Pulmonary Imagine and Diagnostic Procedures Flashcards
What is bronchoscopy used for?
Bronchoscopy
- Indications
- SE
- CI
- allows direct visualization of the trachea, bronchi, and segmental airways out to the 3rd generation of branching.
- can be used to sample and treat lesion or abnormalities such as foreign bodies, bleeding, tumors, or inflammation in those airways
Indications:
- cough
- hemoptysis
- wheeze
- atelectasis
- unresolved pneumonia
- positive cytology
- Abnormal CXR
- Bronchial Obstruction
- Diffuse lung disease
- Pre/post intubation
SE: tachycardia, bronchospasm, or hypoxemia
CI: patients with cardiac problems or sever hypoxemia
What are some of the advantages of flexible bronchoscopy and disadvantages of rigid bronchoscopy?
Advantages of flexible bronchoscopy:
- better control of the airway (can be used for intubation)
- easier to deal with large lesions, foreign bodies
- does not require anesthesia
Disadvantages of rigid bronchoscopy:
-Requires general anesthesia, higher rate of tissue damage/complications.
Complications of bronchoscopy
- injury to teeth
- hemorrhage from the bx site
- hypoxia and cardiac arrest
- laryngeal edema
What are the advantages of Flexible Fiber Optic Bronchoscopy?
- provides magnification and better illumination
- smaller size (permits examination of subsegmental bronchi)
- easy to use in pts with neck or jaw abnormalities
- can be performed under topical anesthesia and useful for bedside examination of critically ill pts.
- suctioning capability helps remove secretion
- can be easily passed through ET tube or in tracheostomy opening
What is Virtual Bronchoscopy?
- computer generated pictures of the endotrachial tree, which are constructed from CT images of the thorax
CXR
-list 4 limitations
Limitations:
- 2D image of 3D structure
- X-ray findings may lag behind other clinical features
- normal x-ray does not rule out pathology
- dependent on good quality image
List the fissures of the left and right lungs
Right:
3 lobes: oblique fissure, horizontal fissure (separates middle from upper lobe)
Left:
2 Lobes : oblique fissure
*Oblique fissure is at T4
Relative Densities
-list from least dense(dark) to most dense(light)
- Gas (Dark)
- Fat
- Water
- Bone
- Metal (light)
What are the three main factors determining the quality of the radiograph?
- inspiration
- penetration…(yes i said it)
- rotation
How should a proper CXR be taken?
- should be taken with full inspiration of air to help assess intrapulmonary abnormalities.
- should see diaphragm at level of 8th-10th rib posteriorly or the 5-6th rib anteriorly.
How might underexposure on CXR affect the radiograph?
How might overexposure affect the radiograph?
-the lungs appear much denser and whiter, may appear as though they have infiltrates.
Overexposure:
-heart becomes more radiolucent and the lungs become much darker, often giving the appearance of lacking lung tissue such as in emphysema.
WHat are the four major positions utilized for producing a CXR?
- Posterior-Anterior (PA)
- Lateral
- Anterior-Posterior (AP)
- Lateral Decubitus
How is a PA CXR taken?
- patient stands upright with the anterior chest placed against the front of the film.
- PA film is viewed as if the patient is standing in front of you with his/her right side on your left.
How is a Lateral Position taken?
-patient stands upright with left side of the chest against the film and the arms raised over the head.
- allows the viewer to see behind the heart and diaphragmatic dome
- typically used in conjunction with PA
How is an Anterior Posterior Position taken?
- when pt is debilitated or immobilized, the film is placed behind the patients back with the patient in supine position
- heart is greater distance from the film it will appear more magnified and the scapulae are usually visible in the lung fields because they are not rotated out of the view.
How is Lateral Decubitus Position taken?
-why would we use this position?
- patient lies on either the right or left side, radiograph is labeled according to the side that is placed down (a left lateral decubitus would have the pts left side down against the film.
- Useful in revealing a pleural effusion that cannot be easily observed in an upright view.
The heart on CXR
- describe its location
- how much of the thorax should it take up?
- what aspects of the heart make sure the left heart border?
- what aspects of the heart make up the right heart border?
Location: 2/3 of the heart should lie on the left side of the chest with the other 1/3 on the right.
- Heart should take up less than half of the thoracic cavity
- The left atrium and left ventricle create the left heart border
- The right heart border is created entirely by the right atrium
What makes up the Hilum?
-major bronchi and the pulmonary veins and arteries
Lungs:
- what to expect on normal CXR
- which fissure can you sometimes see on PA CXR?
- visible markings throughout the lungs d/t the pulmonary arteries and veins, continuing all the way to the chest wall.
- Can sometimes see the horizontal fissure of the right lobe (between middle and upper lobe)
Diaphragm
-which side is higher than the other?
-the right side is usually slightly elevated d/t the liver.
Pleura
-is this visible on CXR?
-no, not unless there is an abnormality such as pleural thickening, or fluid or air in the pleural space.
Silhouette Sign
-what is this?
-if an intrathoracic opacity s in anatomic contact with a border(heart, chest wall, diaphragm), then the opacity will obscure that border.
What is air bronchogram?
What are some common conditions in which you might find one of these?
- a tubular outline of an airway made visible due to the filling of the surrounding alveoli by fluid or inflamm exudates.
- Lung consolidation
- Pulmonary Edema
- Neoplasm
- Normal Expiration
