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Diagnostic Imaging III > Midterm > Flashcards

Midterm Flashcards

1
Q

Which lobes does the right oblique fissure (major) divide?

A

superior & middle lobes are above fissure and inferior lobe is below fissure

*begins at T5 and extends down & fwd to end at anterior pleural gutter of diaphragm

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2
Q

On what type of view is oblique fissure seen?

A

only on lateral film

not seen on PA

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3
Q

Which lobes does the right horizontal fissure (minor) divide?

A

anterior portion of superior lobe is above fissure and middle lobes is below fissure

*begins at the oblique fissure at mid-axillary line and runs horizontally to the sternal end of 4th costal cartilage

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4
Q

On what type of view is right horizontal fissure seen?

A

lateral film

seen in 54% of PA

(absent or incomplete in 25% of individuals)

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5
Q

What lobes does the left oblique fissure (major) separate?

A

left upper lobe from left lower lobe

*begins at T5 and extends obliquely down and fwd to end at anterior plural gutter of diaphragm

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6
Q

In lungs, LUL is analogous to _________

A

RUL & RML combined

LLL = LRL

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7
Q

What are the lingula?

A

there are two lingular bronchopulmonary segments of the left upper lobe (inferior & superior lingular segment)

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8
Q

What is the radiographic significance of lingula?

A

the abut the left heart border causing a silhouette sign when there is lingular collapse or consolidation

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9
Q

What anatomical parts are responsible for the cardiac contours on the PA film?

A

right atrium (R heart border), left atrium & ventricle (L heart border), ascending aorta, aortic arch, pulmonary trunk, brachiocephalic vessels, SVC, IVC

(all of these are retrosternal)

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10
Q

What anatomical parts are responsible for the cardiac contours on a lateral film?

A

Right ventricle, ascending aorta, aortic arch, descending aorta, left atrium & ventricle, IVC

(all of these are in the posterior mediastinum)

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11
Q

Which views are included in a routine plain film examination of the chest?

A

Minimum = PA and left lateral done during full inspiration

put area of interest closest to the film

apical/lordodic view to look at apices in addition to PA (gets clavicle out of the way)

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12
Q

How does positioning of chest study differ from thoracic spine plain film?

A

chest study - PA chest and left lateral chest

thoracic study - AP thoracic & either lateral view

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13
Q

What is the technique for chest study plain film?

A

72” FFD, high kVp, low mA and short time, full inspiration

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14
Q

how does collimation differ on chest vs. thoracic plain film study?

A

chest films must include all air spaces of the lungs vs. tightly collimated thoracic spine films

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15
Q

What condition or anatomical region is best demonstrated by the apical lordotic view?

A

see apices of lung, can dx a pancoast tumor (or anything in the apices of the lung)

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16
Q

Is routine chest xray taken with inspiration or expiration?

A

Full inspiration so there is no crowding and you can see all the vessels

breath held in inspiration expands the lung fields, depresses diaphragm, and provides contrast (air vs. tissue)

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17
Q

Describe the difference in appearance between inspiration and expiration

A

during a good inspiration you should see the first 10 ribs posteriorly, lowers diaphragm

diaphragm crosses T12 vertebral body on lateral film during full inspiration & is at level of posterior R10-11 on PA

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18
Q

What condition is better demonstrated upon expiration than inspiration?

A

pneumothorax - upper right expiration is more sensitive; look for mediastinum displacement

on expiration consolidation appears more bright

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19
Q

What is the appearance of interstitial dz?

A

thickened alveolar septa, alveolar walls; interstitial lymph, veins, cells

usu. a diffuse pattern, mb combined with consolidation

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20
Q

What dz has the pattern of reticular, nodular, honeycomb, or any combo

A

interstitial disease

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21
Q

What do you see with a combination of air space dz and interstitial dz (both types of lung opacification)?

A

acinar shadow

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22
Q

What is the appearance air space disease?

A

silhouette sign, air bronchogram, atelectasisi

pattern = diffuse, lobar/localized, solitary nodule/masses, multiple nodule or masses

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23
Q

What dz has pattern of diffuse, lobar/localized, solitary nodule/masses, multiple nodule or masses?

A

air space disease

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24
Q

air-bronchograms

A

lucent tubular and branching structures representing aerated bronchi surrounded by opaque acini

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25
What are the four patterns of "white lung" disease?
Diffuse - consolidation Localized/Lobar Solitary mass/Nodule Multiple masses/Nodule
26
DDx for diffuse-consolidation pattern of "white lung" disease
pulmonary edema (MC) d/t CHF, stroke, trauma, drugs; systemic/widespread dz such as sarcoidosis, histoplasmosis, TB; unusual infx (pneumocysitis carnii, opportunistic, immune compromised); bronchioalveolar carcinoma; idopathic hemorrhage usu. see bilateral sx; implies involvement of all lobes
27
DDx for localized/lobar pattern of "white lung" disease
bacterial infx or pneumonia (MC); pancoast tumor; pulmonary TB; pulmonary infarct; bronchopulmonary sequestration; atypical pneumonia (viral, mycoplasma) MC presentation for infx usu. only a portion of one lung
28
primary TB is usu. seen with consolidation in _______, while secondary TB is usu. seen with patchy consolidation in ________
``` 1' = lower lobe 2' = upper lobe ```
29
DDx for solitary mass/nodule pattern of "white lung" disease
primary neoplasm (bronchogenic carcinoma - is most alarming); hematogenous metastasis; hamartoma; tuberculoma; lung abscess; hydatid cyst; hematoma; bronchopulmonary sequestration smaller, well-defined area Is there calcification? usu. a good finding, but depends on the pattern
30
DDx for multiple masses/nodules pattern of "white lung" disease
MC indicates pulmonary metastesis; lymphoma; granulomatous infx (TB, histoplasmosis, coccidioidomycosis); Rheumatoid nodules; Wegener's granulomatosis usu. bilateral, see multiple well-defined areas
31
What is the silhouette sign?
obliteration/burring of an anatomical shadow d/t a water density (structure or lesion) in anatomic contact with that structure (can't see structure any longer) *indicates water density materia in air spaces; can localize by structure silhouetted
32
Examples of water densities that may cause a silhouette sign
pneumonia, tumors, pleural effusion
33
Structures that may show a silhouette sign
1) Mediastinal structure - heart, aorta 2) Diaphragms d/t effusion/fluid 3) Chest wall - tumors, etc. 4) Posterior heart structures - descending aorta, aortic knob
34
Where do you normally see a silhouette sign?
heart on left of hemidiaphragm
35
If most of the right heart border is obliterated, it indicates involvement of
right middle lobe
36
If uppermost portion of the right heart border is obliterated, it indicates involvement of
anterior segment of the right upper lobe
37
If most of the left hear border is obliterated, it indicates involvement of
lingular portion of the left upper lobe
38
If uppermost portion of the left heart border is obliterated, it indicates involvement of
anterior segment of the left upper lobe
39
If the aortic knob is obliterated, it indicates involvement of
apical segment of the left upper lobe
40
If the diaphragm is obliterated, it indicates involvement of
appropriate basal segment (determine anterior or posterior)
41
Two water densities ________________ will dim the borders of each but will NOT obliterate them
superimposed but not in contact
42
Water densities that may cause a silhouette sign include
pneumonia, tumors, pleural effusion, etc.
43
With pneumothorax, you see mediastinal push ______ from the area of air/concern
away
44
What main types of atelectasis?
1) Resorptive (obstructive) | 2) Passive (compressive)
45
Causes of central resorptive (obstructive) atelectasis
bronchogenic carcinoma, bronchial adenoma, foreign body, bronchial TB, lymphadenopathy, mediastinal mass, aneurysm
46
Causes of peripheral resorptive (obstructive) atelectasis
pneumonia, mucous plugging, POST-OPERATIVE
47
Causes of passive (compressive) atelectasis
interthoracic space occupying process - pneumothorax (MC), hemothorax, hydrothorax, any mass essentially few actually show signs of atelectasis
48
What is the MC cause of atelectasis?
resorptive (obstructive) - think tumor
49
Signs of resorptive atelectasis
displaced fissures, elevated hemidiaphram, displace hilus, mediastinal shift (everything shifts twd it) Also see increased density, approximation of the ribs, vascular bronchial crowing, compensatory emphysema (other lung shifts twd that side), lung herniation
50
Signs of passive atelectasis
collapsed lung --> look for lack of lung margins and b.v. in periphery & edge of visceral pleura on outer margin of lung
51
What is direction of collapse if different types of atelectasis?
Resorptive = toward collapsed lung Passive = away from collapsed lung
52
What is the air bronchogram sign?
when air spaces are filled with water density --> air filled bronchi are visible *bronchi/bronchioles are normally not visible on chest xray
53
What does air bronchogram indicate?
pneumonia *this sign is likely with diffuse consolidation and possible w/ lobar/localized consolidation; it is unlikely with masses
54
Which condition commonly demonstrates as a mass in the pulmonary apex or hilar area and may cavitate?
bronchogenic carcinoma (2' TB can also show up in pulmonary apex and cavitates in 40%, but it is usu. bilateral, whereas bronchogenic carcinoma is usu. unilateral)
55
Which condition commonly demonstrates pleural plaques in the lung bases (calcified)?
this is the MC change in asbestos related dz 15% visible on chest x-ray
56
What is pathognomonic for asbestos exposure?
calcified pleural plaques - this may take up to 20 yrs after exposure
57
Radiographic signs of pulmonary emphysema?
flattened, depressed hemidiaphragms; hyperlucency; increased retrosternal clear space; increased AP chest diameter; decreased peripheral vascular markings; > 10 ribs visible (hyperinflated); may present with pneumothroax
58
What is an air filled bulla?
abn air filled spaces within lung - mb d/t confluent destruction of alveolar walls 2' to emphysema
59
radiographic image of focal round or oval radiolucencies surrounded by a thin wall
air filled bulla indicates emphysema
60
radiographic findings of meniscus sign, blunted costophrenic angle, effusion (transudate/exudate), blood, pus, lymph (chylothorax)
pleural effusion
61
causes of pleural effusion
CHF, pneumonia, neoplasm, infection (empyema), trauma, embolism, CT dz, TB, abdominal dz (pancreas, cirrhosis)
62
Types of pneumothorax
Spontaneous, traumatic/iatrogenic, tension
63
_________ pneumothorax is seen in tall, thin males and ____________ pneumothorax is seen with underlying lung dz, bullae, blebs, air trapping
primary spontaneous secondary spontaneous
64
valve effect with progressive accumulation of air, shift of mediastinum away from collapsed lung, leads to vascular compromise (MEDICAL EMERGENCY)
tension pneumothorax | need a chest tube
65
what is the appearance of pneumothorax with pleural effusion?
shrunken lung, pleural space larger, no b.v. seen where they should be, heart shifted away from lung, may see meniscus sign from pleural effusion
66
What is the difference btwn tension and spontaneous pneumothorax?
``` Tension = extreme collapse Spontaneous = small amount of collapse ```
67
What is a pancoast tumor?
superior sulcus tumor; apical; extension into adjacent chest wall; usu. squamous cell (can also be adenocarcinoma)
68
clinical presentation of pancoast tumor
Horner syndrome - ptosis, anhydrosis, myosis Pain radiating to arm, apical mass (look for rib or vertebral dysfn), pleural extension
69
What are multiple pulmonary masses of varying sizes suggestive of?
metastatic cancer | bronchogenic is solitary
70
Is calcification common in a malignant pulmonary mass?
NO - most calcifications are benign MC calcification is granuloma (TB, histoplasmosis, cocsidiomycosis)
71
Conditions that demonstrate unilateral elevation of hemidiaphragm
``` atelectasis phrenic nerve palsy splinting eventration subphrenic inflammation ```
72
Conditions that demonstrate bilateral elevation of hemidiaphragm
``` poor inspiration obesity pregnancy ascites hepato-splenomegally ```
73
Normal relation btwn transverse diameter of heart and thoracic cage on PA chest fil,?
located in middle mediastinum, 1/3 to right of midline & 2/3 to left of midline
74
cardiothoracic ratio on PA upright w/ full inspiration
widest coronal diameter of heart is less than or equal to thoracic cavity (no minimum) **not the best evaluation for cardiomyopathy
75
Causes of left ventricle hypertrophy
aortic stenosis, chronic HTN
76
Causes of right atrium enlargement
CHF
77
In lateral view of chest x-ray, heart should be _______ the width of the heart cavity
less than half
78
anterior mediastinum from lateral view
sternum to anterior cardiac silhouette = anterior (retrosternal) clear space
79
middle mediastinum from lateral view
anterior to posterior cardiac silhouette
80
posterior mediastinum from lateral view
posterior cardiac silhouette to posterior border of lung field
81
Contents of anterior mediastinum
thymus gland & lymph nodes
82
Pathologies of anterior mediastinum
3T's and an H Thyroid retrosternal goiter (MC) Hodgkin's Lymphoma Thymic mass - thymoma Teratoma - germ cell tumor
83
contents of middle mediastinum
pericardium, heart, great and pulmonary vessels, phrenic nerve, upper vagus nerves, trachea - primary bronchi, lymph nodes
84
masses above clavicle are in ____________ and masses below clavicle are in ____________
anterior mediastinum middle mediastinum
85
pathologies of middle mediastinum
lymphadenopathy (enlarge LN), bronchogenic carcinoma (in primary bronchi), aortic aneurysm, bronchogenic cyst, CHF, CVD (hardening of aa)
86
contents of posterior mediastinum
descending thoracic aorta, esophagus, thoracic duct, azygous vv., hemizygous vv., sympathetic ganglia, lower vagus nn., lymph nodes
87
pathologies of posterior mediastinum
Hiatal hernia (MC), neurogenic tumors, paravertebral masses, meningocele, esophageal masses, aneurysm
88
increased retrosternal clear space
emphysema
89
what is the MC retrocardiac mass?
hiatal hernia
90
apical lordotic view
pt. learning back and looks like xray beam angled on pt. - fuzzier film * used to view pancoast tumor, reactivated TB
91
loss of costophrenic angle
water from pleural effusion
92
accessory fissure in lungs on upper R side
azygous fissure
93
extrapleural sign
xs bone seen in lung xray --> usu. d/t rib bone metastasis or rib fx with hematoma
94
Black lung dz
pneumothorax, emphysema, cystic dz, trapped air - obstruction

Diagnostic Imaging III (2 decks)

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