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natomy, and Radiographic Findings of Chest Disease Minimum amount of fluid or air that can be demonstrated in a lateral decubitus view?
5 ml of fluid; 15 ml of air (Fraser - 10 mL of fluid)
Normal coronal-to-sagittal diameter ratio of the trachea?
0.6 : 1
Normal amount of fluid within the pleural space
<5 mL
Extrathoracic malignancies with a propensity to metastasize to the lung?
osteogenic sarcoma, breast, and RCC
Anatomy: Trace the branches of the trachea down to its terminal anatomic structure.
trachea > main bronchi > lobar bronchi > segmental bronchi > bronchioles (including the terminal brioncholes then respiratory bronchioles) > alveolar ducts > alveolar sacs
What is the coronal-to-sagittal diameter ratio of a saber sheath trachea?
<0.6 or <2/3
Normal width of the right paratracheal stripe?
4 mm
Normal measurement of the tracheoesophageal stripe?
<5 mm
Compare the right and left main bronchi in terms of their orientation to the long axis of
the trachea and their length.
right is more obtuse, right is shorter
Origins of the arterial supply to the anterior and apicoposterior segments and of the superior and inferior lingular arfteries?
upper division of the left main PA, and left interlobar artery, respectively
Origins of the RUL pulmonary artery and middle lobe pulmonary artery?
truncus anterior and right interlobar artery, respectively
Upper limit of normal for the transverse diameter of the proximal right interlobar artery on PA at the level immediately lateral to the proximal portion of the bronchus intermedius?
17 mm in men and 15 mm in women
What segments does the inferior accessory fissure separate?
separates the medial basal from the rest of the basal segments
What pulmonary arteries are measured in the assessment of PA dilatation on PA and lateral radiographs?
PA - right interlobar pulmonary artery; lateral - left descending pulmonary artery
How do you differentialte pleural from peritoneal fluid on CT?
pleural fluid will displace the crus laterally while the peritoneal fluid will displace it medially
Nodular opacity terms and their corresponding sizes
miliary - <2mm
micronodular - 2-7mm
nodule - 7-30mm
mass - >3cm
What is the most serious and potentially fatal manifestation of sclerosing mediastinitis?
obstruction of the CENTRAL pulmonary veins, mimicking severe mitral stenosis
Differentiate the location of costal cartilage calcifications in men and women.
Men - upper and lower margins, women - central
Malignancies that are most often associated with intrathoracic nodal metastasis?
-GU (renal and testicular)
-H&N (skin, larynx, and thyroid)
-breast
-melanoma
Classic cause of pulmonary venous hypertension
LV systolic failure
Classic cause of obstruction to left ventricular inflow
mitral stenosis (but poor LV compliance [diastolic dysfunction] is more common)
Meaurement of widened vascular pedicle on PA radiograph
> 53 mm
Autoimmune disorders associated with a systemic immune complex vasculitis?
Wegener granulomatosis, SLE, RA, polyarteritis nodosa
Radiographic features that suggest infarction in PE?
pleural effusion and Hampton hump
What is the single most important factor in characterizing SPN as benign or
indeterminate?
internal density
What are the most malignant neoplasms arising from bronchial neuroendocrine/Kulchitsky cells?
small cell ca aka Kulchitsky cell cancers / KCC-3
5 patterns of benign calcifications?
Complete, central, concentric/laminated, popcorn, peripheral
Malignant pattern of calcification?
Eccentric
Fat within an SPN is diagnostic of what lesion?
Pulmonary hamartoma
Metabolically active lesions
carcinoid tumor and bronchioloalveolar cell ca
Which bronchogenic ca is the inhalation of radon asssociated?
small cell ca
Marked mediastinal nodal enlargement producing a lobulated mediastinal contour is characteristic of?
small cell ca
Air bronchongrams or bubbly lucencies within a nodule or mass or mixed solid/ground- glass attenuation is highly suggestive of?
adenoca, particularly bronchioloalveolar ca (BAC)
What cell type is the majority of Pancoast tumors?
squamous cell ca or adenoca
3 subtypes of infection via tracheobronchial tree (based on radiographic pattern)
1 lobar pneumonia, 2 lobular or bronchopneumonia, 3 interstitial pneumonia
3 potential routes of infection
1 tracheobronchial tree (inhalation or aspiration), 2 pulmonary vasculature (systemic sepsis), 3 direct spread (from adjacent extrapulmonary source - mediastinum, chest wall, upper abdomen)
Which segments are involved in aspiration in the supine position?
posterior segments of the upper lobes and superior segments of the lower lobes
Where does the tracheal bronchus / bronchus suis arise from?
right lateral wall within 2 cm of the carina
Which segments are involved in aspiration in the erect position?
basal segments of the lower lobes
Causative agent of valley fever which is a self-limiting viral-type illness associated with erythema nodosum and arthralgia?
Coccidioides immitis
What congenital abnormalities are associated with tracheal bronchus?
congenital tracheal stenosis and abberant left pulmonary artery
Main drugs associated with enlargement of the hilar and mediastinal LNs (rare)
dilantin and methotrexate
Radiographic staging of sarcoidosis
0 - normal
1 - bilateral hilar LN enlargement
2 - bilateral hilar LN enlargement and parenchymal disease
3 - parenchymal disease only
4 - pulmonary fibrosis
What is the CT equivalent of peribronchial cuffing and tram tracking which are seen
radiographically?
thickening of bronchial walls / bronchovascular structures / peribronchovascular interstitium
Earliest findings in LCH
nodules with upper and mid-lung zone distribution
Classical clinical triad of tuberous sclerosis
seizures, mental retardation, and adenoma sebaceum
What is the earliest parenchymal finding in sarcoidosis
diffuse micronodular pattern, identical to miliary TB
What part of the lung does the tracheal bronchus most often supply?
apical segment of the right upper lobe
Anomalies that are associated with congenital tracheal stenosis?
PA sling and tracheal bronchus
Imaging hallmark of tracheobronchomalacia
excessive airway collapse on expiration
What is the coronal-to-sagittal diameter ratio of a saber sheath trachea?
<0.6 or <2/3 (coronal diameter is diminished to <2/3 of the sagittal diameter)
On frontal radiographs, what are the coronal diameters of the trachea and central bronchi in tracheobronchomegaly?
> 3cm and >2.5cm, respectively
Most important plain radiographic finding of emphysema?
hyperinflation
What type of emphysema is associated with deficiency of a-1-antitrypsin (a-1-protease
inhibitor)?
panlobular
Central bronchiectasis is seen only in what conditions?
allergic bronchopulmonary aspergillosis, cystic fibrosis, bronchial atresia, or acquired central bronchial obstruction
What type of bronchiolitis is associated with RA and Sjogren syndrome?
follicular bronchiolitis
d Miscellaneous Chest Disorders Normal fluid in the pleural space
2-5 mL
3 stages of parapneumonic effusions:
stage 1 - exudative stage; visceral pleural inflammation -> increased capillary permeability -> sterile exudative effusion
stage 2 - fibrinopurulent pleural fluid containing bacteria and neutrophils; fibrin deposition on the visceral and parietal pleural impairs resorption and produces loculations
stage 3 (2-3 weeks) - ingrowth of fibroblasts over the pleura, which produces pleural fibrosis and entraps the lung
Causes of inferior rib notching?
COA, TOF, SVC obstruction, Blalock-Taussig shunt (unilateral right), NF, aortic thrombosis, Takayasu aortitis
Why are the first two ribs uninvolved in COA rib notching?
1st and 2nd intercostal arteries arise from the superior intercostal branch of the costocervical trunk of the subclavian artery and therefore do not communicate with the descending aorta
Earliest manifestation of asbestos-related pleural disease
pleural effusion
What is the most reliable radiologic evidence that a lesion is benign?
Calcification
Causes of superior rib notching?
paralysis, RA, SLE
What form of atelectasis is round atelectasis?
compressive
Most important radiologic signs that may be observed in association with an increase in
intrapulmonary air
signs related to the diaphragm
What is/are the direct sign/s of atelectasis?
Fraser - displacement of interlobar fissures and crowding of vessels and bronchi (kay Brant, iyong bronchovascular crowding, indirect)
In what type of atelectasis is the absence of air bronchograms (indirect sign of atelectasis) seen?
resorption (iyong ibang types, pwedeng (+) air bronchograms)
Which is slight more vertical, left or right major fissure?
left
What is the mininum amount of fluid necessary to blunt the lateral costophrenic sulcus on PA radiograph?
175 mL
In an increased retrosternal space, the distance between the sternum and ascending aorta should be greater than?
2.5 cm
Direct measurement of a flattened hemidiaphragm is best done on what view?
lateral x-ray
Overinflation is present if the distance of the dome of the diaphragm to the line connecting the sternophrenic and posterior costrophrenic junctions is less than __.
2.6 cm
Uncommon manifestation of SLE with fever, dyspnea, hypoxemia, & patchy diffuse opacities (xray) in the absence of infection
Acute lupus pneumonitis
