Lecture 3- Chest Imaging: Flashcards
Label the first few slides of the ppt.
ok
describe basics of mediastinal widening
basically; too much heart on R side, not enough on L side
describe sarcoidosis
- rheumatologic condition where the body attacks itself
- will show on chest imaging as bilateral, well-circumscribed, round lymphadenopathy in the hilum
which side of the diaphragm is usually higher?
R is higher than L because you need to make room for the liver on the R
Lung Disease
how should the costophrenic angle appear?
sharp
Pneumothroax
describe traumatic pneumothorax
- penetrating or blunt chest trauma
- latrogenic
Pneumothroax
describe spontaneous pneumothroax
- primary (young, healthy patients)
- secondary to underlying lung disease (COPD, pneumonia, sarcoidosis)
Pneumothroax
simple vs tension pneumothorax
tension: trachea has shifted
Pneumothroax
tension pneumothorax findings CXR
5 components
- shift of mediastinum, hilum, and heart
- tracheal deviation
- deep sulcus sign
- visceral pleural line
- absent vascular markings
COPD
what can form in COPD
- large bullae and blebs can form
- rupture of these can lead to spontaneous pneumothorax
COPD
characteristics on conventional radiograph
5
- lung hyperinflation
- hyperlucent upper lobes
- flattening of diaphragm
- increase in size of retrosternal air space
- barrel chest
what is pneumoperitoneum?
free air in the abdomen
Pleural Effusions
define
fluid in pleural space
Pleural Effusions
what is diagnostic of pleural effusion?
thoracentesis (removal of fluid from cavity relives sx)
Pleural Effusions
how to idenfity?
3
- blunting of costophrenic angles
- filling of fissures (pseudotumor)
- meniscus sign
Pleural Effusions
how much fluid is required to show up on PA or AP view? Lateral view? Decubitus?
- PA/AP: 250 mL pleural fluid
- Lateral: 75 mL
- Decubitus: 15 mL
Pleural Effusions
describe meniscus sign
abnormal lung density that demonstrates meniscoid-shape
Pseudotumor
describe
- fluid in minor fissure
- almost always associated with CHF
Pericardial Effusion
define
fluid around the heart
Pericardial Effusion
radiographic signs
- rapid increase in heart size (increase to old films)
- “water bottle” heart signs
Atelectasis
define
- partial lung collapse in a specific area of the lungs?
Atelectasis
tx?
deep breathing
Atelectasis
what is splinting
restriction of deep breathing
Atelectasis
what is characteristic of atelectasis?
rapid shift and clearance of fluid build up
radiologist terminology for “idk what that is but it shouldn’t be there”
- consolidation
- air space opacity
- fluffly density
- infiltrate
Pneumonia
how to differentiate atelectasis and pneumonia
- atelectasis: will resolve within a few days w/ deep breathing
- pneumonia: requires tx
both are water densities, hx is important
Pulmonary Edema
define
- exudation of fluid from capillaries into interstitial tissues and air spaces of lungs
- most common cause is L sided CHF
Pulmonary Edema
Radiographic Signs of Pulmonary Edema
- increased prominence of upper lobe vessels
- Kerley B lines
- indistinct parahilar vessels (shaggy heart)
- patchy infiltrates (bat wing)
- pleural effusions
Pulmonary Edema
what are Kerley B lines actually?
- represent thickening of interlobular septae
- fluid leaked out of space
- horizontal lines commonly seen in lateral bases of lungs
Pulmonary Edema
go to slide 64 on ppt and label the CXR
okay :(
Pulmonary Embolism
over 90% develop from?
DVTs, esp above level of popliteal veins
Pulmonary Embolism
usually a complication of?
3
- surgery
- bedrest
- cancer
Pulmonary Embolism
sx of PE
6
- CP
- DOE
- wheezing
- hemoptysis
- syncope
- arrhythima
Pulmonary Embolism
why are PE easily missed?
- non specific sx
- non specific labs
- huge ddx
Pulmonary Embolism
describe CXRs in pulmonary embolism
3 components
- high false negative rate
- nonspeific findings (subsegmental atelectasis, small plueral effusions, elevation of hemidiaphragm)
- classic findings not common
Pulmonary Embolism
describe CT Pulmonary Angiogram
CTPA
- imaging study of choice
- 83% sensitive, negative predictive value 95%
Pulmonary Embolism
advantages of CTPA
4
- filling defects in pulm arteries can be directly visualized
- rapid/accurate
- allows for making alternative dx
- can evaluate legs in same study as needed
Pulmonary Embolism
disadvantages of CTPA
4
- requires iodinated contrast
- high radiation dose
- pts need to be supine w/ breath held for 3-10 sec
- may be difficult in obese pts
Pulmonary Embolism
describe Ventilation/Perfusion Lung scan
- nuclear medicine scan
- requires a clear CXR (no asthma/COPD)
- does not require breath hold/contrast
- good in obese pts
- results are reported as high, intermediate, low probability of PE (intermeidate scans are not useful)
Bronchiectasis
image of choice?
high resolution CT
Bronchiectasis
hallmark sign?
- Signet ring sign
- bronchus becomes larger than its associated pulmonary artery
Pulmonary Nodules
size?
focal lesion less than 3cm in diameter
Pulmonary Nodules
cancerous?
benign, primary malignancy, metastatic malignancy
Pulmonary Nodules
indications of malignancy for nodules
6
- non calcification
- poorly defined margins
- associated pleural effusion
- associated atelectasis
- growth over time
- hx of smoking
Granulomas
describe
benign calcified nodules usually less than 1 cm in size
Granulomas
go to slide 83 and answer the question
okay
Metastatic Disease
what are the most likely primary tumors for lung metastases?
- kidney
- breast
- colon
- female GU
- skin CA
Metastatic Disease
what to do if you see a nodule?
chest CT to look for other nodules w/ biopsy
Metastatic Disease
if the nodule is stable for 2+ years it is likely….
benign
Metastatic Disease
what better shows nodules?
CT!
Metastatic Disease
what can CT be used to measure?
density of a nodule or mass if the calcification is not clear on chest radiograph
