presentation of neoplasm • DDX: Bronchogenic carcinoma Hematogenous metastasis Hamartoma Tuberculoma Lung abscess Hydatid cyst Hematoma Bronchopulmonary sequestration • Multiple masses/nodules Multiple fairly well defined areas Common presentation of metastasis DDX: Pulmonary metastasis Lymphoma Granulamatous infection (TB, histoplasmosis, coccidioidomycosis) Rheumatoid nodules Wegener’s granulomatosis
