Introduction to Chest Radiology Flashcards
2 ways of looking at the chest?
- Chest radiograph (CXR)
- Chest CT
Difference between X-ray and radiograph?
A radiograph is the resultant image after a patient or object is exposed to x rays
Describe the detectors currently used in radiography.
All digital
How to describe subject placement in radiography?
First the side receiving the rays first
Then the side next to the film
Which frontal CXR is preferred?
PA
Which lateral CXR is preferred?
Right
How does one make a CT image of the chest?
- Patient passes in short increments through hole in scanner
- XR tube (in housing gantry) rotates around patient in a spiral
- X-rays pass through patient and strike detectors
- Computer generates the image
Does a CT have multi-planar capability? What does this mean?
YES, meaning it can generate images in the axial, coronal, and sagittal planes
What is an axial plane?
Horizontal plane cutting body in superior and inferior portions
What is a coronal plane?
Plane cutting body in anterior and posterior portions
What is a sagittal plane?
Plane cutting body in right and left portions
Other word for axial plane?
Transverse plane
Which CT plane would most closely simulate a lateral CXR?
Sagittal plane
Name the bones.
*coracoid process of the scapula
*spinous proccesses from the vertebrae
Name the “moguls”. What to note?
Note: pulmonary trunk is more of a valley than a bump
In which position are patients passed through a CT scan?
Supine
Other name for lung roots?
Hila
Do the pulmonary arteries travel with the bronchi or the pulmonary veins?
Bronchi
What are the pleural angles?
Junction of costal pleura and diaphragmatic pleura
How to tell the difference between posterior and anterior ribs on a radiography?
The ribs most visible are posterior and horizontal
The faint ribs are anterior
TBD
Are pulmonary arteries and veins parallel?
NOPE
Other name for bifurcation of the trachea?
Carina
Pectoralis muscle on left side and Poland syndrome on the right side = congenital absence of pectoralis muscle associated with hypoplasia of ipsilateral:
- pectoralis major muscle, and
- breast, and
- ribs, and
- upper extremity
Which 2 veins drain into the SVC?
R and L brachiocephalic veins
Is Poland’s syndrome more common in men or women?
Men
What is pneumonia? Where does it originate?
Infection of the lung airspaces
Originates in the alveoli as organisms are inhaled and reproduce in the lungs
What are pores of Kohn?
Small holes connecting alveoli
Can pneumonia spread?
Yes, but only locally through the pores of Kohn
What is the distinguishing feature of pneumonia on a chest CXR?
Fluffy opacities in a focal site due to the inflammatory products replacing alveolar air
Right lung pneumonia
Left lung pneumonia
Right upper lobe pneumonia
What is a pulmonary edema?
Extravasation of fluid from pulmonary capillaries into alveoli replacing the alveolar air space
What is the distinguishing feature of pulmonary edema on a chest CXR?
Fluffy opacities bilaterally and symmetrically favored in mid and lower chest zones because of gravity => basilar dependent
2 possible causes of pulmonary edema? Fraction of cases for each?
- Hydrostatic: due to the capillaries being subject to increased hydrostatic pressure, fluid seeps into the alveoli, usually due to heart failure (2/3rds of cases) or could be due to fluid overload or kidney failure
- Permeability: noncardiogenic cause but increased permeability of pulmonary capillaries (1/3rd of cases)
Other than the distinguishing feature, how else is pulmonary edema visible on a chest CXR?
- Batwing pattern = specific central and symmetric cloudiness pattern
- Enlarged cardiac silhouette if the cause is cardiogenic
Pulmonary edema with enlarged cardiac silhouette
Pulmonary edema with enlarged cardiac silhouette
What is a primary lung carcinoma?
A cancer (tumor) that originates in the lungs or the cells lining the airways as normal lung cells become cancer cells and begin to uncontrollably divide
How to distinguish a malignant tumor from a benign one?
A malignant one is distinguished from a benign one in that it can spread (aka metastasize) to distant sites
Left lower lobe primary lung carcinoma
Left lower lobe primary lung carcinoma
Left lower lobe primary lung carcinoma
Left lower lobe primary lung carcinoma
Left lower lobe primary lung carcinoma on a PET scan showing the high mitotic rate of the cells that are taking up a lot of radioactive glucose, which is indicative of cancer
What is the distinguishing feature of secondary lung carcinoma on a chest CXR?
Multiple bilateral masses in the lungs
What is the distinguishing feature of primary lung carcinoma on a chest CXR?
Large, dense ball with smooth margins
Secondary lung carcinoma metastisized from a colon carcinoma
Secondary lung carcinoma metastisized from a colon carcinoma
2 layers of the pleura? What is in between?
- Visceral pleura
- Parietal pleura
In between = pleural cavity
What is a lung fissure?
A cleavage of the visceral pleura
Other name for minor fissure? Where is it located?
Horizontal fissure on right lung
What does the left major fissure divide?
Left upper lobe and left lower lobe
Place the left major fissure.
What does the right minor fissure divide?
Rigght upper lobe from right medial lobe
What does the right major fissure divide?
The right upper and middle lobes from the lower lobe
Place the right lung fissures.
In what lobe do the schematic objects reside?
Cannot tell for sure
Are the schematic objects in the right or left lobes?
Cannot tell
What is a pneumothorax?
Visceral and parietal pleural are separated by air in the pleural cavity
When pneumothorax occurs, which pleural layer becomes visible on CXR?
The visceral pleura
What is the distinguishing feature of a pneumothorax on a chest CXR?
Air in pleural space is hyper black or hyper luscent and the visceral pleural edge is visible
Right lung pneumothorax
Pneumothorax
Left lung pneumothorax
Left lung pneumothorax
What is a pleural effusion?
Visceral and parietal pleura are separated by fluid in the pleural space
4 types of pleural fluids?
- Water
- Pus
- Blood
- Lymphatic fluid
Other name for lymphatic fluid?
Chyle
What is the distinguishing feature of pleural effusion on a chest CXR?
Costophrenic angles are blunted with a meniscus sign
Normal
Normal
Right pleural effusion
Pleural effusion
Left pleural effusion
Pleural effusion with meniscus sign
Right pleural effusion
Right lung pleural effusion
Right lung pleural effusion
Right lung pleural effusion
Left pleural effusion in supine patient
Left lung pleural effusion in upright position
Is layering of fluid visible on chest CXR with pleural effusions?
YUP
How can you tell if the cardiac silhouette is enlarged?
If it is greater than half the transverse diameter of one hemithorax
If a chest CXR shows an enlarged cardiac silhouette, how can you differentiate between cardiomegaly and pericardial effusion?
You will need an echocardiogram or a CT, the CXR alone cannot distinguish them
Normal
Enlarged cardiac silhouette
Cardiomegaly
Normal
What is cardiomegaly? Main causes?
Enlargement of the cardiac chambers
Main causes: CAD or high BP
Cardiomegaly
Cardiomegaly
Which is the most inferior slide?
A
What is a pericardial effusion?
Visceral and parietal pericardial layers are separated by fluid in the pericardial sac
Pericardial effusion
What is the size of the heart?
Cannot tell for sure
What is the size of the heart?
Normal, because this is a pericardial effusion
Pericardial effusion
Cardiomegaly
Pericardial effusion
3 common causes of pericardial effusion?
- Inflammation
- Viral infection
- Metastatic diseases
Large cardiac silhouette
What is a lung CT specifically used to assess?
The interstitium of the lungs
