Lau PowerPoint - Chest Radiography Part 2 Flashcards
anterior mediastinal mass carries what major differentials?
4 T’s!!!! terribly lymphadenopathy, thymic tumors, teratoma, and thyroid mass.
aortic aneurysm and pericardial cyst are part of the differential for what mass location within the mediastinum?
anterior
what is the one indication that the mass is definitely NOT a hilar mass?
if you can see the mass hilum THROUGH the mass
thyroid masses can be hot or cold - what is the big difference?
hot masses are the cells that are making too much thyroid hormone and may simply be inflamed - cold masses are more indicative of cancer/malignancy
what is the most and least common differential for a mass in the anterior mediastinum?
lymphadenopathy and thyroid mass.
what is a consistently enlarged thymus indicate?
myasthenia gravis
what is the most common cause of middle mediastinal mass?
lymphadenopathy due to metastases or primary tumor
the following are differentials for which location within the mediastinum? hiatial hernia, aortic aneurysm, thyroid mass, duplication cyst, and bronchogenic cyst?
middle mediastinal mass
what is the one characteristic on an CXR that will definitely tell you the person has a hitial hernia?
gastric bubble above the diaphragm
What is the most common complaint from patients suffering from a hiatial hernia?
GERD (and gas)
middle mediastinal mass is most typically what until proven otherwise?
lung cancer (primary or metastasized)
which type of lung cancer is known to produce neuroendocrine hormones?
small cell (gotten by mostly smokers)
the differential for a ____ mediastinal mass includes neoplasm, lymphadenopathy, aortic aneurysm (as a single isolated mass).
posterior
if the mass is projecting above the clavicles where is it’s location?
posterior mediastinal
what is typically the cause of the left diaphragm being higher than right?
phrenic nerve injury (3,4,5)
differentials include tb, cancer and pneumonia - cardiomegaly is also present - what is not most likely of the three?
cancer
the patter of the “bat wing” on CXR is indicative of what?
pulmonary edema
These are short parallel lines at the lung periphery. Typically indicative of CHF
kerley B lines
what is the one major sign that almost always indicated pulmonary edema?
kerley B lines
current jelly sputum - what should be your no. 1 ddx?
aspiration pneumonia
what is the best CXR view to detect presence of LLL pneumonia?
lateral view
what are the three things we are always looking for (as PA’s) when viewing the CXR?
pleural effusion, infiltrates, and pneumothorax
concave menisci with blunting of both posterior costophrenic angles - what should be your no. 1 ddx?
pleural effusion
what is the radiographic sign that is indicative of pericardial effusion?
water bottle heart
a set of findings on physical examination in people with large collections of fluid around their heart.
Ewart’s sign; + typically indicated pericardial effusion
what will pericardial effusion do to the image of the heart on the cxr?
cause an enlarged heart shadow which appears as cardiomegaly
the workup for pleural effusion includes a determination of what?
of whether the effusion is transudative or exudative - Light’s criteria
Protein (pleural to serum ratio) >.5 transudate or exudate?
exudate - these also have greater absolute protein!! (Hint: when you got out - you want to go out with a bang in full effect (heavy) and clear of conscience)
LDH (pleural to serum ratio) >.6 transudate or exudate?
exudate - these also have higher absolute LDH
Clear yellow appearance - transudate or exudate?
transudate - exudate would be clear or turbid in appearance
Specific gravity > 1.016 transudate or exudate?
exudate
Glucose (serum to pleural ratio) <1 transudate or exudate?
transudate - exudate is >1
suggests nephrosis, CHF, cirrhosis - transudate or exudate? MCC?
transudate; CHF
infection (pneumonia, TB), malignancy,
empyema, peritoneal dialysis, pancreatitis, or chylothorax - transudate or exudate? MCC?
exudate; bacterial/pneumonia
what condition with give you both transduative and exudative effusions?
pulmonary embolism
PE in small vessel with give you what type of effusions?
transudate
PE in large vessels will give you what type of effusions?
exudate - Hint: remember, you want to exit in a big way
what are the two MCC of pleural effusion?
CHF and pneumonia
what is the MCC of obstruction of the SVC?
cancer of the apices of the lung
what is the typical presenting sign for cancer of the apices of the lung?
atraumatic shoulder pain
a tumor of the pulmonary apex is called?
pancoast tumor aka sulcus tumor
what is the best way to treat a pancoast tumor? 1. surgery 2. chemo/radiation 3. surgery then radiation 4. no treatment
radiation - surgery would only spread the tumor
combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis), sometimes accompanied by decreased sweating (anhidrosis) of the face on the same side - what is this called?
Horner’s syndrome
what type of lung cancer would also present with Horner’s Syndrome? On which side of the face would the anhidrosis present?
Pancoast tumor/sulcus tumor/cancer of the apex of the lung. RIGHT SIDE
A sulcus line is indicative of what?
pneumothorax
pts with a chronic pneumothorax should be given what for treatment?
doxycycline
what are the four types of pneumo?
spontaneous, traumatic, iatrogenic, tension
pneumo typically occurring as a result of underlying lung disease?
spontaneous (secondary) - primary would be without disease
pneumo assoc with mechanical ventilation w/ barotrauma.
tension pneumo
systolic crunch heard over the cardiac apex
hamman’s sign
syndrome comprised of subcutaneous emphysema (air subcut tissue) and pneumo-mediastinum (air in center of chest cavity)
Hamman’s syndrome - must do needle decompression.
what is the relation between hamman’s syndrome and hamman’s sign?
the syndrome can cause the appearance of the sign
tension pneumo is an example of what kind of shock?
obstructive shock - IOW caused by mechanical impediment to ventricular filling
streaky lucencies over the mediastinum is indicative of what two things?
pneumo-mediastinum and subcutaneous emphysema (and if together you have Hamman’s syndrome)
which conditions include the following differentials: asthma, surgery (post op complication), traumatic tracheo-bronchial rupture, barotrauma, and smocking crack?
pneumomediastinum
pnuemomediastinum should first be distinguished from what other two conditions?
pneumothorax; pneumopericardium
what the one way you can differentiate pneumopericardium from pneumomediastinum? Hint: air pattern
air can be present underneath heart but should not be in neck if pneumopericardium
what heart valve is typically replaced and why?
aortic - to prevent vegetation which leads to endocarditis and eventually the biggest danger is that this becomes a septic embolus
term to describe fluid in the lungs
hydropneumothorax
