Pleura, Chest wall And Diaphragm

Question 0

Types of effusion

Answer 0

Simple
Loculated
Lamellar
Sub pulmonic

Question 1

Types of pneumothorax

Answer 1

Simple
Anterior: air pushes up the costophrenic angles
Loculated
Tension
Pseudo

Question 2

Cause of hydropneumothorax with mediastinal shift towards the affected side

Answer 2

Pneumonectomy

Question 3

Pathological mechanisms of pleural effusion

Answer 3

Increase pleural membrane permeability 
Increased pulmonary capillary pressure
Decreased negative intrapleural pressure
Decreased oncotic pressure 
Obstructed lymph flow

Question 4

Transudate pleural effusions

Answer 4

Left ventricular failure
Liver cirrhosis
Hypoalbuminaemia
Peritoneal dialysis

Hypothyroid
Mitral stenosis
Nephrotic syndrome
Pulmonary embolism

Question 5

Exudate pleural effusions

Answer 5

Malignancy (large no mediastinal shift)
Para pneumonic

Pulmonary infarct
Rheumatoid
Autoimmune
Asbestos
Pancreatitis 
Post MI

Question 6

Causes of mainly left sides effusions.

Answer 6

Pancreatitis 
Oesophageal rupture 
Splenic infarct or abscess
Diaphragm hernia 
Pericardial disease
CABG

Question 7

Causes of right sided effusion

Answer 7

Cirrhosis
Peritoneal dialysis
Hepatic abscess
Liver transplant 
Meigs
Catamenial hemothorax

Question 8

CXR signs of sub pulmonic effusion

Answer 8

Peak of diaphragm laterally displaced with steeper slope.

Increased distance to stomach bubble

Question 9

Describe cause and appearance of Loculated effusion on supine CXR

Answer 9

Increases density. Lines in fissure. Acts as a pseudo tumor.

Usually exudate

Question 10

Classification of effusion on US

Answer 10

Anechoic
Complex non septated: free debris
Complex septated: fibrin strands exudates.
Homogenously echogenic: hemorrhagic or empyema

Question 11

How to distinguish between pleural thickening and effusion on US.

Answer 11

Change in shape with movement
Moving strands
Fluid color sign ( Doppler signal )

Question 12

Features of benign pleural effusion on CT

Features of malignant

Answer 12

Smooth pleural
Pleural enhancement 
Calcification 
\_\_\_\_
Circumferential pleural thickening 
Nodular pleural thickening
Mediastinal involvement

Question 13

Feature of malignant effusion on MRI

Answer 13

Enhance with gadolinium on T1

Hyper intense on T2 and proton density

Question 14

Possible cause of pleural thickening and Loculated pleural effusion

Answer 14

Rheumatoid arthritis
Tb
Mesothelioma

Question 15

Pathological processes of pleural disease

Answer 15

Accumulation of fluid
Air in the potential space
Pleural thickening
Pleural mass lesions

Question 16

Causes of pleural calcification

Answer 16

Empyema

Haemothorax

Question 17

Malignancies which metastasis to the pleural

Answer 17

Lung
Breast
Pancreas
Stomach
Ovary

Question 18

Most common organism in empyema

Answer 18

Staphylococcus

Question 19

Features of an empyema

Answer 19

Loculated
D Configuration
Lack of free drainage
Air with effusion ( bronchopleural fistula)

Question 20

Features of empyema on CT

Answer 20

Uniform pleural thickening
Lento form collection
Free air ( fistula. Medicalintervention. Gas forming organisms )
Increased attenuation of extra pleural fat

Question 21

Features to distinguish between abscess and empyema

Answer 21

Wall: abscess irregular thick
Shape: empyema lenticular 
Angle with pleura: empyema obtuse
Pleural: empyema pleural enhancement 
Adjacent atelectasis: empyema