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radiology > lungs > Flashcards

lungs Flashcards

1
Q

how do you determine if penetration is adequate in a PA CXR

A

YOU SHOULD BE ABLE TO SEE THE THORACIC SPINE THROUGH THE HEART SHADOW Inspiration: should see at least 8-9 posterior ribs

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2
Q

how do you determine if inspiration is adequate in a PA CXR

A

Inspiration: should see at least 8-9 posterior ribs

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3
Q

how do you determine if rotation is adequate in a PA CXR

A

rotation: spinous process should fall equidistant b/w the medial ands of the clavicle

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4
Q

how do you determine if magnification is adequate

A

AP films magnify only slightly

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5
Q

angulation adequate?

A

clavical normally has an S shape and medial end superimpose onto 3rd or 4th rib

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6
Q

if you can not see the htoracic spine through the heart on a PA CXR it is known as

A

underpenetrated

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7
Q

erros of with underpenetration

A

1) L lung base may appear opaque mimicking or hiding true disease in the L lower lung field 2) Pulmonary markings (i.e. mostly the blood vessels in the lung) may appear more prominent than they actually are leading to a false impression of disease like CHF or pulmonary fibrosis

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8
Q

what is the solution for a underpentrated CXR that mimics LL lung dz

A

confirm with lateral CXR

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9
Q

what to do if underpenetration makes CXR look like CHF

A

look for other signs of CHF lateral films for the presence of increase markings airspace dz effusions at the left base that you suspect

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10
Q

pitfall of poor inspiration

A

incomplete inspiration can lead to exaggeration of lung markings and heart size ○ Lung hyperexpansion is a sign of obstructive lung disease

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11
Q

how do you tell the adequacy of a cxr

A

RIP MA rotation inspiration penetration magnification angulation

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12
Q

If spinous processes closer to left clavicular head what can we infer about roation in a CXR

A

pt is rotated to their right

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13
Q

f spinous processes closer to right clavicular head what cna we infer about rotation in the CXR

A

pt is rotated to their left

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14
Q

How can you tell if it’s a AP or a PA film

A

is it a PA or AP film? (if there’s a lateral, it’s a PA!)

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15
Q

what are the problems with poor rotation

A

significant rotation may alter expected contours of the heart and great vessels, the hila and the hemidiaphragms

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16
Q

when do we get a CXR

A

SOB Chest pain Fever Cough Weight loss Trauma Lines/Tubes Foreign bodies

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17
Q

What are we looking for with a CXR

A

Pneumonia, infection Pleural effusion Pneumothorax Pulmonary edema Cancer, mass Heart size Mediastinum Perforated viscous Much, much more…

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18
Q

why do you want hands on hips or suspended above the head

A

to avoid scapula covering thorax

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19
Q

Lateral decubitus film (far right) is used to see if

A

Lateral decubitus film (far right) is used to see if a pleural effusion “layers out” if it doesn’t layer out that means a thorsocopy probably needs to be done

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20
Q

minor lung fissures are more likely to be seen on the

A

right side

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21
Q

mediastinum masses will nee

A

lateral films is the mediastinum mass locator compartments are only used for ddx

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22
Q

compartments

A

anterior, middle, posterior mediastinal compartment superior is used to be specific

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23
Q

what is this

A

lordotic view to highlihgt apex pancoast tumor

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24
Q
A
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25
Q

how wide should the mediastinum be?

A

no more than 8cm unless the pt is supine

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26
Q

how do you tell the normal heart size?

A

the cardiac width at the widest point should be less than half of the width of the entire thoracic cavity. If the width of the cardiac sillouette is more than half of the entire chest then the heart is enlarged (might be plueral effusion, cardiomegaly, spurious)

27
Q

when does the heart appear falsely enlarged?

A

when it is squished (pregnancy)

pectus excavatum

AP

obesity

epiration

bony abnormalities: kyphosis and pectus

pericardial effusions: water bottle shape even though the heart is normal size

28
Q

what view is more sensitive for lateral effusions

A

Lateral view is more sensitive for small effusions.

Lateral - 75ml to blunt

Anterior - 200-300ml to blunt

29
Q

what are some findings you might see with a pleural effusion

A

Concave meniscus

Diaphragm, liver silhouetted

Fissures opacified? from fluid collecting

Loculated? Lateral decubitus

30
Q

how should you approach the lungs

A

periphery first! do not skip ahead

then scan back and forth noodle style

31
Q

describe lung opacities

A

Well defined (discrete) or ill defined borders?

Infiltrate? Air Space or Interstitial? Air bronchograms?

Nodule (<3cm)? Mass (>3cm)? Appear solid? Calcified? Cavitary?

Dense consolidation or patchy infiltrate?

Air-fluid level?

Unilateral? Bilateral? Multiple? Disseminated?

Where is it located??

32
Q

air bronchogram

A

fluid is around the thing that hold the air

33
Q

silhouette sign

A

same density of overlaping sturctures that allows you to tell the location of the infultrate on one film

34
Q

if the diaphragm is obscured what can you determine about the location based on the silhouette sign

A

RLL and LLL infiltrates may create silhouette sign with the diaphragm (on PA, AP)

35
Q

RML and Left Lingular (LUL) infiltrates may create a silhouette sign with

A

● RML and Left Lingular (LUL) infiltrates may create a silhouette sign with the cardiac border (on PA, AP)

36
Q

● Fluid-filled lung will obscure normal border of the structure it is anatomically contiguous with (same density) this is known as a benefit of the

A

silhouette sign

37
Q

Left heart border (left ventricle) is obscured

A

Lingula

38
Q

Right heart border (right atrium) if obscured

A

Right middle lobe

39
Q

Left hemidiaphragm if obscured

A

Left lower lobe

40
Q

Progressive increase in density of spine from top to bottom on lateral CXR is known as a

A

spine sign

41
Q

spine sign is indicative of

A

indicates a lower lobe process

(normally, thoracic spine density decreases - becomes less white)

42
Q

● Infiltrates can be hidden behind the heart on what type of films

A

● Infiltrates can be hidden behind the heart on PA/AP films → always check the lateral!

look for spine sign on lateral

43
Q

Lucencies are what?

A

Lucencies are black areas (black = air)

44
Q

Lucencies are indicative of what etiologies

A

Possible etiologies: pneumothorax, bullae from COPD, cystic structures

45
Q

Prominent vasculature in upper lobes =

A

“cephalization”

46
Q

● Cephalization is a sign of

A

pulmonary venous hypertension.

47
Q

Vascular Markings are seen as what on CXR

A

Prominent central vasculature with elevated pulmonary artery pressure

● Engorged hilar vessels, azygos

48
Q

Reasons for vascular markings on film

A

CHF, PULMONARY EDEMA, MITRAL STENOSIS, RENAL FAILURE, SMOKE INHALATION

49
Q

tip of ET tube should be where

A

Tip should be located in the trachea about 3-5cm above the carina (roughly half the distance between

the medial ends of clavicles and the carina)

50
Q

chat are the advantages of CT of lungs

A

provides details about size, extent, character

51
Q

indications for lung CT

A

Lung nodules / masses / staging of malignancies, systemic lung disease, pleural effusions, PE, aorta,

mediastinal masses, trauma

52
Q

obliterated retrosternal airspace indicates

A

anterior mediastinal mass

53
Q

an increased retrosternal space indicates

A

pulmonary emphysema

54
Q

Thickening of the fissure by fluid is almost always associated with

A

other signs of fluid in the chest, such as Kerley B lines and pleural effusions

55
Q

Thickening of the fissure by fibrosis is the more likely cause if

A

there are no other signs of fluid in the chest.

56
Q

why would you see the loss of vertebral height on a CXR

A

Degeneration of the disk can lead to narrowing of the disk space and the development of small, bony spurs (osteophytes) at the margins of the vertebral bodies.

▪

When there is a compression fracture, most often from osteoporosis, the vertebral body loses height.

57
Q

MIP stands for

A

MIP stands for maximum intensity projection (CT) and is a way to display certain structures of a given density, preferentially making them stand out more easily.

58
Q

The normal relationship between the bronchus and its accompanying pulmonary artery is that the artery is usually ______than the bronchus. In bronchiectasis, that relationship is reversed, with the bronchus becoming ____the artery (signet-ring sign)

A

he normal relationship between the bronchus (solid white arrow) and its accompanying pulmonary artery (dotted white arrow) is that the artery is usually larger than the bronchus. In bronchiectasis, that relationship is reversed, with the bronchus becoming larger than the artery (signet-ring sign)

59
Q

The trachea, usually oval shaped, is about ____- cm in diameter on CT

A

The trachea, usually oval shaped, is about 2 cm in diameter.

60
Q

In most people, there is a space visible just underneath the arch of the aorta but above the pulmonary artery called the _______ and it is an important landmark because

A

In most people, there is a space visible just underneath the arch of the aorta but above the pulmonary artery called the aortopulmonary window.The aortopulmonary window is an important landmark, because it is a common location for enlarged lymph nodes to appear.

seen here as the white arrow in the left picture

61
Q

The minor fissure travels in the same horizontal plane as an_____ CT image so that it normally is not visible, except in the ____or _____

A

The minor fissure travels in the same horizontal plane as an axial CT image so that it normally is not visible, except in the sagittal or coronal plane

62
Q

cardiogenic interstitial edema (early) is characterized by

A

fluid in the fissures

kerley b LINES

PLEURAL EFFUSIONS

Peribronchial cuffing

63
Q

alveolar airspace edema late CHF is characterized by

A

bilateral fluggy pathy indistinct airspace densities

bat wing

pleural effusions commonly no air bronchogram

radiology (13 decks)

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