Module 3 Thoracic Cavity Flashcards
1
Q
OPENINGS OF THE THORACIC CAVITY
A
- Superior thoracic aperture
- Inferior thoracic aperture
2
Q
SUB DIVISIONS OF THE THORACIC CAVITY
A
- Right Pleural Cavity
- Left Pleural Cavity
- Pericardial Cavity
3
Q
STRUCTURES OF THE RESPIRATORY SYSTEM
A
- Pharynx
- Trachea
- Bronchi
- Lungs
4
Q
DEF: PARENCHYMA
A
A characteristic tissue of a particular organ.
5
Q
LUNG PARENCHYMA
A
Light and spongy
6
Q
PORTIONS OF THE LUNG
A
- Apex
- Base
- Costophrenic angles
- Hilum
7
Q
MEDIASTINUM
A
Mass of tissue between the pleura of the lungs and includes all the contents of the thoracic cavity except the lungs. Divided into superior, anterior, middle and posterior mediastinum.
8
Q
CXR POSITIONING
A
- exposure taken on second inspiration
- CR at T7
- SID MUST be 180CM
- Done preferably at erect
9
Q
REASONS FOR DOING BOTH INSP AND EXP CXR
A
- Pneumothorax
- Atelactasis ( partial collapse or incomplete inflation of the lung )
- Presence of a FB
- Diaphragmatic Excursion ( movement of the thoracic diaphragm during breathing
10
Q
ISTHMUS
A
A narrow band of tissue the connects the two lobes of the thyroid a cross the anterior trachea
11
Q
THYROID GLAND
A
An endocrine gland that produces hormones that serve to increase metabolism .
- Thyroxinehormone
- Triodothyronine hormones
12
Q
PARATHYROID GLANDS
A
Glands that produce parathyroid hormones which playa role in calcium homoestasis. They are two in number and situated on the superior aspect of each thyroid hormone
13
Q
PHARYNX
A
A common passage for the respiratory and digestive systems located in front of the vertebrae and behind the nose and mouth. Pharynx is divided into three.
- nasopharynx
- oropharynx
- laryngeal pharynx
14
Q
LARYNX
A
Commonly referred to as a voice box, located below the the tongue base in front of the laryngeal pharynx, subdivided into three compartments
- Superior pair folds
- Inferior pair folds
- Rima Glottis
15
Q
AP SOFT TISSUE NECK PROJECTION
A
- Dome supine or upright, preferably erect
- Align MSP to the CR
- Raise chin to prevent mandibular shadow
- Cent-erring point is the laryngeal prominence
- Collimation must include EAM and jugular notch
- Exposure must be done under slow respiration
16
Q
AP PROJECTION STRUCTURES DEMONSTRATED
A
- Larynx and pharynx from C3- T3 and must be filled with air and visualised through the C spine
- Pathology affecting the larynx,trachea, thyroid and thymus glands may be seen when present
- Radiopaque or opacified foreign bodies may be visualised when present:
17
Q
LATERAL SOFT TISSUE NECK PROJECTION
A
Done : -
- Upright if possible
- Depress the shoulders
- Extend the patients chin slightly
- SID/ FFD must be 180cm to minimise magnification
- Exposure done during slow nasal inspiration ( to fill up the upper airway)
- Collimate to include EAM to jugular notch
18
Q
SOFT TISSUE NECK LATERAL PROJECTION, STRUCTURES DEMONSTRATED
A
- Pharynx and larynx should be filled with air and we’ll visualised
- Radiopaque or opacified FB may be visualised if present
19
Q
AP PROJECTION OF TRACHEA
A
- Done supine or upright ,preferably erect
- Raise chine slightly and place MSP perpendicular tooth IR
- Centre to the manubrium
- Expose during slow deep inspiration to ensure filling of the trachea and upper airway
20
Q
AP PROJECTION STRUCTURES DEMONSTRATED NECK
A
- Outline of the air filled trachea superimposed over the cervical vertebrae
- Visibility of the area from mid- cervical to mid thoracic region
21
Q
LATERAL PROJECTION
TRACHEA
A
- Patient in erect position with body in true lateral position
- Patients hands clasped behind their back with shoulders rotated posteriorly
- Collimate to above the upper border of the laryngeal prominence and the sorrow ding soft tissue
- Expose during slow , deep inspiration to fill the trachea and upper airway with air
22
Q
LATERAL TRACHEA PROJECTION
STRUCTURAL DEMONSTRATION
A
- Air-filled trachea
- Area from mid- cervical to mid-thoracic region must be seen
- Trachea-and superior mediastinum free
23
Q
PA CHEST PROJECTION
A
- Position patient upright of seated
- MSP perpendicular to the IR
- MCP parallel to the IR
- Patients dorsal surface of the hands placed on the hips
- Patients shoulders rotated forward and relaxed downwards
- Place the top of the IR 5cm above the shoulders
- Collimate to the exposure field
- Centre to the level of T7
- Place lead runner for gonadal shielding
- Practice breathing with the patient a few time and then instruct them to hold their breath and expose
24
Q
LATERAL CHEST PROJECTION
A
- Position patient upright, seated or standing with left side in contact with the IR
- Make sure the patient has a balanced stance
- MSP is parallel to the IR
- MCP is perpendicular to the IR
- Raise patients arms above the chest with chin elevated and looking straight a head
- Top of IR. use be 5 cm above the top of the shoulders
- Centre at the level of T7 ( inferior angle of scapular)
- Provide shielding
- Ask patient to inhale and exhale then inhale and hold
-
25
AP CHESTPROJECTION
- Position patient supine or upright facing the x-ray position
- MSP perpendicular to the IR
- MCP parallel to the IR
- Arms clear of the thorax region with the chin elevated and straight
- Place IR 5 cm above the shoulders
- Centre at the level of T7
- Provide lead shielding
- Practice breathing with patient then inhale and hold.
-
26
AP CHEST PROJECTION: Pulmonary Apices
Position patient standing or seated upright about 30cm in front of the IR.
- MSP perpendicular to IR
- Place arms clear of the thorax with the chine raised and
Poking straight ahead
- Place IR 5 cm above the shoulders
- Centre at the mid sternum
- Provide lead shielding
- practice breathing with patient
- NB= Modification - patients back flat of the IR, then angle CR 15-20 deg up
27
PA CHEST RAD CRITERIA
- Include apices to costophrenic angles
- Scapulae outside the lung fields
- 3 ribs above the clavicle
- Manubrium superimposed over the 4th thoracic vertebrae
Equal distance fromSC joint to vertebral column
- 10 posterior ribs seen above the diaphragm on full inspiration
28
LEFT LATERAL. CHEST
RADIOGRAPHIC CRITERIA
- Include Apices to costophrenic angles, sternum to posterior ribs
- Project the right costophrenic angle inferiority
- Posterior Rib separation of no more than 1 cm must be seen
- Superimposed Thoracic vertebral bodies
No hi Earl superimposition on lung Apices must be seen
29
INFANT AP CHEST RADIOGRAPHIC CRITERIA
- Apices to costophrenic angles seen
- CR at T4
- Baby’s chin must not superimpose the lung field
- Equal distance from SC joints to the vertebral column
- 8 or 9 posterior ribs seen above the diaphragm on full inspiration
- All tubes and lines must be visible
30
INFANT OR CHILDS LATERAL CHEST
| RADIOGRAPHIC CRITERIA
- Must include Apices to costophrenic angles, sternum and posterior ribs
- Posterior-ribs must be superimposed
- Avoid humeral superimposition of lung Apices
- Avoid exposure of chin or head
- Centre @ T5
31
CENTRAL VENOUS CATHETER ( CVC)
- A catheter inserted through subclavian or jugular vein
- Ideal position is within the SVC 2,5 cm above the right atrium
- Used to administer chemotherapy or parental nutrition
-
32
PERIPHERALLY INSERTED CENTRAL CATHETER ( PICC LINE )
- Central line inserted through one of the peripheral veins
- Ideal position is in the SVC
- Used for long term IV therapy
33
ENDOTRACHEAL TUBE. (ETT)
- Tube used to inflate the lungs
- It is inserted into the trachea
- And it’s ideal position 2,5-5cm above the carina
34
TRACHEOSTOMY
- Surgical opening made in the trachea to create an artificial airway
- Ideal position 1/2 distance from the tracheal stoma and carina
- NB =Never to be tempered with
35
CHEST TUBE FOR PNEUMOTHORAX
- Tube inserted into the chest for the purpose to remove air that has accumulated in the pleural cavity
- Ideal position is within the pleural cavity anteriorly placed at the mid clavicular,level
36
CHEST TUBE ( drain) FOR PLEURAL EFFUSION
- A chest tube inserted to remove fluid that has accumulated in the pleural cavity
- The tubes ideal position is within the pleural cavity laterally placed at the 5th intercostal space
37
PACEMAKER
- A medical device that generates impulses to regulate the heart rate
- 8It is inserted through the antecubital, femoral, jugular, or subclavian vein
- It’s ideal position is into the subcutaneous fat of the anterior chest wall with the catheter tip with in the right atrium and or ventricle
38
PORT-O-CATH
- A medical device used to draw blood and give treatment
| - It’s ideal position is in the subcutaneous fat of the anterior chest wall with the catheter tip advanced to the SVC
39
PULMONARY ARTERIAL CATHETER (SWAN- GANZ CATHETER)
- A catheter inserted through subclavian, jugular or femoral veins
- It’s ideal position is seen within the heart shadow with the catheter travelling to SVC, right atrium, right ventricle, pulmonary trunk and end at the right or left pulmonary artery
- Used to measure the pressure in the pulmonary artery and atriums
- Also measures the cardiac output
40
NEONATES CHEST UMBILICAL ARTERY CATHETER
- Ideal position is in the thoracic aorta at the level of T6-T9 or below the renal artery
- It’s purpose is to measure oxygen saturation
41
NEONATAL. CHEST UMBILICAL VEIN CATHETER
- A catheter used to deliver fluids and medications
| - Ideal position is the junction of the IVC and right atrium
42
HYALINE MEMBRANE DISEASE ( RESPIRATORY DISTRESS SYNDROME )
- Neonatal respiratory distress syndrome more common in premature babies born six or more weeks.
- Seen in premature infants with lack of surfactant ( a substance that lowers surface tension of fluid lining the alveoli, allowing the alveoli to remain expanded and promote gaseous exchange)
- Without surfactant the alveoli are unable to stay inflated , and collapse when the baby exhales
- Clinical signs- Dyspnea- shortness of breath- hypoxia
- Imaging- AP mobile chest
- RADIOGRAPHIC appearance- - Under aeration if the lung- Lungs have a granular appearance, ground glass appearance, hazy- Air bronchograms
43
CYSTIC FIBROSIS
- A hereditary disorder that is affecting the exocrine glands
- Exocrine glands secrete excessive mucous which affect multiple systems ( digestive and respiratory )
- The exocrine secretions block the bronchi and trachea leading to areas of collapsed lung and recurrent lung infection
- IMAGING - CXR
- Chest CT
- RADIOGRAPHIC APPEARANCE- Hyperinflation of the lung
P. - Late stage: Brochiectasis
- TREATMENT - Daily chest physio to loosen the mucous in the chest
- Antibiotics for chest infections
-
44
AIR SPACE DISEASE
- Non filling of the pulmonary tree with material that attenuates x rays more than the surrounding lung parenchyma
- Produces opacities in the lung, producing a fluffy or hazy appearance
- Can be throughout the lung or localised
- Air bronchogramms are commonly seen due to the bronchi being surrounded by opacified alveoli
45
SUBCUTANEOUS EMPHYSEMA
- This is free air within the tissues of the chest, neck and axilla
- CLINICAL SIGNS- The skin will feel crunchy when touched
- RADIOGRAPHIC APPEARANCE- Free air with in the muscle appears as a stripped appearance
46
EMPHYSEMA
- Trapped air in the lungs because of the destroyed alveolar walls, this causes air to be trapped in the spaces on exhalation
- Lung elastic recoil is damaged further increasing the air trapped in the lungs
- CAUSE- Inhalation of cigarette smoke
- CLINICAL SIGNS- Shortness of breath and wheezing
- IMAGING- PA and Lateral CXR
- RADIOGRAPHIC APPEARANCE- Lungs are hyper inflated, increased radio density
- Blunted Diaphragms
- Bullae, enlarged air spaces appear
47
ASTHMA
- Bronchial, airway narrowing due to sensitivity to specific allergens causing air
To be trapped in the lungs
- CLINICAL SIGNS- Dyspnea, wheezing
- Chest tightness
- Tachycardia and fatigue
- Imaging- PA and Lateral CXR
- RADIOGRAPHIC APPEARANCE- Typically normal chest appearance
- During an attack the lungs may appear hyper inflated due to trapped air
48
OBSTRUCTIVE ATELECTASIS
- Collapse of the entire lung or segment of lung with loss of lung volume
- Caused y air way obstruction ( tumour, foreign body or mucus) , or inadequate surfactant
49
CLINICAL SIGNS AND IMAGING FOR OBSTRUCTIVE ATELECTASIS
Signs- Dyspnea
- Chest pains
Imaging- PA and Lateral CXR
50
RADIOGRAPHIC APPEARANCE OF OBSTRUCTIVE ATELECTASIS
- - Increased radiopacity of the lung due to loss of air in alveoli
- Elevated diaphragm
- Displaced lung fissures
- Over inflation of unaffected lung or in affected lobes or segments of lung
- Parietal and visceral pleura remain intact , causing shift of trachea, heart and hemidiaphragm towards the side of volume loss
51
COMPRESSIVE ATELECTASIS
External compression of the lung caused by pneumothorax or pleural effusion
52
CLINICAL SIGNS AND IMAGING FOR COMPRESSIVE ATELECTASIS
Clinical signs - Dyspnea
- Chest pain
Imaging. - PA and Lateral CXR
53
RADIOGRAPHIC APPEARANCE FOR COMPRESSIVE ATELECTASIS
Volume loss or collapse of lung due to external pressure of fluid or air
54
BRONCHIECTASIS
Chronic dilatation of the bronchi or bronchioles usually caused by bacteria, staphylococcus
55
CLINICAL SIGNS AND IMAGING FOR BRONCHIECTASIS
Signs - Productive cough
- Hemoptysis
Imaging- High Resolution CT chest
56
RADIOGRAPHIC APPEARANCE OF BRONCHIECTASIS
- Enlarged bronchi
| - Signet ring sign
57
CHRONIC BRONCHITIS
Inflammation of the air ways with excessive secretions of mucus caused by virus influenza A or B or by inhaling an irritant like cigarette smoke
58
CLINICAL SIGNS AND IMAGING FOR CHRONIC BRONCHITIS
Clinical signs- Productive cough
- Wheezing
Imaging- PA and Lateral CXR
59
RADIOGRAPHIC APPEARANCE OF CHRONIC BRONCHITIS
As the disease progresses the CXR may show signs of hyperinflation of the lung and increased vascular markings due to chronic obstruction of airways
60
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
This chronic obstruction of the airways due to chronic bronchitis or emphysema primarily caused by inhaling cigarette smoke
- Bronchitis causes airway obstruction through excessive mucus production
- Emphysema destroys the alveoli walls thus enlarging the airspace’s and trapping air
61
CLINICAL SIGNS AND IMAGING FOR COPD
Clinical signs- Productive cough
- Dyspnea
- Wheezing
- Barrel chest
Imaging. - PA and Lateral CXR
62
RADIOGRAPHIC APPEARANCE OF COPD
- Blunted diaphragms,
- Hyper-inflated lungs
- Increased retrosternal space
63
PULMONARY EMBOLISM PE
This is blood clots within the pulmonary arteries often caused by an embolus from the deep veins of the legs ( DVT)
DVT maybe caused by prolonged sitting, prolonged bed rest-or immobility, surgery, recent fractures of the hip or lower leg etc.
64
CLINICAL SIGNS AND IMAGING FOR PULMONARY EMBOLISM
Clinical signs- Sudden onset, sharp chest pain
- Dyspnea
- Diaphoresis ( excessive sweating)
NB :May be fatal if pulmonary infarction results
Imaging. - CT PE protocol, with contrast media utilised
65
RADIOGRAPHIC APPEARANCE OF PULMONARY EMBOLISM
Contrast filling defect on CT scan with in the pulmonary arteries affected
66
PULMONARY EDEMA
Fluid accumulation with in the lung tissue and alveoli-commonly caused by increased pulmonary venous pressure due to left sided heart failure
67
CLINICAL SIGNS AND IMAGING FOR PULMONARY EDEMA
Clinical signs- Dyspnea
N. - Wheezing
- Feeling of suffocation
Imaging- PA and Lateral Chest
68
RADIOGRAPHIC APPEARANCE OF PULMONARY EDEMA
- Fluffy, patchy airspace densities, centrally located
| - Bat- wing or Butterfly appearance
69
PRIMARY LUNG CANCER
Most common fatal malignancy amongst en and second most common among women. Can be classified by their cell types SMALL CELLS are centrally located and NONSMALL CELLS are peripheral in location
70
CLINICAL SIGNS AND IMAGING FOR PRIMARY LUNG CANCER
Clinical signs = Dyspnea
= Hemoptysis
Imaging = CXR
= CT chest
71
RADIOGRAPHIC APPEARANCE OF PRIMARY LUNG CANCER
- Usually a solitary mass
- With irregular margins
- Could be peripherally or centrally located based on the type of lung cancer demonstrated
72
METASTATIC LUNG DISEASE
Spread of malignant cells to the lung via blood stream or lymphatic.
Most common primary sites of metastatic lung disease is COLORECTAL CARCINOMA in males and BREAST cancer in females
73
CLINICAL SIGNS AND IMAGING FOR METASTATIC LUNG DISEASE
Clinical signs. = Dyspnea
= Hemoptysis
Imaging =. CXR
CT chest
74
RADIOGRAPHIC APPEARANCE OF METASTATIC LUNG DISEASE
Multiple nodules throughout the lung
- With various size nodules well marginated
75
SEVERE ACUTE RESPIRATORY SYNDROME ( SARS )
A respiratory disease caused by SARS corona virus
76
CLINICAL SIGNS AND IMAGING FOR SEVERE ACUTE RESPIRATORY SYNDROME ( SARS )
Clinical signs = Flu- like symptoms
= Cough
= Sore throat
= Fever
Imaging. = CXR
= CT chest
77
RADIOGRAPHIC APPEARANCE OF SEVERE ACUTE RESPIRATORY SYNDROME ( SARS )
Bilateral patchy airspace opacity
78
ACQUIRED IMMUNODEFICIENCY SYNDROME ( AIDS )
A condition caused by human immunodeficiency virus HIV which affects the lungs, GI system and CNS
79
CLINICAL SIGNS AND IMAGING OF ACQUIRED IMMUNODEFICIENCY SYNDROME ( AIDS )
Clinical signs- Fever
N. - Cough
- Night seats
Imaging - CXR
- MRI
80
RADIOGRAPHIC APPEARANCE OF ACQUIRED IMMUNODEFICIENCY SYNDROME ( AIDS )
Pneumonia, airspace consolidation, air bronchograms
81
EPIGLOTTITIS
This is the swelling of the epiglottis causing an obstruction to the airway caused by a bacterial infection of the epiglottis ( supraglottic region) seen in children
82
CLINICAL SIGNS AND IMAGING FOR EPIGLOTTITIS
Clinical signs = The child presents with mouth open, leaning forward and unable to n. swallow, drooling
Imaging = Upright soft tissue neck x ray
NB: Never lie a child down with suspected epiglottitis !!!!!
83
RADIOGRAPHIC APPEARANCE OF EPIGLOTTITIS
Typical appearance of the epiglottis is a thin shadow, in EPIGLOTTITIS it appears as a thumb print, a thick soft tissue
84
CROUP
A viral infection of the subglottic region of the trachea which causes the narrowing of the upper trachea
85
CLINICAL SIGNS AND IMAGING FOR CROUP
Clinical Signs - Child has a barking cough, like a seal
Imaging - AP soft tissue airway
86
RADIOGRAPHIC APPEARANCE OF CROUP
Tapered narrowing of the upper trachea
87
PNEUMONIA
- This is infection and inflammation of the alveoli
- Fluid replaces air with in the alveoli
- Commonly caused by streptococcus bacteria
88
CLINICAL SIGNS AND IMAGING FOR PNEUMONIA
Clinical signs- Cough and fever
- Chest pain
- Dyspnea
Imaging- CXR
89
RADIOGRAPHIC APPEARANCE PNEUMONIA
- Radiopaque opacities in the lung tissue
- Air bronchograms maybe present if the bronchi are not filled with exudate
- No shift of mediastinal structures
90
PNEUMOTHORAX
This the present of air in the pleural cavity caused by a penetrating injury or a spontaneous rupture of a small blob on the surface of the lung
91
CLINICAL SIGNS AND IMAGING FOR PNEUMOTHORAX
Clinical signs- Chest pains
- Dyspnea
Imaging- CXR inspiration and expiration
92
RADIOGRAPHIC APPEARANCE OF PNEUMOTHORAX
- Decreased lung volume
- No vascular markings within the free air
- No mediastinal shift structures seen
- Out line of visceral pleura seen
93
TENSION PNEUMOTHORAX
Presence of air in the pleural space which continues to leak to a point that their is lung collapse with mediastinum shift away from the side of the pneumothorax
94
CLINICAL SIGNS AND IMAGING of TENSION PNEUMOTHORAX
Clinical Signs- Chest pain
- Dyspnea
Imaging- CXR inspiration and expiration
95
RADIOGRAPHIC APPEARANCE OF TENSION PNEUMOTHORAX
- Decreased lung volume
- No vascular markings within the free space
- White line outlining visceral pleura
- Shift-of mediastinal structures
96
PLEURAL EFFUSION
Free fluid in the pleural cavity commonly caused by congestive heart failure, pneumonia and pulmonary embolism
A pleural tap or thoracentesis is done to remove the fluid
97
CLINICAL SIGNS AND IMAGING FOR PLEURAL EFFUSION
Clinical signs- Shortness of breath
- Dyspnea
Imaging - CXR INSPIRATION AND EXPIRATION AND LATERAL DECUBITUS
98
RADIOGRAPHIC APPEARANCE OF PLEURAL EFFUSION
- Blunted costophrenic angles
- Radiopaque appearance
- Large pleural effusion may cause a shift of trachea, heart and hemidiaphragm from affected side
99
EMPYEMA
Presence of infected fluid or pus within the pleural space, abbé caused by pneumonia or lung abscess etc.
100
CLINICAL SIGNS AND IMAGING FOR EMPYEMA
Clinical signs = Dyspnea
Imaging = CXR
101
RADIOGRAPHIC APPEARANCE OF EMPYEMA
Appearance is similar to a pleural effusion with increased density within the hemithorax
102
ATRIAL SEPTAL DEFECT
The most common congenital cardiac lesion which is enlargement of the right heart ( Atrium and ventricle) due to increased left atrial pressure from a left to right atrium shunt that developed from the failure of the closure of the foramen ovale after birth
103
CLINICAL SIGNS AND IMAGING OF ATRIAL SEPTAL DEFECT
Clinical signs- May be a symptomatic
- An unusual sound heard during a heart beat
- Dyspnea
Imaging- CRX
104
RADIOGRAPHIC APPEARANCE OF ATRIAL SEPTAL DEFECT
Enlarged right atrium and/or right ventricle
105
VENTRICULAR SEPTAL DEFECT
This is the opening in the interventricular septum, this causes shunting which occurs during systole and increases blood flow through pulmonary veins to the left side of the heart
106
CLINICAL SIGNS AND IMAGING OF VENTRICULAR SEPTAL DEFECT
Clinical signs- - An unusual sound heard during heart beat
Imaging- CXR
107
RADIOGRAPHIC APPEARANCE OF VENTRICULAR SEPTAL DEFECT
- Enlarged left atrium and ventricle
- No enlargement of right ventricle
-
108
PATENT DUCTUS ARTERIOUS
This is a condition caused by failure of closure of the Ductus ARTERIOUS after birth thus causing shunting from left to right heart ( aorta to pulmonary artery )
109
CLINICAL SIGNS AND IMAGING FOR PATENT DUCTUS ARTERIOUS
Clinical signs- Excess blood in the pulmonary artery, left atrium and left ventricle
Imaging- CXR
110
RADIOGRAPHIC APPEARANCE OF PATENT DUCTUS ARTERIOUS
- Enlarged left atrium and ventricle ( Cardiomegaly )
| - Increased Pulmonary vascularity
111
TETRALOGY OF FALLOT
This is increased pressure to the right ventricle caused by 4 abnormalities
- Ventricular Septal Defect
- Pulmonary Stenosis
- Overriding of the aorta above the ventricular defect
- Right Ventricular Hypertrophy
112
CLINICAL SIGNS AND IMAGING FOR TETRALOGY OF FALLOT
Clinical signs- Cyanosis
- Child fails to thrive
- Fatigued easily
Imaging- CXR
113
RADIOGRAPHIC APPEARANCE OF TETRALOGY OF FALLOT
Wooden shoe shaped heart
114
COARCTATION OF THE AORTA
A narrowing of the aorta distal to the aortic arch.
| - Collateral circulation may develop beyond the narrowing
115
CLINICAL SIGNS AND IMAGING FOR COARCTATION OF THE AORTA
Clinical signs - Increased pressure in the upper extremities, head, and anterior intercostal arteries
Imaging- CXR
- Barium Swalllow
116
RADIOGRAPHIC APPEARANCE OF COARCTATION OF THE AORTA
CXR- Rib notching due to increased pressure in the intercostal arteries
- Figure 3 sign bulging Aortic knob,
- Narrowing at coarctation,
- dilation below stenosis
Barium Swallow- Reverse Figure of 3 sign
117
DEXTROCARDIA
A congenital condition, where the apex of the heart is positioned to the right of the mediastinum instead of to the left.
- It may be a symptomatic or be associated with other heart defects
118
CLINICAL SIGNS AND IMAGING FOR DEXTROCARDIA
Clinical signs- No symptoms if the heart is normal other than the dextrocardia
Imaging- CXR
- CT
119
RADIOGRAPHIC APPEARANCE OF DEXTROCARDIA
Apex of the heart pointed to the right
120
CORONARY ARTERY DISEASE
This stenosis of the coronary arteries which cause insufficient oxygen supply to the myocardium resulting into ischemia ( decreased supply of oxygenated blood to the heart muscle ) .
121
MYOCARDIAL INFARCTION
Caused by a prolonged stenosis of coronary arteries which then leads to necrosis of the myocardium
122
CLINICAL SIGNS OF CORONARY ARTERY DISEASE
- Pain and pressure in the chest , jaw and or left arm
- Excessive sweating Diaphoresis
- The above usually occurs during exercise, stress, and after a heavy meal
123
TREATMENT OF CORONARY ARTERY DISEASE
- Nitroglycerin tablets placed under the tongue of the patient, this causes venous dilation decreasing the oxygen demands of the myocardium
- Stenting
- Coronary by pass grafting
- Percutaneous trans luminal angioplasty
124
ATHEROSCLEROSIS
The hardening of the artery which is the result of narrowing of the artery lumen caused by fatty deposits called plaques.
125
CLINICAL SIGNS AND IMAGING OF CORONARY ATHEROSCLEROSIS
Imaging - CXR
I. - Nuclear Medicine
- CT
- Coronary Angiogram
126
RADIOGRAPHIC APPEARANCE OF CORONARY ATHEROSCLEROSIS
CXR- CXR are generally normal in appearance, performed to rule out congestive Heart Failure
- Vessels may demonstrate calcification
127
HYPERTENSION
- High blood pressure which could lead to strokes and or congestive heart failure
128
CAUSES OF HYPERTENSION
- Increased blood volume, salt/ water imbalance
- Artherosclerosis
- Stenosis of the renal artery
129
TREATMENT OF HYPERTENSION
- Diuretic to reduce blood volume
- Beta blockers to control blood pressure
- Angioplasty to the renal artery
130
CONGESTIVE HEART FAILURE
An acute or chronic state which developes when the heart cannot meet the oxygen demands of the body
May be caused by - Coronary artery disease
- Hypertension
- Valvular disease
- Lung disease
131
CLINICAL SIGNS AND IMAGING FOR CONGESTIVE HEART FAILURE
Clinical signs- Fatigue
- Fluid retention causing Edema in the ankles, legs abdomen and lung
- Dyspnea
Imaging- CXR
132
RADIOGRAPHIC APPEARANCE OF CONGESTIVE HEART FAILURE
Cardiomegaly, heart shadow is greater than 50% of the cardio thoracic ratio
133
RADIOGRAPHIC APPEARANCE OF RIGHT- SIDED HEART FAILURE
- Enlarged atrium and ventricle
- Enlarged SVC AND mediastinum
- Peripheral Edema
134
RADIOGRAPHIC APPEARANCE OF LEFT SIDED HEART FAILURE
- Cardiomegaly
- Pleural Effusion
- Pulmonary Edema
135
ANEURYSM
A dilation of an artery, vein or heart chamber due to a weakening within the wall
= most common is the abdominal aorta.
136
SACCULAR ANEURYSM
A dilation of an artery or vein with a bulge on one side of the vessel
137
FUSIFORM ANEURYSM
A dilation of an artery or vein which involves the entire circumstance of the vessel
138
ANEURYSM CUASES
- Some a congenital like the berry aneurysms in the Circle of Willis
- Trauma
- Inflammation
- Degeneration
139
CLINICAL SIGNS AND IMAGING OF ANEURYSM
CLINICAL SIGNS-
- pain or pressure
- rupture or haemorrhage
Imaging- CXR
- AXR series
CT Angiography
140
RADIOGRAPHIC APPEARANCE OF ANEURYSM
- A calcified vessel maybe demonstrated n plain radiographs
| - On CTA will demonstrate the size of the aneurysm and whether the rupture or dissection has occurred
141
DISSECTION OF AORTA
A tear In the intima of the artery allowing blood to enter the wall of the artery separating its layers
142
CLINICAL SIGNS AND IMAGING OF DISSECTION OF AORTA
Clinical signs- Sudden severe pain
- No Diaphoresis
Imaging - CXR
- CT
143
RADIOGRAPHIC APPEARANCE OF DISSECTION OF AORTA
- Widened mediastinum on the CXR appearance,
| - on contrast enhanced CT it will demonstrate an intimate flap which identifies the true and false lumen
144
PERICARDIAL EFFUSION AND CARDIAC TEMPONADE
Excessive fluid in the pericardial cavity , maybe caused by trauma , pericarditis, dissecting aortic aneurysm, myocardial infarction.
= can be treated by performing a pericardiocentesis
145
CLINICAL SIGNS AND IMAGING FOR PERICARDIAL EFFUSION AND CARDIAC TEMPONADE
Clinical signs-=
- Chest pain and pressure
- Dyspnea
- Syncope, light headed ness
Imaging = CXR
146
RADIOGRAPHIC APPEARANCE OF PERICARDIAL EFFUSION AND CARDIAC TEMPONADE
Enlarged cardiac silhouette
147
THROMBUS
A blood clot with in a blood vessel which may be caused by =
- Slow moving blood
- Viscous blood
- The inner lining of the wall, forming a clot
148
EMBOLUS
When a thrombus or part of a thrombus moves away from its site of origin and can cause an occlusion
This can be treated with Anticoagulants ( Warfarin, Coumadin) blood thinners
149
VARICOSE VEINS
Dilated, elongated and tortuous vessels commonly superficial cause by weak valves in the veins that allow blood to pool.
Risk factors are=
- hereditary
- prolonged standing
- pregnancy
150
CLINICAL SIGNS AND IMAGING FOR VARICOSE VEINS
Clinical signs=
- Raised veins seen through the skin
- Swelling and itching
Imaging =. Ultrasound
151
ATRIAL FIBRILLATION ARRHYTHMIA
Uncoordinated contractions of the two atriums which causes an irregular heartbeat
152
CLINICAL SIGNS AND IMAGING FOR ATRIAL FIBRILLATION ARRHYTHMIA
Clinical signs =
- Maybe asymtomatic
- Palpitations
- Chest pain
- Syncope
Imaging - CXR
153
RADIOGRAPHIC APPEARANCE OF ATRIAL FIBRILLATION ARRHYTHMIA
- Pneumonia
- Congestive Heart Failure
-
154
VENTRICULAR FIBRILLATION ARRHYTHMIA
Uncoordinated contractions of the. Ventricles which are caused by a myocardial infarction
155
CLINICAL SIGNS AND IMAGING FOR VENTRICULAR FIBRILLATION ARRHYTHMIA
Clinical signs =
- Sudden collapse and unconscious
Imaging = CXR
156
LEUKAEMIA
Increased number of white blood cells. Two types =
= Myelocytic Leukemia- Malignancy of the bone marrow causing over production of granulocytes ( type of WBC) and under production of RBC and platelets
= Lymphatic Leukemia- Malignancy of the lymph nodes, over production of lymphocytes
157
CLINICAL SIGNS AND IMAGING FOR LEUKAEMIA
Clinical signs =
- Shortness of breath
- Fatigue
- Blood Clotting issues
NB= Patient becomes highly susceptible to infection due to increased circulation of immature WBC,s
Imaging =
- Skeletal survey
- CXR
158
RADIOGRAPHIC APPEARANCE OF LEUKAEMIA
Skeletal Survey=
- Radiolucent bands at the metaphysical ends of long bones ( knees, ankles and wrists)
- Moth- eaten appearance of bone as disease progresses
CXR=
- Enlarged mediastinum
159
LYMPHOMA
A group of cancers derived from lymphocytes, WBC,s in the lymphatic system .
Lymphoma occurs whenB and T cells-under go a transformation and begin to multiply and settle in various lymph odes or other lymphatic tissue
Two types=
- Hodgkin Lymphoma
Non Hodgkin Lymphoma
160
Non Hodgkin Lymphoma
- Most common of the two
- Originates in organs
- Abnormal cells are derived from B or T cells
161
Hodgkin Lymphoma
- Originates in the lymph nodes
| - Abnormal cells are derived from specific B- cells called REED- STERNBERG CELLS
162
CLINICAL SIGNS AND IMAGING FOR LYMPHOMA
Clinical signs =
- Painless enlargement of lymph nodes especially around the neck, axilla and groin
- Weightloss
- Night Sweats
- Itchy skin
Imaging =
- CXR
- UGI
- Spine imaging
- CT
163
RADIOGRAPHIC APPEARANCE OF LYMPHOMA
CXR=
- Mediastinal lymph nodes enlargement, bilateral asymmetric
- Gastrointestinal and skeletal involvement
Spine imaging =
- Ivory Vertabra appearance
CT=
- Malignant lymph nodes will appear enlarged, round or oval
