Practice viva Flashcards
Pulmonary hypertension, plain film
Elevated apex - RVH
Enlarged right atrium
Prominent pulmonary outflow tract, enlarged pulmonary arteries
Pruning of peripheral pulmonary vessels
Mural calcification of pulmonary vessels highly specific - seen in Eisenmengers
Pulmonary HTN 2008 world sympsosium
PA pressure >25, wedge pressure >15
1 - idiopathic, drug toxin induced, connective tissue disease
2 - left sided heart disease
3 - lung disease or hypoxia - COPD, interstitial lung disease
4 - thromboembolism
5 - multifactorial
Mediastinal mass localisation
Mediastinal masses create obtuse angles with lung, and disrupt mediastinal lines
Anterior mediastinal mass
Obliterated retrosternal clear space
Loss of sharp ascending aorta or anterior junctional line (lower of the two lines, doesn’t go above 1st rib / clavicle)
Hilum overlay (most will be anterior)
Loss of cardiophrenic angle
Lymphoma most common child (actually thymic hyperplasia 1), thymic adult
Middle mediastinal mass
To 1cm posterior to anterior vertebral line
AP window, paratracheal stripes
Azygooesophageal recess displacement (Right - new intervace, looks like a paravertebral line) (Can be displaced by posterior mass)
Left pseudoparavertebral line
Mass on posterior trachea on lateral
Doughnut sign - mass surrounds bronchus on lateral
Lateral chest x-ray (add stuff from the MCQ file)
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Cervicothoracic sign
Superior border of mass descernible, above the clavicels
Must be in Apical upper lobe, pleural, or posterior medastinum
Foregut duplication cyst
Generic term
Encompasses neurenteric cysts and bronchogenic cysts., oephageal
Bronchogenic tend to be middle mediastinum, neurenteric posterior.
Paeds mediastinal masses
Lymphoma most common anterior
Duplication cyst most common middle
Neurogenic tumour most common posterior
ECMO
Venoarterial or venovenous
Venoarterial - out via right atrium (via femoral or IJV), in via femoral, subclavian artery line, aorta.
Venovenous - In and out via central venous lines. Can have double lumen catheter.
Anticoagulated (consider if need to put chest drain)
Mitral stenosis
Often secondary to rheumatic fever
Left atrial enlargement - splayed carina, elevation left main bronchus, convex left atrial appendage, double right heart border,
Upper lobe venous engorgement from venous hypertension
Other valvular diseases?
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Chest wall soft tissues
Alway evaluate for mastectomy
Secondary findings
E.g. right sided arch, but also lymphoma
Or additional aberrant subclavian
Primary TB
Patchy or lobar consolidation, any lobe, preference for middle and lower lobes
Lymphadenopathy (especially in children - 90%, only 10-30% adults. Low density with rim enhancement)
May be miliary (immunocompromised more)
Pleural effusions (30-40% adults, 10% children)
May resolve without any radiological abnormality, or Ghon focus scar may remain (calcified granuloma)
Symptoms only in 5%
Cavitation uncommon
May have massive haemoptysis from erosion into a bronchial artery
Secondary TB
Upper zone predominant Far more likely to cavitate Lymphadenopathy less common Effusion less common Usually patchy Can have lobar consolidation, miliary, tuberculoma
Massive haemoptysis
Cancer Bronchiectasis, bronchitis TB Aspergilloma Pneumococcal Contusion PE Other
Bronchiectasis is most common cause of bronchial artery hypertrophy leading to massive haemoptysis
Left atrium, congenital
Enlarged in VSD, PDA. Normal size in ASD
Left atrial enlargement
Congenital (VSD, PDA)
Or acquired - mitral valve disease, most commonly Rheumatic
Tetralogy of fallot
VSD
Overarching aorta
Pulmonary stenosis
RVH
Dilated ascending aorta
Aneurysm HTN Dissection Coarctation Valvular disease including bicuspid valve Congenital heart disease Connective tissue disorders.
Bicuspid aortic valve
Major cause of aortic valve disease in young adults 2% incidence, more common in males Dilated ascending aorta 70% of coarctations have bicuspid valve 10% of Turners have it Associated with ADPKD Associated with berry aneurysms
Pacemaker
Single chamber
Dual chamber
Biventricular (additional lead through coronary sinus to left ventricular vein)
Coronary sinus drains to RA, drains cardiac veins, courses along posterior LA.
Unroofed coronary sinus has opening to LA also, a rare ASD
Hiccups?
Ribbon ribs
Thinned ribs
Commonly due to neurofibromas in NF1
Also seen in OI, Edwards (18), Gorham disease (progressive massive osteolysis)
Left to right shunt
ASD, VSD, PDA, AVSD
Sarcoid, biochemical markersm, imaging stage
ACE - 40% false negative, 10% false positive
30-50% hypercalcuric, 10-20% hypercalcaemic
May be stage 1-3 at presentation, unlikely 4 (fibrosis)
Common cavitating lesions
Malignancy most common
Then infection
Cancer, autoimmune, vascular, infection, trauma, young
Sarcoid can cavitatae
Transposition
L - congenitally corrected
D - egg-on-a-string - narrowed superior mediastinum due to stress thymic atrophy and pulmonary hyperexpansion, parallel great vessels, globular heart from LA enlargement and convex RA
L - AV discordance and VA discordance
Plain film appearance?
