Imaging of the chest

Question 1

Rib Lesion: what could it be

Answer 1

Most common is callous due to a healing fracture

Metastatic lesion most common in older age group

Benign lesions exist but most require additional imaging to better characterize

Question 2

Heart Size on CXR

Answer 2

should be less than half of the diameter of the thorax

can appear bigger if person laying down

Question 3

Causes of Enlarged Heart on CXR

Answer 3

Hypertrophy due to overuse

Cardiomyopathy caused by CV disease, Drugs, Infectious

Fluid around the heart

Question 4

Abnormal Aorta on CXR

Answer 4

Aneurysm

Aortic Dissection

Post traumatic Injury with Hematoma

Question 5

Tracheal Deviation: most common cause

Answer 5

Enlarged thyroid

Question 6

Lymph node enlargement on CXR caused by

Answer 6

Metastatic Disease
Lymphoma
Reactive nodes related to infection (TB)
Granulomatous disease like Sarcoid

Question 7

Interstitial Infiltrates

Answer 7

Disease in the interstitium BETWEEN the alveoli
Lacy, reticular pattern on CXR
Most commonly seen with atypical pneumonia, early CHF, fibrosis

Question 8

Alveolar Infiltrates

Answer 8

Disease within the alveoli themselves
Fluffy, consolidating pattern on CXR
Air bronchograms present
Seen most commonly in bacterial pneumonia, late CHF, ARDS

Question 9

Congestive Heart Failure on CXR

Answer 9

Early pulmonary edema is interstitial
Late pulmonary edema is alveolar
Pleural effusions are common
Cardiomegaly is often seen
Kerley’s B lines or septal lines are strongly suggestive

Question 10

Size of Nodules and Masses

Answer 10

Lung nodules are less than 3cm in size, while masses are greater than 3cm in size

Question 11

Pneumothorax

Answer 11

Air between parietal and visceral pleura

Seen in 30-40% of patients with blunt chest trauma, usually associated with rib fx

May be spontaneous or iatrogenic
Bx, thoracentesis, line placement

> 20% will require chest tube placement

Question 12

Tension PTX

Answer 12

can be life threatening

Air accumulates due to one way valve mechanism, causing increased pressure with vena cava compression and impaired venous return

Question 13

Pulmonary Embolus

Answer 13

Clot in the pulmonary artery

3rd most common cause CV death (50-100,000/yr)
Only 30% diagnosed prior to death

Less than 35% of patients with suspected PE actually have PE

Question 14

Aortic Dissection: what is it

Answer 14

Most common aortic emergency requiring immediate surgery

Tear in intimal layer of vessel separates intima from media or adventia, causing a false channel

Question 15

Aortic Dissection: clinical presentation

Answer 15

Severe pain with tearing or ripping quality

Question 16

Aortic Dissection: Risk Factors

Answer 16

Risk Factors:	
HTN
Marfans or Ehler-Danlos
Cocaine use
Pregnancy

Question 17

Aortic Dissection: when to do surgery

Answer 17

If ascending aorta is involved it is a surgical case

If descending only patient can be treated medically