Medical Imaging: Pleural Pathology Flashcards
If there is fluid in the pleura, will it accumulate posteriorly or anteriorly first? Why?
- Posteriorly
- The costophrenic recess is deepest posteriorly
What is the costophrenic recess also called?
Costodiaphragmatic recess
What is a pleural pseudotumour?
Focal interlobar pleural effusion (enclosed)
What does a sponatenoues pneumothorax look like on CXR?
- Visceral pleural line
What does a tension pneumothorax look like on CXR?
- Flattened diaphragm
- Collapsed lung
- Mediastinal shift to contralateral side
- On expiration, becomes more apparent
What is hydropneumothorax?
Presence of air and fluid in the pleural space
What does the fluid layer look like on hydropneumothorax?
Solid, straight line
What is a meniscus in terms of fluid in a container (or lung…)
Curving water when it touches another material
Signs of free pleural fluid
- Meniscus
- Blunt costodiaphragmatic recess
- Fluid in fissures
List four signs of subpulmonic effusion
- High pseudo-diaphragm
- Increased distance between stomach bubble and lung base
- Pseudodiaphragm apex is more lateral than usual
- Pseudodiaphragm appears more horizontal
How to determine haemothorax on CXR
Same as pleural effusion, but history will suggest blood (e.g., stabbing, trauma etc.)
Haemothorax X raysa fter taken supine in the trauma setting. How does this affect appearance?
Blood “veils” whole lung after settling superiorly
What does loculated mean on CXR
Localised to a particular place; “stuck”
What does empyema look like on CXR?
- Typically loculated
- Does not shift with changing positoin
- May simulate focal lung disease
- Convex borders; obtuse angle with pleura
What does empyema look like on CT chest?
- Split pleura sign
- Both layers of pleura are visible, and there is a different-looking layer of pus between them
What can cause total lung whiteout on cxr?
- Complete consolidation
- Atalaectasis
- Pleural effusion
- Pneumonectomy
Whiteout showing air bronchograms (i.e., bronchi are visible). What is the cause?
Lung consolidation
What is the common shape of a pleural pseudotumour?
Oval-shaped
What are the most common pleural tumour?
- Pleural plaques
- Benign soft tissue plaques
Multiple calcified pleural plaques raise suspicion of what?
Asbestos exposure
What are the three broad kinds of diaphragmatic trauma?
- Diaphragmatic eventration
- Congenital hernias
- Acquired hernias (hiatus, traumatic)
What is a diaphragmatic eventration? What causes it? Is it acquired or congenital?
- Abnormal focal elevation of a part of the diaphragm
- Caused by congenital abnormal muscularisation of the diaphragm
- More commonly shows up in older age
What is a bochdalek hernia?
- Bilateral, at the back
- Congenital
- Can occur on left or right (more commonly left)
What is a morgagni hernia?
- Medial and anterior
- Congenital
- Small
Is a bochdalek hernia usually diagnosed before birth?
Yes
Risk factors for hiatus hernia
- Obesity
- Increased pressure (heavy lifting, coughing, straining)
Symptoms of hiatus hernia
- Fullness
- Heartburn
- Nausea/vomiting
What is hiatus hernia?
Herniation of abdominal contents through the oesophageal hiatus
What are the three types of hiatus hernia?
- Type 1: Gastro-oesophagheal junction
- Type 2: Fundus of stomach
- Type 3: Both
HIatus hernia xcr findings
Retrocardiac mass with air fluid level
