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CRRAB 1 Week 1 > Imaging of the Chest > Flashcards

Imaging of the Chest Flashcards

1
Q

What is the most common view of the chest taken in clinic or hospital?

A

a PA view

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2
Q

What are 4 things to consider if a film is adequate?

A
  • adequate breath?
  • over or under pentrated?
  • anything cut off?
  • patient rotated?
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3
Q

How can you tell if it was an adequate breath?

A

should have 10-11 ribs visible within the lung fields

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4
Q

Why do you need an adequate breath?

A

inadequate breath will crowd the lung structures and make them look pathologic

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5
Q

If a film looks too dark, is it over or under penetrated?

A

over

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6
Q

What should you check the bones for on a CXR?

A

fractures are most common - old or new

lesions are next - lytic or blastic

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7
Q

If you see something that looks like a rib lesion, what is the MOST likely diagnosis?

A

not a lesion at all - a callous due to a healing fracture - look to see if there are others on the adjacent ribs - it’s almost impossible to break only one rib

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8
Q

What are the most common lesions in older age groups?

A

metastatic lesions

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9
Q

What is located in the mediastinum to look at on a CXR?

A

heart, aorta, pulmonary vessels, trachea and esophagus

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10
Q

WHat’s a good rule of thumb for how big the heart should be?

A

It should be less than half the size of the entire chest

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11
Q

What are some non-pathological things that can make a heart look bigger on CXR?

A

poor inspiration

supine pictures = AP films in general

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12
Q

What are three reasons for the heart to actually be enlarged?

A

hypertrophy due to overuse
cardiomyopathy from CV disease, drugs or infection
fluid around the heart

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13
Q

Can you tell what’s making the heart big on CXR?

A

not really - tissue will look the same as fluid - you need a CT

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14
Q

If you see a slight bulge in the left atrium in the context of no cardiomegaly, what does that suggest?

A

mitral stenosis

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15
Q

What are the two main worrisome things with an abnormal aorta?

A

aneurysm or dissection

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16
Q

Can you usually see a diaphragm on a CXR?

A

You shouldn’t see the diaphragm itself, but you can see where it is based on the lung contour - the only way you’d see it is if there were air under the diaphragm

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17
Q

If you don’t have a sharp border showing the diaphragm, what’s something you should check for? How?

A

diaphragm paralysis

do inspiration and expiration films or a fluoroscopic evaluation with a sniff test. the diaphragm should move down and if it doesn’t, it’s paralyzed

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18
Q

What does air trapping due to COPD look like on a CXR?

A
  1. the lungs will look too dark (radiolucent)
  2. the lungs will be hyper-expanded
  3. Flat diaphragm
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19
Q

What’s the most common cause of tracheal deviation?

A

enlarged thyroid gland

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20
Q

Can you usually see lymph nodes on CXR?

A

nope - only if they’re enlarged. they’re look like fluffy masses

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21
Q

What are the possibilities when you see lymph nodes on CXR?

A

metastatic disease
lymphoma
reactive nodes related to infection - TB
granulomatous disease like sarcoidosis

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22
Q

What is the silhouette sign?

A

basically, you can only see other things on CXR because of the border they make with the air in the lungs. So if there is a border that’s obscured, that means there’s something that’s replaced the air and it also tells you WHERE it is in the lungs

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23
Q

Which lung has three lobes and which has two?

A

right - three

left - two

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24
Q

What does the left have in stead of a third lobe?

A

A lingula…it’s basically another lobe, but it isn’t divided by a fissure

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25
Q

If something blurs the left heart border (left ventricle), where is the pneumonia?

A

lingula

26
Q

If something blurs the left diaphragm, where is the pneumonia?

A

left lower lobe

27
Q

If something blurs the right diaphragm, where is the pneumonia?

A

RLL

28
Q

If something blurs the right atrium, where is the pneumonia?

A

right middle lobe

29
Q

If something blurs the superior vena cava, where is hte pneumonia?

A

right upper lobe

30
Q

If something obscures the aortic knob, where is the pneumonia?

A

left upper lobe

31
Q

In addition to the obscured border, what will you often see on CXR in a pneumonia?

A

air bronchograms -

they’re air-filled bronchoa nd bronchioles that are outlined by disease int he adjacent alveoli, so you’ll see black tubes in the white stuff

32
Q

Can a CXR tell what’s filling up the alveoli and making them look dense?

A

nope - pus, fluid and blood all look the same on CXR

33
Q

What are the two general areas infiltrates can develop in the lungs?

A

interstiail - between the alvolei or in the alveoli themselves

34
Q

What does an interstitial infiltrate look like?

A

lacy, reticular (linear) pattern

35
Q

What is an interstitial infiltrate associated with?

A

atypical pneumonia, early CSF and fibrosis

36
Q

What do alveolar infiltrates look like?

A

fluffy consolidating patterns, usually with air bronchograms

37
Q

What is an alveolar infiltrate associated with?

A

bacterial pneumonia, late CSF or acute respiratory distress syndrome

38
Q

What are some common CXR findings in CHF?

A

early pulmonary is intersitial while late pulmonary edema is alveolar
pleural effusions
cardiomegaly
Kerley’s B lines (septal lines)

39
Q

What will pleural effusions appear as on CXR?

A

blunting of the costophrenic angles

40
Q

How can you tell if costophrenic angle blunting is from scarring or from effusion?

A

do a decubitus view and see if the fluid layers out.

41
Q

WHat’s the difference between a lung nodule and lung mass?

A

nodules are less than 3 cm, masses are greater than 3cm

42
Q

What is the number one thing to do if you’re trying to rule out cancer with a newly found lung mass?

A

check old films - stability over 2-3 years suggests a benign process

43
Q

What else can you look for to rule out cancer?

A

calcifications - coarse, central calcifications suggest a benign process

44
Q

What should be on your differential when you see multiple nodules in the lungs?

A

metastatic disease
infeciton
granulomatous disease

45
Q

What should be on yoru differential when you see a solitary nodule in the lungs?

A 
lung cancer
abscess
infection - TB or blasto
AV malformation
Granulomatous disease
Benign Granuloma
46
Q

When you have a patient presenting with chest pain, what is the number one thing on the DDx?

A

acute coronary syndrome - MI or angina

47
Q

How is the diagnosis of an acute coronary syndrome made?

A

EKG and enzymes - not really with imaging

48
Q

What is the second thing to have on your DDx with chest pain?

A

pneumothorax

49
Q

Pneumothorax puts air between what?

A

hte parietal and visceral pleura

50
Q

Which PTX is life threatening?

A

tension - air accumulates and can’t get out, causing increased pressure and vena cava compression/impaired venous return

51
Q

What will you see on CXR with PTX?

A

you’ll see a sharp line in the mid lung field, which is the visceral pleura

no lung markings lateral to that line

52
Q

What percentage of PE are diagnosed before death? What percentage of those diagnosed with PE actually ahve one?

A

only 30%

less than 35%

53
Q

What are the non specific signs of PE on CXR?

A

Hamptom’s hump - a wedge-shaped opacity corresponding to lung infarct

Westermark’s sign - a translucent area

54
Q

What scans can be used to diagnose PE?

A

A VQ Scan - nuclear medicine scan with ventrilation and perfusion components; perfusion abnormality with normal ventilation suggests PE

Chest CT angiography is more common now

55
Q

What is the most common aortic emergency requiring immediate surgery?

A

aortic dissection

56
Q

What happens in aortic dissection?

A

you get a tear in the intimal layer of the vessel, which separates the intima from the media or the adventitia on the outside, which causes a false channel to form in the aorta

57
Q

What do people present with when they have an aortic dissection?

A

severe pain with tearing or ripping quality

58
Q

What are the risk factors for aortic dissection?

A

HTN is the main one
marfans or ehler-danlos
cocaine use
pregnancy

59
Q

What will a dissection look like on CXR?

A

a wide mediastinum
abnormal arch configuration - it will bow way out
pleural effusion L>R

60
Q

What is the study of choice for diagnosing dissection?

A

CT

61
Q

How does CT help in determining treatment for dissection?

A

If it involves the ascending aorta, they need immediate surgery

if it’s just the descending, the patient can be treated medically - lower HTN and it will often heal on its own

CRRAB 1 Week 1 (9 decks)

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