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Chest Anatomy, Procedures, And Techniques > Normal Lung Anatomy > Flashcards

Normal Lung Anatomy Flashcards

1
Q

The right paratracheal stripe should not exceed how many mm in width?

A

Should not exceed 4 mm in width

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2
Q

The tracheoesophageal stripe should measure less than how many mm?

A

Less the 5 mm

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3
Q

Thickening of the tracheoesophageal stripe is commonly seen in what disease?

A

Esophageal carcinoma

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4
Q

The right mainstem bronchus is considerably shorter than the left.

What are their average mean length?

A 
Right = 2.2 cm
Left= 5 cm
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5
Q

The airway just before the first respiratory bronchioles is known as?

A

Terminal bronchiole

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6
Q

It is the smallest bronchiole without respiratory exchange structure.

A

Terminal bronchiole

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7
Q

The inferior pulmonary ligament is a sheet of connective tissue that extends from what structures?

A

Extends from the hilum superiorly to a level at or just above the hemidiaphragm

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8
Q

What comprises the inferior pulmonary ligaments?

A

It comprises fused visceral and parietal pleura and binds the lower lobe to the mediastinum and runs along side the esophagus

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9
Q

The inferior pulmonary ligament contains what structures?

A

Contains the inferior pulmonary vein superiorly and a variable number of lymph nodes

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10
Q

What comprises the azygous fissure?

A

Composed of 4 layers (2 visceral and 2 parietal pleura) and represents invagination of the right apical pleura by the azygous vein, which has incompletely migrated to its normal position at the right tracheobronchial angle.

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11
Q

What is the significance of the azygous fissure?

A

Its ability to limit the spread of the apical segment consolidation to the azygous lobe and in excluding pneumothorax from the apical portion of the pleural space.

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12
Q

It is the portion of apical segment delineated by the azygous fissure.

A

Azygous lobe

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13
Q

The trachea is approximately how many cm long in adults?

A

12 cm long

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14
Q

It is the narrowing of the coronal diameter producing a coronal-to- sagittal ratio of <0.6

A

Saber sheath trachea

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15
Q

The major and minor fissure are best visualised on what radiographic view?

A

Lateral radiographs

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16
Q

The minor fissure projects at the level of what rib?

A

4th rib

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17
Q

Most common accessory fissure?

A

Inferior accessory fissure (10 to 20% of individuals)

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18
Q

What does the inferior accessory fissure separate?

A

It separates the medial basal from the remaining basal segments of the lower lobe

It is often incomplete

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19
Q

The inferior accessory fissure has been misidentified as what structure?

A

Inferior pulmonary ligament

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20
Q

What structure can help identify the inferior accessory fissure?

A

A small triangle of extrapleural fat, seen at its point of insertion of the diaphragm

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21
Q

This represent invaginations of the visceral pleura deep into the substance of the lungs.

A

Interlobar pulmonary fissures

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22
Q

Incomplete fissures has important consequences regarding what processes?

A

Interlobar spread of parenchyma consolidation, collateral air drift in patients with lobar bronchial obstruction, and appearance of pleural effusion in the supine patient

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23
Q

This fissure is complete in about 25% of individuals but fuses with the RUL in about 50% of cases.

A

Minor fissure

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24
Q

The left major fissure is similar to the right major fissure, with fusion along what aspect in approximately 35% of individuals?

A

Posterior aspect

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25
Q

The superior accessory fissure separates what segments?

A

It separates the superior segment from the basal segments of the lower lobe.

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26
Q

The left minor fissure seperates what segment?

A

It separates the lingual from the remaining portions of the upper lobe.

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27
Q

Th tethering effect of the inferior pulmonary ligament on the lower lobe accounts for the medial location and triangular appearance of what disease process?

A

Lower lobe collapse

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28
Q

It is a linear structure seen on CT near the inferior pulmonary ligament extending into the lung from the mediastinal pleura.

It has been mistaken for the inferior pulmonary ligament.

A

Sublobar septum

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29
Q

What ligament is a triangular density extending toward the lung that is seen along the posterior aspect of the right heart border on lung window on chest CT?

A

Pericardiophrenic ligament

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30
Q

This structure represents a reflection of pleura over the inferior portion of the phrenic nerve and pericardiophrenic vessels.

A

Pericardiophrenic ligament

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31
Q

How can you distinguished the pericardiophrenic ligament from the sublobar septum?

A

By its more anterior location and its characteristic ramifications as branches of the nerve and vessel reflect over the diaphragm

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32
Q

What structure arises from the right ventricle at approximately 1-o’clock position relative to the ascending aorta?

A

Pulmonary artery

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33
Q

What artery is a direct continuation of the main pulmonary artery?

A

Left pulmonary artery

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34
Q

What pulmonary artery branches just below the carina, with an angle close to 90 degrees?

A

Right pulmonary artery

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35
Q

The right pulmonary artery divides within what structure?

A

Within the pericardium into the truncus anterior and interlobar arteries

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36
Q

What are the primary nutrient vessels of the lungs?

A

Bronchial arteries

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37
Q

Where does bronchial arteries usually arise?

A

From the proximal descending thoracic aorta at the level of the carina but may show significant variability.

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38
Q

How many bronchial arteries in right lung and in the left lung?

A

One right-sided and two left-sided arteries

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39
Q

Where does the right bronchial artery usually arise?

A

Usually arises from the posterolateral wall of the aorta in common with an intercostal artery as an intercostobronchial trunk

40
Q

Where does the left bronchial arteries arise?

A

Left bronchial arteries arise individually from the anterolateral aorta or, rarely, from an intercostal artery

41
Q

Approximately two-thirds of the blood from the bronchial arterial system returns to the pulmonary venous system via what veins?

A

Bronchial veins (a small right-to-left shunt)

42
Q

Where does the pulmonary veins arise?

A

Within the interlobular septa from the alveolar and visceral pleural capillaries

43
Q

The pulmonary veins may number from how many?

A

Three to eight

44
Q

This lymphatic pathway form a network over the surface of the lung that roughly parallels the margins of the secondary lobules.

A

The visceral pleural lymphatic

45
Q

What lymphatic pathways communicate via a obliquely oriented lymphatic located within the central region of the lung?

A

Perivenous and bronchoarterial lymphatics

46
Q

Periveneous lymphatics and their surrounding connective tissue, when distended by fluid, account for the radiographic appearance of what?

A

Kerley A lines

47
Q

It is the scaffolding of the lung and as such provides support for the airways and pulmonary vessels.

A

Pulmonary interstitium

48
Q

It is the interstitial compartment that extends from the mediastinum and envelopes the bronchovascular bundles.

A

Axial interstitium

49
Q

The axial fiber system of the interstitium continues distally as what?

A

The centrilobular interstitium along with the arteriolar, capillaries, and bronchioles to provide support for the air-exchanging portions of the lung

50
Q

What are the parts of the peripheral interstitium?

A

The subpleural interstitium and interlobular septa

51
Q

What divides the secondary pulmonary lobules?

A

Peripheral interstitium

52
Q

Pulmonary veins and lymphatics lie within what interstitium?

A

Peripheral interstitium

53
Q

A thin network of fibers that bridges the gap between the centrilobular and peripheral compartments

A

Intralobular interstitium

54
Q

Edema involving the axial interstitium is recognized radiographically as what?

A

Peribronchial cuffing

55
Q

Edema of the peripheral and subpleural interstitium accounts for what radiographic finding?

A

Kerry B lines (or interlobular lines on HRCT) and “thickened” fissures on chest radiograph

56
Q

The lung-lung interfaces as seen on frontal radiographs relate directly to the space available in three regions viewed on the lateral film. What are these spaces?

A

The retrosternal space, the retrotracheal triangle, and the retrocardiac space

57
Q

What airspace reflects contacts of the anterosuperior aspect of the upper lobes?

A

Retrosternal airspace

58
Q

The anterior junction line often disappears in what situations?

A

After sternotomy, or when abundant anterior mediastinal fat precludes retrosternal contact of the upper lobes

59
Q

This is a radiolucent region representing contact of the posterosuperior portions of the upper lobes.

A

Retrotracheal triangle

60
Q

If the retrotracheal space available is small, only what interface will be visualized on the PA view?

A

Only a right paraesophageal interface is visualized

61
Q

If the retrotracheal space is large, what line will be seen?

A

Posterior junction line

62
Q

The azygoesophageal recess of the RLL can abut the preaortic recess of the LLL to produce an inferior posterior junction line. If what lung-lung interface is large?

A

Retrocardiac space

63
Q

Thickening or nodularity of the paratracheal stripe is seen abnormalities of the tissues comprising the strip, including what disease processes?

A

Tracheal tumors, paratracheal lymph node enlargement, and right pleural effusion

64
Q

What structure separates the right paraesophageal from the upper azygos esophageal space?

A

The arch of the azygos vein

65
Q

What manoeuvres will increase the azygos venous diameter?

A

Supine positioning and Muller manoeuver (forced inspiration against closed glottis)

66
Q

A diameter of >10 mm on PA radiograph of the azygos vein will raise the possibility of what processes?

A

Mass, adenopathy, or dilatation of the azygos vein

67
Q

Dilation of the azygos vein may be seen in what situations?

A

Right heart failure, obstruction of venous return to the heart, or congenital venous anomaly such as azygos continuation of the inferior vena cava

68
Q

Convexity of the superior third of the azygoesophageal interface should suggest what pathology?

A

Subcarinal lymph node enlargement or a mass

69
Q

Convexity of the middle third of the azygoesophageal recess usually results from what situations?

A

Result of the confluence of right pulmonary veins or the right border of the left atrium

Left atrial dilatation will enlarge and laterally displace this interface, producing a double-density interface composed of the right lateral borders of both the right and left atria

70
Q

Convexity of the inferior third of the azygoesophageal recess is commonly due to pathology?

A

Sliding hiatal hernia

Occasionally, a tortuous descending aorta or enlarged paraesophageal lymph nodes can cause this recess to be convex to the right in its lower third

71
Q

What interface is a straight, vertical interface extending the length of the right hemithorax and represents contact of the right lung with small amount of tissue lateral to the thoracic spine?

A

Paraspinal interface

72
Q

The inferior vena cabal interface is best visualized on what radiographic view?

A

Lateral radiographs

73
Q

It is unusual for the LUL to interface with the left lateral wall of the trachea to form the left paratracheal stripe. Why?

A

Because the subclavian artery and adjacent fat usually intervene

74
Q

This represents the superior intercostal vein as it arches anteriorly from its spinal position around the aortic arch to drain into the posterior aspect of the left inominate vein.

A

Aortic nipple

75
Q

In approximately 5% of individuals, the left superior intercostal vein may be seen on frontal radiographs as a rounded or triangular opacity that focally indents the lung immediately superolateral to the aortic arch. What is this density termed?

A

Aortic nipple

76
Q

The aortic nipple normally measures how many mm?

A

<5 mm

May enlarge with elevation of right atrial pressure or with congenital or acquired obstruction of venous return to the right heart.

77
Q

Immediately inferior to the aortic arch, the LUL contacts to the mediastinum to produce what interface?

A

Aortopulmomary window interface

78
Q

Concavity of the AP window interface is seen on what situations?

While lateral convexity would suggest what pathology?

A

Concavity = Tortuous aorta, emphysema, congenital absence of the pericardium

Convexity = Mass or lymph node enlargement

79
Q

Immediately inferior to the aortopulmomary window is what structure?

A

Left lateral border of the main pulmonary artery

80
Q

Enlargement of the main pulmonary artery is seen in what circumstances?

A

Idiopathic condition in young women, as a result of poststenotic dilatation in valvular pulmonic stenosis, or in conditions where there is increased flow or pressure in the pulmonary arterial system, such as left-to-right intracardiac shunts.

81
Q

What interface is seen in small percentage of normal individuals as a reflection of the LLL with the esophagus anterior to the descending aorta, extending vertically from the undersurface of the aortic knob a variable distance toward the diaphragm?

A

Preaortic recess interface

82
Q

What interface is usually etched in black? (Negative Mach effect)

A

Preaortic recess interface

83
Q

What interface represents the reflection of the left lung off the paraspinal soft tissues, which largely consist of fat but also contain the sympathetic chain, proximal intercostal vessels, intercostal lymph nodes, and hemyazygos and accessory hemiazygos veins?

A

Left paraspinal interface

84
Q

What interface is etched in white? (Positive Mach effect)

A

Left paraspinal interface

85
Q

What diseases can cause lateral displacement of the left paraspinal interface?

A

Neurogenic tumors, hematoma, paraspinal abscess, lipomatosis, and medial pleural effusion

86
Q

What structure forms a concave interface immediately below the main pulmonary artery?

A

Left atrial appendage

87
Q

Straightening or convexity of the left atrial appendage interface is commonly seen in what cases?

A

Rheumatic mitral valve disease but may be seen in patients with left atrial enlargement of any cause

88
Q

This structure may create a focal bulge in the left cardiac contour that obscures the heart border at the left cardiophrenic angle.

A

Fat adjacent to the cardiac apex or epipericardial fat

89
Q

The epipericardial fat pad is most often seen in what patients?

A

Obese patients and this on corticosteroids

A typical appearance on the lateral radiograph is usually diagnostic; CT is helpful in equivocal cases

90
Q

On frontal radiographs exposed in deep inspiration, the apex of the right hemidiaphragm typically lies at the level of what anterior rib?

A

Level of the sixth anterior rib, approximately one-half interspace above the apex of the left hemidiaphragm

91
Q

Focal bulges in the diaphragmatic contour are usually a result of what pathology?

A

Acquired diaphragmatic eventration (thinning)

92
Q

What is the Raider triangle?

A

The retrotracheal triangle

93
Q

Borders of the retrotracheal triangle

A

Posterior border of the trachea/esophagus
Anterior border of the spine
Top of the aortic arch

94
Q

Abnormal opacities in the retrotracheal triangle is seen in what disease?

A

Masses and air-space disease near the spices, retrotracheal masses (e.g., aberrant subclavian artery or posterior thyroid goiter), or esophageal masses

95
Q

The impression on the anterior surface of the lingual is termed what.

A

Cardiac incisura

Should not be mistaken for a mass

96
Q

The anterior pericardium can be identified separately from the myocardium in 20% of subjects. This thin line represents the pericardial layers between the epicardial and pericardial fat.

Nodularity or thickness of greater than how many mm would suggests disease or effusion?

A

> 2.0 mm

Chest Anatomy, Procedures, And Techniques (5 decks)

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