Radiology 1 Flashcards
How to calculate the estimated height of a child?
- Add mother and father’s height in cm
- Add 13 cm for boys or subtract 13 cm for girls
- Divide by 2
Child (at the puberty) should fall into the centile that is above or below 8 cm from the above target/estimated height
*children with parents having very different heights (e.g. very short and very tall) tend to go either way
Ix in case of suspected congenital hypothyroid
If TSH elevated on skin prick test:
1. If elevated >10 → start treatment with thyroid hormone
2. If elevated but no too much → test for T3 and T4 and if low then start treatment
*also radiological Ix e.g. USS scan in order to detect any anatomical abnormalities of thyroid gland
What’s a depression of diaphragm sign of on CXR?
Tension pneumothorax
What’s that?
Pneumomediastinum
Thin parietal pleural layer stripped of mediastinum as gas gets into mediastinal compartment
Causes: ruptured oesophagus, asthma, barotrauma, hyperventilation (e.g. in metabolic acidosis)
What’s continuous diaphragm sign?
If gas between heart and diaphragm → sign of pneumomediastinum
What’s that?
Middle lobe consolidation → pneumonia
What’s that?
Right lower lobe consolidation e.g. in pneumonia
We know it’s R lower lobe, as lower lobe has the same radiographic density as hemidiaphragm
What’s that?
Lingular consolidation pneumonia
Obscuration of a heart border with a diaphragm intact
What’s the diagnosis?
Bilateral perihilar airspace shadowing
Pneumocystic jiroveci pneumonoa
What’s that?
Ground glass perihilar airspace shadowing = pneumocystis jiroveci pneumona
- tends to spare peripheries and bases
- no lymphadenopathy
- no pleural effusions
What’s that?
describe CXR
COVID-19 pneumonia
- bilateral consolidation (either symmetrical or asymmetrical)
*but diagnosis should be made by PCR
Diagnosis
Miliary TB
- lots of nodules (no larger than 3 mm)
*but diagnosis made together with clinical features
What are Kerley B lines?
Areas of the interlobular septum (so the gaps between individual lobules) which fill with fluid that oozes out of pulmonary veins
- sign of HF
(2) findings on this CXR
- Kerley B lines
- early alveolar and interstitial pulmonary oedema
How do Kerley B lines happen?
Oozing out from pulmonary veins into interlobular septa
What’s Bat’s wing sign?
It’s alveolar pulmonary oedema
*usually with small bilateral pleural effusions
(2) findings
- Bat’s wing → pulmonary oedema
- wrongly placed NG tube
What’s lamellar ‘pleural’ effusion?
Lamellar ‘pleural’ effusion
It’s actually not a pleural effusion, it’s a fluid oozing out of intralobular septa into the gap between visceral pleura and the lung
*sign of a HF
What’s that?
Left Lower Lobe collapse
- Sail sign behind cardiac shadowing
- Remaining lung looks less dense than on the R
*most likely cause in an adult pt is endobronchial cancer
What’s that?
Left upper lobe collapse
- increased density over the lung field
What’s that?
R MIDDLE lobe collapse
Middle lobe collapse is:
- denoted by a shallow, wedge-shaped opacity
- R heart border is lost
- often seen in asthmatics (mucous plague), possible in an endobronchial tumour
What’s that?
Requirements for that
Correctly placed NG tube
- it should go through oesophageal junction into the stomach
- it should bisect carina
*x-ray quality needs to be good, it needs to be well-centered and not rotated
Requirements for confirmation of correct NG tube placement (CXR)
- it should go through oesophageal junction into the stomach
- it should bisect carina
- it should take a left turn as it enters gastro-oesophageal junction
*x-ray quality needs to be good, it needs to be well-centred and not rotated
*if we are not sure → NEVER feed the patient, eek advice from radiologist, senior doctor
What’s that?
Misplaced NG tube
*there is also a pulmonary oedema
- it goes to R main bronchus and R lower lobe bronchus
- it needs to be pulled out immediately and replaced
Is that NGT placed correctly?
There is a deviation to the R at the level of the carina
(always be suspicious if NGT is not bisecting carina and heading to the left)
Another exposure: tube is in R lower lobe
What may happen if NGT is placed incorrectly and when it went too far?
Be prepared to expect PNEUMOTHORAX
Describe + possible causes
‘Whiteout‘→ opacification of L hemithorax
Look at the previous film it that was + know the history:
- Actue change: pneumonia, pleural effusion (including hemothorax), and collapse/atelectasis
- Longstanding possible pneumonectomy
Interpret
Subtle pneumoperitoneum on erect CXR
*surgical clips can be seen so the possible cause is laparotomy
Interpret
Flail segment → fracture of two or more ribs in two or more places
What’s that?
Large pleural effusion
