Lecture 3 (x-ray-chest), Exam 2 Flashcards

Question 1

Q

Chest

Plain flim diagnosis of heart disease is limited because why?
What is the standard set of imaging?
How should you look at the chest r-xay?

Answer

A

Plain film diagnosis of heart disease islimited to the determination of cardiacenlargement, pulmonary vascularabnormalities, cardiac calcifications andCHF
PA and Lateral comprise standard set of imaging
Start at apices, thencostophrenicangles,cardiophrenicangles, diaphragms, gastric bubbles,pulmvasculature, and then trachea and heart size.

Question 2

Q

Chest PA vs AP

How is PA chest radiograph obtained?
What does AP projection result in?
What is the x-ray for those that cannot stand?

Answer

A

Posteroanterior (PA) chest radiograph obtained by placing the x-ray source behind the patient.
Anteroposterior projection (AP)results in apparent enlargementof the heart, a phenomenonknown as magnification.
AP Chest reserved for those thatcannot stand

Question 3

Q

Which one is AP and PA?

Answer

A

The AP shows magnification of the heart and widening of the mediastinum. Whenever possible the patient should be imaged in an upright PA position. AP views are less useful and should be reserved for very ill patients who cannot stand erect.

Question 4

Q

The Heart – Key Concepts

Advanced imaging can give detailed information about what?
Heart size should be no larger than what?
When can cardiac enlargment be simulated or masked?

Answer

A

Advanced imaging can give detailedinformation about cardiac thickness andmotion, precise chamber size, the presenceof valvular disease, coronary artery disease,pericardial disease, and cardiac function
Heart size should be no larger than half ofthe thoracic cage at its widest margin (thisis known as the cardiothoracic ratio)
Cardiac enlargement may be simulated (ason poor inspiration) or masked (as in apatient with a pleural effusion)

Question 5

Q

The cardiac silhouette normally occupies what? What happens if it exceeds that?
What can the exceed space be the result from?
What are non-cardiac causes of an enlarged silhouette?

Answer

A

The cardiac silhouette normally occupies less than 50% of the transverse diameter of the chest on a PA radiograph. If this cardio-thoracic ratio exceeds 50%, the cardiac silhouette may be enlarged.
This can result from enlargement of the heart or from pericardial fluid.
Non-cardiac causes of an enlarged silhouette include increased mediastinal fat, thoracic cage deformities such as pectus excavatum, and poor inspiration.

Question 6

Q

Lateral views

How is lateral view obtained?
What ribs are larger?
What is usually lower than the right?
What is easy to see?

Answer

A

The lateral view is obtained with the left chest against the cassette.
Right ribs are larger (red arrows)
Left hemidiaphragm (black arrow) and left costophrenic angle (blue) areusually lower than the right
easy to see posterior fluid collection

Question 7

Q

On the left lateral chestfilm, the convexposterior heart border does what?

Answer

A

On the left lateral chestfilm, the convexposterior heart border does not extendbeyond the posterior margin of the inferiorvena cava
* (A to B) X2 =C to D

Question 8

Q

Lateral Decubitus Position:
* Could be helpful in what?
* Not a _ view
* What does the this flim show?

Answer

A

This could be helpful to assess the volume of pleural effusion and demonstrate whether a pleural effusion is mobile or loculated (look at difference).
Not a standard view
Decubitus film in this case showing a mobile pleural effusion (arrows).

Nowadays: order CT +percuss on PE

Question 9

Q

What are the factors that alter the cardiothoracic ratiomeasurement?

Answer

A

Factors that alter the cardiothoracic ratiomeasurement:
Expiratory films
Whenever any kind of abdominal distension ispresent (pregnancy, ascites, intestinal obstruction),you will not be able to determine heart size
AP portable chest film will slightly magnify theheart
A rotated film will change the size of the heartand shape of themediastinum–cannotdetermineheart size

Question 10

Q

Chest:
* Patient should be examined when? What does this help with?
* What can expiration lead to?
* What level should the diaphragm be found out?

Answer

A

The patient should be examined in full inspiration. This greatly helps the radiologist to determine if there are intrapulmonary abnormalities.
Expiration can lead toloss of the right heart border silhouette.
The diaphragm should be found at about the level of the 8th- 10thposterior rib or 5th- 6thanterior rib on good inspiration.

Question 11

Q

Which one is underpenetrated and overpenetrated?

Question 12

Q

What type of film is this?

Answer

A

Right: rotated film skin folds can be mistaken for a tension pneumothorax.
* Notice the skewed positioning of the heads of the clavicles.

Question 13

Q

Which views comprise a standard CXR series
* AP and lateral
* PA and lateral
* AP and PA
* PA and decubitus

Answer

A

PA and lateral

Question 14

Q

What are the lobes and fissures of the lungs?
* What divides lobes? What does it allow?
* On PA chest x-ray, the minor fissure divides what?
* What is really not seen well?
* If there is fluid in the fissure, it is occasionally manifested as what?

Answer

A

Fissures divide lobes. Knowing them allows localization of lesion.
On the PA chest xray, the minor fissure divides the right middle lobe from the right upper lobe and is sometimes not well seen. There is no minor fissure on the left.
The major fissures are usually not well seen on the PA view because you are looking through them obliquely.
If there is fluid in the fissure, it is occasionally manifested as a density at the lower lateral margin.

Question 15

Q

What does the x-rays show?

Question 16

Q

Fill in the lung margins

Question 17

Q

Fill in

Question 18

Q

Fill in

Question 19

Q

Fill in

Question 20

Q

Great Vessels

What is indicated of the right aortic arch?
Where is the descending aorta?

Answer

A

Presence of a right aortic arch is indicated by a large bulge on the right side of the trachea (arrows) and leftward deviation of the trachea.
The descending aorta is just to the left of the spine shadow in patients with a left arch and usually to the right of the spine in those with a right arch.

Depending on age, the ascending aorta may not be visible. The aortic arch is on the left in almost all individuals, but is found on the right in a small number (see figure below). Right aortic arch is occasionally associated with other cardiac anomalies or dysphagia.

Question 21

Q

Great Vessels: what is this?

Answer

A

In the adult, the pulmonary trunk (arrow) is normally concave or straightened.

Question 22

Q

The main pulmonary artery (pulmonary trunk) is normally where? Why?
In adults it should be what?
In children and young adults it will be what?
Enlargement of the pulmonary trunk suggests what?

Answer

A

The main pulmonary artery (pulmonary trunk) is normally present just below the aortic arch. Because it is within the pericardium, its shadow is continuous with the left cardiac border.
In adults it should be either flat or concave (see figure below).
In children and some young adults it will be convex.
Enlargement of the pulmonary trunk suggests increased pulmonary blood flow or increased pressure due to pulmonary valvular stenosis.

Question 23

Q

What is this?

Answer

A

Enlargement of the azygous vein (arrow) in a patient with right ventricular failure secondary to left ventricular failure or vena cava obstruction.

Question 24

Q

What is this?

Answer

A

Enlargement of the inferior vena cava is indicated by bulging of the cava at the right cardiophrenic angle (arrow, left) and posteriorly (arrow, right) in this patient with severe tricuspid regurgitation.

Question 25

Q

The inferior vena cava (IVC) is usually visible where?
What does the SVC usually form?
What may indicate increased right atrial pressure?

Answer

A

The inferior vena cava (IVC) is usually visible posterior to the posterior border of the heart on the lateral projection.
The superior vena cava (SVC) usually forms the right border of the upper supracardiac mediastinum.
Distension of the SVC or posterior bulging (see figure below) or visibility of the IVC in the right cardiophrenic angle may indicate increased right atrial pressure

Question 26

Q

Pulmonary Vascular Patterns:
* A normal pulmonary vascular pattern in the adult is characterized by what?
* What tapers laterally
* What should happen inferiorly?
* Where should there be no markings?

Answer

A

A normal pulmonary vascular pattern in the adult is characterized by a concave or straight pulmonary trunk and normal gravitational distribution of the blood flow.
Blood vessels taper laterally (bolded medially)
Increase in caliber inferiorly (gravity)
Outer 1cm should have no markings (becasue distal is the most smallest vessel)

Question 27

Q

What are erect individuals, what will the lobes look like?
What will the lobes look like in a supine patient?

Answer

A

In the erect individual this meansthat the upper lobe vessels will be smaller than the lower lobevessels, and that none of the vessels will be enlarged. In the supinepatient, the upper and lower lobe vessels will be more equal insize.

Question 28

Q

What is this?
What is it usually caused by?
> _ mmHg
Redistribution of blood flow to the upper lung zones results in what?

Answer

A

PVH is usually caused by left atrial hypertension
> 12-14mmHg (start seeing cephilization)
Redistribution of blood flow to the upper lung zones results in abnormal enlargement of the upper lobe vessels.

Normal pressure is under 10

Look at picture and like increase pressure

Question 29

Q

Mild elevation of the PCWP (pulmonary wedge pressure) results in what?

Answer

A

in redistribution of the pulmonary blood flow to the non-dependent lung zones

Question 30

Q

What is this?
What is present and thickened?
What is the pressure?

Answer

A

Pulmonary Venous Hypertension
Interstitial edema with indistinct vessels and thickened interlobular septa (Kerley B lines)-> CHF, ARDS and pulm edema
Pressure approaches 20 mmHg

Question 31

Q

What is this?
* Pressures in the mid 20s typically cause what?
* What do you need to note?
* What are common causes?

Answer

A

Pulmonary Venous hypertension
Pressures in the mid 20s typically cause alveolar edema
Note airspace edema with confluent airspace opacities in both lungs

Question 32

Q

What is this?
* What is present?

Question 33

Q

Pulmonary arterial hypertension results from what?
What is it characterized? This has been referred to as what?

Answer

A

Pulmonary arterial hypertension results from elevation of the resistance in the pulmonary arterial bed, usually at the arteriolar level.
It is characterized radiographically by enlargement of the pulmonary trunk and right and left main pulmonary arteries with disproportionately small peripheral vessels. This has been referred to as “pruning” of the pulmonary arteries.

Question 34

Q

What is this?
What happens to vessels?

Answer

A

Mild pulmonary HTN

Question 35

Q

Pulmonary overcirculation, also referred to as shunt vascularity, results from what?
Radiographically it is characterized by what?

Answer

A

Pulmonary overcirculation, also referred to as shunt vascularity, results from an absolute increase in blood flow to the lungs and in adults is most often associated with left to right shunts.
Radiographically it is characterized by proportional enlargement of all of the central and peripheral pulmonary vessels

Question 36

Q

What is this?
Who is this seen in?

Answer

A

Diminished vascularity in a patient with Ebstein’s anomaly. Both the central and peripheral vessels are small. There is also massive right heart enlargement owing to severe tricuspid valve regurgitation.

Water bottle heart

Question 37

Q

Diminished pulmonary vascularity is rare in the adult. the most frequently encountered lesion being what?
What is decreased in size?

Answer

A

Diminished pulmonary vascularity is rare in the adult. the most frequently encountered lesion being Ebstein’s anomaly of the tricuspid valve. Both the central and peripheral vessels are decreased in size.

Question 38

Q

What is this?

Answer

A

Tetralogy of Fallot. The pulmonary vascularity is markedly diminished and the heart is not enlarged.

PS, VSD, OA, RVH

Question 39

Q

What are these?

Question 40

Q

What is this?

Answer

A

Cardiac Enlargement:
* Left atrial enlargement in a patient with chronic mitral regurgitation.
* There is a double density behind the right side of the heart (arrows).

Question 41

Q

What is this?
Who is this seen in?

Answer

A

Right atrial enlargement in a patient with mild Ebstein’s anomaly (normal pulmonary vascularity). The right heart border is prominent (arrows, left) and the retrosternal clear space is filled in by the right heart (arrows, right)

Question 42

Q

What is this?

Answer

A

Pericardial Effusion

Question 43

Q

Pericardial Effusion:
* What type of shadow?
* What is a fat pad sign?
* What is the choice to screen for effusions?
* 400-500 ml of fluid must be in the pericardium to lead to what?

Answer

A

Globular shaped shadow
A “fat pad” sign, a soft tissue stripe wider than 2mm between the epicardial fat and the anterior mediastinal fat can be seen anterior to the heart on a lateral view.
Echo is the modality of choice to screen foreffusions
400-500 ml of fluid must be in the pericardium to lead to a detectable change of increased heart shadow on CXR

Question 44

Q

What is this?

Answer

A

Fat Pad Sign
* Indication of percardial effusion so get echo

Question 45

Q

What is this?

Answer

A

Heart lesions:
* Calcified myocardium (arrows, left) in a patient with previous myocardial infarction. Calcified aortic valve (arrows, right) in a patient with left ventricular failure secondary to critical aortic stenosis.

Question 46

Q

What is this?

Answer

A

Heart lesions:
* Rheumatic mitral valve stenosis (after strept throat infection without abx). There is enlargement of the left atrium (arrows, left) and left atrial appendage-> cleft formation in a.fib (arrows, right). The latter is relatively specific for rheumatic heart disease and is rarely seen in non-rheumatic mitral disease.

Question 47

Q

How do we read an x-ray?

Answer

A

Notes from under PP:
* It is best to do a directed search of the chest film rather than simply gazing at the film. An abnormality will not likely hit you over the head.
* Remember that detail vision is only permitted at the fovea centralis of your retina. This area contains only cones and is the part that you use to read. The remainder of the retina helps you to put this detailed portion in context and helps to determine whether this is a saber tooth tiger sneaking up on you. Therefore, it is best to look for abnormalities and to have a planned search in mind.
* Your eye gaze should scan all portions of the film, follow lung/mediastinal interfaces and look again carefully in areas where you know that mistakes are easily made, such as over the spine on the lateral view and in the apex on the PA view.

Question 48

Q

What is present?

Question 49

Q

Answer

A

Pulmonary arteries and veins

Question 50

Q

What is this?
What are some causes?

Question 51

Q

What is this?
* Loss of lung/soft tissue interface caused by what?
* What will obscure the border?
* The location of this abnormality can help to determine what?

Answer

A

Silhouette sign
* Loss of lung/soft tissue interface caused by a mass or fluid in the normally air-filled lung
* If an intrathoracic opacity is in anatomic contact with, for example, the heart border, then the opacity will obscure that border.
* The location of this abnormality can help to determine the location anatomically.

Question 52

Q

What is an air bronchogram?

Answer

A

An air bronchogram is a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates. In this case patient hasbilateral lower lobe pulmonary edema.
Air Bronchograms = Alveolar filling

Question 53

Q

What is this?

Question 54

Q

Atelectasis:
* What is it? Common or uncommon?
* What is it caused by?
* What is an unusual type of atelectasis?
* Atelectasis is almost always associated with what? What does the apex tend to be?
* The density is associated with what? What are some indirect signs?
* What might there be?
* Most common in who?

Answer

A

Atelectasis is collapse or incomplete expansion of the lung or part of the lung. This is one of the most common findings on a chest x-ray.
It is most often caused by an endobronchial lesion, such as mucus plug or tumor. It can also be caused by extrinsic compression centrally by a mass such as lymph nodes or peripheral compression by pleural effusion.
An unusual type of atelectasis is cicatricial and is secondary to scarring, TB, or status post radiation.
Atelectasis is almost always associated with a linear increased density on chest x-ray. The apex tends to be at the hilum.
The density is associated with volume loss. Some indirect signs of volume loss include vascular crowding or fissural, tracheal, or mediastinal shift, towards the collapse.
There may be compensatory hyperinflation of adjacent lobes, or hilar elevation (upper lobe collapse) or depression (lower lobe collapse). Segmental and subsegmental collapse may show linear, curvilinear, wedge shaped opacities.
This is most often associated with post-op patients and those with massive hepatosplenomegaly or ascites .

Question 55

Q

What is this?

Question 56

Q

What is this?

Question 57

Q

What is this?

Question 58

Q

Left Lower Lobe Atelectasis:
* What can be seen on the left?
* It is important to remember that these findings are all nonspecific, often occuring in cases of what?
* A substantially collapsed lower lobe will usually show as what?

Answer

A

Silhouetting of the corresponding hemidiaphragm, crowding of vessels, and air bronchograms are sometimes seen, and silhouetting of descending aorta is seen on the left.
It is important to remember that these findings are all nonspecific, often occuring in cases of consolidation, as well.
A substantially collapsed lower lobe will usually show as a triangular opacity situated posteromedially against the mediastinum.

Question 59

Q

What is this?

Question 60

Q

What is this?

Question 61

Q

What is this?
* What is it a common acuse of?
* What can be done to remove it?

Question 62

Q

What is cardogenic and noncardogenic pul edema caused from?

Question 63

Q

What is a helpful mnemonic for noncardiogenic pul edema?

Answer

A

A helpful mnemonic for noncardiogenic pulmonary edema is NOT CARDIAC (near-drowning, oxygen therapy, transfusion or trauma, CNS disorder, ARDS, aspiration, or altitude sickness, renal disorder or resuscitation, drugs, inhaled toxins, allergic alveolitis, contrast or contusion.

Question 64

Q

On a CXR, cardiogenic pulmonary edema can show what?
Unilateral, miliary and lobar or lower zone edema are considered what?
A unilateral pattern may be caused by what?
Unusual patterns of edema may be found in patients with what?

Answer

A

On a CXR, cardiogenic pulmonary edema can show; cephalization of the pulmonary vessels, Kerley B lines or septal lines, peribronchial cuffing, “bat wing” pattern, patchy shadowing with air bronchograms, and increased cardiac size.
Unilateral, miliary and lobar or lower zone edema are considered atypical patterns of cardiac pulmonary edema.
A unilateral pattern may be caused by lying preferentially on one side.
Unusual patterns of edema may be found in patients with COPD who have predominant upper lobe emphysema.

Answer 47

A

Cephalization = Blood vessels are more prominent in the upper lung fields compared to the base (opposite to normal)

Answer 48

A

This is a typical chest x-ray of a patient in severe CHF.
Note the cardiomegaly, alveolar edema, and haziness of vascular margins.

Answer 49

A

These are horizontal lines less than 2cm long, commonly found in the lower zone periphery.
These lines are the thickened, edematous interlobular septa.
Causes of Kerley B lines include; pulmonary edema, lymphangitis carcinomatosa and malignant lymphoma, viral and mycoplasmal pneumonia, interstital pulmonary fibrosis, pneumoconiosis, sarcoidosis.
They can be an evanescent sign on the CXR of a patient in and out of heart failure.

Answer 50

A

Lobular - often Staphlococcus, multifocal, patchy, sometimes without air bronchograms
Interstitial - Viral or Mycoplasma; latter starts perihilar and can become confluent and/or patchy as disease progresses, no air bronchograms
Aspiration pneumonia - follows gravitational flow of aspirated contents; impaired consciousness, post anesthesia, common in alcoholics, debilitated, demented pts; anaerobic (Bacteroides and Fusobacterium)
Diffuse pulmonary infections - community acquired (Mycoplasma, resolves spontaneoulsy) nosocomial (Pseudomonas, debilitated, mechanical vent pts, high mortality rate, patchy opacities, cavitation, ill-defined nodular) immunocompromised host(bacterial, fungal, PCP)
*

Answer 51

A

Primary tuberculosis (TB) is the initial infection withMycobacterium tuberculosis.
Post-primary TB is reactivation of a primary focus, or continuation of the initial infection.
Radiographically, TB is represented by consolidation, adenopathy, and pleural effusion.

Answer 52

A

Pulmonar embolism
CTA is the study of choice
Never order CXR to diagnose PE
Large PE could be seen on CXR
Westermark’s sign (acute)-> dark patch with sharp cut off=occulusion so need CTa
Hamptons Hump (wedge-shaped opacity) (chronic)-> vessel occulusion cause tissue dealth

Answer 53

A

Westermark sign – Dilation of pulmonary vessels proximal to embolism, collapse of vessels distally with a sharp cutoff, central hyperlucency

Answer 54

A

Normal CXR

Answer 55

A

Fluid can be exudative, transudative, blood or pus

Answer 56

A

The Meniscus sign
* Signifies presence of effusion

Answer 57

A

Decubitus position allows layering of effusion
Also reveals if effusion is mobile in nature, rather than loculated

Answer 58

A

The six most common causes of diffuse interstitial pulmonary fibrosis are idiopathic (IPF, >50% of cases), collagen vascular disease, cytotoxic agents and nitrofurantoin, pneumoconioses, radiation, and sarcoidosis.
Clinically the patient with IPF will present with progressive exertional dyspnea and a nonproductive cough.
IPF carries a poor prognosis with death due to pulmonary failure usually occurring within 3-6 years of the diagnosis unless lung transplant is performed.

Answer 59

A

Wide and flat

Answer 60

A

Asbestosis/Mesothelimoa
* Pleural involvement from asbestos fibers inhalation
* See pleural plaques and local fibrosis

Answer 61

A

Part of pneumoconioses
* From inhaled mineral dust
Multiple pulmonary nodules bilaterally in “eggshell” pattern (more pronounced than pul fibrosis)
Similar appearance to anthracosis and silicosis

Answer 62

A

In smokers with known emphysema the upper lung zones are commonly more involved than the lower lobes.
This situation is reversed in patients with alpha-1 anti-trypsin deficiency, where the lower lobes are affected.

Answer 63

A

Emphysema:
* COPD causes Hyperaeration, whichstretchesthe heart and makes it look smaller than usual.

Answer 64

A

By far the most common is a hiatal hernia - the stomach slips through the esophageal hiatus into the chest.
A Bochdalek hernia is through a weakness in the diaphragm, and usually occurs on the left side posteriorly (Bochdalek - back and to the left).
Morgagni hernias typically occur medially. Weakness of the diaphragm can occur without frank herniation of abdominal contents. This is termed an eventration, and it usually occurs on the right with a portion of the liver bulging cephalad.

Answer 65

A

Rib fracture:
* Fracture of the upper three ribs is associated with an increased risk of aortic injury because of the excessive force needed to fracture these ribs.
* Fracture of the lower three ribs can be associated with liver or spleen injury.
* Multiple bilateral rib fractures in various stages of healing are associated with child abuse in children or alcohol abuse.

Answer 66

A

consist of the 4 “T’s”
* Terrible lymphadenopathy (T-cell lymphoma)
* Thymic tumors
* Teratoma
* Thyroid mass

Can also be seen in
* aortic aneurysm
* pericardial cyst
* epicardial fat pad

CT or fine needle aspiration is needed to make the definitive diagnosis

Answer 67

A

saccular aortic aneurysm

Answer 68

A

Differential should include neoplasm (esophageal), lymphadenopathy, aortic aneurysm, adjacent pleural or lung mass, neuroenteric cyst or lateral meningocele, and extramedullary hematopoiesis.

Answer 69

A

Note that this mass is detected by a pleural margin search as you move your eye along the superomedial part of the right lung.
The interface is interrupted. Think about the anatomy of the lung in this area.
The anterior mediastinum ends at the level of the clavicles.
Any abnormality in the apex of the thorax must be posterior in the chest.
It is a schwannoma, a benign tumor of the nerve sheath.

Answer 70

A

Left: bilateral pulmonary artery enlargement. Note the smooth contours of the arteries.
Right: the lumpy-bumpy opacities characteristic of hilar adenopathy.

Answer 71

A

Mass is generally well defined
Opacity is generally ill-defined

Answer 72

A

A – Intraparenchymal (within lung tissue)
B – Pleural (outside of lung)
C - Extrapleural (outside of pleural)

Answer 73

A

A solitary nodule in the lung can be totally innocuous or potentially a fatal lung cancer.
After detection the initial step in analysis is to compare the film with prior films if available.
A nodule that is unchanged for two years is almost certainly benign.
If the nodule is completely calcified or has central or stippled calcium it is benign.
Nodules with irregular calcifications or those that are off center should be considered suspicious, and need to be worked up further with a PET scan or biopsy.
Be sure to evaluate for the presence of multiple nodules as this finding would change the differential entirely.
If the nodule is indeterminate after considering old films and calcification, subsequent steps in the work-up include ordering a CT and a tissue biopsy.
The patient may choose to have an indeterminate nodule removed if there is no evidence of spread on CT as this would diagnose and treat a cancer if present.

Answer 74

A

Faint lung cancer

Answer 75

A

Left upper lobe

Answer 76

A

Adenocarcinoma – (35-50%) Peripheral, sometimes associated with scars, high incidence of early metastasis
Squamous Cell Carcinoma – (30%) Central, with hilar involvement, cavitation is common, slow growing
Small Cell - (15-20%) Central, cavitation is rare, hilar and mediastinal masses often the dominant feature, rapid growth and early metastases
Large cell – (10-15%) Peripheral, large, cavitation present
Bronchaveolar – (3%) Peripheral, rounded appearance, pneumonia-like infiltrate (air bronchograms), occasionally multifocal
Carcinoid – (less than 1%) Typically a well defined endobronchial lesion; nodal, liver and brain metastases may enhance densely (i.e. They may be hypervascular)

Answer 77

A

The above image shows a right lower lobe squamous cell cancer. Notice the cavitation, which is found more characteristically in squamous cell than in other bronchogenic carcinomas.
Stages of T4, N3 and M1 make the masses unresectable.

Answer 78

A

Total lung collapse
Massive pleural effusion
Pneumonia with total consolidation
Large mass
Pneumonectomy
Severe unilateral pulmonary edema
Severe aspiration

Answer 79

A

All of the above

Answer 80

A

community acquired pneumonia

Answer 81

A

The newer spiral (also called helical) CT scan takes continuous picturesof the body in a rapid spiral motion, so that there are no gaps in the picturesco

Answer 82

A

Need to slow the HR
Slowly replacing stress test

Answer 83

A

Coronary artery calcifications are shownwell at CT
Noncontrastcardiac CT can be used toscreen patients with unexplained chest painfor the presence of coronary artery disease.

Answer 84

A

Blood vessels are shown well in crosssection by CT, especially when theprocedure is performed with IV contrast.
A newer technique for displaying bloodvessels by CT iscomputed tomographyangiography,or CTA, which employs thesame computer reconstruction principles asMRA.
* Although much faster, CTA requires contrast administration

Answer 85

A

To perform CTA, the radiologist rapidlyscans a region of anatomy (preferably with afast spiral/helical or multidetector scanner)to obtain very thin, contiguous CT sliceswhile the patient is injected with IV contrast.
The CT computer can then reconstruct a 3DCTA model.

Answer 86

A

3D CTA:
* Left:CTA (3DCT) of the lower legs showing the popliteal arteries behind the knees and their divisions into the anterior tibial, posterior tibial, and peroneal arteries.
* Right:CTA of the abdominal aorta. S, splenic artery; H, common hepatic artery; M, superior mesenteric artery. The arrows point to the renal arteries.

Answer 87

A

Left:CT reformation of the coronary arteries. The arrow indicates a tight stenosis in the left anterior descending branch of the left coronary artery.
Middle:3D CT reformation of the heart showing the same stenosis in the left anterior descending branch.
Right: Left coronary arteriogram in same patient showing the same stenosis.

Answer 88

A

For determination of ventricular wallmotion in the post MI patient
Dextrocardiogram(right) – contrast fillingof the right atrium, right ventricle, andpulmonary arteries
Levocardiogram(left) – filling ofpulmonary veins, left ventricle, left atrium,and ascending aorta

Answer 89

A

Evaluation before cardiac surgery
Evaluation after coronary artery bypassgraft (CABG) surgery
Determination if a patient is a candidate forangioplasty
CORONARY ANGIOGRAPHY IS THE“GOLD STANDARD”FOREVALUATION OF THE CORONARY ARTERIES

Answer 90

A

Arteriography

Radiolucenciesand lack of vasculature – atherosclerosis in coronaries

Answer 91

A

Separation of the layers of aortic wall,usually through the medial layer
A new lumen is formed (false lumen); bloodmay flow though this lumen andthrombose,resulting in a dissecting hematoma
Due to anintimaltear. Hypertension is the mostcommon cause. Increased incidence in patients with Marfan’s, coarctation of the aorta , and bicuspid aortic valve.
Patients present with the sudden onset “tearing”chest pain, radiating to the back.

Answer 92

A

Aortic dissection
* Type 1 – includes entire aorta
* Type 2 – ascending only
* Type 3 – descending aorta only.

Answer 93

A

On acute basis, CT with IV contrast for both Chest with Abdomen and Pelvis will be necessary.

Answer 94

A

Aneurism – not ruptured – in young healthy patient post MVA.Indicationof aortic injury.
False aneurism –> defect in the aorta = aortic injury.

Answer 95

A

Radiopacityon left lung – blood. Contrast leaking out of aorta withblood.
Also,intraluminalfilling defect on descending aorta, both indicating aortic injury

Answer 96

A

Atherosclerosisis the primary cause of occlusivedisease in the arterial system
The two clinical manifestations of occlusivedisease in the lower extremityare intermittentclaudicationand rest pain
The area ofstenosiscan be anywhere from theaorta to the pedal arteries. Therefore it is commonfor a patient to undergo anaortogramwith arunoff arteriogram

Answer 97

A

Stenosis – can do bypass or angioplasty.
On right – no BS below knee – cant do bypass – have to amputate.

Answer 98

A

PAD
* chronic
* Most likely diabetes

Answer 99

A

For larger veins; may require catheterization
For extremities involves direct injection intoa peripheral vein
Typically done to screen for good vessel prior to surgery or dialysis

Typically setting of CABG (saphenous vein (runes to medial malleoli))

Answer 100

A

Arterial duplex (for arterial occlusivedisease)
Venous duplex (for DVT and venousvalvularincompetence)
Color doppler, while notdiagnostic in itsown right, canprovide valuable informationwith regard toflow turbulence and variancein anatomic routes

Answer 101

A

Risk factors: prolonged immobilization,pregnancy, CHF, and neoplastic disease
Patients present with pain and swelling ofthe affected limb
Traditionally diagnosed with venography,but venous duplex is more often done todayto rule out DVT

Answer 102

A

Imaging the subclavian vein can expeditethe placement of Hickman catheters,portacaths, and PICC lines.
PICC line (Peripherally Inserted CentralCatheter).
A PICC is inserted in a peripheral vein,such as the cephalic vein, basilic vein, or brachial veinand then advanced through increasingly larger veins, toward the heartuntil the tip rests in the distal superior vena cavaor cavo-atrial junctions

Answer 103

A

IVC filters are placed in patents with ahistory of DVT and pulmonary embolism toprevent future pulmonary emboli
Indicated in patients with documented PE orDVT who have contraindications toanticoagulation therapy or who havesuffered recurrent PE while being treatedoptimal levels of anticoagulation
Usually inserted through a femoral vein, butoccasionally through a jugular vein in apatient with iliac vein thrombosis

Answer 104

A

Umbrella filter was developed as a replacement for surgical ligation,caval plication, andcaval clips and partially to interrupt the flow in the IVC and toprevent PE. Since then, several filters have been introduced.

Answer 105

A

The reopening of an occluded or stenotic artery by displacement of the obstructingmaterial within it, usually atherosclerotic plaque
Radiologists use a percutaneously inserted balloon catheter that is inflated within thestenotic or occluded artery
Most successful for the treatment of short single stenoses and occlusions
Less successful in the treatment of longsegment occlusions and severely calcifiedstenoses

Answer 106

A

Recurrentstenoses
Angioplasty failure