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Clin Med II > L9: Pulmonary Diagnostic Imaging > Flashcards

L9: Pulmonary Diagnostic Imaging Flashcards

1
Q

List 5 indications for ordering chest x-ray.

A
  • SOB
  • Persistent cough
  • Hemoptysis
  • Chest pain or injury
  • Fever
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2
Q

Describe the systematic approach to reading a CXR.

A 
A: Airways (trachea midline?)
B: Bones (good inspiration, fractures?)
C: Cardiac silhouette/CPA (are they clear?)
D: Diaphragms (is there free air?)
E: Edges (pleural plaques, effusion?)
F: Fields (infiltrates, nodules?)
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3
Q

What are the 2 most basic views that should be ordered for a CXR?

A

PA and Lateral

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4
Q

What benefits does a lateral view have?

A

Pts lay on L side
Helps to not significantly magnify the heart
Allows us to see posterior structures

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5
Q

When would an apical lordotic view be useful?

A

When trying to visualize the apices of the lungs (such as with TB)

*Pt positioned at 30 degrees forward

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6
Q

A Hampton’s Hump seen on CXR is indicative of a:

A

Pulmonary infarct

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7
Q

What conditions cannot be seen on a CXR?

A

Very small cancers

Pulmonary emboli

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8
Q

List 5 indications for ordering a CT scan of the lungs.

A
  • To clarify ABNORMAL CXR
  • Characterize PULMONARY NODULES
  • Assist in DIAGNOSIS of clinical signs/sxs (cough, SOB, CP, fever)
  • DETECTION and STAGING of 1*/metastatic lung neoplasms (including SCREENING for lung CA)
  • Evaluate suspected MEDIASTINAL or HILAR MASSES
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9
Q

1mm slice, better detail

This type of CT scan is a:

A

High resolution (HRCT)

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10
Q

10mm slice, “step and shoot”, takes 25-30 minutes

This type of CT scan is a:

A

Conventional scan

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11
Q

Less detail, used for screening

This type of CT scan is a:

A

Low dose (LDCT)

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12
Q

Faster, continuous, takes <5 minutes

This type of CT scan is a;

A

Helical (spiral) CT

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13
Q

What type of CT scan helps to visualize blood vessels?

A

CT angiography

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14
Q

What 2 populations should we avoid giving CT scans to if possible? Why?

A

Peds: more radiosensitive, increased risk for leukemia and brain tumors with CT scans

Pregnant women: In utero exposure linked to pediatric CA mortality; ALWAYS ASK LMP PRIOR TO IMAGING!

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15
Q

What type of radiocontrast is used with CT? What are 3 scenarios we would use contrast for?

A

Iodine

Visualization of:

  • Vessels
  • Malignancies
  • Chest trauma
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16
Q

What are the potential risks to consider when giving a patient radiocontrast for a CT?

A
  • Allergic reaction (minor to severe)
  • Contrast induced nephropathy (CIN)
  • Development of lactic acidosis if taking glucophage (Metformin) - may require holding for 48 hrs after imaging
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17
Q

What are the risk factors for a pt developing an allergic contrast after receiving radiocontrast? How can you treat this prophylactically?

A

Risk factors: Prior rxn, hx of asthma or atopy (NOT SHELLFISH!)

Pre-treat with prednisone and diphenhydramine (Benadryl)

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18
Q

What are the lab values seen in a patient with radiocontrast induced nephropathy? When do sxs start presenting and when do they peak?

A

Increase in serum Cr >/= 0.5 mg/dL or >/= 25% from baseline

  • sxs appear 24-48 hrs post exposure
  • Peaks at 3-5 days
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19
Q

A pt with decreased kidney function should not be given radiocontrast if their:

A

Creatinine > 1.5 mg/dL or GFR <60

20
Q

You should assess renal function prior to giving contrast if a patient presents with any 5 of the following indications:

A 
Age > 60 yrs
Hx of renal disease
Hx of HTN treated with medication
Hx of diabetes
Taking Metformin
21
Q

What has largely replaced conventional (catheter directed) pulmonary angiography?

A

CT Pulmonary Angiography (CTPA)

*Less invasive, less expensive, less time-consuming

22
Q

What are 4 things a CTPA is useful in detecting?

A
  • PE
  • Aortic dissection
  • Superior vena cava syndrome
  • Identifying vascular malformations and arterial invasion by a neoplasm
23
Q

What are 5 risks and limitations of a CTPA?

A
  • May miss sub-segmental PE
  • Allergy risk to contrast
  • CIN from contrast
  • Radiation exposure
  • Body habitus >450lbs
24
Q

What is the gold standard for an evaluation of a PE?

A

Catheter-Directed Pulmonary Angiography (“Direct PA”)

  • Needle/catheter inserted into R femoral or internal jugular vein; into R side heart and pulm. arteries
  • Dye injected, x-rays taken
25
Q

A catheter-directed pulmonary angiography is useful when a ____ or ____ is inconclusive.

A

V/Q scan

CTPA

26
Q

What are 5 risks of a direct pulmonary angiography?

A
  • Bleeding or hematoma at insertion site
  • Heart arrhythmia
  • Allergic reaction to contrast material
  • CIN from contrast
  • Radiation exposure
27
Q

Does a CT or MRI show a more detailed view of lung parenchyma?

A

CT

But MRI has no bone artifact and no ionizing radiation

28
Q

What is the contrast used for MRI?

A

Gadolinium

29
Q

You should avoid use of gadolinium if the pt’s GFR is _____, as this may cause _____.

A

if GFR <30ml/min

Risk of nephrogenic systemic fibrosis (skin fibrosis +/- systemic involvement); irreversible

30
Q

What are 4 contraindications for use of MRI?

A

Implanted pacemaker or defibrillator
Metal in eye
Aneurysm clips
Cochlear implant

31
Q

What are the 2 types of nuclear imaging used for evaluation of the chest?

A

Ventilation-perfusion scan (V/Q)

PET scan

32
Q

What are 2 indications for the use of a V/Q scan?

A

Eval of pulmonary embolisms (best in pts with normal CXR but high suspicion for PE)
Pre-op assessment prior to lung resection (estimates post-op reserve capacity)

33
Q

What does a V/Q mismatch mean?

A

Imbalance of blood flow and ventilation

34
Q

What is the test of choice for diagnosis of a PE in pregnant women?

A

V/Q scan (very low dose radiation exposure)

35
Q

What is one downside to V/Q scans? (think specificity, sensitivity)

A

Sensitive for PE but poor specificity (few false negatives, high number of false positives)

36
Q

What are PET scans most useful in detecting?

A
  • Cancer and metastases
  • Effects of CA therapy
  • Mediastinal imaging (superior to CT; can identify tumor in normal sized LN)
37
Q

What is the radioactive substance used in a PET scan?

A

Fluorodeoxyglucose (FDG)

  • Injected into patient
  • Accumulates in tissues/organs with high metabolic activity (like cancer cells)
38
Q

During a PET scan, measurements of uptake are made in SUVs (standardized uptake values). What SUV level raises possibility of malignancy?

A

SUV > 2.5

39
Q

What are 2 major benefits to using a PET scan?

A
  • Can detect biochemical changes BEFORE they are apparent on CT or MRI
  • Radioactivity is short-lived
40
Q

What is a limitation of PET scans in regards to false + and -?

A

False results occur with metabolic imbalances:
False (+): occur with inflammatory lesions/granulomas
False (-): occur with slow growing tumor

41
Q

What are 3 indications of a thoracic ultrasound?

A
  • Bedside detection of pleural fluid, hemothorax, or pneumothorax
  • Guidance for thoracentesis
  • Guidance for placement of thoracostomy tubes
42
Q

What are 3 diagnostic indications for a bronchoscopy?

A
  • Eval of pneumonia, hemoptysis, cough
  • Dx of tracheoesophageal fistulas/tracheobronchomalacia
  • Tissue sampling
43
Q

What are 2 therapeutic indications for a bronchoscopy?

A
  • Removal of excess mucus or foreign bodies

- ET tube placement

44
Q

What are the 2 types of bronchoscopy? Which is commonly used in pts with obstruction of the trachea or a proximal bronchus?

A

Rigid vs Flexible

Rigid used in that scenario

45
Q

What are 5 contraindications for bronchoscopy?

A
  • Severe hypoxia
  • Risk of bleeding
  • Pulmonary HTN
  • Severe coughing/gagging
  • Tracheal stenosis

Clin Med II (9 decks)

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