EXII reading part 2 Flashcards
which 3 diseases commonly cause unilateral pleural effusion?
TB
pulmonary thromboembolism
trauma
which 3 diseases commonly cause left-sided pleural effusion?
pancreatitis
distal thoracic duct obstruction
dressler syndrome
which 3 diseases commonly cause right sided pleural effusion?
abdominal disease of liver or ovaries
RA
proximal thoracic duct obstruction
what is a subpulmonic effusion?
almost all collect below the lung
-blunt costophrenic angles when fluid >300ml
what is the meniscus sign?
What does it strongly suggest the presence of ?
- fluid appears to rise higher on lateral margin of thorax
- Identifying an abnormal lung density that demonstrates a meniscus shape of strongly suggestive of a pleural effusion
what are the 3 benefits to a decubitus view with pleural effusion?
confirm presence
determine if it flows freely (must determine before drainage)
uncover a portion of underlying lung
how can you tell if effusion fluid is flowing freely?
sandlike area of ↑ density along inner margin of chest cage in the dependent side of body
what is an opacified pleural effusion?
2L of fluid makes the whole thorax opaque → CT
what are loculated effusions?
adhesions from previous infection → may limit the mobility of an effusion
- abnormal shape/location
- clinical importance
what are fissure psedotumors?
vanishing tumors (sharply marginating collections of pleural fluid within fissures) transudate in CHF can cause -lenticular shape in minor fissure with pointed ends (not free flowing)
what are laminar effusions?
thing bandlike density on lateral chest wall near costophrenic angle
- CHF or lymphangitic malignancy
- not free flowing
what is a hydropneumothorax?
presence of air and water in pleural space
- trauma, surgery, recent thoracentesis
- air/fluid level in hemithorax
can pneumonia agents be identified via xray?
no, but certain organisms create specific patterns
what does pneumonia look like?
consolidation: fluffy alveolar markings
some create interstitial pattern
what are the 5 patterns of pneumonia on xray?
lobar segmental interstitial round cavitary
what is lobar pneumonia commonly caused by? what are the characteristics?
pneumococcal pneumonia
one +margins of pneumonia may be sharply marginated
indistinct and irregular margin when not bound by a fissure
almost always contain a bronchogram if in central part of lung
what is segmental pneumonia commonly caused by? what are the characteristics?
staph aureus spread to many foci, several segments all margins fluffy & indistinct exudate fills bronchi air bronchograms not present frequent atelectasis
what is interstitial pneumonia commonly caused by? what are the characteristics?
mycoplasma p, pneumocystitis p in AIDS
airway walls and septa involved
early stage: fine, reticular patterns
late stage: interstitial pattern unrecognizable
what does PCP look like in AIDS?
interstitial at first perihilar, reticular may mimic pulmonary edema no pleural effusion no hilar adenopathy
what is round pneumonia?
mostly in children, spherical shape
posterior in lungs and lower lobes
can be confused with tumor
what is cavitary pneumonia?
what commonly causes it?
post primary TB thin walled, smooth inner margin no air-fluid level trans bronchial spread (other agents: staph pneumonia, strep pneumonia, klebsiella pneumonia, coccidiodomycosis)
what does the position during aspiration have to do with the associated affected lobes?
upright: lower lobes
supine: upper/posterior lobes
what are the 3 patterns of aspirate on xray?
- bland gastric acid/water: rapidly appearing/learning airspace disease in dependent lobes (not pneumonia, 1-2days)
- infected aspirate: lower lobes, frequently cavitates, may take months to clear (usually anaerobic)
- unneutralized stomach acid: immediate appearance of airspace disease that frequently becomes infected. chemical pneumonia → pulmonary edema
what structures would not be visible in each place a pneumonia may be present?
RUL: ascending aorta RML: r. heart border RLL: right hemidiaphragm LU/LL: descending aorta Lingula of LUL: l. heart border LLL: left hemidiaphragm
