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103 theme 4 > imaging the thorax > Flashcards

imaging the thorax Flashcards

1
Q

how can lungs be imaged

A

Chest X ray
CT scan
Ventilation and perfusion imagery

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2
Q

how can a CXR be assessed

A

Basic parameters
Rotation
Exposure
Coverage

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3
Q

how are areas of the lungs reviewed

A 
Review areas 
Apices
Costo-phrenic angle
Behind the heart
Hila
Peripheries
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4
Q

how is heart size assessed

A

Cardiothoracic ratio
=C/T HEART AND WIDEST POINT OF THE CHEST CAVITY
Normally <0.5 on PA

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5
Q

what are the strengths and weaknesses of CT

A

Strengths
Cross sectional
Spatial resolution
Widely available

Weakness
Ionising radiation
Limited sift tissue contrast

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6
Q

why are CT scans used on lungs

A

Shows greater detail
Resolve small structures
Resolve small differences in attenuation (densities)

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7
Q

What do CT thorax and HRCT lungs show

A

Slice thickness
Resolution
Thin section (1mm) is optimal technique for demonstrating lung
CT thorax 5mm slice thickness

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8
Q

what is the lobar anatomy of lungs

A

divided into sections

Main lobes divided by fissures

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9
Q

what is the structure of lungs

A

The primary pulmonary lobule and acinus 6-10mm
Secondary pulmonary lobule 5-20mm diameter is the functional unit of the lung
300M alveoli per adult – total area 143m2

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10
Q

what is the function of the lungs

A

gas exchange

Ventilation perfusion and diffusion

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11
Q

how can ventilation and perfusion be monitored

A

Ventilation
Radioactive gas breathed in – xenon-133, krypton-81m then use decay to detect via imaging
Lung perfusion
2-500,000 intravenous particles
16-90 micron diameter
Macroaggregated human serum albumen
Occlude <1% of pulmonary circulation
Blood flow study so taken on back for better distribution of blood flow
Perfusion and ventilation images should match

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12
Q

what are lung pathologies seen on Xray

A

Pneumothorax – air in parietal space (tension or non tension)
Pleural effusion
High temp and cough > pneumonia (consolidation, fluid in airways)
smoke inhalation

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13
Q

what is consolidation

A 
Air space shadowing 
Fluffy blobs 
About 1cm diameter
Tending to confluence 
Could be oedema/transudate/exudate/pus/blood
\+/- air bronchogram  (bronchi visible)
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14
Q

what are the strengths and weaknesses of radiography

A 
Strength 
Great spatial resolution – esp bone 
Cheap and available 
Easy interpretation 
Weakness
Projectional
Ionising radiation
Very limited soft tissue visualisation
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15
Q

what can be seen on Xray

A

Air/gas
Fat
Water/soft tissue (all body fluids and tissues except bone and fat)
Bone
High atomic number – calcium iodine barium metals
Inc density

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16
Q

What are the 3 types of ultrasound probes

A 
Linear array (rectangular) - high freq, not deep eg anterior chest wall (pleura)
Curvilinear (widest) and Phased Array - low freq, deep eg heart and lungs
17
Q

what does echoic mean

A 
ability to reflect waves around it
hyperechoic (brighter than normal)
isoechoic (same as other tissue)
hypoechoic (darker than normal)
anechoic (no reflection, black)
18
Q

why do a lines appear on a lung ultrasound

A 
reverberation artefacts of the pleural lines
b lines (look like search lights) from fluid filled lungs (between alveolar spaces)
19
Q

what is M mode on an ultrasound

A

motion mode
x axis - time
y axis - what is seen over time
pleural line - beach and lungs -waves

20
Q

where can the heart viewed on US

A

left chest, 3-4th intercostal space

marker pointing to the right shoulder

21
Q

how is the heart viewed on US apically

A

5th intercostal space, MCL (where apex beat is)

22
Q

when is a chest drain used

A

air pneumothorax
blood haemothorax
fluid pleural effusion
pus empyema

23
Q

what is hyper expansion

A

greater than 6 anterior ribs visible above diaphragm

normal on young, COPD, asthma

24
Q

what is the hilar point

A

v shaped point where lower lobe pulmonary arteries cross the upper lobe pulmonary veins (should be symmetrical)
raised hilum can mean upper lobe collapse or fibrosis and obscured can mean lymphadenopathy, tumour or mediastinal mass

25
Q

key mediastinal structures

A

aortic arch and left and right heart borders

26
Q

what is cardiomegally

A

enlarged heart

eg LVF, pericardial effusion or dilated cardiomyopathy

103 theme 4 (20 decks)

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