Radiography and other images Flashcards
What is an echocardiogram used for?
Structural evaluation of: Left or right ventricles and their cavities Valves Pericardium Atria and Septa Great Vessels
With 2D Echos, what are the planes?
A) Parasternal Long axis- left atrium ventricle, and aortic arch
B) Parasternal Short Axis (cross-sectional)- Depending on level, can see left ventricle, right ventricle, left/right atrium, pulmonary/tricuspid/aortic valve, pulmonary artery
C) Apical 4 Chamber- coronal section 4 chambers
How can left ventricular ejection fraction be calculated using echocardiogram?
Measure the size of the ventricle at end-systolic and end-diastolic and compare.
What is transoesophageal echocardiogram?
Sedation and bite guard used, probe is passed down oesophagus until in line with heart Used to assess valve function (particularly in replacements) and assessment of infective endocarditis
What is cardiovascular magnetic resonance and when is it indicated?
MRI used to evaluate structure of heart Used quantification of left/right ventricular function, myocardial tissue characterisation, heart failure assessment (cardiomyopathy), ischaemic heart disease (MI/viability/perfusion), adult congenital heart disease, valvular heart disease
How is dying important when using MRIs and what is an example?
Can help enhance contrast of certain structures, allowing for better visualization.
Late Gadolinium Enhancement- Scar tissue will retain more dye, appearing white on the scan, and this allows for characterization of MI damage
What is Computed Tomography Coronary Arteries? What contrast is used in this exam?
CT of coronary arteries.
Use Liquid Iodine- it increases density of the vessels allowing for visualization of the inside and outside of the vessels. Will use beta blockers to slow the heart allowing for images to be taken.
What is a stress test?
Prove or exclude inducible ischaemia in myocardium by using exercise or drugs (dobutamine, atropine, adenosine)
What is an exercise tolerance test?
A form of stress test. In low risk high rate of false positives In high risk, it cannot rule of coronary artery disease
What is a stress echo?
Looks at motion on imaging alongside exercise or drugs. Looks at contractility during stress
What is a nuclear cardiology scan and how does this test work (include protocol)?
SPECT scanner
Rest scan- Gamma-emitting radioactive isotope (thallium, technetium) injected into patient, wait, then camera takes images (will pick up gamma-emission from radioisotope)
Induced stress- Adenosine usually given. Patient is given more radioisotope, more images are taken. The radioisotope (typically bound to ligand that will bind muscle) will move into the heart muscle. Areas of reduced flow wont take up as much of the isotope and will appear less bright.
What is a coronary angiogram?
Uses X-Ray imaging and a catheter with dye to visualize the heart vessels. Can be used in percutaneous coronary intervention to aid in revascularization of coronary vessels caused by stenosis.
What are some abnormalities that may impact the chest cavity?
Pectus Carinatum (protuberant sternum) Pectus Excavatum (indentation) Thoracoplasty Iatrogenic (crushed lungs as thought it would kill TB)
What implications can broken ribs cause and how is it treated?
Pneumothorax (air in pleural space), haemothorax, splinting.
Insert a chest tube into thoracic cavity-allows evacuation of air (or blood) from pleural cavity. May need surgery depeding on extent of damage.
What happens if a pneumothorax is left?
More air can leak out of lung into pleural space, increasing pressure in the thoracic cavity. Venous blood flow is too compressed to return blood to heart.
What happens if fluid accumulates in the thorax? Name it
Pleural effusion (aka hydrothorax) Shows up as cloudy image at costodiaphragmatic angle.
What is a mesothelioma?
Asbestos causing tumour growth along pleural space that increase pressures.
What can asbestos inhalation cause?
Mesothelioma can cause calcification of pleural cavity
What are the internal mammary arteries used for?
Used for bypass of Coronary arteries
What is a fluoroscopy?
Continuous imaging using x-ray can help visualize things like breathing.
How does the phrenic nerve route differ between left and right?
Left moves out more laterally around left ventricle.
What sort of causes can result in diaphragm paralysis? Separate into peripheral and central
Central: Spinal cord injury Cord compression, Central hypoventilation syndrome, Tumours
Peripheral: Iatrogenic (surgery, chiropractic, anaesthetic blocks) Trauma Neuropathy/ Neuritis Viral
When looking at a chest x-ray, how would you look for a pneumothorax?
Look for lung markings, if its entirely black, that is likely air trapped in the thorax
No radiology? Listen for hyper-resonance (like drum) in chest.
What is tension pneumothorax?
Life-threatening condition resulting from collapsed lung when air trapped in pleural cavity compromises cardiopulmonary functioning. Can be identified by looking for rib expansion and compression of lung/heart (via moving them to the opposite side)
How do you treat a tension pneumothorax?
Find 2nd intercostal space at midclavicular line, insert catheter about 3cm to allow air to escape.
What is a haemothorax and how do you find it on an x-ray?
Blood in pleural cavity Look for black, where air is, and there should be whitening near this which is the blood
What is a flail segment and what implications does it have?
Where 3 or more rib fractures are all broken in at least 2 places The flailed segment cant move properly cause of breaks, so segment of lung beneath this fracture doesn’t inflate properly Cant result in uncoordinated movement of chest wall, poor lung inflation and gas exchange
How is flail chest treated?
Intubation (to help with inflation- depends on severity) May need surgery if severe to fix ribs
How can those experiencing severe pain following a rib fracture be treated?
Nerve blocks that directly anaesthetise the impacted nerve roots. Find the nerves using ultrasound as guide and infiltrate with local anaesthetic
What is a lung contusion?
Bruising of lungs
Complications: If they don’t work to inflate and use lungs properly following contusion, lung can develop infection and pneumonia (late)
Where do the right and left recurrent laryngeal nerves travel?
Right: travels down, and wrap anterior->posteriorly around subclavian artery to insert onto right larynx Left: Travels down and wraps anterior->posteriorly around aortic arch, then moves up to insert onto left larynx
Are the lung fissures visual on an X-ray?
Yes
What nerves are found in the mediastinum?
Vagus, phrenic, right and left recurrent laryngeal nerves
What may cause recurrent laryngeal damage and how may this present?
Presentation: hoarseness (particularly prolonged) or stridor (noisy breathing) Causes: Lung cancer, TB/lymph nodes may have attacked nerve, trauma (prolonged CABG, oesophagectomy, thyroid surgery)
Where and when are lymph nodes present in a lung x-ray, and how do they appear?
Always appear abnormal as only present when something is wrong- they’re typically less than 1 cm in size and not visualizable on X-rays They are at the hilum of the lungs.
Identify the side, and lobes seen in this image.
Identify theside and lobes seen in this image.
Where is the infection in this image?
Horizontal fissure is visible and clear, and clouding is above it indicating infection of superior right lobe
Where is the infection in this image?
Cloudy-ness is seen below the horizontal fissure, diaphragm is still well defined, indicating infection of right middle lobe
Where is the infection in this image?
Cloudy-ness is seen in the lower portion of the right lobe,
horizontal fissure is not well defined,
diaphragm is not defined,
therefore infection is in inferior lobe
Where is the infection in this image?
Inferior Left Lobe is infected
Can see left border of heart clearly indicating superior lobe is not infected, diaphragm on left side is not easily visible as well
Where is the infection in this image?
Left Superior Lobe
Even though upper portion looks clear, cloudy-ness is causing lack of visualization of left cardiac border, indicating infection in the lower portion of the superior left lobe
Label this image.
- Aorta
- Left Atrium
Label the image
Label the vessels in this image.
What is occuring in this image?
Elevation of the right diaphragm, indicating paralysis of phrenic nerve- phrenic nerve palsy secondary to a tumour at hilum on right.
Due to hilar mass tumour
What is abnormal in this image?
Lymph nodes are noticable at hilum of lungs- indicated by arrows
Can indicate cancer spread, lymphoma
What is empyema?
When a pleural effusion becomes infected
What can be observed by examining this chest X-Ray?
Right superior apex is unclear, there is opacity present.
This is due to pancost tumour.
Label the image
