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Quiz III Flashcards

1
Q

differentiate between conditions that will cause air space disease and interstitial lung disease to show up on CXR

A

ASD: fluid, pus, blood, tumors

ILD: fluid or inflammation leading to fibrosis

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2
Q
A

cavitary TB

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3
Q

what is this? when would you take this?

A

expiratory AP

looking for pneumothorax

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4
Q
A

right upper lung opacity

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5
Q

what structures should be examined in a systematic review of a chest xray (9)

A
  1. general
  2. bony structures
  3. soft tissues
  4. lungs
  5. pleura
  6. hila
  7. fissures
  8. mediastinum
  9. artificial changes
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6
Q

how will aspiration pneumonia caused by anaerobic organisms present on CXR

A

lower lobe airspace disease the cavitates

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7
Q

is pneumonia airspace, interstitial, or both?

which is most likely

A

it can be either one, or both

airspace

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8
Q

three indicators of aspiration pneumonia

A

almonst alwats occurs in the dependent portions of the lung

right side more likely that left

acute looks like airspace disease

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9
Q

what 6 structures are found in the mediastinum

A
  1. heart
  2. great vessels
  3. trachea
  4. mainstem bronchi
  5. esophagus
  6. lymph nodes
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10
Q

three rules of a lateral chest x ray

A
  1. diaphragm shadows should be clear
  2. show of the upper vertebrae is whiter than the lower
  3. retrosternal and retrocardiac spaces should both be the same color and are both normally dark
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11
Q

DDx for interstitial opacities

A
  1. idiopathic interstitial pnemonia
  2. infection
  3. pulmonary edema from CHF
  4. idiopathic pulmonary fibrosis
  5. environmental factors
  6. hemorrhage
  7. sarcoidosis
  8. tumor/metastases
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12
Q
A

reticulonodular interstitial disease

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13
Q
A

interstitial pneumonia

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14
Q
A

segmental pneumonia

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15
Q

36yo male with fever, cough and SOB of 1 week duration

View:

  • Airway:
  • Bones:
  • Cardiac Silhouette:
  • Diaphragm:
  • Equal lung fields:
  • Foreign bodies:
  • Gastric bubble:
  • Hilum/mediastinum:

DX:

A

View: PA

  • Airway: OK
  • Bones: OK
  • Cardiac Silhouette
    • silhouette right heart border
  • Diaphragm
    • ill defined opacity on the right
  • Equal lung fields
    • RML opacity with a sharp superior border and difffuse inferior border
  • Foreign bodies: OK
  • Gastric bubble: OK
  • Hilum/mediastinum: OK

DX: pneumonia, RML atelectasis, lung carcinoma

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16
Q

what is the DDx for chronic air space opacity

A
  1. bronchoalveolar cell carcinoma
  2. alveolar cell proteinosis
  3. sarcoidosis
  4. lymphoma
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17
Q

two divisions of focal disease patterns

A

nodules/masses

blebs/bullae/cysts/cavities

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18
Q

what is the acute DDx for air space opacity

A
  1. pneumonia
  2. pulmonary alveolar edema
  3. hemorrhage
  4. aspiration
  5. near-drowning
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19
Q

consolidation

A

infiltrate or solid engorgement

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20
Q

obstructuve ateleactasis

A

blocked bronchus causes reabsorption of air in the alveoli distal to the obstruction leading to collapse

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21
Q
A

trachea

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22
Q

differentiate between air space disease and interstitial lung disease in term of location in the lung

A

there is no difference both diesease can be in any zone

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23
Q

barrel chest is a sign of what

A

COPD emphysema

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24
Q
A

pneumothorax on inspiration

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25
two signs of congestive heart failure on CXR
hilar engorgement and increase heart size
26
A aortic arch B aortopulmonary window C descending pulmonary artery D left atrium E left ventricle F gastric bubble G splenic flexure of the colon H descending aorta
27
miliary TB
28
A Pulmonary vein B Right atria C aortic valve D mitral valve E tricuspid valve F Right ventricle G Lefr ventricle
29
why is an AP view usually taken supine
they are taken on the portable when the patient cant make it to radiology
30
lobar pneumonia
31
38yo male with fever, chills and SOB of 4 days duration View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette: OK * Diaphragm: OK * Equal lung fields * fluffy indistinct opacity in the LLL * silhouette against the left diaphragm on PA * sillhouette on spine in lateral * Foreign bodies: none * Gastric bubble: ok * Hilum/mediastinum: ok DX: pneumonia
32
lobar pneumonia cause four indicators on CXR
pneumococcal pneumonia (s pneumoniae) 1. classically fills most or all of a lobe or lung 2. may have a sharp border 3. almost always produce a silhoutte sign with heart, aorta, diaphragm 4. almost always have air bronchogram
33
what happens to the heart during congestive heart failure/pulmonary edema
heart enlarges
34
three indicators of cardiomegaly on AP radiograph
left heart border touching or almost touch left lateral chest wall = heart enlarged heart appears significantly enlarged = heart probably enlarged heart appears borderline enlarged = probably normal size
35
interstitial pneumonia
36
pneumocystic pneumonia
37
aspiration pneumonia
38
left ventricle
39
pulmonary interstitial edema
40
signs to look for in pleural effusion
blunting of the costophrenic angle movement of opacity
41
two divisions of diffuse disease pattern
airspace disease and interstitial opacity
42
pleural effusion
43
pneumothorax on expiration
44
alveolar refers to what part of the lung
air sacs
45
should a CXR be symmetrical? if not, why?
mostly symmetrical 1. right hemidiaphragm should be a little higher 2. left heart shadow more prominent 3. aortic knob projects right
46
define the mnemonic **I** **Q**uit **A**nd Wanna **B**e **F**ree
**I**dentify the patient **Q**uality of the film **A**ir **W**ater (fluid) **B**one **F**unny looking things (foreign bodies)
47
what sign will be visable on CXR during left ventricular failure
interstitium widening followed by alveolar and pleural filling fluid will back up into the pulmonary veins and lungs
48
compressive atelectasis
passive compression of the lung due to pleural effusion, pneumothorax, or space occupying mass
49
lymphadenopathy
50
how far is the xray source from the plate in an AP? PA? Lateral?
AP is 3 feet PA is 6 feet lateral is 6 feet
51
nodule
52
cysts location defining characteristic
cavities that can be congential or acquired through infection occur in the lung parenchyma and mediastinum thin walled but larger than bullae (\<3mm)
53
52yo female smoker presents to the clinic with 5 month history of a chronic productive cough View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View: PA and lateral * Airway * cant see because the view in under pentrated * Bones * increased AP diameter * Cardiac Silhouette * appears small * Diaphragm * flattened * Equal lung fields * hyperlucency bilateraly * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum: OK DX: COPD
54
when can you see lung fissures on a chest xray
when the beam is parallel to the fissure
55
1. superior vena cava 2. right atria 3. inferior vena cava 4. aortic arch 5. left pulmonary trunk 6. left pulmonary artery 7. left atrium 8. left ventricle 9. cardiophrenic angle
56
tension pneumo
57
lymphadenopathy
58
subsegmental atelectasis
lung collapse of part of a lung usually caused by patients not taking deep breaths, often related to surgery or pleuritic chest pain
59
bullae
less than 1cm cavitys associated with emphysema, only partially visable on CXR
60
four signs of atelectatsis
1. displacement of the interlobar fissure toward the collapsed lobe 2. increased density of the affected lung 3. shift of mobile structures in the thorax 4. overinflation of the ipsilateral lobes and/or contralateral lung
61
7 year old previously healthy Hispanic male presented to an emergency department with 1 week of a non-productive cough and intermittent fevers measured at home to 103.5°F View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA/lateral * Airway: OK * Bones: OK * Cardiac Silhouette: OK * Diaphragm: OK * Equal lung fields * RUL opacity * Foreign bodies: OK * Gastric bubble: not visable * Hilum/mediastinum * slightly increased vascularity DX: pneumonia
62
reticular intestitial disease
63
four indicators of cavitary pneumonia from primary TB
cavitation is rare upper more likely than lower lobes hilar adenopathy large, often unilateral pleural effusions
64
what are two structures that can mimic pneumothorax how can they be differientated from pneumo
overlapping skin folds scapular border follow the lung markings
65
name the three parts of the bronchial tree define the first part
carina, bronchi, bronchioles carina: the bifurcation of the trachea into bronchi
66
58 yo male with SOB View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette * not visable on the right * Diaphragm * not visable on the right * Equal lung fields * no lung markings on the right * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum: OK DX: pleural effusion, hemothorax, right pneumoectomy
67
pulmonary artery
68
if air bronchogram sign is present where is the lesion causing the issue
in the lung
69
nodular interstitial disease
70
two examples of diseases would cause pleural abnormalities on CXR
1. pleural effusion 2. pneumothorax
71
three causes of inadequate inspiration on CXR
obesity pregnancy ascites
72
five patterns of disease lung disease
1. diffuse 2. focal 3. lung volume 4. pleural disease 5. lymphadenopathy
73
two chest wall deformities that might cause cardiac enlargement on CXR
straight back syndrome pectus excavatum
74
mediastinal widening
75
in what disease would a miliary pattern appear on xray
tuberculosis
76
four signs of pulmonary interstitial edema
thickening of the interlobular septa peribronchial cuffing fluid in lung fissures pleural effusions
77
what are three examples of disease that can lead to fibrosis/interstitial lung disease
1. industrial lung disease 2. inflammation 3. sarcoidosis
78
5 ways to describe a nodule or mass
1. single vs multiple 2. size 3. border defintion 4. calcification 5. location
79
right mainstem bronchus
80
what should be ordered if you are unsure if there is a pneumo but have high clinical suspicion
get an expiratory film
81
what are three examples of artificial changes to note on CXR
1. surgical clips 2. foreign bodies 3. pacemakers
82
right ventricle
83
cardiothoracic ratio
the size of the heart compared to the size of the thorax
84
four unique facts pneumocystis pneumonia
perihilar, reticular, institial pneumonia or airspace disease may mimic pulmonary edema no hilar adenopathy or pleural effusion found in AIDS patients
85
what is this view? why is it done
oblique to look around the heart at the trachea, esophagus, or vertebrae
86
left ventricle
87
liver
88
pericardial effusion
89
interstitial lung disease from advanced pulmonary fibrosis
90
right middle lobar pneumonia
91
pleural effusion
92
diaphragm
93
right atrium
94
normal vs alveolar opacity
95
what are the structures of the lungs that should be noted in alphabetical order (D, E, and H have two things)
A- airway B- bones C- cardiac D- densities and diaphragms E- effusions and equal lung fields F- foreign bodies G- gastric bubble H- hilum and mediastinum I- inspiration
96
how will primary lung cancer look on xray
ill defined, speculated, lobulation
97
pneumopericardium
98
aortic arch
99
A Superior vena cava B azygoesphageal recess C right main pulmonary artery D right descending pulmonary artery E Right atrium F cardio phrenic angle G Liver H Breast Shadow
100
hilum of the lungs
where the pulmonary arteries enter the lung and branch off
101
what three structures in the thorax can shift due to atelectasis
trachea, heart, lungs
102
why is it important to find lung markings and follow them to the edge of the chest
because they determine the size and contour of the lung
103
hilum
the origin of the lungs
104
what changes in the mediastinum should be noted on a systematic review of a CXR
1. cardiothoracic ratio 2. widening 3. shifts or abnormalities
105
diaphragm shadow
106
Kerly B lines
short (1-2) cm long very thin and horizontal lines four at or near the costophrenic angle
107
35yo female with history of heavy smoking and chronic lung disease View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View: PA * Airway * right deviation * Bones: OK * Cardiac Silhouette: OK * Diaphragm: OK * Equal lung field * linear/curvilinear opacities bilateraly * assymetry of the left breast * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum: OK DX: CHF, diffuse pneumonia, interstitial lung disease
108
63 yo male smoker with history of dyslipidemia, HTN and myocardial infarction presents with increasing SOB of 1 week duration View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View: PA * Airway: midline * Bones: OK * Cardiac Silhouette: slightly enlarged * Diaphragm: OK * Equal lung fields * increased vascular markings * engorged hilar vasculature * kerly B lines * fluid in horizontal fissure * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum: engorged hilar vasculatire DX: CHF, diffuse pneumonia, pulmonary edema
109
45yo female with productive cough and fever for 1 week View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette: OK * Diaphragm: OK * Equal lung fields * hazy opacity in the left lingual segment on PA * more pronounced on lateral over the heart * Foreign bodies: none * Gastric bubble: ok * Hilum/mediastinum: ok DX: LUL lingual pneumonia
110
what is wrong with this CXR
over penetrated
111
mediastinum
the extrapleural space between the lungs
112
five boney structure of the thorax
1. ribs 2. clavicles 3. shoulder articulation 4. spine 5. scapula
113
define the reticular/nodular pattern found in interstitual lung disease
small, well defined white nodules and lines that cna be fine, thin, lacy densities
114
T/F air bronchogram is specific to pneumonai
false
115
three indicators of cavitary pneumonia from post primary TB
cavitation is common (thin walls with smooth margins) no air fluid level apical or posterior segments of the upper lobes that may be bilateral
116
round pneumonia
117
how will hematologic mets look on x ray
multiple smooth round lung nodules often variable in size
118
round pneumonia
119
segmental pneumonia
120
nodule
121
linear interstitial disease
122
interstitial pneumonia causes two indicators on CXR
viral pneumonia, mycoplasm pneumoniae, pneumocystis 1. involve airway walls and alveolar septa 2. fine, reticular pattern in the lungs spreading to alveoli (patchy confluent airspace disease)
123
pneumonia
consolidation of lung produced by inflammatory exudate, commonly caused by infection
124
34yo male with cough of 10 days duration View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA/lateral * Airway: OK * Bones: OK * Cardiac Silhouette: OK * Diaphragm: OK * Equal lung fields * RUL opacity * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum: OK DX: lobar pneumonia - RUL
125
extracardiac causes of cardiac enlargement
1. AP radiograph 2. inadequate inspiration 3. chest wall deformities 4. rotation 5. pericardial effusion
126
62 yo male presents to the ER with worsening SOB View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette * silhouette right heart border due to opacity * Diaphragm * silhouette obscuring right hemi diaphragm * Equal lung fields * right fluid density ove the RML and RUL * peribronchial cuffing on the right and upper left lobes * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum * slightly increased vascularity on the right DX: pleural effusion
127
where are bullae found? why are they only partiall visable on CXR
lung parechyma very thin wall
128
pulmonary alveolar edema
129
pleural effusion
130
what lateral view would you get for a left sided lesion
a left lateral view
131
blebs
very small blister like lesions that form in the visceral pleura, usually in the apices
132
COPD
133
four common causes of lymphadenopathy
1. lymphoma 2. metastatic carcinoma 3. sarcoidosis 4. TB
134
lateral chest
135
air bronchogram
136
two pleural layers visable on chest xray
parietal and visceral
137
right middle lobe opacity
138
pulmonary artery
139
what four bony structures should be examined on a systematic review of a CXR
1. shoulder joint 2. ribs 3. spine 4. scapula
140
what is wrong with this CXR
underpenetrated
141
why can the ipsilateral lobes/contralateral lungs overinflate due to atelecatsis
there will be an attempt to overcompensate due to volume loss
142
characteristics of malignant nodules
1. steady, predictable growth 2. larger than 5cm 3. can be smooth round or ill defined depending on source
143
how will interstitial look different than airspace pneumonia
interstitial pneumonia are have more interstitial markings, spread to adjacent airways airspace wil appear fluffly, homogenous, and indistinct
144
two indicators of miliary tuberculosis
small nodules 1mm in size that can grow to 2-3mm clear rapidly once treated
145
why is a lordotic view done
to see the apices of the lungs
146
calcified nodules
147
48yo female with substernal chest pain View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette: OK * Diaphragm: OK * Equal lung fields: OK * Foreign bodies: breast implants * Gastric bubble: OK * Hilum/mediastinum * calcification in the aortic knob DX: athersclerosis
148
describe the orientation of the lung fissures with respect to the lobes
the left oblique fissure separates the upper and lower lobe the right oblique fissures separates the middle and lower lobe the horizontal fissure separates the upper and middle lobe
149
interstitial lung disease
development of particles in the interstitium
150
three characteristics of interstitial lung disease
1. reticular, nodular, or reticulonodular pattern 2. packets of disease surrounded by normal lung 3. can be focal of diffuse
151
segmental pneumonia (bronchopneumonia) cause 5 indicators on CXR
staph aureus or pseudomonas aeruginosa 1. involved several segments 2. margins tend to be fluffy or indistinct 3. produce exudate the fill bronchi 4. NO AIR BRONCHOGRAM 5. may see atelectasis
152
what should you do if you suspect pleural effusion or lung infiltrate
move the patient effusion will move in response to gravity infiltrate wont
153
interstitial lung disease vs normal lung
154
differentiate between air space disease and interstitial lung disease in term of appearance on CXR
ASD: confluent shadows with air bronchogram ILD: linear/reticular/nodular shadows
155
characteristics of benign nodules
1. can be slow or fast growing 2. usually round and less than 4cm 3. usually found in non smokers under 35 4. can be calcified 5. well definded edges
156
pleural effusion
fluid in the pleural cavity
157
retrocardiac space
158
interstitium
connective tissue, lymphatics, blood vessels, and bronchi that surround and support airspaces
159
interstitial pneumonia
160
what does pneumonia look in CXR
denser than normal lung may see air bronchogram
161
distinguish between a nodule and mass
nodule is any pulmonary radiographic lesion that is sharply defined, discrete, nearly circular, and less that 3cm a mass is larger than 3cm
162
round pneumonia
163
how would cardiomegaly be identified on a lateral CXR
note the space posterior to the heart and anterior to the spine at the level of the diaphragm if the cardiac silhouette extends posteriorly over the spine = cardiomegaly
164
why will an AP radiograph make the heart appear enlarged
a combination of magnification, rotation, and poor inspiration
165
how will lymphatic mets look on xray
more like interstitial lung disease
166
20yo with gradually increasing SOB & cough over 6 mo View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette * numerous opaque densities bilaterally * Diaphragm: OK * Equal lung fields * numerous round opaque densities bilaterally * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum * widenend DX: metastatic disease
167
horizontal fissure
168
why are lungs hyper inflated in COPD/Emphysema
air trapping due to incomplete expiration
169
COPD
170
what three features of the lungs should be reviewed on CXR
1. pulmonary vessels 2. airspace 3. interstitial pattern
171
38yo male with dyspnea and pleuritic chest pain for a week View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette: ok * Diaphragm: ok * Equal lung fields: left lung cavitary lesion in the LUL with and air fluid level * Foreign bodies: none * Gastric bubble: NA * Hilum/mediastinum: ok, loss of aortic knob DX: cavitary lesion associated with community acquired MRSA
172
COPD
173
what view is this? three indentifiers
1. diaphragm is more lifted 2. clavicle is higher 3. heart is less defined
174
atelectasis
collapse of the lung due to obstruction
175
what is the gold standard view? why
PA it gives maximum visabilty of the heart
176
what usually causes pneumopericardium
direct wound
177
commonalities between blebs, bullae, cysts, and cavities four points of variation between them
all air and or fluid containing lesions in the lung 1. size 2. location 3. wall composition 4. fluid content
178
what is wrong with this CXR? how can you tell?
it is rotated the clavicles are not equidistant from the spinous processes
179
how does normal cardiothoracic ratio differe between adults and children
a normal pediatric cardiothoracic ratio can be up to 65%
180
lateral costophrenic angles
181
two fissures of the lungs visable on chest xray
major and minor
182
horizontal and oblique fissure
183
what does the parietal pleura cover? visceral pleura? what is the space between them?
the interior of the chest wall the lungs a potential space that can fill with air or fluid
184
describe what the airspace disease will look like on xray
hazy, fluffy, confluent opacities with indistinct margins and airbronchogram or silhouette sign
185
what is the probability of malignancy if a malignant lung nodule is larger that 5cm
95%
186
how will subsegmental atelectasis look different from other atelectasis on CXR
linear densities parallel to diaphragm seen at the lung bases
187
what is snowball sign used to do elaborate on how
determine if a mass or nodule comes from the lung or surrounding tissue if the snow ball is round, it is in the lung, if the snow ball is flat it is in the surrounding tissue
188
round pneumonia
189
round pneumonia
190
round pneumonia causes two identifiers on CXR
haemophilus influenzae, streptococcus, pneumococcus mostly in kids usually the posterior, lower lobes
191
list the lobes of the left and right lungs
left: upper and lingual, lower right: upper, middle, lower
192
cavity location wall characteristic description often includes what
variable in size and shape lung parenchyma wall greater than 3mm white soft tissue density ring with an air density center air fluid level
193
what will definitely be visable on CXR in the case of pneumothorax
a white viseceral line at the periphery
194
60yo female with cough and SOB over the last 6 days View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA/Lateral * Airway: OK * Bones: OK * Cardiac Silhouette: OK * Diaphragm * high * Equal lung fields * opacity RUL with air bronchogram * Foreign bodies: OK * Gastric bubble: not visable * Hilum/mediastinum: silhouette with RUL DX: pneumonia with air bronchogram
195
Ap costophrenic angles
196
pattern of pulmonary interstitial edema
thickening of the interlobular septa (kerly A and B) peribronchial cuffing fluid in fissures pleural effusions
197
what are the individual sides of the diaphragm called
left and right hemidiaphragm
198
round pneumonia
199
24 yo male with sudden onset of SOB while lifting weights View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette: OK * Diaphragm: OK * Equal lung fields * expanded right lung * left pulmonary lines lost * visceral line noted * hyperlucent hemithorax * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum: OK DX: pneumothorax
200
what three abnormalities might you see in the fissures of the lung on CXR
1. presence 2. shift in location 3. abnormalities
201
26yo female who presents with an abrupt onset of SOB following a motorcycle accident View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA * Airway * Left shift * Bones: OK * Cardiac Silhouette * left shift * Diaphragm * loss of costophrenic angle due to mediastinal shift * Equal lung fields * hyperlucent right side * no lung markings * haziness over left lung * Foreign bodies: OK * Gastric bubble: NA * Hilum/mediastinum * left shift DX: tensio pneumothorax
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60yo female with history of congestive heart failure presents to the clinic with a 3 week history of worsening SOB View * Airway * Bones * Cardiac Silhouette * Diaphragm * Equal lung fields * Foreign bodies * Gastric bubble * Hilum/mediastinum DX
View * Airway: OK * Bones: OK * Cardiac Silhouette: NA * Diaphragm: NA * Equal lung fields * RLL and LLL obscured by fluid density * fluid in the right horizontal fissure * Foreign bodies: OK * Gastric bubble: NA * Hilum/mediastinum * widened, opaque DX: pleura effusion
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stomach
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what are the radiological signs of heart failure
fluid in lung fissures kerley B lines prominent upper lobe pulmonary arteries fluild in the lung interstitium large heart pleural effusion
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when examining the lung air space, what would be four features you might note
1. nodules 2. masses 3. atelectasis 4. COPD
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kerly b an kerly a
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define the mnemonic **A**re **T**here **M**any **L**ung **L**esions
**A**bdomen **T**horax **M**ediastinum **L**ungs individually **L**ungs comparitively
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right middle lober pneumonia
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lordotic
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right middle lobar pneumonia
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reticular interstitial disease
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what is the most common mediastinal mass
lymphadenopathy
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A Left upper B Right Upper C Right middle lobe D Lingula E Right lower lobe Left Lower Lobe
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what is the normal cardiothoracic ratio of an adult
\<50%
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signs of COPD or emphysema
1. hyperinflation 2. flattened diaphragm 3. heart appears smaller
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milliary intertstitial disease
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description of interstitial opacities based on pattern
1. reticular (too many lines) 2. nodular (too many dots) 3. reticulonodular (too many lines and dots)
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COPD
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atelectasis
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can blebs always be seen on CXR? what sequla is associated with blebs
not usually spontaenous pneumo
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what is the main way to determine if pulmonary edema is cardiogenic in nature
enlarged heart kerly B lines
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65yo male with DOE and a feeling that he “can’t catch my breath” View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette * slightly enlarged * borders less distincton the RML and RUL * Diaphragm: OK * Equal lung fields * reticular opacity bilaterally * Foreign bodies: EKG wires noted * Gastric bubble: NA * Hilum/mediastinum * hazy vascular margins DX: CHF exacerbation leading to pulmonary edema
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tension pneumo
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four microbial causes of cavitary pneumonia
straph, strep, klebsiella, coccidomycosis, tuberculosis
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pulmonary alveolar edema how will this look on CXR
elevated venous pressure pushes fluid from the interstitium into the alveoli fluffy indistinct patchy "batwing" airspace densities that are usually centrally located, more likely in the lower than upper lung
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during a systematic review of CXR, what are the features examined on general overiew (6)
1. contrast 2. projection 3. orientation L.R 4. correct patient 5. correct films 6. inspiration
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what is the difference between these two radiographs
the left is inspiratory, right is inspiratory
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left and right hilar points
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what are the three costophrenic angles
anterior, posterior, lateral deep recesses formed by the diaphragm and the ribs on PA and lateral views
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58 yo male smoker with complaints of SOB View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA * Airway: OK * Bones: OK * Cardiac Silhouette * narrowed * Diaphragm: OK * Equal lung fields * bullae * hyperlucent bilaterally * opaque lesion on the right lower lobe * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum * narrow DX: emphysema, asthma, bronchiolitis
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what will airspace disease look like is it focal or diffuse
a confluent fluffy or hazy opacity resulting from fluid density in the alveoli it is diffuse and can involve part or the whole lung
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what are two considerations when examining cardiothoracic ratio in pediatrics
infants dont take deep inspiration lobulated thymus can overlap portions of the heart
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what 8 views are used to view the chest
1. PA 2. AP 3. lateral 4. inspiratory 5. expiratory 6. lordotic 7. decubitus 8. oblique
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cyst
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cyst with an air fluid level
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where are the pulmonary arteries found on radiograph
superior to the atria on both sides the left pulmonary artery is inferior to the aortic arch
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signs of heart failure in chronological order
heart enlargement kerly B line Kerly A line fluid in lung fissures fluid in the interstitium (batwing)
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45yo non-smoker presents with rhinorrhea and sneezing View * **A**irway * **B**ones * **C**ardiac Silhouette * **D**iaphragm * **E**qual lung fields * **F**oreign bodies * **G**astric bubble * **H**ilum/mediastinum DX
View: PA * **A**irway: OK * **B**ones: OK * **C**ardiac Silhouette: OK borders not well defined * **D**iaphragm: OK * **E**qual lung fields: round opaque lesion in the RML * **F**oreign bodies: none * **G**astric bubble: NA * **H**ilum/mediastinum: mostly ok, maybe a little wide DX: carcinoid tumor
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aortic arch
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when examining soft tissue (lung, breast, diaphragm) on CXR what **four** qualities should be noted
1. thickness 2. contour 3. foreign body 4. densities
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A Left brachial vein B Superior vena cava C Ascending aorta D Aorta E Pulmonary artery F Left Pulmonary artery
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what view is this? give three indicators
PA chest 1. clavicles are low 2. heart is well defined 3. diaphragm is more flat
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what is a common cause of subsegmental atelecatasis two conditions that would lead to this
patients who arent taking deep breaths post-op patients or patients with pleuritic chest pain
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signs to look for to indicate pneumothorax
1. symmetrical 2. lung markings to periphery 3. white visceral lines and bones
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retrosternal space
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kerly A lines
extend from the hila for up to 6cm and dont reach to lung periphery
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how will lymphadenopathy present on xray
medialstinal widening and hilar prominence
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what is air bronchogram sign what is it indicative of
indication of airspace disease an air filled bronchus surrounded by an airless lung
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what is this view? why is it done
decubitus looking for an air fluid level
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what will atelectasis look on xray
white tissue due to lack of air volume
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interstitial
spaces within a lung or tissue/spaces between alveoli
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causes of lung cysts
abscesses, TB, carcinoma
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anterior/middle/posterior mediastinum
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why would the heart look larger on expiration than inspiration
the diaphragm moves up and compresses the heart
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kerly B
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T/F a small, acute atelectasis will create a larger overinflation of the the contralateral lung
false, a large or chronic atelectasis will produce a larger compensation
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pneumothorax
air in the pleural cavity
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A Right Pulmonary artery B Knob of the aortic arch C Right pulmonary artery D Left pulmonary artery E Right pulmonary artery (lower lobe) F RIght border fo the heart G inferior vena cava
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26 yo with cough for the past 3 weeks View: * Airway: * Bones: * Cardiac Silhouette: * Diaphragm: * Equal lung fields: * Foreign bodies: * Gastric bubble: * Hilum/mediastinum: DX:
View: PA/lateral * Airway: OK * Bones: OK * Cardiac Silhouette * right heart border a little enlarged * Diaphragm * mininimally flattened * Equal lung fields: OK * Foreign bodies: OK * Gastric bubble: OK * Hilum/mediastinum: OK DX: Normal - indicates asthma or bronchitis based on symptoms
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atelecatsis three types
collapse or volume loss obstructuve, compressive, subsegmental
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air bronchogram

Radiology (14 decks)

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