Imaging of the heart and lungs Flashcards
What does this person have?
Dextrocardia
What imaging modalities are there for heart and lungs
Chest radiograph (CXR)
- CT
- Ultrasound / echocardiography
- MRI
- Angiography
Are chest x rays expected to be used for diagnosis by juniors
Can be difficult to interpret
- Junior staff not expected to make absolute diagnosis
- Must be reviewed and result recorded in the notes (IRMER)
- Use your radiologist
What should you consider when you are looking at an X - ray?
Name
• Side marker (which way is right and left)
- PA or AP - AP magnigies heart as it is further from patients - use if patients too unwell to stand
- Supine or erect - supine enlarge heart + pleural effusions and pneumothoraces difficult to detect; poorer inspiration
- Inspiration - 5 anterior ribs - underinspired = apparent congestion and lung base lesions to be missed
Rotation - spinous process relation to the medial ends of the clavicle, altered transradiance of the lungs and abnormal mediastinum
penetration - dark enough to see T6, not too dark so you cant see the
exposure - Left hemidiaphragm visible to the spine and vertebrae visible behind heart
See what the density is - dark to light: soft tissue(fat), air, calcification, metallic/contrast
Check for lung abnormalities - soft tissue nodules <3cm, mass >3cm
Air space opacity - consolidation
Reticular opacity - mesh
Nodules - lots of tiny
RIPE(rotation, inspiration, penetrance, exposure )
What does this person have?
What does this person have?
Osteosarcoma - soft tissue mass
What does this show
Knife through the back
- Clearly shown with a much lighter film
What abnormality can you see on this X-ray?
What does this person have?
Multiple metastasis - cannonball mets?
What does this person have?
Left Upper Lobe - TB - you can see the nodularity - ill defined - more infective lesion
Ulcers, sores and crusting, in and around the nose, with destruction of nasal cartilage.
Rhinorrhoea, often bloody.
Haemoptysis.
Haematuria.
Rashes (up to 50%) - often small red/purple raised areas or blister-like lesions, ulcers or nodules
You see the clinical presentation above and the chest x ray shows this
What does this person have?
Granulomatosis with polyangitis (GPA) - cavitating masses
Describe this X ray
Left lower lobe air space opacity - could be puss, could be malignancy, could be inflammtory such as pneumonia
Describe the X ray and say what they may have
Perihilar region - wings of consolidation - pulmonary oedema secondary to left ventricular failure
What X ray pattern does this person have
Clinical symptoms: persistant life long cough with thick mucus. recurrent pulmonary infection and pancreatic insuffeciency
Reticular-nodular -cystic fibrosis - you get thickened bronchial walls and mucus
What does this person have?
Reticular pattern - fibrosis Usual interstitial pneumonia (interstitial lung fibrosis)
Honey combing seen - advanced pulmonary fibrosis
What does this person have?
Instertitial oedema - scaffolding with fluid - early stage pulmonary oedema
What does this person have?
Sarcoidosis is most likely due to nodular pattern
What does this person have?
This person has sudden shortness of breath
This person has a silouette sign.
The left border is not seen easily
This person has a left lower lobe collapse
What has this person got?
Sudden shortness of breath
Right middle lobe collapse
What has this person got
Left upper lobe collapse
What makes up the mediastinal contours?
This person has an enlarged heart. How do you know and what can cause it. What other signs support it?
CTR >0.5 roughly
What has this person got?
Mitral valve disease with enlarged left atrial appendage
This person has dilated ascending aorta - in elderly this could just be tortuois
