Midterm DI 3 Flashcards

1
Q

Describe the appearance of the major and minor fissures on PA and lateral chest films.

A

Left Oblique Fissure
Separates Left Upper Lobe from Left Lower Lobe
Begins at level of T5
Extends obliquely down and forward
Ends at anterior pleural gutter of diaphragm

Right Oblique Fissure
Separates Right Upper and Middle Lobes from Right Lower Lobe
Begins at level of T5
Extends obliquely down and forward
Ends at anterior pleural gutter of diaphragm
Less vertical than left oblique fissure

Right Horizontal Fissure
Separates Anterior Segment of Right Upper Lobe from Right Middle Lobe
Begins at Right Oblique Fissure at mid-axillary line
Runs horizontally anteriorly to sternal end of 4th costal cartilage

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2
Q

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

A

Left lateral and PA. can do Left lateral decubitus for fluid, and apical lordodic for apices

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3
Q

How does a thoracic spine plain film study differ from a chest study?

A

Spine is done AP, Chest is PA. Attenuation is different to see the spine better or the lungs better, respectively.

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4
Q

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

A

Best view for the apices of the lungs, so you can see things like a pancoast tumor or secondary TB

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5
Q

Is the routine chest x-ray taken with inspiration or expiration?

A

Held inspiration

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6
Q

Describe the difference in appearance between inspiration and expiration chest films.

A

heart is narrower on full inspiration and lungs are spread out. If you don’t inhale, lungs look full of stuff (blood) and heart looks enlarged

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7
Q

What condition is better demonstrated upon expiration than inspiration?

A

If there is a bronchial obstruction, the involved lung remains well inflated on expiration

Pneumothorax

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8
Q

What is the appearance of interstitial disease?

What is the appearance of alveolar-air space disease?

A
Ground glass
Linear (reticular)
Nodular
Reticulonodular
Honeycombing

Silhouette sign, Air bronchogram, Pattern - diffuse, Lobar/localized, Solitary nodule/mass, Multiple nodule/mass, Atelectasis

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9
Q

What is the appearance(s) of alveolar/air-space disease?

A

Localized (lobar) or diffuseal

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10
Q

List the 4 patterns of “white lung” disease (lung opacification on chest films) and a differential list for each.

A

Diffuse: CHF, viral pneumonia,
Localized / Lobar: Bacterial pneumonia
Solitary mass / nodule: Bronchogenic carcinoma
Multiple masses / nodules: Mets, asbestosis

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11
Q

What is the silhouette sign?

A

When two structures of the same radiographic density (water) are in anatomic contact, the margins of those structures will be obliterated

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12
Q

What are the causes of atelectasis?

A

Airway obstruction (tumor, mucus plug, foreign object), anesthesia, lung collapse (pleural effusion, pneumothorax)

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13
Q

Which is the most common cause of atelectasis?

A

Obstruction/Resorptive

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14
Q

What are the signs of atelectasis?

A

Displaced fissure

Mediastinal shift, elevated hemidiaphragm, displaced hilus

INC density

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15
Q

What is the direction of the collapse in the different types of atelectasis (towards or away from collapsed lung)?

A

Towards the collapsed lung if it is resorptive, as in carcinoma or pneumonia; away if it is passive, as in pneumothorax

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16
Q

What is an air bronchogram sign and what does it indicate?

A

When air spaces filled with water density, air filled bronchi are visible = air bronchogram

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17
Q

Which condition commonly demonstrates as a mass in the pulmonary apex or hilar area and may cavitate?

A

Pancoast tumor, bronchogenic carcinoma

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18
Q

Which condition commonly demonstrates pleural plaques in the lung bases?

A

Asbestos related dz - mesothelioma

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19
Q

What are the radiographic signs of pulmonary emphysema?

A

Depressed, flattened hemidiaphragms, hyperlucency, Increased retrosternal clear space, increased AP chest diameter, decreased peripheral vascular markings

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20
Q

What is an air filled bulla?

A

Basically an air blister in the lungs. Alveolar walls are destroyed so there is a large lucent bleb in the lungs.

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21
Q

Describe the appearance of pleural effusion and name some causes.

A

Pleural effusion appears in the bottom, posterior area of the lungs first. It is water density. May have costophrenic angle blunting or meniscus sign.

DDx: CHF, pneumonia, neoplasm, infx, trauma, embolism, CT dz, TB, abd. dz

22
Q

What are the different types of pneumothorax?

A

spontaneous, tension, trauma

23
Q

What is the appearance of pneumothorax with pleural effusion?

A

Shrunken lung, pleural space larger, meniscus sign from pleural effusion

Increase peripheral lucency with blunted costophrenic angle on affect side

24
Q

What is the difference in appearance between spontaneous and tension pneumothorax?

A

Tension pneumothorax is when the lung is completely shrunken with a severe mediastinal shift AWAY from collapsed lung

Spontanous: mediastinal shift TOWARD side of collapse

25
Q

What is pancoast tumor?

A

Bronchogenic carcinoma in the apex of the lung (superior sulcus tumor)

26
Q

Are multiple pulmonary masses of varying sizes suggestive of primary bronchogenic or metastatic carcinoma?

A

Metastatic carcinoma (multiple)

27
Q

Is calcification common in a malignant pulmonary mass?

A

NO!

Most calcifications are benign!

28
Q

List 4 conditions that demonstrates elevation of the hemidiaphragm.

A
UNILATERAL
Atelectasis
Phrenic nerve palsy
Splinting 
Eventration  (congenital)
Subphrenic inflammation
BILATERAL
Poor inspiration
Obesity
Pregnancy
Ascites
Hepato-splenomegaly
29
Q

What is the butterfly/bat wing appearance?

A

Often seen in Pulmonary edema, it is bilateral haziness in the perihilar areas

30
Q

What is the normal relation between the transverse diameter of the heart and the thoracic cage on the PA chest film?

A

1/3 to right of midline, 2/3 to left of midline

PA: widest diameter of heart is less than or equal to 1/2 of thoracic cavity

31
Q

List 2 causes of left ventricle hypertrophy.

A

Aortic stenosis, HTN (chronic)

Also, congenital, exercise

32
Q

What is the significance of the retrosternal/anterior and retrocardiac/posterior clear spaces?

A

You can see masses or effusions in them

33
Q

What is the most common retrocardiac (posterior mediastinal) mass?

A

Hiatal hernia

34
Q

Most common cause of extrapleural sign?

A

Metastatic rib lesion

35
Q

What type of pathology can you see in the retrosternal-anterior clear spaces?

A

Thymoma, Substernal thyroid goiter, Hodkin’s lymphoma

36
Q

What type of pathology can you see in the anterior mediastinum?

A

Retrosternal goiter, Hogkin’s lymphoma, Thymic mass (thymoma), Germ cell tumor

37
Q

What are the divisions and boundaries of the mediastinum?

A

Superior & inferior mediastinum (divided by line that joins manubriosternal junc. anteriorly to inferior margin of T4 vertebral body posteriorly)

Anterior Inferior & middle inferior (divided by anterior pericardium)

Middle inferior & posterior inferior (divided by tracheal bifurcation, pulmonary vessels, posterior pericardium, posterior portion of upper surface of diaphragm)

38
Q

What are the borders and contents and pathologies of the superior mediastinum?

A

Borders: anterior (manubrium), posterior (T1-4), Inferior (line from sternal angle to inferior body of T4)

Thymus, Aortic arch, Brachiocephalic, Subclavian, Common carotid, Superior vena cava, trachea, esophagus

Pathology: dissecting AA, thymoma

39
Q

What are the borders, contents, and pathologies of the anterior inferior mediastinum?

A

Borders: anterior pericardium

Contents: nothing major

Pathology: retrosternal goiter, hodkin’s lymphoma, thymic mass, germ cell tumor

40
Q

Where is the anterior inferior mediastinum on CXR?

A

Sternum to anterior cardiac silhouette - anterior (retrosternal) clear space

41
Q

What are the borders, contents, and pathologies of the middle inferior mediastinum?

A

Borders: btwn anterior & posterior pericardium

Contents: heart, ascending aorta, superior/inferior vena cava, trachea, bifurcation, pulmonary arteries/veins, phrenic nerves

Pathology: LAD, bronchogenic carcinoma, aneurysm, bronchogenic cyst, CHF

42
Q

Where is the middle inferior mediastinum on CXR?

A

Anterior to posterior cardiac silhouette

43
Q

What are the borders, contents, and pathologies of the posterior inferior mediastinum?

A

Borders: posterior pericardium, tracheal bifurcation, pulmonary vessels

Contents: descending aorta, vagus/splanchnic nerves, azygos/hemiazygos veins, esophagus, thoracic duct, LN

Pathology: HH, Neurogenic tumor, paravertebral mass, meningocele, esophageal mass, aneurysm

44
Q

Where is the posterior inferior mediastinum on CXR?

A

Posterior cardiac silhouette to posterior border of lung field

45
Q

What is the significance (what bronchogenic parts are involved) when obliteration of the following is observed: aortic knob?

A

Apical posterior segment of LUL

46
Q

What is the significance when obliteration of the following is observed: ascending aorta?

A

Anterior segment of RUL

47
Q

What is the significance when obliteration of the following is observed: R heart border?

A

RML

48
Q

What is the significance when obliteration of the following is observed: L heart border?

A

LUL

49
Q

What is the significance when obliteration of the following is observed: R diaphragm?

A

basal segments

50
Q

What is the significance when obliteration of the following is observed: L diaphragm?

A

basal segments, Magenblasse

51
Q

What is the significance when obliteration of the following is observed: heart?

A

LLL (basal segment)