Pulmonology Imaging

Question 1

What are the indications for a CXR?

Answer 1

Initial imaging test to assess dyspnea, chronic cough, chest pain, injury
Evaluate for pneumonia, COPD, rib/collarbone fractures, TB, pneumothorax, pleural effusion, interstitial lung dz

Question 2

What are the benefits for CXR?

Answer 2

Fast, widely available, cheap, usually no side effects

Question 3

What are the risks for CXR?

Answer 3

Low risk of cancer from excess radiation exposure, avoid in pregnant women due to risk of radiation injury to fetus

Question 4

What is the most sensitive sign on CXR for hyperinflation of the lungs?

Answer 4

Flattened diaphragm usually due to emphysema (COPD)

Question 5

What is the imaging of choice for flattened diaphragm?

Answer 5

CXR

Question 6

Describe a barrel chest

Answer 6

Increase AP diameter of the chest wall
Most commonly associated with COPD
CXR provides adequate imaging with minimal risk

Question 7

Air fluid level on a CXR indicates presence of what?

Answer 7

Cavitation due to lung abscess (collection of pus within parenchyma)
Commonly caused by infection or by aspiration of oropharyngeal contents

Question 8

What is the most common risk factor for lung abscess with air fluid level?

Answer 8

Alcoholism

Question 9

What are the sx for lung abscess with air fluid level?

Answer 9

Fatigue, night sweats, fever, weight loss, productive cough, chest pain, +/- bad breath

Question 10

What is the modality of choice for lung abscess with air fluid level?

Answer 10

CXR

Question 11

What is a pleural effusion?

Answer 11

Abnormal accumulation of fluid in the pleural space

Question 12

What are the sx for pleural effusion?

Answer 12

Dyspnea, pleuritic chest pain, +/- cough

Question 13

What will be present during the PE for a pt with pleural effusion?

Answer 13

Dullness to percussion and decreased breath sounds

Question 14

What is the imaging of choice for pleural effusion?

Answer 14

CXR is best initial test, shows blunting of costophrenic angle

Question 15

What is the pulmonary meniscus sign?

Answer 15

Meniscus found on the surface of fluid commonly seen with pleural effusion on CXR
Due to surface tension b/w two different fluids in pleural cavity (normal serous fluid and pleural effusion)
Accumulates in costophrenic angles on PA CXR and in substernal region on lateral CXR

Question 16

What are the indications for a ventilation perfusion (VQ) scan?

Answer 16

Primarily used to diagnose or rule out pulmonary embolism

Question 17

What are the pros for a VQ scan?

Answer 17

Readily available, minimal risk, accurate in detecting blood clots

Question 18

What are the risks of a VQ scan?

Answer 18

Injection pain, injection site bruise, radioisotope allergy, small amount of radiation exposure, not recommended if pregnancy or breast feeding

Question 19

What are the sx of a pulmonary embolus?

Answer 19

Suddenly onset dyspnea, pleuritic chest pain, tachypnea, tachycardia, low grade fever, cough

Question 20

What is the imaging of choice for pulmonary embolism?

Answer 20

Chest CT with contrast in stable pts with suspected PE bc its noninvasive and more available than VQ scan

Question 21

If a pt has normal CXR with suspected pulmonary embolus what imaging is done?

Answer 21

VQ scan

Question 22

What is the “gold standard” for PE?

Answer 22

Pulmonary angiography but it is very expensive

Question 23

What are the pulmonary indications for CT?

Answer 23

Pulmonary nodule screening, lung cancer, bronchiectasis, interstitial lung disease (if CXR raises suspicion)

Question 24

What are the risks for contrast enhanced CT?

Answer 24

Low risk of cancer from excess radiation exposure, allergic reaction to contrast

Question 25

What are the contraindications for contrast enhanced CT?

Answer 25

No contrast in pts with renal dz, pregnant women (Can have CT in emergency only)

Question 26

What are the pros for contrast enhanced CT?

Answer 26

Low dose radiation CT is superior in lung cancer screening bc it is more sensitive then CXR with less radiation exposure vs standard chest CT

Question 27

Describe a fractured rib

Answer 27

Often seen due to hematoma at site of the fracture
Ribs 4-10 fractures most often
Appears as abrupt discontinuity in the smooth outline of rib +/- lucent fracture line

Question 28

What is the common pattern for rib evaluation?

Answer 28

Examine posterior portion of rib
Anterior portion
Lateral portion
Flow entire rib if abnormality is spotted

Question 29

What is the imaging of choice for fractured rib?

Answer 29

May not see on fracture on CXR
CT is more sensitive
CXR is taken after to asses for possible pneumothorax