Radiology

Question 1

This pt presents w/ acute onset SOB, cough and pleuritic chest pain. A CXR is performed and his D dimers are high, what is the most likely diagnosis?

Answer 1

PE

CXR is normal, so not likley pneumothorax, pneumonia or pleurisy. Chest pain is pleuritic so not likley MI.

Question 2

This is a PA cxr, how would an AP cxr be different?

Answer 2

in AP cxr the lungs are further from the film so appear smaller, the heart is closer so appears bigger.

Question 3

When is an AP CXR performed?

Answer 3

When the pt is too unwell to stand up for the PA cxr

Question 4

How should xrays be evaluated for quality?

Answer 4

RIP:

Rotation- are the spinous processes of the spine between the clavical

Inspiration- if they took a good enough breath their 5th,6th or 7th anterior ribs will cross the diaphragm at the midclavicular line

Penetration- if enough electrons pass through, youll still be able to see the outline of the vertebra behind the heart

Question 5

Comment on the quality of is CXR

Also what are the blue and red arrows pointing at?

Answer 5

Rotation- good, very slightly to R
Inspiration- good, 7th rib crosses diaphragm @ MCL

Penetration- can just see spine through heart so ok

Blue arrow= gastric bubble (normal)

Red arrows= costophrenic angle

Question 6

How are CXRs systemically evaultated? (5)

Answer 6

1. Pt history
2. Quality (RIPS)
3. obvious abnormalities (opacities, densities, consolidation ect)
4. Evaulate ABCD areas
5. Review areas

Question 7

What are the ABCD areas to look at on a CXR?

Answer 7

Airways: trachea shifting? normal bronchi?

Breathing: check all areas from top left to bottom right, look @ pleural spaces, look at interfaces and for clear margins

Circulation: is aortic knuckle present? are heart contours clear? is heart correct size?

Diaphragm/ Dem bones: free gas under diaphragm? fractures or dislocations?

Question 8

What are the review areas which need checking for in CXRs?

Answer 8

• Apices (small pneumothorax)
• Paratracheal strip: may see masses/ enlarged lymph nodes
• Hila: may see collapsed lungs
• Silhouette sign - this is loss of contours round the heart and indictes pathology touching these boarders

Question 9

What may cause mediastinal shift towards the affected side?

Answer 9

Lobar lung collapse, fibrosis (reduce pressure on that side)

Question 10

What may cause mediastinal shift away from he affected side?

Answer 10

Tension pneumothorax, tumours

Question 11

What pathology is shown in this CXR? Describe how you came to this conclusion

Answer 11

Pneumothorax

• thin more dense (grey) line seperating two areas in the lung feild, where there should be no line (sometimes fissure lines can be seen). This line is the lung edge, it seperates air in lungs from air in pleura (pneumothorax)

Question 12

What is in the CXR shown? How did you come to this conclusion?

Answer 12

Right Tension pneumothorax

• Mediastinal/ trachea pushed to left
• Right lung collapsed
• right hemidiaphragm depressed
• Heart boarders pushed to left

Question 13

Tension pneumothorax shouldn’t go for CXR they should be treated immediatly. Why?

Answer 13

Because they compress the IVC, which means less blood returns to heart so can quickly lead to heart failure and asytole

Question 14

How will tension pneumothorax present?

Answer 14

• breathlessness
• cough
• collapse
• deviated trachea
• hyperresonant precussion
• cyanotic
• rapid heart and respiatory rate
• often low BP
• rapid onset

Question 15

Breifly describe the CXR shown and give a likely diagnosis

Answer 15

Large area of homogenous density covering the middle and lower zones of the left lung w/ loss of heart contours, costophrenic angle and hemidiaphragm. Also tracheal deviation to the right.

It is a pleural effusion

Question 16

What two processes can cause a collapsed lung?

Answer 16

1. lung collapses under pressure from pneumothorax or sometimes large pleural effusions
2. a bronchus becomes obstructed, air distal to the obstruction is absorbed by the parenchyma, leading to volume reduction// lung collapse

Question 17

What is shown in this CXR?

Answer 17

Right lung collapse

• large homogenous area of opacity
• mediastinal pull

Question 18

What is shown in this CXR?

Answer 18

Right lower lobe collapse

Question 19

What is shown in this CXR? What may have caused it?

Answer 19

Right upper lobe consolidation

• filling of small airways and alveoli with radioopaque contents (pus, blood, fluid, cells)

may be due to infection, cancer, odema (heart failure), fibrosis

Question 20

What abnormality is seen in this CXR what is the likely causes?

Answer 20

• cavitiating infection (abcess)- pneumonia, TB ect
• carcinoma
• septic emboli
• trauma

Question 21

Describe what is seen in the CXR and the likely cause

Answer 21

multiple, small, round space occupying legions across all areas of both lungs

probably due to lung metastasis

Question 22

What does this CXR show and what does it indicate?

Answer 22

Diffuse odema across middle of both lung feilds- batwing sign. Also high cardiac idex (>50% of full thickness)- cardiomegaly.

This pt therefor has heart failure.

Question 23

Describe the abnormalities shown in the CXR and what caused it?

Answer 23

loss of costophrenic angle (flat diaphragm), low cardiac index (thin heart)

COPD