L14 Radiology of the Thorax 1

Question 1

4x Locations of Problems in the Thorax

Answer 1

Mediastinum (outline of heart that overlies the vertebrae)
Pleura
Lungs/Bronchi (vessels and bronchi coming into them)
Chest Wall (ribs)

Question 2

Radiographic densities

Answer 2

1. Normal:
Calcium: Bone
Soft tissues
Fat
Air
2. Abnormal:
Metal

Question 3

Lateral Chest X-ray

Answer 3

posterior posturepedic angle

-show small pleura diffusion

Question 4

To locate is to diagnose

Answer 4

Location Location Location

Mediastinum + Pleura + Lungs/Bronchi + Chest Wall

Question 5

Mediastinum abnormality

Answer 5

mass extending from mediastinum

• enlarged heart
• tumour

Question 6

Pleura

Answer 6

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

Question 7

Pleural Problems

Answer 7

1. Pneumothorax
2. Pleural effusion
3. Tumours
   - Plaques +/- calcium
   - Lung Cancer
   - Metastases
   - Mesothelioma

Question 8

Pnuemothorax

Answer 8

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

Question 9

Pleural effusion

Answer 9

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

Question 10

Causes of Pleural Effusion

Answer 10

1) Common:
CHF/Fluid overload (Bilateral)
Parapneumonic (Pleurisy) (Unilateral)
2) Less Common:
Cancer/Metastases
Trauma- includes iatrogenic (Lines)

Question 11

White-out Pneumothorax trauma

Answer 11

absolute straight to emergency ward

-ruptured SVC or pulmonary veins

Question 12

Pleural effusion development

Answer 12

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

Question 13

Pulmonary odema

Answer 13

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

Question 14

As Lungs clear

Answer 14

can see margins b/w BV and alveoli

Question 15

What are the most common and important causes of pleural effusions

Answer 15

1) pneumonia
2) congestive heart failure (orthopnia/short of breath when lie down + swollen ankles)
- different history

Question 16

Aortic Transection

Answer 16

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

Question 17

Tumours Pleural Problems

Answer 17

Least common effect on pleural

• Plaques +/- calcium (asbestis)
• Lung Cancer
• Metastases
• Mesothelioma

Question 18

Asbestis

Answer 18

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

Question 19

Difference between inside Pleura and inside lung

Answer 19

Well defined air mass interfaces

=cancer= mass has epicentre in lung = arising from mediastinum

Question 20

Distinction between origins

Pulmonary vs Extrapulmonary

Answer 20

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)

Question 21

Pulmonary vs Extrapulmonary angles

Answer 21

Pulmonary: acute angle of lung between lesion and pleura
-epicentre still in lung
Extrapulmonary: obtuse angle of lung between lesion and pleura

Question 22

Tracheobronchial tree/airways

Answer 22

Symptoms
PFTs
CXR
CT scanning
Bronchoscopy
-given barium mixture historically. now CT scan w. parenchyma