Pulmonary Diagnostics

Question 1

CXR indications for use? (5)

Answer 1

Initial study for:

1) cough
2) hemoptysis
3) chest injury
4) chest pain
5) SOB

Question 2

CXR benefits? (4)

Answer 2

1) Low radiation
2) Low expense
3) Availability
4) Fast

Question 3

CXR risks?

Limitations?

Answer 3

Radiation (0.1 mSv)
Pregnancy

Undetectable:
small CA
PEs

Question 4

Computed Tomography (CT) indications for use? (4)

Answer 4

1) Add’l exam for CXR abnormalities
2) Characterize nodes
3) Eval/Staging CA
4) Differentiate LAD from vascular structures

Question 5

CT benefits? (6)

Answer 5

1) More detail than CXR
2) Real-time imaging
3) Fast, available
4) Less expense than MRI
5) Few motion artifacts
6) Can use w/ metal implants

Question 6

CT risks?

Limitations?

Answer 6

High radiation (8 mSv)
Contrast allergy/nephrotoxicity
Pregnancy

Kids ↑ risk CA

Question 7

CT Angiography (CTA) indications for use? (3)

Answer 7

1) Blood vessel detail
2) Identification of arteriovenous malformation
3) Assess pulmonary artery invasion by neopl
4) r/o PE
5) Surgical guidance

Question 8

CTA benefits?

Answer 8

Less invasive/expensive/time than catheter-directed

Question 9

CTA risks?

Limitations?

Answer 9

Contract allergy/nephrotoxicity
High radiation (15 mSv)

ø catch sub-segmental PE
Can’t fit fatties

Question 10

Pulmonary Angiography (PA) indications for use? (2)

Answer 10

1) Gold Standard for PE

2) Inconclusive/suspicious V/Q or CTA

Question 11

PA risks?

Answer 11

1) Arrhythmia
2) Bleeding
3) Contract allergy/nephrotoxicity
4) Radiation (5 mSv)
5) Invasive/expensive

Question 12

Magnetic Resonance Imaging (MRI) indications for use? (3)

Answer 12

1) Hilar/mediastinal densities
2) Sulcus tumors
3) Cysts/lesions of chest wall

Question 13

MRI benefits? (2)

Answer 13

1) No bone artifacts (vs CT)

2) No ionizing radiation

Question 14

Magnetic Resonance Angiography (MRA) indications for use?

Answer 14

High quality image of blood vessels w/ less parenchyma resolution

Question 15

MRA limitations?

Answer 15

1) Gadolinium (MRA contrast), can’t use w/ kidney dx
2) No fatties
3) No implants (pacemaker, metals, etc)

Question 16

VQ Nuclear Imaging Scan indications for use?

Answer 16

1) Eval PE

2) Lung surgery preop eval

Question 17

VQ phases of detection?

Answer 17

1) IV (perfusion): Tech-99-labeled albumin follows blood flow
2) Inhalation (ventilation): radio-labeled Xenon gas

Question 18

VQ benefits?

Answer 18

1) Allergy rare

2) Low radiation (2 mSv)

Question 19

Positron Emmission Tomography (PET) indications for use?

Answer 19

1) CA detection

2) Eval of CA tx

Question 20

PET mechanism of action?

Answer 20

radio-labeled glucose injected,
uptake values measured,
↑ uptake = ↑ CA probability

Question 21

PET benefits?

Answer 21

1) Early detection of biochem Δs

2) Radioactivity short-lived (low exposure)

Question 22

PET limitations?

Answer 22

False + w/:
Inflammatory lesions (granulomas)

False - w/:
slow-growing tumors

Question 23

Ultrasound indications for use?

Answer 23

Limited

Localized fluid collection

Question 24

ABCs of CXR?

Answer 24

Airways
Bone/Breast shadows
Cardiac silhouette
Diaphragm
Edges
Fields

Question 25

CXR findings for pneumonia?

Answer 25

Bronchopneumo: Patchy Small bronch/adjacent alveoli Lobar Pneumo: Consolidation >= 1 lobe

Question 26

Air Bronchograms seen when? In what conditions?

Answer 26

fluid-filled alveoli surround air-filled bronchus -> makes it visible (dark spots) Pulm Edema Blood Gastric Aspirate Inflamm Exudate

Question 27

Interstitial Lung Dx (ILD)

Answer 27

slide 55 blank

Question 28

ILD caused by?

Answer 28

slide 56 blank

Question 29

Causes of increased radiolucency? (3)

Answer 29

COPD Cysts/bulla from emphysema Pneumothorax

Question 30

CXR findings w/ COPD? (5)

Answer 30

``` Hyperlucent lung fields Prominent pulm arteries ↑ AP diameter Flat diaph Retrosternal and infracardial air (air trapping) ```

Question 31

Transudative Pleural Effusion is?

Answer 31

Accumulation of fluid b/w membranes in lungs/chest cavity, caused by abn lung pressure (e.g. HF, cirrhosis)

Question 32

Exudative Pleural Effusion is?

Answer 32

Accumulation of fluid b/w membranes in lungs/chest cavity, caused by inflamm of pleura (e.g. infection, CA, PE)

Question 33

Pneumothroax is? Causes what?

Answer 33

Air trapped b/w lung and chest wall Atelectasia (lung collapse)

Question 34

Pneumothorax caused by?

Answer 34

Trauma Iatrogenic (post tx) Chronic lung dx