Imaging of thorax

Question 1

how to image a fractured rib and its associated symptoms

Answer 1

difficult to see via XRAY so CT more sensitive

often due to hematoma at site of fracture

ribs 4-10 most commonly fractured

Associated with pneumothorax/hemothorax, injuries to spleen, liver, and kidney

Question 2

Spontaneous Pneumothorx

Answer 2

spontaneous rupture of alveoli through visceral pleura so air leaks into cavity

risks- smoking, COPD, cystic fibrosis, inherited apical bleb

lung collapse, compression of mediastinal structures and vessels

lung appears black (open cavity)

Question 3

Tension pneumothorax

Answer 3

air enters the thorax but cannot exit

caused by: trauma where injury fails to seal
-positive pressure ventilation particularly during resuscitation

lung collapse but also impairs venous return that can lead to cardiac arrest

Question 4

Pulmonary meniscus sign

Answer 4

meniscus seen on surface of fluid: commonly seen with pleural effusion on X-ray

meniscus is due to surface tension between two different fluids in pleural cavity (normal serous fluid and pleural effusion)

accumulates in costophrenic angles on the PA radiograph and in the substernal region on lateral radiographs

Question 5

Coin sign

Answer 5

solitary round circumscribed shadows on X-ray

may be calcified

Patient can be asymptomatic

causes: Tuberculosis, neoplasms. cysts, and vascular anomalies

Question 6

Kerley A ligns

Answer 6

diagonal lines running from hila to periphery

often caused by distension of anastomosic channels between peripheral and central lymphatics

causes: Pulmonary edema, lymphoma and other cancers
pneumonia

Question 7

Kerley B lines

Answer 7

short parallel lines at the periphery (represent interlobular septa) perpendicuular to pleura

causes: Pulmonary edema, lymphoma and other cancers
pneumonia

Question 8

Cardiac Tamponade

Answer 8

fluid build up with pericardial cavity

obstructing blood flow

water bottle heart, globular heart silhouette in X-ray

causes: Neoplasms, pericarditis, effusion due to renal failure, trauma

symptoms: Becks triad
- distant heart sounds
- jugular distension
- hypotension (low BP)
- may show signs of shock

Question 9

Echocardiography (doppler)

Answer 9

adult heart

• probe on anterior skin
• heart apex is up in figures
• red indicates flow toward probe
• blue indicates flow away from probe

ventricle appears above atrium