EXII reading part 2

Question 1

which 3 diseases commonly cause unilateral pleural effusion?

Answer 1

TB
pulmonary thromboembolism
trauma

Question 2

which 3 diseases commonly cause left-sided pleural effusion?

Answer 2

pancreatitis
distal thoracic duct obstruction
dressler syndrome

Question 3

which 3 diseases commonly cause right sided pleural effusion?

Answer 3

abdominal disease of liver or ovaries
RA
proximal thoracic duct obstruction

Question 4

what is a subpulmonic effusion?

Answer 4

almost all collect below the lung

-blunt costophrenic angles when fluid >300ml

Question 5

what is the meniscus sign?

What does it strongly suggest the presence of ?

Answer 5

• 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

Question 6

what are the 3 benefits to a decubitus view with pleural effusion?

Answer 6

confirm presence
determine if it flows freely (must determine before drainage)
uncover a portion of underlying lung

Question 7

how can you tell if effusion fluid is flowing freely?

Answer 7

sandlike area of ↑ density along inner margin of chest cage in the dependent side of body

Question 8

what is an opacified pleural effusion?

Answer 8

2L of fluid makes the whole thorax opaque → CT

Question 9

what are loculated effusions?

Answer 9

adhesions from previous infection → may limit the mobility of an effusion

• abnormal shape/location
• clinical importance

Question 10

what are fissure psedotumors?

Answer 10

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)

Question 11

what are laminar effusions?

Answer 11

thing bandlike density on lateral chest wall near costophrenic angle

• CHF or lymphangitic malignancy
• not free flowing

Question 12

what is a hydropneumothorax?

Answer 12

presence of air and water in pleural space

• trauma, surgery, recent thoracentesis
• air/fluid level in hemithorax

Question 13

can pneumonia agents be identified via xray?

Answer 13

no, but certain organisms create specific patterns

Question 14

what does pneumonia look like?

Answer 14

consolidation: fluffy alveolar markings

some create interstitial pattern

Question 15

what are the 5 patterns of pneumonia on xray?

Answer 15

lobar 
segmental
interstitial
round
cavitary

Question 16

what is lobar pneumonia commonly caused by? what are the characteristics?

Answer 16

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

Question 17

what is segmental pneumonia commonly caused by? what are the characteristics?

Answer 17

staph aureus
spread to many foci, several segments 
all margins fluffy & indistinct
exudate fills bronchi
air bronchograms not present 
frequent atelectasis

Question 18

what is interstitial pneumonia commonly caused by? what are the characteristics?

Answer 18

mycoplasma p, pneumocystitis p in AIDS
airway walls and septa involved
early stage: fine, reticular patterns
late stage: interstitial pattern unrecognizable

Question 19

what does PCP look like in AIDS?

Answer 19

interstitial at first 
perihilar, reticular
may mimic pulmonary edema
no pleural effusion 
no hilar adenopathy

Question 20

what is round pneumonia?

Answer 20

mostly in children, spherical shape
posterior in lungs and lower lobes
can be confused with tumor

Question 21

what is cavitary pneumonia?

what commonly causes it?

Answer 21

post primary TB
thin walled, smooth inner margin
no air-fluid level
trans bronchial spread 
(other agents: staph pneumonia, strep pneumonia, klebsiella pneumonia, coccidiodomycosis)

Question 22

what does the position during aspiration have to do with the associated affected lobes?

Answer 22

upright: lower lobes
supine: upper/posterior lobes

Question 23

what are the 3 patterns of aspirate on xray?

Answer 23

1. bland gastric acid/water: rapidly appearing/learning airspace disease in dependent lobes (not pneumonia, 1-2days)
2. infected aspirate: lower lobes, frequently cavitates, may take months to clear (usually anaerobic)
3. unneutralized stomach acid: immediate appearance of airspace disease that frequently becomes infected. chemical pneumonia → pulmonary edema

Question 24

what structures would not be visible in each place a pneumonia may be present?

Answer 24

RUL: ascending aorta
RML: r. heart border
RLL: right hemidiaphragm
LU/LL: descending aorta
Lingula of LUL: l. heart border
LLL: left hemidiaphragm

Question 25

what is the spine sign?

Answer 25

on lateral xray thoracic spine should get darker from shoulder → diaphragm
if not, soft tissue/fluid density is blocking lower lobe

Question 26

what should you do if a pneumonia on xray is not resolving?

Answer 26

get a CT to check for neoplasm