L9, 12 Radiology of the Thorax

Question 1

What does pneumothorax look on xray

Answer 1

You can see the border of the lung shrunk within the cavity.

Question 2

What does pleural effusion look on xray

- can be due to heart failure, following pneumonia (pleurisy), cancer, or trauma from line placement

Answer 2

There is a meniscoid appearance at the bottom of the lung, instead of a sharp inferior border. It puts pressure on the heart and lungs.

Question 3

What are types of growths on the outside of the lung

Answer 3

• Calcium plaque are dense small masses from chronic inflammation.
• Mesothelioma: irregular thickening of parietal pleura/mediastinal pleura. No effect on the ribs but constriction of the hemithorax.
• Lymphadenopathy of mediastinum
• Neurofibroma: arising from intercostal nerves erroding ribs

Question 4

How can you tell if a mass is pulmonary or extrapulmonary

Answer 4

Pulmonary:

• lung makes acute angles between lesion and chest wall.
• May have fuzzy margins, may have air bronchiograms

Extrapulmonary

• Lung makes obtuse angles
• sharp margins: have a layer of pleura over it. - Tumour is out of the boundary of the lung

Question 5

What are signs associated with pneumonia vs cancer

Answer 5

Both: shortness of breath
Pneumonia: productive cough, fever, viral infection acute, increased WBC, CRP
Cancer: weight loss, coughing blood, smoking, chronic

Question 6

Compare the appearance of cancer vs pneumonia

Answer 6

Pneumonia is poorly defined, within the lung. There are air bronchiograms: black branching structures because there is pus in the surrounding lung tissue. Round mass in younger people.

In Cancer the mass is more well defined. If some lobes are collapsed tumour can be inside bronchus supplying it. Lymphadenopathy in paravertebral nodes make mediastinum look wider

Question 7

What are the signs of TB

Answer 7

History of weight loss, fever, cough.
On CXR spotting/ nodules in the upper lobes/ apical segment of the lower lobes.
Benign TB can present as granulomas.
TB can cause cavitation.
Often occurs with pleural effusion or lymphadenopathy.

Question 8

What is the sail sign mean in the lung

Answer 8

The left lower lobe has collapsed

Question 9

What are the major symptoms of acute pulmonary embolism

Answer 9

Acute shortness of breath, pleuritic chest pain, arrythmia, abnormal D-dimer, travel, immobility.
First CXR to exclude pneumonia. Then CT pulmonary angiogram using iodine based contrast. Should appear as small vessels

Question 10

What are the possibilities for a multifocal appearance of lung abnormality

Answer 10

Acute: Infection (TB), staph pneumonia

Subacute/chronic: metastases of cancer, sarcoidosis

Question 11

Give examples acute and chronic diffuse abnormalities

Answer 11

Acute: 
Fluid: pul oedema from congestive HF
Pus: pneumonia: from viral
Chronic: destruction: emphysema
Malignancy, 
Fibrotic lung disease- different types depending on region