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Radiology > Quiz III > Flashcards

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
Q

two signs of congestive heart failure on CXR

A

hilar engorgement and increase heart size

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26
Q
A

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

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27
Q
A

miliary TB

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28
Q
A

A Pulmonary vein

B Right atria

C aortic valve

D mitral valve

E tricuspid valve

F Right ventricle

G Lefr ventricle

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29
Q

why is an AP view usually taken supine

A

they are taken on the portable when the patient cant make it to radiology

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30
Q
A

lobar pneumonia

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31
Q

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

A

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

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32
Q

lobar pneumonia

cause

four indicators on CXR

A

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
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33
Q

what happens to the heart during congestive heart failure/pulmonary edema

A

heart enlarges

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34
Q

three indicators of cardiomegaly on AP radiograph

A

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

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35
Q
A

interstitial pneumonia

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36
Q
A

pneumocystic pneumonia

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37
Q
A

aspiration pneumonia

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38
Q
A

left ventricle

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39
Q
A

pulmonary interstitial edema

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40
Q

signs to look for in pleural effusion

A

blunting of the costophrenic angle

movement of opacity

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41
Q

two divisions of diffuse disease pattern

A

airspace disease and interstitial opacity

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42
Q
A

pleural effusion

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43
Q
A

pneumothorax on expiration

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44
Q

alveolar refers to what part of the lung

A

air sacs

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45
Q

should a CXR be symmetrical?

if not, why?

A

mostly symmetrical

  1. right hemidiaphragm should be a little higher
  2. left heart shadow more prominent
  3. aortic knob projects right
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46
Q

define the mnemonic I Quit And Wanna Be Free

A

Identify the patient

Quality of the film

Air

Water (fluid)

Bone

Funny looking things (foreign bodies)

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47
Q

what sign will be visable on CXR during left ventricular failure

A

interstitium widening followed by alveolar and pleural filling

fluid will back up into the pulmonary veins and lungs

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48
Q

compressive atelectasis

A

passive compression of the lung due to pleural effusion, pneumothorax, or space occupying mass

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49
Q
A

lymphadenopathy

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50
Q

how far is the xray source from the plate in an AP? PA? Lateral?

A

AP is 3 feet

PA is 6 feet

lateral is 6 feet

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51
Q
A

nodule

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52
Q

cysts

location

defining characteristic

A

cavities that can be congential or acquired through infection

occur in the lung parenchyma and mediastinum

thin walled but larger than bullae (<3mm)

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53
Q

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

A

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

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54
Q

when can you see lung fissures on a chest xray

A

when the beam is parallel to the fissure

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55
Q
A
  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
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56
Q
A

tension pneumo

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57
Q
A

lymphadenopathy

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58
Q

subsegmental atelectasis

A

lung collapse of part of a lung usually caused by patients not taking deep breaths, often related to surgery or pleuritic chest pain

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59
Q

bullae

A

less than 1cm cavitys associated with emphysema, only partially visable on CXR

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60
Q

four signs of atelectatsis

A
  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
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61
Q

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:

A

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

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62
Q
A

reticular intestitial disease

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63
Q

four indicators of cavitary pneumonia from primary TB

A

cavitation is rare

upper more likely than lower lobes

hilar adenopathy

large, often unilateral pleural effusions

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64
Q

what are two structures that can mimic pneumothorax

how can they be differientated from pneumo

A

overlapping skin folds

scapular border

follow the lung markings

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65
Q

name the three parts of the bronchial tree

define the first part

A

carina, bronchi, bronchioles

carina: the bifurcation of the trachea into bronchi

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66
Q

58 yo male with SOB

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
    • 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

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67
Q
A

pulmonary artery

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68
Q

if air bronchogram sign is present where is the lesion causing the issue

A

in the lung

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69
Q
A

nodular interstitial disease

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70
Q

two examples of diseases would cause pleural abnormalities on CXR

A
  1. pleural effusion
  2. pneumothorax
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71
Q

three causes of inadequate inspiration on CXR

A

obesity

pregnancy

ascites

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72
Q

five patterns of disease lung disease

A
  1. diffuse
  2. focal
  3. lung volume
  4. pleural disease
  5. lymphadenopathy
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73
Q

two chest wall deformities that might cause cardiac enlargement on CXR

A

straight back syndrome

pectus excavatum

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74
Q
A

mediastinal widening

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75
Q

in what disease would a miliary pattern appear on xray

A

tuberculosis

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76
Q

four signs of pulmonary interstitial edema

A

thickening of the interlobular septa

peribronchial cuffing

fluid in lung fissures

pleural effusions

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77
Q

what are three examples of disease that can lead to fibrosis/interstitial lung disease

A
  1. industrial lung disease
  2. inflammation
  3. sarcoidosis
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78
Q

5 ways to describe a nodule or mass

A
  1. single vs multiple
  2. size
  3. border defintion
  4. calcification
  5. location
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79
Q
A

right mainstem bronchus

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80
Q

what should be ordered if you are unsure if there is a pneumo but have high clinical suspicion

A

get an expiratory film

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81
Q

what are three examples of artificial changes to note on CXR

A
  1. surgical clips
  2. foreign bodies
  3. pacemakers
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82
Q
A

right ventricle

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83
Q

cardiothoracic ratio

A

the size of the heart compared to the size of the thorax

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84
Q

four unique facts pneumocystis pneumonia

A

perihilar, reticular, institial pneumonia or airspace disease

may mimic pulmonary edema

no hilar adenopathy or pleural effusion

found in AIDS patients

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85
Q

what is this view? why is it done

A

oblique

to look around the heart at the trachea, esophagus, or vertebrae

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86
Q
A

left ventricle

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87
Q
A

liver

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88
Q
A

pericardial effusion

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89
Q
A

interstitial lung disease from advanced pulmonary fibrosis

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90
Q
A

right middle lobar pneumonia

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91
Q
A

pleural effusion

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92
Q
A

diaphragm

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93
Q
A

right atrium

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94
Q
A

normal vs alveolar opacity

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95
Q

what are the structures of the lungs that should be noted in alphabetical order

(D, E, and H have two things)

A

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

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96
Q

how will primary lung cancer look on xray

A

ill defined, speculated, lobulation

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97
Q
A

pneumopericardium

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98
Q
A

aortic arch

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99
Q
A

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

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100
Q

hilum of the lungs

A

where the pulmonary arteries enter the lung and branch off

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101
Q

what three structures in the thorax can shift due to atelectasis

A

trachea, heart, lungs

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102
Q

why is it important to find lung markings and follow them to the edge of the chest

A

because they determine the size and contour of the lung

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103
Q

hilum

A

the origin of the lungs

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104
Q

what changes in the mediastinum should be noted on a systematic review of a CXR

A
  1. cardiothoracic ratio
  2. widening
  3. shifts or abnormalities
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105
Q
A

diaphragm shadow

106
Q

Kerly B lines

A

short (1-2) cm long very thin and horizontal lines four at or near the costophrenic angle

107
Q

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

A

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
Q

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

A

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
Q

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

A

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
Q

what is wrong with this CXR

A

over penetrated

111
Q

mediastinum

A

the extrapleural space between the lungs

112
Q

five boney structure of the thorax

A
  1. ribs
  2. clavicles
  3. shoulder articulation
  4. spine
  5. scapula
113
Q

define the reticular/nodular pattern found in interstitual lung disease

A

small, well defined white nodules and lines that cna be fine, thin, lacy densities

114
Q

T/F air bronchogram is specific to pneumonai

A

false

115
Q

three indicators of cavitary pneumonia from post primary TB

A

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
Q
A

round pneumonia

117
Q

how will hematologic mets look on x ray

A

multiple smooth round lung nodules often variable in size

118
Q
A

round pneumonia

119
Q
A

segmental pneumonia

120
Q
A

nodule

121
Q
A

linear interstitial disease

122
Q

interstitial pneumonia

causes

two indicators on CXR

A

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
Q

pneumonia

A

consolidation of lung produced by inflammatory exudate, commonly caused by infection

124
Q

34yo male with cough of 10 days duration

View:

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

DX:

A

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
Q

extracardiac causes of cardiac enlargement

A
  1. AP radiograph
  2. inadequate inspiration
  3. chest wall deformities
  4. rotation
  5. pericardial effusion
126
Q

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:

A

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
Q

where are bullae found?

why are they only partiall visable on CXR

A

lung parechyma

very thin wall

128
Q
A

pulmonary alveolar edema

129
Q
A

pleural effusion

130
Q

what lateral view would you get for a left sided lesion

A

a left lateral view

131
Q

blebs

A

very small blister like lesions that form in the visceral pleura, usually in the apices

132
Q
A

COPD

133
Q

four common causes of lymphadenopathy

A
  1. lymphoma
  2. metastatic carcinoma
  3. sarcoidosis
  4. TB
134
Q
A

lateral chest

135
Q
A

air bronchogram

136
Q

two pleural layers visable on chest xray

A

parietal and visceral

137
Q
A

right middle lobe opacity

138
Q
A

pulmonary artery

139
Q

what four bony structures should be examined on a systematic review of a CXR

A
  1. shoulder joint
  2. ribs
  3. spine
  4. scapula
140
Q

what is wrong with this CXR

A

underpenetrated

141
Q

why can the ipsilateral lobes/contralateral lungs overinflate due to atelecatsis

A

there will be an attempt to overcompensate due to volume loss

142
Q

characteristics of malignant nodules

A
  1. steady, predictable growth
  2. larger than 5cm
  3. can be smooth round or ill defined depending on source
143
Q

how will interstitial look different than airspace pneumonia

A

interstitial pneumonia are have more interstitial markings, spread to adjacent airways

airspace wil appear fluffly, homogenous, and indistinct

144
Q

two indicators of miliary tuberculosis

A

small nodules 1mm in size that can grow to 2-3mm

clear rapidly once treated

145
Q

why is a lordotic view done

A

to see the apices of the lungs

146
Q
A

calcified nodules

147
Q

48yo female with substernal chest pain

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: OK
  • Diaphragm: OK
  • Equal lung fields: OK
  • Foreign bodies: breast implants
  • Gastric bubble: OK
  • Hilum/mediastinum
    • calcification in the aortic knob

DX: athersclerosis

148
Q

describe the orientation of the lung fissures with respect to the lobes

A

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
Q

interstitial lung disease

A

development of particles in the interstitium

150
Q

three characteristics of interstitial lung disease

A
  1. reticular, nodular, or reticulonodular pattern
  2. packets of disease surrounded by normal lung
  3. can be focal of diffuse
151
Q

segmental pneumonia (bronchopneumonia)

cause

5 indicators on CXR

A

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
Q

what should you do if you suspect pleural effusion or lung infiltrate

A

move the patient effusion will move in response to gravity infiltrate wont

153
Q
A

interstitial lung disease vs normal lung

154
Q

differentiate between air space disease and interstitial lung disease in term of appearance on CXR

A

ASD: confluent shadows with air bronchogram

ILD: linear/reticular/nodular shadows

155
Q

characteristics of benign nodules

A
  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
Q

pleural effusion

A

fluid in the pleural cavity

157
Q
A

retrocardiac space

158
Q

interstitium

A

connective tissue, lymphatics, blood vessels, and bronchi that surround and support airspaces

159
Q
A

interstitial pneumonia

160
Q

what does pneumonia look in CXR

A

denser than normal lung

may see air bronchogram

161
Q

distinguish between a nodule and mass

A

nodule is any pulmonary radiographic lesion that is sharply defined, discrete, nearly circular, and less that 3cm

a mass is larger than 3cm

162
Q
A

round pneumonia

163
Q

how would cardiomegaly be identified on a lateral CXR

A

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
Q

why will an AP radiograph make the heart appear enlarged

A

a combination of magnification, rotation, and poor inspiration

165
Q

how will lymphatic mets look on xray

A

more like interstitial lung disease

166
Q

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

A

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
Q
A

horizontal fissure

168
Q

why are lungs hyper inflated in COPD/Emphysema

A

air trapping due to incomplete expiration

169
Q
A

COPD

170
Q

what three features of the lungs should be reviewed on CXR

A
  1. pulmonary vessels
  2. airspace
  3. interstitial pattern
171
Q

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

A

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
Q
A

COPD

173
Q

what view is this?

three indentifiers

A
  1. diaphragm is more lifted
  2. clavicle is higher
  3. heart is less defined
174
Q

atelectasis

A

collapse of the lung due to obstruction

175
Q

what is the gold standard view?

why

A

PA

it gives maximum visabilty of the heart

176
Q

what usually causes pneumopericardium

A

direct wound

177
Q

commonalities between blebs, bullae, cysts, and cavities

four points of variation between them

A

all air and or fluid containing lesions in the lung

  1. size
  2. location
  3. wall composition
  4. fluid content
178
Q

what is wrong with this CXR? how can you tell?

A

it is rotated

the clavicles are not equidistant from the spinous processes

179
Q

how does normal cardiothoracic ratio differe between adults and children

A

a normal pediatric cardiothoracic ratio can be up to 65%

180
Q
A

lateral costophrenic angles

181
Q

two fissures of the lungs visable on chest xray

A

major and minor

182
Q
A

horizontal and oblique fissure

183
Q

what does the parietal pleura cover?

visceral pleura?

what is the space between them?

A

the interior of the chest wall

the lungs

a potential space that can fill with air or fluid

184
Q

describe what the airspace disease will look like on xray

A

hazy, fluffy, confluent opacities with indistinct margins and airbronchogram or silhouette sign

185
Q

what is the probability of malignancy if a malignant lung nodule is larger that 5cm

A

95%

186
Q

how will subsegmental atelectasis look different from other atelectasis on CXR

A

linear densities parallel to diaphragm seen at the lung bases

187
Q

what is snowball sign used to do

elaborate on how

A

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
Q
A

round pneumonia

189
Q
A

round pneumonia

190
Q

round pneumonia

causes

two identifiers on CXR

A

haemophilus influenzae, streptococcus, pneumococcus

mostly in kids

usually the posterior, lower lobes

191
Q

list the lobes of the left and right lungs

A

left: upper and lingual, lower
right: upper, middle, lower

192
Q

cavity

location

wall characteristic

description

often includes what

A

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
Q

what will definitely be visable on CXR in the case of pneumothorax

A

a white viseceral line at the periphery

194
Q

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:

A

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
Q
A

Ap costophrenic angles

196
Q

pattern of pulmonary interstitial edema

A

thickening of the interlobular septa (kerly A and B)

peribronchial cuffing

fluid in fissures

pleural effusions

197
Q

what are the individual sides of the diaphragm called

A

left and right hemidiaphragm

198
Q
A

round pneumonia

199
Q

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

A

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
Q

what three abnormalities might you see in the fissures of the lung on CXR

A
  1. presence
  2. shift in location
  3. abnormalities
201
Q

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:

A

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

202
Q

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

A

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

203
Q
A

stomach

204
Q

what are the radiological signs of heart failure

A

fluid in lung fissures

kerley B lines

prominent upper lobe pulmonary arteries

fluild in the lung interstitium

large heart

pleural effusion

205
Q

when examining the lung air space, what would be four features you might note

A
  1. nodules
  2. masses
  3. atelectasis
  4. COPD
206
Q
A

kerly b an kerly a

207
Q

define the mnemonic Are There Many Lung Lesions

A

Abdomen

Thorax

Mediastinum

Lungs individually

Lungs comparitively

208
Q
A

right middle lober pneumonia

209
Q
A

lordotic

210
Q
A

right middle lobar pneumonia

211
Q
A

reticular interstitial disease

212
Q

what is the most common mediastinal mass

A

lymphadenopathy

213
Q
A

A Left upper

B Right Upper

C Right middle lobe

D Lingula

E Right lower lobe

Left Lower Lobe

214
Q

what is the normal cardiothoracic ratio of an adult

A

<50%

215
Q

signs of COPD or emphysema

A
  1. hyperinflation
  2. flattened diaphragm
  3. heart appears smaller
216
Q
A

milliary intertstitial disease

217
Q

description of interstitial opacities based on pattern

A
  1. reticular (too many lines)
  2. nodular (too many dots)
  3. reticulonodular (too many lines and dots)
218
Q
A

COPD

219
Q
A

atelectasis

220
Q

can blebs always be seen on CXR?

what sequla is associated with blebs

A

not usually

spontaenous pneumo

221
Q

what is the main way to determine if pulmonary edema is cardiogenic in nature

A

enlarged heart

kerly B lines

222
Q

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:

A

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

223
Q
A

tension pneumo

224
Q

four microbial causes of cavitary pneumonia

A

straph, strep, klebsiella, coccidomycosis, tuberculosis

225
Q

pulmonary alveolar edema

how will this look on CXR

A

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

226
Q

during a systematic review of CXR, what are the features examined on general overiew (6)

A
  1. contrast
  2. projection
  3. orientation L.R
  4. correct patient
  5. correct films
  6. inspiration
227
Q

what is the difference between these two radiographs

A

the left is inspiratory, right is inspiratory

228
Q
A

left and right hilar points

229
Q

what are the three costophrenic angles

A

anterior, posterior, lateral

deep recesses formed by the diaphragm and the ribs on PA and lateral views

230
Q

58 yo male smoker with complaints of SOB

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
    • 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

231
Q

what will airspace disease look like

is it focal or diffuse

A

a confluent fluffy or hazy opacity resulting from fluid density in the alveoli

it is diffuse and can involve part or the whole lung

232
Q

what are two considerations when examining cardiothoracic ratio in pediatrics

A

infants dont take deep inspiration

lobulated thymus can overlap portions of the heart

233
Q

what 8 views are used to view the chest

A
  1. PA
  2. AP
  3. lateral
  4. inspiratory
  5. expiratory
  6. lordotic
  7. decubitus
  8. oblique
234
Q
A

cyst

235
Q
A

cyst with an air fluid level

236
Q

where are the pulmonary arteries found on radiograph

A

superior to the atria on both sides

the left pulmonary artery is inferior to the aortic arch

237
Q

signs of heart failure in chronological order

A

heart enlargement

kerly B line

Kerly A line

fluid in lung fissures

fluid in the interstitium (batwing)

238
Q

45yo non-smoker presents with rhinorrhea and sneezing

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: OK borders not well defined
  • Diaphragm: OK
  • Equal lung fields: round opaque lesion in the RML
  • Foreign bodies: none
  • Gastric bubble: NA
  • Hilum/mediastinum: mostly ok, maybe a little wide

DX: carcinoid tumor

239
Q
A

aortic arch

240
Q

when examining soft tissue (lung, breast, diaphragm) on CXR what four qualities should be noted

A
  1. thickness
  2. contour
  3. foreign body
  4. densities
241
Q
A

A Left brachial vein

B Superior vena cava

C Ascending aorta

D Aorta

E Pulmonary artery

F Left Pulmonary artery

242
Q

what view is this?

give three indicators

A

PA chest

  1. clavicles are low
  2. heart is well defined
  3. diaphragm is more flat
243
Q

what is a common cause of subsegmental atelecatasis

two conditions that would lead to this

A

patients who arent taking deep breaths

post-op patients or patients with pleuritic chest pain

244
Q

signs to look for to indicate pneumothorax

A
  1. symmetrical
  2. lung markings to periphery
  3. white visceral lines and bones
245
Q
A

retrosternal space

246
Q

kerly A lines

A

extend from the hila for up to 6cm and dont reach to lung periphery

247
Q

how will lymphadenopathy present on xray

A

medialstinal widening and hilar prominence

248
Q

what is air bronchogram sign

what is it indicative of

A

indication of airspace disease

an air filled bronchus surrounded by an airless lung

249
Q

what is this view? why is it done

A

decubitus

looking for an air fluid level

250
Q

what will atelectasis look on xray

A

white tissue due to lack of air volume

251
Q

interstitial

A

spaces within a lung or tissue/spaces between alveoli

252
Q

causes of lung cysts

A

abscesses, TB, carcinoma

253
Q
A

anterior/middle/posterior mediastinum

254
Q

why would the heart look larger on expiration than inspiration

A

the diaphragm moves up and compresses the heart

255
Q
A

kerly B

256
Q

T/F a small, acute atelectasis will create a larger overinflation of the the contralateral lung

A

false, a large or chronic atelectasis will produce a larger compensation

257
Q

pneumothorax

A

air in the pleural cavity

258
Q
A

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

259
Q

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:

A

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

260
Q

atelecatsis

three types

A

collapse or volume loss

obstructuve, compressive, subsegmental

261
Q
A

air bronchogram

Radiology (14 decks)

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