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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
PET scan false negative
Can occur in slowly growing tumors <1 cm
26
PET scan false positive
Inflammatory diseases like TB, sarcoidosis, histoplasmosis, coccidioidomycosis
27
PET sensitivity
80-95%, on par with histological examination
28
VQ scan function
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
VQ scan use
Look for PE, has largly replaced CT angiography
30
EBUS
Endobronchial ultrasound Used for diagnosing lung cancer and other lung diseases minimally invasive, highly effective
31
Flexible bronchoscope advantages
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
Rigid bronchoscope advantages
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
Flexible bronchoscopy disadvantages
1. Does not produce stable airways | 2. Suction is limited
34
Rigid bronchoscope disadvantages
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
Bronchoscope sampling techniques
1. Washings 2. Brushings 3. Bronchoalveolar lavage (BAL) 4. Biopsy (transbronchial needle aspiration or transbronchial biopsy)
36
Washings
Saline injected through bronchoscope and then aspirated back for sampling
37
Brushings
A brush for suspicious lesions that collect cell samples
38
BAL
100-200ml of saline into distal bronchoalveolar trees and suctioned out again with all microorganisms, proteins and cells located at alveolar level
39
Diagnostic indications for bronchoscopy
1. Suspected lung cancer 2. Cancer staging 3. Suspected ILD 4. Microbiological sampling 5. Suspected broncho-esophageal fistula
40
Therapeutic indications for bronchoscopy
1. Aspiration of airway secretion 2. Aspiration of foreign body 3. Large airway stenosis
41
Contraindications of bronchoscopy
- non-compliant patient - unstable angina, MI within 6 weeks - unstable bronchial asthma - severe respiratory failure - bleeding predisposition - pulmonary HTN - immunosuppression - SVC syndrome
42
Contraindications for biopsy
- PLT < 100 - INR > 1,4 - Severe renal failure - Anticoagulant treatment
43
NBI
Narrow band imaging Microvascular analysis based on light absorption in Hb
44
AFI
Autofluorescence imaging Illumination of tissue at specific wavelength can give us information about abnormal (thickened) mucosa
45
EUS
Transesophageal ultrasound Can assess lung cancer spread to regional lymph nodes
46
TNB indications
Transthoracic needle biopsy - inoperable tumor - high risk patient
47
TNB contraindications
- Mechanical ventilation - Contralateral pneumonectomy - Suspected vascular lesions - Hydatid cyst - Pulmonary HTN - Bleeding disorders A lot more
48
TNB complications
- PTX - hemoptysis - parenchymal hemorrhage - air embolism - subcutaneous emphysema
49
Thoracoscopy
Endoscope examination of pleural space through a small incision
50
VATS
Video assisted thoracoscopy Allows surgeon to visualize equipment with minimal invasion
51
VATS indication
- Correction of spontaneous PTX - Bullectomy/lung volume reduction in emphysema - Wedge resection - Lung parenchymal biopsy
52
Thoracentesis
Used to aspirate fluid from pleural effusion
53
Diagnostic thoracentesis
Almost all patients with new pleural fluid or uncertain about the etiology of it
54
Therapeutic thoracentesis
Relief of symptoms from a large pleural effusion

Pulmo (4 decks)

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