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Clinical Medicine II > Pulmonary diagnostics > Flashcards

Pulmonary diagnostics Flashcards

1
Q

CXR: what views and what does it evaluate

A

views: PA, AP, Lateral, decubitus
* get decubitus to see pleural effusion or distinguish empyema (common with staph infection)
* usually get PA and Lateral

Evaluation of lung parenchyma, pleura, chest wall, diaphragm, mediastinum and hilum

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2
Q

CXR: indications for use

A

persistent cough, chest injury, hemoptysis, chest pain, SOB

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3
Q

What anatomical landmark is sometimes seen near the diaphragm in CXR

A

breast shadows

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4
Q

Lobes: right and left lung

A

right: upper, middle, lower
left: upper, lower… not a lobe but also has lingula

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5
Q

Benefits of CXR

A

low radiation, least costly, available, convenient

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6
Q

risks/limitations of CXR

A

radiation (0.1 mSV (biological effective dose on human tissue) ~ background radiation from 10 days) minimal but cumulative

Pregnancy exposure

Doesn’t detect every condition ie small cancers or PE

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7
Q

CT: background and types

A

*real time detailed imaging useful for biopsies
Conventional: 10mm slice
Spiral: 1 mm slice (faster and less motion artifact)

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8
Q

when to order a CT

A
  • further examination of CXR abnormalities
  • characterize pulmonary nodules
  • Eval/stage primary and metastatic lung neoplasm
  • differentiate mediastinal and hilar LAD from vascular structures (evaluate aortic dissection and aneurysm)
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9
Q

Benefits of CT

A

fast, available, detailed, cheaper than MRI, unlike MRI, can be performed if pt has implanted device, less sensitive to pt movement

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10
Q

Risks of CT

A

~ 8mSv radiation exposure (+ about 3 yr background radiation)

If using contrast: risk allergic rxn (shellfish, iodine); caution if impaired kidney function (Cr>1.5, GFR<60; and pt taking metformin/glucophage should not take for 48 hr after exam)

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11
Q

Special populations to consider re. CT

A

Peds: more radiosensitive, ^risk leukemia and brain tumors w/ CT, radiation risk compounded by longer lifespan

Pregnant: exposure linked to ped CA

side note: airport passenger screening equivalent to only about 2 min airflight background radiation

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12
Q

Purpose of angiography

A
  1. Assess vasculature in body: brain, kidneys, pelvis, legs, lungs, heart, neck
  2. Perform in combo with imaging modalities: CT, MRI, fluoroscopy with catheter directed exams
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13
Q

What does CTA provide

A

provides anatomical detail BV, identifies ateriovenous malformation (AVM), assesses pulmonary arterial invasion by neoplasm

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14
Q

Benefits CTA

A

can r/o PE (has largely replaced conventional catheter pulmonary angiography)
anatomical guidance in surgery
less invasive/costly/dangers/time consuming than catheter directed angiography

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15
Q

Risks/limits CTA

A 
can miss sub segmental PE (smaller PEs)
Allergy to contrast
Nephrotoxicity from contrast
Radiation exposure: 10-15 mSv
Body habitus >300 lbs
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16
Q

CT and CXR evidence PE

A

CXR: right PA enlargement, Hampton’s hump

CT: filling defect in pulmonary branch, right pleural effusion

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17
Q

Background on Pulmonary angiography

A

GOLD standard for PE eval
*needle/catheter inserted into R femoral or internal jugular v –> r side heart –> pulmonary aa. (dye injected, xray taken)

  • used if V/Q scan or CTA inconclusive and high clinical suspicion
  • invasive/expensive
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18
Q

Risks of Pulmonary Angiography

A
  1. bleeding or hematoma at insertion
  2. heart arrythmia
  3. allergic rxn to contrast
  4. impaired kidney function - usually reversible
  5. radiation exposure
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19
Q

background and benefits of MRI

A

not freq used; indicated for hilar or mediastinal densities, sulcus tumors, possible cysts and lesions of chest wall

benefits: no bone artifact as in CT, no radiation

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20
Q

what is MRA

A

looking at BV via MRI (good option if iodine allergy bc uses gadolinium as contrast)

*high quality view BV; less detailed view of lung parenchyma and diminished spacial resolution compared to CT

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21
Q

Limitations of MRA/MRI

A

No gadolinium in pt with kidney disease
Claustrophobia/large body habitus
Absolute contraindication: pacemaker, defib, metal in eye, clips used on brain aneurysms
Relative: cochlear implant

22
Q

Use for nuclear imaging VQ scan

A

eval PE and preop assessment prior to lung resection

23
Q

How was VQ scan work?

A

emitted radiation is captured by external gamma camera detects in 2 phases:

  1. IV: tech 99m labeled to human albumin is injected and follows distribution of blood flow (perfusion)
  2. Inhalation: radio labeled Xenon gas demonstrates distribution of ventilation
24
Q

indication for VQ scan re PE

A

high probability PE but normal xray

*look for absence of perfusion with normal ventilation

25
Q

Benefits nuclear imaging

A

allergic rxn rare
low dose radiation (2-2.5 mSv)
can be used in pregnant
useful to estimate post op reserve capacity for pt undergoing lung resection

26
Q

positron emission tomography PET: use

A

detect cancer and examine effects of cancer therapy

  • useful to eval for metastasis from primary site
  • can detect recurrence in previously irradiated, scarred areas of the lung
27
Q

How does a PET scan work?

A

image obtained via detection of radiation from emission of positrons (tiny particles emitted from radioactive substance)

  • pt injected with radioactively labeled glucose called fluorodeocyglucose)
  • pt scanned, measurements of uptake made in standardized uptake value (SUV)
  • higher SUV, higher chance malignancy
28
Q

Benefits of PET

A

Benefit:

  1. can detect biochemical changes of anatomy before apparent on CT or MRI
  2. short lived radioactivity = low radiation
29
Q

Limitations PET

A

Limit

  1. false results with metabolic imabalances (false + inflammatory lesions - granulomas (Cocci and histoplasmosis) and false - with slow growing tumor)
  2. time sensitive bc radioactive sub short lived
30
Q

Use for US

A

(limited use in chest disease; better for eval heart and great vessels)

  • localizing fluid collection is common indication ie guiding thoracentesis
  • good bc no ionizing radiation
31
Q

ABCs or CXR

A 
airways
bones/breast shadows
Cardiac silhouette
diaphragm
edges
fields
32
Q

CXR: radiographic pattern of opacification interpretation

A
  1. Localize region of opacification of the parenchyma:
    3 cm = mass
    infiltrate: alveolar vs. interstitial pattern
    *diffuse disease with opacification
33
Q

CXR: radiographic pattern of radiolucency interpretation

A
  • cysts or bulla as seen in emphysema
  • pneumothorax
  • hyperlucency with COPD
34
Q

Distinguishing mass vs infiltrate

A

infiltrate more diffuse w/o distinct border, mass more localized
*pneumonia tends to cause infiltrate

35
Q

Types and Pneumonia and their characteristics

A
  1. Bronchopneumonia: patchy, involves small bronchioles and adjacent alveoli
  2. Lobar pneumonia: consolidation, involve 1 or more lobes
36
Q

When do you see air bronchograms

A

see air bronchograms when fluid filling alveoli surround air filled bronchus making it more visible
(such as with pulmonary edema, blood, gastric aspirate, inflammatory exudate)

37
Q

What is interstitial lung disease (ILD) *note: won’t be on test yet

A

large group of conditions ~ 150 infividual diseases that involve the lung parenchyma (alveolar epithelium, pulmonary capillary endothelium, perivascular and perilymphatic tissue)

38
Q

Progression of ILD

A

chronic inflammation –> alveolitis, interstitial inflammation and radiologic findings

39
Q

characteristic radiologic findings ILD

A

nodules, reticular honeycombing, ground glass appearance

40
Q

Most common causes of ILD

A
  1. Idiopathic
  2. Asbestosis
  3. Silicosis
  4. CT diseases (SLE, RA, Sjogrens)
  5. Sarcoidosis
  6. Granulomatous (wegeners: autoimmune disease affecting lungs and kidneys
41
Q

Common xray results COPD (AP view)

A

hyperlucent lung fields, prominent pulmonary arteries

*diaphragm gets flatter

42
Q

Common xray results COPD (lateral view)

A
  • increased AP diameter/barrel chest
  • flat diaphragms
  • retrosternal and infracardiac air (air trapping)
43
Q

What are some other conditions dx on CXR and chest CT

A
  1. Pulmonary Infarct (see wedge shaped outer aspect of lung by pleura
  2. Pleural Effusion (scooped out appearance CXR)
  3. Pneumothorax
  4. Pericardial effusion
  5. Widened Mediastinum i.e. aortic aneurysm
  6. Atelectasis (see little white line indicating collapse of alveoli)
44
Q

What is a pleural effusion

A

accumulation of fluid bw layers of membrane that lines lungs and chest cavity
*see scooped out appearance on CXR and fluid collection in CT

45
Q

What kinds of pleural effusion can you get and what are they caused by

A
  1. Transudative: caused by abnormal lung pressures (HF, cirrhosis)
  2. Exudative: caused by inflammation of pleura (infectious ie pneumonia, malignancy, PE)
46
Q

What is a pneumothorax

A

occurs when air gets trapped bw lung and chest wall causing part of all of the lung to cave in/collapse
*noticed crackling when push down on pt chest due to subcutaneous air

47
Q

Causes of Pneumothorax

A 
Trauma
Iatrogenic (physician caused)
Spontaneous (especially in tall thin male)
Chronic lung disease
Barotrauma
acute infections i.e. pneumonia
48
Q

CXR signs of pericardial effusion

A

waterbottle sign due to fluid around the heart

49
Q

What are some things that can cause atelectasis (alveolar collapse)

A

infection, post pneumonia, post surgery)

50
Q

quiz:

  1. hamptons hump associated with?
  2. Hyperinflation of lungs consistent with?
  3. Kerly B lines assoc with?
  4. Pneumonia is assoc with what type of pleural effusion?
  5. Silhouette sign on right could indicate?
A
  1. PE
  2. COPD
  3. CHF
  4. Exudative
  5. middle lobar pneumonia

Clinical Medicine II (8 decks)

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