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Pulmo > Imaging diagnostics and biopsies > Flashcards

Imaging diagnostics and biopsies Flashcards

1
Q

Indications for chest x-ray

A

Asymptomatic patients (screening for cancer/TB)

Symptomatic patients: chest pain, fever, persistent cough, shortness of breath

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2
Q

Asthma/bronchiectasis CXR indications

A

Only if diagnosis is unclear or the patient undergoes a severe attack

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3
Q

Absolute contraindications of CXR

A

None

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4
Q

Relative contraindications of CXR

A

Pregnancy, patient weight

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5
Q

Pulmonary consolidation

A

replacement of air-filled regions of lung tissue with liquid

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6
Q

Atelectasis

A

loss of lung volume

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7
Q

Shifting of trachea

A
  • to the opposite site in pleural effusion

- to the same side in atelectasis

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8
Q

Consolidation presentation

A

Areas of opacification (less transparent), silhouette sign

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9
Q

Silhouette sign

A

Loss of sharp outline

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10
Q

Cavitations

A

Appear as darker areas (radiolucency)

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11
Q

Tuberculoma

A

Round nodule with a sharp edge

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12
Q

TB features on x-ray

A

Tuberculoma, cavitations, fibrosis, calcification

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13
Q

Honeycombing

A

Feature in fibrosis where small cystic spaces will create a honeycomb appearance

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14
Q

Traction bronchiectasis

A

Airway distortion due to mechanical traction on bronchi from surrounding fibrosis

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15
Q

Mediastinal masses - anterior compartment

A

Thymic tumors
Thyroid masses
Dermoid cysts

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16
Q

Mediastinal masses - middle compartment

A

Enlargment of aorta or ventricle

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17
Q

Mediastinal masses - posterior compartment

A

Neural lesions

Esophageal cysts

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18
Q

Most common uses for CT

A

To investigate mediastinal disease, to stage cancer and to determine extent of bronchiectasis

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19
Q

HRCT

A

High res CT

Provides detailed images of all lung tissue, useful for emphysema and ILD

Does not image the whole long, not suitable for screening or lung cancer assessment

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20
Q

MRI in pulmonology

A

Not used much, but useful for:

assessment of pancoast tumors and possible cysts

suspected PE where contrast material cant be given

detect metastasis to the brain (exam Q)

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21
Q

Ultrasound

A

Useful for locating pleural effusions, to visualize PTX and perform EBUS, but not much else

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22
Q

PET scan in pulmo

A

Useful for DDX of intermediate solitary nodules, as they are too small for biopsy

Superior to CT for mediastinal cancer staging

23
Q

Benign tumor signs PET scan

A

Calcification and/or lack of growth

24
Q

Malignant tumor signs PET scan

A

Active accumulation of FDG (F-fluoro-2-deoxy-glucose) in the lesion

25
Q

PET scan false negative

A

Can occur in slowly growing tumors <1 cm

26
Q

PET scan false positive

A

Inflammatory diseases like TB, sarcoidosis, histoplasmosis, coccidioidomycosis

27
Q

PET sensitivity

A

80-95%, on par with histological examination

28
Q

VQ scan function

A

Scintigraphy and radioactive isotopes are used to examine airflow and blood perfusion in the lungs

  1. Radioactive isotopes are inhaled and airflow is evaluated
  2. Another radioactive material is given IV to look at the perfusion
29
Q

VQ scan use

A

Look for PE, has largly replaced CT angiography

30
Q

EBUS

A

Endobronchial ultrasound

Used for diagnosing lung cancer and other lung diseases

minimally invasive, highly effective

31
Q

Flexible bronchoscope advantages

A
  1. Can be done bedside
  2. Requires minimal sedation
  3. Can examine upper lobe and peripheral airways, up to 6 segmental bronchi
  4. Can be performed by pulmonologist
32
Q

Rigid bronchoscope advantages

A
  1. Provides stable airways
  2. Better for removal of objects than flexible version
  3. Additional tools available (even a flexible bronchoscope can be added)
33
Q

Flexible bronchoscopy disadvantages

A
  1. Does not produce stable airways

2. Suction is limited

34
Q

Rigid bronchoscope disadvantages

A
  1. Performed in OR
  2. Needs general anesthesia
  3. Difficult to examine upper lobes and peripheral airways
  4. Usually requires a surgeon or interventional pulmonologist
  5. Increased chance of mechanical damage (i.e. broken teeth)
35
Q

Bronchoscope sampling techniques

A
  1. Washings
  2. Brushings
  3. Bronchoalveolar lavage (BAL)
  4. Biopsy (transbronchial needle aspiration or transbronchial biopsy)
36
Q

Washings

A

Saline injected through bronchoscope and then aspirated back for sampling

37
Q

Brushings

A

A brush for suspicious lesions that collect cell samples

38
Q

BAL

A

100-200ml of saline into distal bronchoalveolar trees and suctioned out again with all microorganisms, proteins and cells located at alveolar level

39
Q

Diagnostic indications for bronchoscopy

A
  1. Suspected lung cancer
  2. Cancer staging
  3. Suspected ILD
  4. Microbiological sampling
  5. Suspected broncho-esophageal fistula
40
Q

Therapeutic indications for bronchoscopy

A
  1. Aspiration of airway secretion
  2. Aspiration of foreign body
  3. Large airway stenosis
41
Q

Contraindications of bronchoscopy

A
  • non-compliant patient
  • unstable angina, MI within 6 weeks
  • unstable bronchial asthma
  • severe respiratory failure
  • bleeding predisposition
  • pulmonary HTN
  • immunosuppression
  • SVC syndrome
42
Q

Contraindications for biopsy

A
  • PLT < 100
  • INR > 1,4
  • Severe renal failure
  • Anticoagulant treatment
43
Q

NBI

A

Narrow band imaging

Microvascular analysis based on light absorption in Hb

44
Q

AFI

A

Autofluorescence imaging

Illumination of tissue at specific wavelength can give us information about abnormal (thickened) mucosa

45
Q

EUS

A

Transesophageal ultrasound

Can assess lung cancer spread to regional lymph nodes

46
Q

TNB indications

A

Transthoracic needle biopsy

  • inoperable tumor
  • high risk patient
47
Q

TNB contraindications

A
  • Mechanical ventilation
  • Contralateral pneumonectomy
  • Suspected vascular lesions
  • Hydatid cyst
  • Pulmonary HTN
  • Bleeding disorders

A lot more

48
Q

TNB complications

A
  • PTX
  • hemoptysis
  • parenchymal hemorrhage
  • air embolism
  • subcutaneous emphysema
49
Q

Thoracoscopy

A

Endoscope examination of pleural space through a small incision

50
Q

VATS

A

Video assisted thoracoscopy

Allows surgeon to visualize equipment with minimal invasion

51
Q

VATS indication

A
  • Correction of spontaneous PTX
  • Bullectomy/lung volume reduction in emphysema
  • Wedge resection
  • Lung parenchymal biopsy
52
Q

Thoracentesis

A

Used to aspirate fluid from pleural effusion

53
Q

Diagnostic thoracentesis

A

Almost all patients with new pleural fluid or uncertain about the etiology of it

54
Q

Therapeutic thoracentesis

A

Relief of symptoms from a large pleural effusion

Pulmo (4 decks)

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