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Respiratory > Radiology > Flashcards

Radiology Flashcards

1
Q

Discuss the various X-ray views

A

AP/PA: Pt must be in full inspiration for best image
Lateral:Used to confirm location of structures seen on AP/PA
Supine: pleural fluid can be missed, heart appears larger
Decubitus: Assess for free vs localized fluid, used for pneumo pt that cant stand
Expiratory: For pneumohorax and air trapping
Lordotic: For view of lung apices

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2
Q

Discuss the various types of CT scans

A 
Single
Spiral
Spiral w/ multidetector:
HRCT: can miss small lesions
Pulmonary CT Angiography: Used for pulmonary emboli, Aortic dissection and AA
Low dose
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3
Q

Discuss PET scans

A

Provides physiologic information rather than anatomic

-Use F-18 FDG, mimics use of glucose, finds metabolically active tissue, evaluate malignant and inflamed tissue

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4
Q

Function of NM scan

A

-Used mainly to assess pulmonary embolus, was replaced by CTA but is coming back d/t less radiation; used when no antecubital site to use for contrast, or contrast allergy

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5
Q

V:Q scan

A
  • perfusion study: perfusion via the deposition of microaggregates of albumin labeled isotopes , blood flow to the lung
  • ventilation study: inhale xenon 133 or technetium 99 aerosol; assess ventilation in each portion of the lung
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6
Q

What is the gold standard for detecting pulmonary embolisms?

A

Pulmonary Angiography

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7
Q

How can you assess normal inspiration on an X-ray?

A

Adults should have 10 posterior ribs above the diaphrgam. If not, heart may be large or lungs will appear dense (false pathology)

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8
Q

What is the systematic approach to viewing?

A

-Large airways, hilum and mediastinum, bronchi and lungs, pleura and diaphragm , chest wall

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9
Q

How do the Xray rules change with infants?

A
  1. Normally supine
  2. Above 4th rib for hypoventilation, below 8th for hyperventilation
  3. -Decubitus: if inadequate inspiration, sufficient expansion is obtained in the non-dependent lung (ex: R decubitus shows better airation of L lung)
  4. Thymus gland is prominent
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10
Q

What is the normal anatomy on Xray of large airways?

A
  • Epiglottis: tip projects just superior to hyoid; should look like pinky NOT thumb
  • Aryepiglottic folds: delineate pyriform sinuses laterally
  • Thyroid: wraps around trachea
  • Cricoid cartilage: posterior to trachea
  • Anteiror cervical tissue width = <7mm @ C2, & < 21m @ C6
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11
Q

Discuss pathological anatomy of large airways on Xray

A
  • Subepiglottic tissue: critically swollen in croup
  • Tonsils: enlarge posterior to mandible in tonsillitis
  • Epiglottis: looks like thumb in epiglottitis
  • Thyroid: trachea may be bowed w/ thyromegaly
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12
Q

What are some indication of diseases on Xray?

A
  • Ludwig’s angina: cellulitis of mouth floor (edema, narrowed airway)
  • “Steeple Sign”: trachea comes to a point d/t narrowing on AP projection
  • Foreign body: use lateral view to confirm in esopagus
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13
Q

Discuss normal hilum anatomy

A
  • L hilum is more SUPERIOR than R hilum
  • L Pulmonary a. passes OVER LUL bronchus
  • R Pulmonary a passes horizontally ACROSS mediastinum
  • Azygos v. passes OVER RUL bronchus to join SVC
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14
Q

How does Acute and Chronic Bronchitis present on CXR?

A

Obstructive Disease
Acute: Normal or thickened bronchial walls
Chronic: Normal or thickened LARGE bronchi (tram lines or circles; prominent at bases

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15
Q

Discuss Bronchiecstasis

A

Obstructive Disease

  1. Chronic inflammation w/ cartilage damage
  2. Irreverisble dilation of bronchial tree
  3. Use HRCT for confirming dilated bronchi
  4. Tram lines or circle shadows
  5. Bronchi will have greater diameter than pulmonary artery
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16
Q

Discuss Bronchiolitis Obliterans

A

Occludes small airways proximal to alveoli; Occluded by constrictive fibrosis or proliferation of granulation tissue within bronchioles.

Can cause hyperlucent lung with chronic air trapping (Swyer-James)

17
Q

Discuss Emphysema on CXR

A
  1. Centrolobular (proximal acinus, upper lobes); Smoking
  2. Panlobular (enitre acinus, lower lobes); alpha 1 antitrypsin deficiency
  3. Paraseptal: idiopathic

CXR: hyperinflation (Increased retrosternal space), hyperlucency of parenchyma, narrowed cardiomediastinal sillhouette

18
Q

Discuss the appearance of Airspace disease

A

Silhouette sign: Loss of margin of normal structures d/t loss of air-fluid interface
Ground glass apperance: indicates active and treatable process via steroid

19
Q

What is the apperance of Shaken Infant Syndrome?

A

Rib fractures, ‘corner’ and ‘bucket handle’ fractures at metaphysis of extemities

False positives: Osteogensis Imperfecta, Metaphyseal dysplasia

20
Q

Discuss the various Xray views of the sinuses?

A

Waters: Angled AP to show maxillary sinus
AP: ethmoid sinuses
Lateral: sphenoid and mastoid air cells
Axial: confirm whats seen on other views

21
Q

Distinguish Acute from Chronic Mastoiditis

A

Acute: fluid but still fine bony septations
Chronic: minimal/no fluid and sclerotic thickened septations

22
Q

Discuss Bullae

A
  1. Air space > 1cm
  2. Has walls
  3. Associated with paraseptal emphysea
23
Q

Bronchial Obliterans Organizing Pnuemonia

A

Restrictive disease that is not dominated by airway obstruction
Bronchiolitis obliterans IS dominated by airway obstruction

24
Q

Pneumothorax on CXR

A

Use expiratory view and lateral decubitus

25
Q

Pleural effusion on CXR

A

-CXR: meniscus sign – collection of fluid @ posterior costophrenic angles w/ standing pt. (lateral view)

26
Q

Sinus Xray views

A
  • Waters – angled AP to better show maxillary sinus
  • AP (Caldwell) – better visualization of ethmoid sinuses w/ this view
  • Lateral – best view to sphenoid sinuses & mastoid air cells
  • Axial – least useful view, only used to confirm findings from other views
27
Q

Mastoiditis on Xray

A

Normal: No fluid, filled with air
Acute: Fluid but still fine bony septations
Chronic: No fluid and sclerotic thickened bony septations

Respiratory (33 decks)

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