Midterm DI 3 Flashcards
Describe the appearance of the major and minor fissures on PA and lateral chest films.
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
Which views are included in routine plain film examination of the chest?
Left lateral and PA. can do Left lateral decubitus for fluid, and apical lordodic for apices
How does a thoracic spine plain film study differ from a chest study?
Spine is done AP, Chest is PA. Attenuation is different to see the spine better or the lungs better, respectively.
What condition or anatomical region is best demonstrated by the apical lordotic view?
Best view for the apices of the lungs, so you can see things like a pancoast tumor or secondary TB
Is the routine chest x-ray taken with inspiration or expiration?
Held inspiration
Describe the difference in appearance between inspiration and expiration chest films.
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
What condition is better demonstrated upon expiration than inspiration?
If there is a bronchial obstruction, the involved lung remains well inflated on expiration
Pneumothorax
What is the appearance of interstitial disease?
What is the appearance of alveolar-air space disease?
Ground glass Linear (reticular) Nodular Reticulonodular Honeycombing
Silhouette sign, Air bronchogram, Pattern - diffuse, Lobar/localized, Solitary nodule/mass, Multiple nodule/mass, Atelectasis
What is the appearance(s) of alveolar/air-space disease?
Localized (lobar) or diffuseal
List the 4 patterns of “white lung” disease (lung opacification on chest films) and a differential list for each.
Diffuse: CHF, viral pneumonia,
Localized / Lobar: Bacterial pneumonia
Solitary mass / nodule: Bronchogenic carcinoma
Multiple masses / nodules: Mets, asbestosis
What is the silhouette sign?
When two structures of the same radiographic density (water) are in anatomic contact, the margins of those structures will be obliterated
What are the causes of atelectasis?
Airway obstruction (tumor, mucus plug, foreign object), anesthesia, lung collapse (pleural effusion, pneumothorax)
Which is the most common cause of atelectasis?
Obstruction/Resorptive
What are the signs of atelectasis?
Displaced fissure
Mediastinal shift, elevated hemidiaphragm, displaced hilus
INC density
What is the direction of the collapse in the different types of atelectasis (towards or away from collapsed lung)?
Towards the collapsed lung if it is resorptive, as in carcinoma or pneumonia; away if it is passive, as in pneumothorax
What is an air bronchogram sign and what does it indicate?
When air spaces filled with water density, air filled bronchi are visible = air bronchogram
Which condition commonly demonstrates as a mass in the pulmonary apex or hilar area and may cavitate?
Pancoast tumor, bronchogenic carcinoma
Which condition commonly demonstrates pleural plaques in the lung bases?
Asbestos related dz - mesothelioma
What are the radiographic signs of pulmonary emphysema?
Depressed, flattened hemidiaphragms, hyperlucency, Increased retrosternal clear space, increased AP chest diameter, decreased peripheral vascular markings
What is an air filled bulla?
Basically an air blister in the lungs. Alveolar walls are destroyed so there is a large lucent bleb in the lungs.