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.
Describe the appearance of pleural effusion and name some causes.
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
What are the different types of pneumothorax?
spontaneous, tension, trauma
What is the appearance of pneumothorax with pleural effusion?
Shrunken lung, pleural space larger, meniscus sign from pleural effusion
Increase peripheral lucency with blunted costophrenic angle on affect side
What is the difference in appearance between spontaneous and tension pneumothorax?
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
What is pancoast tumor?
Bronchogenic carcinoma in the apex of the lung (superior sulcus tumor)
Are multiple pulmonary masses of varying sizes suggestive of primary bronchogenic or metastatic carcinoma?
Metastatic carcinoma (multiple)
Is calcification common in a malignant pulmonary mass?
NO!
Most calcifications are benign!
List 4 conditions that demonstrates elevation of the hemidiaphragm.
UNILATERAL Atelectasis Phrenic nerve palsy Splinting Eventration (congenital) Subphrenic inflammation
BILATERAL Poor inspiration Obesity Pregnancy Ascites Hepato-splenomegaly
What is the butterfly/bat wing appearance?
Often seen in Pulmonary edema, it is bilateral haziness in the perihilar areas
What is the normal relation between the transverse diameter of the heart and the thoracic cage on the PA chest film?
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
List 2 causes of left ventricle hypertrophy.
Aortic stenosis, HTN (chronic)
Also, congenital, exercise
What is the significance of the retrosternal/anterior and retrocardiac/posterior clear spaces?
You can see masses or effusions in them
What is the most common retrocardiac (posterior mediastinal) mass?
Hiatal hernia
Most common cause of extrapleural sign?
Metastatic rib lesion
What type of pathology can you see in the retrosternal-anterior clear spaces?
Thymoma, Substernal thyroid goiter, Hodkin’s lymphoma
What type of pathology can you see in the anterior mediastinum?
Retrosternal goiter, Hogkin’s lymphoma, Thymic mass (thymoma), Germ cell tumor
What are the divisions and boundaries of the mediastinum?
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)
What are the borders and contents and pathologies of the superior mediastinum?
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
What are the borders, contents, and pathologies of the anterior inferior mediastinum?
Borders: anterior pericardium
Contents: nothing major
Pathology: retrosternal goiter, hodkin’s lymphoma, thymic mass, germ cell tumor
Where is the anterior inferior mediastinum on CXR?
Sternum to anterior cardiac silhouette - anterior (retrosternal) clear space
What are the borders, contents, and pathologies of the middle inferior mediastinum?
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
Where is the middle inferior mediastinum on CXR?
Anterior to posterior cardiac silhouette
What are the borders, contents, and pathologies of the posterior inferior mediastinum?
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
Where is the posterior inferior mediastinum on CXR?
Posterior cardiac silhouette to posterior border of lung field
What is the significance (what bronchogenic parts are involved) when obliteration of the following is observed: aortic knob?
Apical posterior segment of LUL
What is the significance when obliteration of the following is observed: ascending aorta?
Anterior segment of RUL
What is the significance when obliteration of the following is observed: R heart border?
RML
What is the significance when obliteration of the following is observed: L heart border?
LUL
What is the significance when obliteration of the following is observed: R diaphragm?
basal segments
What is the significance when obliteration of the following is observed: L diaphragm?
basal segments, Magenblasse
What is the significance when obliteration of the following is observed: heart?
LLL (basal segment)
