L14 Radiology of the Thorax 1 Flashcards
4x Locations of Problems in the Thorax
Mediastinum (outline of heart that overlies the vertebrae)
Pleura
Lungs/Bronchi (vessels and bronchi coming into them)
Chest Wall (ribs)
Radiographic densities
1. Normal: Calcium: Bone Soft tissues Fat Air 2. Abnormal: Metal
Lateral Chest X-ray
posterior posturepedic angle
-show small pleura diffusion
To locate is to diagnose
Location Location Location
Mediastinum + Pleura + Lungs/Bronchi + Chest Wall
Mediastinum abnormality
mass extending from mediastinum
- enlarged heart
- tumour
Pleura
Two layers surround each lung
-Visceral- adherent to the lung
-Parietal- lines the thoracic cavities
Pleural cavity is the potential space between the pleura and normally contains a small amount of serous pleural fluid
Pleural Problems
- Pneumothorax
- Pleural effusion
- Tumours
- Plaques +/- calcium
- Lung Cancer
- Metastases
- Mesothelioma
Pnuemothorax
air between two layers of pleura
-doctor inserting central line + car accidents
(pneumonia develop cysts which pump air into pleura)
-increased separation
1) no vessels seen beyond lung
2) cannot see lung outline
3) air in cavity stopping lungs getting back to SVC and IVC in lung
4) CANT GET AIR IN - aspiration + bilateral pneumothoracis
Pneumothorax = White lung + Black outside
-most dramatic and life threatening
-common after trauma, penetrating injury, extreme asthma cannot force air out
Pleural effusion
between the two layers of pleura
Meniscoidal appearance (balloon forced into water)
=Most common in Pneumonia, irritation of pleura surface creating fluid
=Plerosis = inflammation of the pleura
Causes of Pleural Effusion
1) Common: CHF/Fluid overload (Bilateral) Parapneumonic (Pleurisy) (Unilateral) 2) Less Common: Cancer/Metastases Trauma- includes iatrogenic (Lines)
White-out Pneumothorax trauma
absolute straight to emergency ward
-ruptured SVC or pulmonary veins
Pleural effusion development
Bilateral pleural effusions, look for other features of congestive heart failure before anything else
-80%+ larger right effusion congestiv heart failure
-ECG leads- came in with chest pain + bilateral effusions + big heart + big vessels
= bilateral pleural effusions caused by congestive heart failure
Pulmonary odema
cannot see vessels
Fluid from BV leaking into alveoli
Lower lobe veins constrict, fluid leaks into interstitian + lymphatics
then happens in upper lobes
then alveoli = alveolar stage is p oedema
=pleural effusions happen next
=overall condition congestive herat failure as heart is congested and lungs aren’t clear
As Lungs clear
can see margins b/w BV and alveoli
What are the most common and important causes of pleural effusions
1) pneumonia
2) congestive heart failure (orthopnia/short of breath when lie down + swollen ankles)
- different history
Aortic Transection
major trauma
part of aorta stays moving and part stationary (more stabilised in chest)
moving part tears inner two layers of aorta
outer layer adventitia only part holing aorta together
90% injury dies
Tumours Pleural Problems
Least common effect on pleural
- Plaques +/- calcium (asbestis)
- Lung Cancer
- Metastases
- Mesothelioma
Asbestis
calcification (calcified pleural plaque)
messed up mediastinum
CT scan = extra calcifications on parietal pleura + diaphragm
–> develop mesothelioma
=nasty irregular thickening on pleura + on medistinal side of pleura
=lung cannot expand
oblique fissure thickened by tumour
=parasagital white rind of tumour surrounding lung
Difference between inside Pleura and inside lung
Well defined air mass interfaces
=cancer= mass has epicentre in lung = arising from mediastinum
Distinction between origins
Pulmonary vs Extrapulmonary
1) Pulmonary
- Lung makes acute angles between lesion and chest wall
- May have fuzzy margins (pneumonia)
- May have air bronchograms
2) Extra-pulmonary
- Lungs makes obtuse angles
- Sharp margins (pushing pleura out of way)
Pulmonary vs Extrapulmonary angles
Pulmonary: acute angle of lung between lesion and pleura
-epicentre still in lung
Extrapulmonary: obtuse angle of lung between lesion and pleura
Tracheobronchial tree/airways
Symptoms PFTs CXR CT scanning Bronchoscopy -given barium mixture historically. now CT scan w. parenchyma
