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CHEST RADIOLOGY > Pleura, Chest Wall, and Miscellaneous Disorders > Flashcards

Pleura, Chest Wall, and Miscellaneous Disorders Flashcards

1
Q

What is the most common benign manifestation of asbestos inhalation?

A

Pleural plaques.

20 to 30 years after initial asbestos exposure.

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2
Q

Pleural plaques secondary to asbestosis affects what layer of the pleura?

A

Parietal pleural.

Most common over the diaphragm and lower posterolateral chest wall.

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3
Q

Pleural plaques secondary to interstitial fibrosis affects what layer of the pleura?

A

Visceral pleural.

Along the the major fissures.

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4
Q

What is the most common thoracic manifestation of asbestos inhalation?

A

Pleural plaques.

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5
Q

What is the most common pulmonary manifestation of asbestosis?

A

Rounded atelectasis.

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6
Q

What is the earliest manifestation of the asbestos-related pleural disease?

A

Pleural effusion.
10-20 years after initial exposure.
NOTE: if pleural effusion develops after >20 years, evaluate for mesothelioma.

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7
Q

What is the term for diffuse pleural thickening involving >1/4 of the costal pleural surface?

A

Fibrothorax.
Involve both parietal and visceral pleural.
Follows asbestosis-related pleural effusion.

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8
Q

Which of the following is dose related complication of asbestosis?

a. Pleural plaques.
b. Mesothelioma.

A

Mesothelioma.

Pleural plaques are dose related.

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9
Q

What is the most widely used form of asbestos?

A

Chrysotile.

Another form of asbestos is crocidolite.

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10
Q

What are the imaging features of the malignant mesothelioma?

A

Thick (>1 cm) and nodular diffuse pleural thickening.
Calcification.
Pleural effusion.
Malignant involvement of the mediastinal pleura.

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11
Q

What is the most common cause of transudative pleural effusion?

A

Congestive heart failure.

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12
Q

Describe the 3 stages of the parapneumonic effusion.

A

Exudative stage: visceral pleural inflammation resulting to increasing capillary permeability.
Fibrinopurulent stage: fibrin deposits which impairs fluid resorption and produces loculations.
Parapneumonic effusion: pleural fibrosis and lung entrapment.

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12
Q

Describe the 3 stages of the parapneumonic effusion.

A

Exudative stage: visceral pleural inflammation resulting to increasing capillary permeability.
Fibrinopurulent stage: fibrin deposits which impairs fluid resorption and produces loculations.
Parapneumonic effusion: pleural fibrosis and lung entrapment.

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13
Q

Describe split pleural sign.

A

Split pleural sign: individual visualization of the enhancing visceral and parietal pleural separated by a empyema. Useful sign to differentiate empyema from pulmonary abscess.

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14
Q

What type of pleural effusion is associated with Meig’s Syndrome?

A

Transudative.

Benign pleural effusion.

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15
Q

Where would be the chylothorax when the thoracic duct is disrupted on its upper segment?

A

Left.

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16
Q

Where would be the chylothorax when the thoracic duct is disrupted on its lower segment?

A

Right.

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17
Q

What are the signs of pneumothorax on supine radiograph?

A

Hyperlucent upper abdomen.
Deep sulcus sign.
Double diaphragm sign.
Epicardial fat pad sign.

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18
Q

Most common cause of primary or spontaneous pneumothorax?

A

Marfan syndrome.

In young and middle-aged men.

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19
Q

What is the most common predisposing condition for secondary pneumothorax?

A

Chronic obstructive pulmonary disease.

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20
Q

Most common laterality of unilateral pleural effusion.

A

Right-sided pleural effusion.

21
Q

Differentiate a medially-retracted lung versus fallen-lung sign.

A

Fallen lung sign: lateral displacement of atelectatic lung, due to disruption of the proximal bronchi secondary to trauma.

Medially retracted lung: seen in the tension pneumothorax.

22
Q

Pleural calcification secondary to hemothorax and empyema involves what layer?

A

Visceral pleura.

23
Q

Unilateral absence of sternocostal head of the pectoralis major, rib anomalies, and syndactyly.

A

Poland syndrome.

24
Q

What is the most common benign tumor of the chest wall?

A

Lipoma.

25
Q

What is the most common malignant soft tissue neoplasm of the chest wall?

A

Sarcomas.

26
Q

What is the rib morphology associated with neurofibromatosis?

A

Ribbon ribs.

Due to erosion of neurofibroma.

27
Q

Most common cause of bilateral inferior rib notching.

A

Coarctation of aorta.
Juxta ductal type.
Rib notching rare in <7 years of age.
First two ribs are uninvolved.

28
Q

What are some of the causes of unilateral rib notching?

A
  1. SCA obstruction.

2. Blalock-Taussig procedure.

29
Q

What are some of the condition associated with superior rib notching?

A

Paralysis.
Rheumatoid arthritis.
Systemic lupus erythematosis.

30
Q

What is the most common benign neoplasm of the ribs in adults?

A

Osteochondroma (exostoses).

31
Q

What is the most common rib malignancy?

A

Chondrosarcoma.

32
Q

Deformity produced by an elevated and hypoplastic scapula?

A

Sprengel deformity.

33
Q

Sprengel deformity + omovertebral bone.

A

Klippel-Feil syndrome.

34
Q

Discuss winged scapula.

A

Superiorly displaced scapula.
Foreshortened appearance on radiograph.
Results from disruption of innervation of serratus anterior muscle.

35
Q

Partial or complete aplasia of the clavicle.

A

Cleidocranial dysostosis.

36
Q

What is the most commonly fractured segment of the clavicle?

A

Distal third.

37
Q

Differentiate the erosion from rheumatoid arthritis versus from hyperparathyroidism.

A

RA: distal clavicle is sharply defined and tapers to a point.
HyperPTH: widened and irregular.

38
Q

What is the characteristic appearance of the vertebra with sickle-cell anemia?

A

H-shaped vertebra.

Lincoln Log appearance.

39
Q

What is the characteristic appearance of the vertebra with renal osteodystrophy?

A

Rugger jersey sign.

Different from the “sandwich vertebrae” of osteopetrosis.

40
Q

What are the imaging findings of pectus excavatum?

A
  1. Heart displaced on the left.
  2. Loss of right heart border.
  3. Vertically oriented anterior ribs.
  4. Medial breast margin sign.
41
Q

Discuss the fluoroscopic or ultrasonographic sniff test.

A

Positive if there is paradoxical superior movement of the diaphragm with sniffing (due to negative intrathoracic pressure on flaccid diaphragm).
Seen in idiopathic phrenic nerve dysfunction.

42
Q

What is the most common diaphragmatic hernia?

A

Esophageal hernia.

Herniation of the a portion of the stomach through the esophageal hiatus.

43
Q

Discuss Bochdalek hernia.

A

Persistence of foramen of Bochdalek, defect in the site of embryonic pleuroperitoneal canal.
Most common in the left side.
Appear as posterolateral mass above the left hemidipahragm.

44
Q

Discuss Morgani hernia.

A

Defect in the parasternal portion of the diaphragm.
Right sided.
Appear as cardiophrenic angle mass.

45
Q

What is the most common side of injury of the diaphragm.

A

Left side.

Liver receives traumatic forces in the right.

46
Q

What are some CT findings suggestive of traumatic diaphragmatic injury.

A
  1. Thickening or retraction of diaphragm away from the site of injury.
  2. “Collar” or “waist” sign: narrowing or waist of the diaphragm.
  3. “Dependent viscera” sign: contact between the posterior rib and liver or stoamch.
47
Q

What are the imaging findings of the radiation-induced lung disease?

A
  1. Sharply marginated, localized area of airspace opacification that does not conform to the lobar/segmental anatomic boundaries.
  2. Adhesive atelectasis due to loss of surfactant by damaging type 2 pneumocytes.
48
Q

Rheumatoid arthritis and SLE produce what type of pleural effusion?

A

Exudative pleural effusion.

49
Q

What does the presence of air-fluid level in post-pneumonectomy space suggest?

A

Bronchopleural fistula.

CHEST RADIOLOGY (2 decks)

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