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Respiratory System Module > L19 Radiology of the Thorax II > Flashcards

L19 Radiology of the Thorax II Flashcards

1
Q

Chest X-ray which bloops out everywhere

A

Lymphoma Lymphadenopathy

-goes into both pneumothoraxes

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2
Q

Neurofibroma

A

makes obtuse angles with rest of lung = coming from pleura or chest wall
invades into rib= weird soft tissue tumour or rising from vessels/nerves = the neurovascular bundle
-nerve is most likely to go wrong

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3
Q

What can lung disease’s effect?

A
  1. Pulmonary arteries e.g. vasculitis, Pulmonary Emboli
  2. Bronchi e.g. Asthma, Bronchitis, Bronchiectasis
  3. Lung Parenchyma e.g. Pneumonia, Lung cancer, Emphysema, Chronic Intersitial Lung disease
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4
Q

Lung disease’s effecting the Pulmonary arteries

A 
-long flight
Vasculitis (very rare)
Pulmonary Emboli (sore leg, sitting down for ages, short of breath)
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5
Q

Lung disease’s effecting the Bronchi

A

Asthma
Bronchitis (smoking)
Bronchiectasis (smoking, viruses in cold conditions)

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6
Q

Lung disease’s effecting the Lung Parenchyma

A

-vivid in chest X-ray
-clinical conditions
Pneumonia
Lung cancer
Emphysema
Chronic Interstitial Lung Disease

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7
Q

Common Lung Abnormalities

A 
Pneumonia
Lung cancer- primary or metastases
Trauma
Pulmonary Emboli
Cardiac Failure (CHF)
Chronic Diffuse Lung Diseases
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8
Q

Important Questions if abnormality in the lungs (not mediastinum, pleura or chest wall)

A
  1. Pattern of Lung abnormality (to figure cause)
    - Focal
    - Multifocal
    - Diffuse
  2. Acute or Chronic
    - history is crucial
  3. Other clues e.g. cardiomegaly
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9
Q

Focal abnormlaity: Lung nodule

A

little white dust mark= centrally calcified nodule (satellite lesions)

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10
Q

Focal abnormality: Granuloma

A

granuloma= focal response of lung to fight off infection (TB) (histoplasmosis USA)

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11
Q

Focal abnormality: symptoms

A 
poorly marginated. potentially pneumonia or cancer
pacemaker= heart big
well defined (not size)= more likely to appear with symptoms of cancer (haemoptosis and weight loss)
-weight loss
-short breath
-productive cough
-fever
-haemoptosis
-chest wall pain if hit pleura/ribs
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12
Q

Lobar collapse

A

What is blocking the bonchus??
-difficult to differentiate b.w pneumonia or cancer
-Pneumonia more likely to cause complete collapse of a lobe
-tumour in lower lobe bronchus= obstruction behind it
Sreatment: Straight to bronchoscopy or CT scan
-CT to look at liver and do staging + see where cancer is

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13
Q

Pneumonia vs cancer

A

History, Symptoms, time course (perfect–> queasy)
Exam
CXR appearance

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14
Q

Focal lesion

A

mass like opasity
-opaque to x-ray (better word than density as means blackness)
-fever? infectious symptoms?
- looks mass like so do follow up chest x-ray to make sure it goes away
-Lateral film = looks like a lobar process
-not total lobar collapse as oblique fissure isnt that high
= lobar pneumonia as good signs of co-infection

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15
Q

Lung total/partial collapse

A

Partial collapse in pneumonia:
lung isnt expanding well as is full of junk
Complete collapse: can happen in pneumonia but really hints to having tumour to cause the obstruction

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16
Q

Multifocal- including nodules

A 
Acute:
-infection ep TB
-Staphalococcus pneumonia (multiple lung lesions/nodules, really sick, IV lungs and splat out into lungs and pot. cavitates. IV drug abusers. lungs can be quickly completely destroyed)
Subacute or Chronic:
-Metastases
-Sarcoidosis
17
Q

Classic appearance

A

that is ______ until proven otherwise

-multifocal

18
Q

Staphalococcus Pneumonia

A 
multiple lung lesions/nodules
really sick
infects lungs and splat out into lungs 
pot. cavitates.
 IV drug abusers. lungs can be quickly completely destroyed
19
Q

TB

A

Hall marks:
-Multiple nodules (UPPER lobes)
-assoc. with mediastinal lymph nodes (Lymphadeopathy)
-Cavitary lesions w. air fluid level: pot. pleural effusions
cavitating mass is upper lobes
-recently travelled to india
Tb is weird with symptoms.
-doesnt have to be symptomatic. can be asymptomatic when with TB
-X-ray can be varied

20
Q

Kidney Removal

A
  • Metastatic spread from renal cancer
  • progressively getting short breaths over 6 months
  • large lymph nodes in mediastinum
  • multiple non-well defined nodules
21
Q

Diffuse Lung disease questions if diffusely abnormal X-ray

A

over 200

  1. Acute vs Chronic: How long has the patient being sick
  2. Pattern of Distribution
22
Q

Diffuse Lung Abnormality: Acute

A

Acute:
FLUID: e.g. Pulmonary Oedema (Congestive heart failure. specific symptoms important/Grade. More short of breath when lying down. Orthopnea. ankle Oedema)
PUS (infection): e.g. Pneumonia (airspace disease everywhere, fever)
BLOOD (rare): e.g. Goodpastures (membrane antibase)

23
Q

Diffuse Lung Abnormality: Chronic

A

Chronic (6 months):
Destruction: e.g. Emphysema (smoking destroyed all of lungs- easy to diagnose)
Malignancy
Fibrotic Lung disease >100
Caused by:
1. Bronchoalveolar Cell Carcinoma
2. Alveolar Protonosis (alveoli fill up with gram _ve biofringent material)- Lungs lavarged out every 6months. B. material gets washed out. No cure, keep returning every 6 months. 6 years Lungs then fibrose down –> death

24
Q

Pulmonary Oedema

A

Diffuse Lung Abnormality: Acute:
FLUID: e.g. Pulmonary Oedema (Congestive heart failure. specific symptoms important/Grade. More short of breath when lying down. Orthopnea. ankle Oedema)

25
Q

Acutely unwell overnight

A 
Heart attack: heart just failing and getting rampant pulmonary oedema
ECG leads= chest pain
Large heart
Airspace disease
No/Little effusion
26
Q

Chronicly unwell/ Resolving Pulmonary Oedema

A

ECG lead
Heart big
Bilateral pleural effusions
doesnt really have the airspace stuff= started to clear into pleural space = resolving pulmonary oedeama

27
Q

Multifocal SARS

A

SARS: spanish flu. (Infection)
(the MERS camels middle easten respiratory syndrome and Bird Flu)
Multifocal –> Diffuse
SARs Symptoms: Fever. Dry cough. Multifocal abnormalities
-Not congestive heart failure/Pulmonary oedema as doesnt have orthopnea, elevated jugular vein, ankle odema, chest pain

28
Q

Tracheoctomay

A

still have IV (incubated)

29
Q

Assymetric appearance

A

Asymetric = more likely to be pneumonia

  • attack one part of the lung first –> then spread
  • could have congestive heart failure as well
30
Q

Airless lungs

A

totally white

31
Q

Alveolar Protonosis

A

(alveoli fill up with gram _ve biofringent material)- Lungs lavarged out every 6months. B. material gets washed out. No cure, keep returning every 6 months. 6 years Lungs then fibrose down –> death

32
Q

To distinguish the >100 diseases

A

History CRITICAL esp. Acute vs Chronic
Distribution important
Other clues: e.g. nodes, effusions, cardiac size

33
Q

Ways lung respond to insult

A

Diseases predominatly effecting the Upper lobes:

  1. Fibrosis/scarring
    - occurs in TB. (scarring during healing)
    - lung pulls toward the scar
  2. Silicosis- large scale: patent working in silica mining. Diffuse lung disease but predominately upper lobes. Inhaled so much silica that scarring happens where lungs are Least Airated
  3. Sarcoidosis
34
Q

Least airated areas of lungs

A
  • Upper Lobes
  • Least airated relative to the Blood supply
  • There is more blood in the lower Lobes, (blood) helping to clear away disase-stuff in the lower lobes
35
Q

Distribution: Chronic Diffuse Lung Disease

A

Upper Lobes: Tb, Sarcoidosis, Silicosis
Lower Lobes: UIP/Fibrosing Alveolitis (most common diffuse fibrotic lung disease) (peripheral), Asbestosis
Anywhere: Lymphangitic Metastases

36
Q

UIP and IPF

A

Usual Interstitial Pneumonitis (peripheral)
Idiopathic Pulmonary Fibrosis/ Fibrosing Alveolitis
-1 year development becoming shorter of breath
- Non specific auditory/ausculatory findings: dry crackles in both of lung bases
-Idiopathic: dont know cause
-feel like lungs are constricting and cant take a big breath
-Gross morphology: characteristic Peripheral Honeycomb lung (CT scan) (almost normal lung centrally)
-Histology: some thickened alveoli septa = decreases diffusing capacity and hence ability to breathe. increases V-Q mismatch
-associated with other CT diseases
-fibrosising= lung gets smaller

37
Q

CT scan

A

illustrate that is peripheral

  • honeycomb lung in CT
  • avoid biopsy of most common diffuse lung disaese (fibrotic lung disease)
  • feel like lungs are constricting and cant take a big breath
38
Q

Connective Tissue Diseases associated with Lung disease

A
  1. Rhuematoid Arthritis
  2. Progressive Systemic sclerosis/Scleroderma
  3. Systemic Lupus Erythematosis (SLE)
    1-3: most likely to show peripheral honeycomb fibrosis
  4. Dermatomyositis/ Polymyositis
  5. Sjogren’s syndrome
  6. Asbestosis (effect of asbestosis needles causing similar pattern of peripheral honeycomb lung)

Respiratory System Module (25 decks)

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