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radiology > radiology > Flashcards

radiology Flashcards

1
Q

retrosternal clear space

A

normally relatively lucent crescent behind sternum; when filled in with soft tissue density an anterior mediastinal mass is present

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2
Q

hilar region

A

made up of pulmonary arteries

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3
Q

fissures

A

both major (oblique) and minor (horizontal fissures); should be very thin, if visible at all

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4
Q

thoracic spine

A

rectangular vertebral bodies with parallel end plates; disk spaces maintain height from top to bottom of thoracic spine

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5
Q

diaphragm and posterior costophrenic sulci

A

right hemidiaphragm slightly higher than left; sharp posterior costophrenic sulci

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6
Q

spine sign

A

normally, the thoracic spinen gets blacker as you view it from neck to diaphragm because there is less dense tissue for the x-ray beam to traverse; not the case w/ consolidation

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7
Q

most frequency reason retrosternal clear space is obscured

A

adenopathy (eg: lymphoma); also, thymoma, teratoma, substernal thyroid enlargement

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8
Q

lateral vs posterior costophrenic sulcus

A

lateral = outer edge of lung on frontal CXR
posterior = posterior angle on lateral CXR
- pleural effusions accumulate in recesses of costophrenic sulci, causing blunting
- to blunt lateral = 75cc; posterior = 250cc

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9
Q

factors to determine technical adequacy

A

penetration, inspiration, rotation, magnification, angulation

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10
Q

penetration

A

the spine should be visible through the heart

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11
Q

inspiration

A

at least 8-9 posterior ribs should be visible

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12
Q

rotation

A

spinous process should fall equidistant between the medial ends of the clavicles

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13
Q

magnification

A

AP films (mostly portable CXRs) will magnify the heart slightly

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14
Q

angulation

A

clavicle normally has an S shape and superimposes on the 3rd or 4th rib

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15
Q

how to classify parenchymal lung disease

A

two categories: airspace (alveolar) disease and interstitial (infiltrative) disease

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16
Q

characteristics of airspace disease

A
  • opacities that are fluffy, cloudlike, and hazy
  • confluent, merging into one another
  • margins are fuzzy and indistinct
  • air bronchograms or silhouette sign may be present
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17
Q

what can fill the airspaces besides air?

A 
fluid (pulmonary edema)
blood (pulmonary hemorrhage) 
gastric juices (aspiration) 
inflammatory exudate (pneumonia)
water (near-drowning)
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18
Q

examples of airspace diseases

A

acute: pneumonia, pulmonary alveolar edema, hemorrhage, aspiration, near-drowning
chronic: bronchoalveolar cell carcinoma, alveolar ell proteinosis, lymphoma

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19
Q

what is lung interstitium?

A

connective tissue, lymphatics, blood vessels, and bronchi (surround and support the airspaces)

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20
Q

characteristics of interstitial lung disease

A
  • discrete reticular, nodular, or reticulonodular patterns
  • packets of disease are separated by normal, aerated lung
  • margins are sharp and discrete
  • disease may be focal or diffusely distributed in the lungs
  • usually no air bronchograms
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21
Q

examples of interstitial diseases

A

reticular: idiopathic pulmonary fibrosis, pulmonary interstitial edema, rheumatoid lung, scleroderma, sarcoidosis
nodular: bronchogenic carcinoma, metastases, silicosis, miliary tuberculosis, sarcoidosis

22
Q

pulmonary interstitial edema: causes

A
  • increased capillary pressure (CHF)
  • increased capillary permeability (allergic reactions)
  • decreased fluid absorption (lymphangitic blockade from metastatic disease)
23
Q

classic findings of pulmonary interstitial edema

A
  • fluid in the fissues (major and minor)
  • peribronchial cuffing (from fluid in walls of bronchioles)
  • pleural effusions
  • Kerley B lines
24
Q

Kerley B lines

A

fluid in interlobular septa

25
Q

categories of metastases to the lung

A
  • hematogenous metastases (cannonball metastases)
  • lympphangitic spread
  • direct extension
26
Q

causes of an opacified hemithorax

A
  • atelectasis of the entire lung
  • large pleural effusion
  • pneumonia of an entire lung
  • pneumonectomy
27
Q

causes of atelectasis of entire lung

A
  • complete obstructino of right or left main bronchus (neoplasm such as bronchogenic carcinoma, mucus plugs, or foreign body)
28
Q

what will happen w/ obstructive atelectasis?

A

visceral and parietal pleura do not separate from one another –> mobile structures (heart, trachea, and hemidiaphragm) are pulled ipsilaterally

29
Q

what will happen w/ massive pleural effusion?

A
  • fluid (blood, exudate, or transudate) acts like a mass, pushes mobile structures away
30
Q

what can cause a massive pleural effusion?

A
  • malignancy (bronchogenic carcinoma or metastases)
  • trauma –> hemothorax
  • tuberculosis
  • not typically CHF, as often bilateral, but asymmetrical, and rarely grow large enough to occupy entire hemithorax
31
Q

what will happen w/ a pna of an entire lung?

A
  • no shift of mobile structures

- air bronchograms may be present

32
Q

what will a pneumonectomy look like?

A
  • 5th or 6th rib almost always removed (metallic surgical clips)
  • there is eventually volume loss on the side from which lung has been removed
33
Q

what is atelectasis?

A

loss of volume in some or all of lung, leading to increased density of lung involved

34
Q

signs of atelectasis

A
  • displacement of the major or minor fissure toward atelectasis
  • increased density of the atelectatic portion of lung
  • shift of the mobile structures in the thorax (heart, trachea, hemidiaphragms)
  • compensatory overinflation of the unaffected segments, lobes or lung
35
Q

subsegmental atelectasis: cause

A
  • usually occurs in patients who are not taking a deep breath (splinting)
  • likely related to deactivation of surfactant, leading to collapse of airspaces
36
Q

subsegmental atelectasis: signs

A

linear densities of varying thickness usually parallel to diaphragm, most common at lung bases
- not sufficient volume loss to produce shift

37
Q

compressive atelectasis: cause

A
  • occurs passively when the lung is collapsed by poor inspiration (at bases) or from a large, adjacent pleural effusion or pneumothorax
38
Q

compressive atelectasis: signs

A

volume loss of compressive atelectasis can balance volume increase from effusion or pneumothorax resulting in no shift

39
Q

obstructive atelectasis: cause

A

obstruction of a bronchus from malignancy, mucus plugs (bedridden or postop pts, asthma, CF), foreign body aspiration, inflammation (scarring from TB)

40
Q

obstructive atelectasis: signs

A

visceral and parietal pleura maintain contact; mobile structures in the thorax are pulled toward the atelectasis

41
Q

diseases that produce bilateral effusions

A

CHF, lupus erythematosus

42
Q

diseases that produce effusions on either side (but usually unilateral)

A

tuberculosis, viruses, pulmonary thromboembolic disease, trauma

43
Q

diseases that usually produce left-sided effusions

A

pancreatitis, distal thoracic duct obstruction, dressler syndrome

44
Q

diseases that usually produce right sided effusions

A

abdominal disease related to liver or ovaries (Meigs syndrome), RA, proximal thoracic duct obstruction

45
Q

subpulmonic effusions

A
  • all pleural effusions first collect in subpulmonic location beneath lung between parietal pleura lining the superior surface of the diaphragm, and visceral pleural under lower lobe
  • most flow freely as patient changes position
46
Q

blunting of costophrenic angles

A
  • as subpulmonic effusion grows, it blunts the posterior costophrenic sulcus (w/ 75cc fluid); visible on lateral view
  • when it reaches 300cc, it blunts lateral costophrenic angle, visible on frontal view
    note: pleural thickening by fibrosis can also produce blunting of costophrenic angle
47
Q

meniscus sign

A

because of the natural elastic recoil of the lungs, pleural fluid appears to rise higher along the lateral margin of the thorax than it does medially in the frontal projection

48
Q

opacified hemithorax

A
  • usually > 2L of fluid
  • large effusions sufficiently opaque to mask whatever disease may be present in lung (need CT)
  • large effusions displace mobile structures away from side of opacification
49
Q

loculated effusions

A

adhesions in pleural space may limit normal mobility of a pleural effusion

50
Q

pseudotumor

A

type of effusion that occurs in the fissures of the lung (mostly the minor fissure) and is most frequently secondary to CHF

51
Q

laminar effusion

A

at lung base just above costophrenic angles on frontal projection and most often occur as a result of either CHF or lymphangitic spread of malignancy

radiology (3 decks)

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