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Anatomy of the thorax > Imaging of the lung and mediastinum > Flashcards

Imaging of the lung and mediastinum Flashcards

1
Q

What can be discerned when imaging the lung fields

A 
Lung fields
Diaphragm and recesses
Fissures
Hilar region
Thoracic cage
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2
Q

What can be discerned when imaging the mediastinum

A

Heart &
Great vessels
Trachea
Soft tissues

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3
Q

Describe medical imaging modalities

A

Radiography (plain and special)
Computerised Axial Tomography (CT or CAT)
Magnetic Resonance Imaging (MRI)
Ultrasonography (Ultrasound)
Nuclear Medicine Imaging (Radionuclide Imaging) Eg:Technetium-99 scans

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4
Q

Describe PA X-ray

A

Film is viewed as if you are facing the patient face to face
X-Ray goes through back of patient- X-ray film on chest
X-ray tube
(posterior)

Person/part

Film
(anterior)

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5
Q

Describe the basic projections of the different X-rays

A

Postero-anterior (PA) view (erect)
Antero-posterior (AP) view (erect or supine )
Lateral view

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6
Q

Describe the PA view of the chest radiograph

A

Routinely used

Heart close to film

Heart undistorted

Scapula rotated away from lung

Clavicles cross lung fields

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7
Q

Describe the AP view of the chest radiograph

A

mainly for supine patients
Heart magnified
Scapula overlaps
Clavicles projected above apex

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8
Q

What should you do when you get a chest X-ray

A

Patient details
Rotation – is the image ‘straight’?
Inspiration – at least top 9 pairs of ribs
Position- AP, PA, lateral, supine, decubitus
Exposure – should be able to see IV discs behind cardiac shadow.

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9
Q

What should you look at on the chest X-Ray

A 
A. Airways
B. Bones
C. Circulation – heart & vessels
D. Diaphragm
E. Effusion – lung edges
F. Fields – lung fields
G. Gas bubble – stomach
H. Any others
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10
Q

What should be seen on a chest X-Ray

A

Lung fields
Mediastinal shadow
Cardiac silhouette
Transverse diameter of heart should not exceed 50% of that of thorax

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11
Q

What is a bronchogram

A

Radio opaque contrast medium was introduced into the airways to coat the interior surface.
Not used anymore. CT scan reconstructions are available now

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12
Q

What can be seen on a bronchogram

A

RUL-right upper lobe bronchus
RML- right middle lobe bronchus
RLL- right lower lobe bronchus

A -Trachea
B- Left main bronchus
C- Left upper lobe bronchus
D- Left lower lobe bronchus

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13
Q

Describe a pneumothorax

A

Right lung collapsed
Hence no vascular markings
Hyperlucent right lung field
Air in pleural cavity

Clavicle fracture
No lung markings on right side
No lung sounds –right side 
Tachycardia +
Treatment -Chest drain placed
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14
Q

Describe pleural effusion

A

Fluid in right middle lobe fissure
Fluid level in relation to the right dome
Right costo-diaphragmatic recess obliterated

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15
Q

Describe lung- hilar lymphadenopathy (lung enlargement)

A

Lymph node masses usually due to sarcoid or lymphoma e.g carcinoma of uterine cervix.

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16
Q

Describe pulmonary artery angiogram

A

Radio opaque contrast material is injected into the pulmonary artery and imaged as it passes through the arterial tree.

Arteries (blue lines) are more vertical than veins

17
Q

Describe the pulmonary vein angiogram

A

Radio opaque contrast material is injected into the pulmonary artery and imaged as it passes through the venous tree.

Veins (red lines) are more horizontal than arteries

18
Q

Which chest view is used to image the heart

A

PA view is routinely used to evaluate the heart

Heart is close to film

Heart undistorted

19
Q

What impressions can be seen on the oesophagus

A

Aortic arch
Lt main bronchus impression
Left atrial impression

20
Q

What are the cardiac outlines

A 
Aortic arch
Pulmonary artery
Appendage of LA
LV
RA
SVC
Cardiophrenic angle (angle between heart and diaphragm)
21
Q

Describe subtraction angiography

A

During angiography it is often difficult to appreciate the contrast agent in the vessels through the overlying bony structures.
To circumvent this, the technique of subtraction of angiography has been developed.
One or two images are obtained before the injection, the images are inverted (negative image created from a positive one)
After injection- series of images obtained to determine passage of contrast agent
By adding the negative precontrast agent to the positive postcontrast, the bones and soft tissue are subtracted to produce a solitary image of contrast only.

22
Q

How are images obtained in a CT scan

A

X-ray tube moves in an arc around the body
The image detectors moves in opposite direction in the same arc
Only the axial point is in focus
The signals are put into a computer
The image is reconstructed by the computer and displayed

23
Q

Describe the planes of the images in CT

A

Images in axial (transverse) sections (with some exceptions)
Images viewed from inferior side (normal convention)
X-rays are used for imaging
Good details and relations
Choices: Standard CT, CT angiography, Contrast, Windowing, and Reconstructions

24
Q

What is meant by a window setting

A

After a CT scan is obtained the data is digitally manipulated to reveal different structures in great detail

25
Q

Describe MRI

A

MR imaging is similar to CT but more details and tissue differentiation is seen.
MRI uses strong magnetic field
Depends on the alignment of protons of hydrogen atoms (of water in body tissues) in the magnetic field
Radio waves are used to excite these protons which then ‘flip over’
Flipped protons give measurable energy (signal) when they flip back when the pulsing is removed
More protons (tissues with high water content) emit larger signal
Signals are processed by a computer and images are formed

26
Q

What is an advantage of MRI

A

However, an advantage of MRI is the ability to image in any plane – with the obliquity of the heart, this enables us to visualise areas of more relevance through cardiac-specific planes.

27
Q

What are the different uses of T1 and T2 MRIs

A

Image c is T1 weighted to show soft tissue structures more clearly
Image d is T2 weighted to show fluid filled areas more clearly

Anatomy of the thorax (11 decks)

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