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Block 2 > Introduction To Thoracic (Cardiac & Respiratory) Imaging > Flashcards

Introduction To Thoracic (Cardiac & Respiratory) Imaging Flashcards

1
Q

What is the commonest modality used to image the thorax? Why?

A

CXR

Can see lung + cardiac pathology

Useful quick primary screen that is relatively cheap

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2
Q

What other modality’s can be used to image the thorax? Why?

A

CT: see multiple thoracic structures

CTPA: pulmonary angiography e.g. in embolism

US: pleural pathology

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3
Q

Why would you not use MRI as a first choice to image the thorax?

A

Expensive, takes time + is unpleasant for patients

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4
Q

What is MRI used mainly for in terms of imaging the thorax?

A

Cardiac investigation

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5
Q

How do X-rays work?

A

X-ray generator produces X-ray beams which come out of point source projector + spread out going through the patient + into the detector/film

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6
Q

How directions can thorax X-rays be done in? How do you achieve this?

A

PA: X-ray source anterior to patient, detector posterior

AP: X-ray source posterior to patient, detector anterior

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7
Q

What direction are most thoracic films taken in? Why?

A

PA

Want the heart to appear life size so it must be as near to detector as possible

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8
Q

How should thoracic images be read in a systematic way?

A
  1. Demographics (ID, DOB + name)
  2. RIP (rotation, inspiration + penetration)
  3. ADCDE (airway, breathing, cardiac, diaphragm + everything else)
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9
Q

How can you assess the rotation of a patient on an X-ray?

A

Sternal head of clavicle + spinous processes in midline of vertebrae (tear drops) - see if spinous processes equidistant from collar bone joint + if so, the patient is head on

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10
Q

How can you assess the inspiration of a patient on an X-ray?

A

You want to be able to see ribs 5-7 anteriorly

Start counting from the 2 dark ovals at the lung apex (rib 1) + follow their curvature

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11
Q

How can you assess the penetration of an X-ray?

A

You want to be able to see the vertebral column outline + invertebral discs behind the heart

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12
Q

What will the trachea look like on an X-ray?

A

Midline (should be lined up with spinous processes) mostly below the clavicle

Appears dark as air is in it whilst surrounding tissue is white due to sot tissue, fat + blood etc.

Should be able to trace it down to R + L bronchus at rib 2 where it bifurcates

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13
Q

What should the diaphragm look like on an X-ray?

A

Dome shaped on both sides

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14
Q

Why do the back of the ribs on an X-ray appear whiter than the front?

A

Because the front is cartilage

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15
Q

What is penetration?

A

How well the X-ray has been absorbed by the structures i.e. how well you can visualize them

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16
Q

Why should you not rely on the heart as a marker for the direction the patient is facing?

A

In conditions such as dextrocardio, the heart is on the right, so this will confuse the image

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17
Q

What in the airways do you want to mainly look at on X-ray?

A

Tracheal position

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18
Q

What do you want to look for in a X-ray in terms of breathing + cardiac structures?

A

Breathing: hilum + lung fields

Cardiac: cardiothoracic ratio

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19
Q

What should the hilum of the lung look like on X-ray?

A

Hilar point is V-shaped where bronchi start to divide

Appears whiter than surrounding lung tissue as its denser due to vessels + bronchi

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20
Q

If the lung hilum is not visible due to a larger white structure in the way, what may this be? Why might a patient have this?

A

Mediastinal lymphadenopathy

Tumour may have metastasized to the lymph nodes in the mediastinum

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21
Q

If a patient has mediastinal lymphadenopathy, what clinical picture may they present with?

A 
Dysphagia
Stridor in breathing (due to tracheal compression)
Hoarse voice (due to RLN compression)
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22
Q

What should normal lung fields look like on an X-ray?

A

White lines should project to edge of thoracic cage meeting outer perimeter due to blood supply + tracheobronchial tree

23
Q

What are the 4 different zones examined on X-ray of the lungs?

A
  1. Apical: above clavicle
  2. Upper: below clavicle + above lung hilum/cardiac shadow
  3. Middle: level with lung hilum
  4. Lower: below hilum + including costodiaphragmatic recess
24
Q

What should the costodiaphragmatic recess look like on X-ray?

A

V-shaped black groove in lower zone of lungs

25
Q

What is a lower zone opacity?

A

Costodiaphragmatic recess whiter in colour having lost its shape indicating fluid build-up here

26
Q

Why do you take X-rays on inspiration?

A

As costodiaphragmatic recess lined by parietal pleura + lungs travel into these when you take a deep breath in as diaphragm contracts dropping down opening up these V-shaped grooves for the lungs to slide into

27
Q

How can you tell if opacity is fluid?

A

Fluid line i.e. meniscus affected by gravity

28
Q

Why can pleural effusions occur on 1 side of the lung?

A

Because pleura are not continuous from the left to the right lung

29
Q

What is the Mach effect?

A

Optical illusion where the edges of darker objects adjacent to lighter ones appear lighter (vice versa) - can trick you into thinking there is a shadow on an X-ray

30
Q

What marking can you use for the horizontal lung fissure of the right lung?

A

Costal cartilage of rib 4

31
Q

What marking can you use for the middle lobe of the right lung?

A

Wedge-shaped structure just below the costal cartilage of rib 4

32
Q

Why can you not see the whole of the inferior lobes on X-ray?

A

A lot of it extends round the back of the other lobes (will become visible if it becomes white due to pathology)

33
Q

Why would you want to be able to know where the different lung lobes are on X-ray?

A

So you know where pathology is occurring e.g. can just get a middle lobar pneumonia where just this lobe shows opacity

34
Q

What type of scan was utilised before CT scans? Why is this no longer used?

A

Radio-opaque high MW substance injected into tracheobronchial tree enhancing contrast

Substance was oily so after patients got infections/inflammation - no longer used as CT has superseded it

35
Q

What are the smallest functional segments of the lung?

A

Bronchopulmonary segments (further subdivision of lobes)

36
Q

What might you see in an X-ray if bronchopulmonary segments are pathologically affected?

A

Gravity dependent regions due to postural gravity drainage so fluid may collect when a patient is laying down

37
Q

What is an atelectasis? What can cause it?

A

Collapse of lung

Blockage of segmental or lobar bronchus

38
Q

What is a silhouette?

A

Structures that cast a shadow e.g. heart

39
Q

If the lung fields appear blacker, what is the problem?

A

Pneumothorax

40
Q

In order, what are the common causes of pleural effusion?

A
  1. CHF (transudate)
  2. Pneumonia (exudate)
  3. Cancer (exudate)
  4. Pulmonary embolus (transudate/exudate)
  5. Viral disease (exudate)
  6. CAB surgery (exudate)
  7. Cirrhosis with ascites (transudate)
41
Q

What is the difference between transudate and exudate fluid in a pleural effusion?

A

Transudate is fluid pushed through the capillary due to high pressure within the capillary. Exudate is fluid that leaks around the cells of the capillaries caused by inflammation

42
Q

Why is the diaphragm slightly higher up on the right?

A

Liver

43
Q

You need to take the X-ray along with the ___ __ to make a diagnosis.

A

Clinical picture

44
Q

What will you see in an X-ray of a COPD patient?

A

Hyperinflated thorax
Flattened diaphragm
Increased Hilar shadow
Perhaps bullae

45
Q

How can you quantify the size of the heart on an X-ray?

A

A normal sized heart on a PA X-ray should be 50% or < of the cardio-thoracic width on inspiration at rest

Measured by cardiac width/thorax width

46
Q

What should the aorta look like on X-ray?

A

Hockey stick/candy cane as it curls up, around + down

47
Q

If the aorta appears enlarged, what might the problem be?

A

Aortic aneurysm

48
Q

What should the pulmonary trunk look like on X-ray?

A

Grey T-shaped shadow showing the PA going to the L lung

49
Q

What is the problem called if there is black space below the diaphragm?

A

Pneumoperitoneum

50
Q

What other form of scan may be used to view the pulmonary trunk?

A

Artery angiogram

51
Q

What other organs, not in the thorax, may show up on thoracic X-rays?

A

Abdominal organs

52
Q

How are axial CT images viewed?

A

As if you are looking up the feet of a patient lying in their bed

53
Q

Why can you view internal structures in the lung clearly on a CT scan?

A

Can change black + white points

54
Q

When viewing the heart on a coronary CT, what must you be aware of to help orientate yourself?

A

Most of LV is round the back along with LA (will be lower on scan)

RV + RA round the front (will be higher on scan)

Block 2 (45 decks)

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