Radiology Flashcards
Identifying poor inspiration on chest x-rays
6 ribs aren’t visible
Anterior lobes visible on x-ray
Right upper and middle lobes
Left upper and lingula
Lesion behind oblique fissure vs in front
Lesion behind oblique fissure = Lower lobe
Lesion above oblique fissure = Upper lobe
Above horizontal fissure vs below
Above horizontal fissure = Right upper lobe
Below horizontal fissure = Right lower lobe
60 year old smoker, 2 stone weight loss, haemoptysis, cough, “second heart line” seen on chest x-ray, no diaphragm seen
Right lower lung collapse
Lung collapse features on x-ray
Mediastinum and trachea tend to shift in direction of collapse, lungs seen as white normally with compensatory inspiration of other lung. Elevation of ipsilateral hemidiaphragm
Lung collapse vs atelectasis
Atelectasis is a more generic term for ‘incomplete expansion’ which can be due to alveoli becoming deflated. Lung collapse is a subtype under. Atelectasis is used during partial collapse.
Right middle lobe collapse is seen easier on what type of x-ray
Easy to identify on lateral chest x-ray as a triangular opacity in the anterior aspect of chest overlying chest shadow
Features of right lower lobe collapse
Medial aspect of dome of right hemidiaphragm is lost, right hilum is depressed, right heart border is seen
Why is right heart border still seen in right lower lobe collapse
As the right heart border is contacted by the right middle lobe
Features of lower left lung collapse
Edge of collapse lung may create a double cardiac contour, left hilum is depressed, loss of ipsilateral hemidiaphragm outline
What is air bronchogram
The phenomenon of air-filled bronchi (dark) being made visible by opacification of surrounding alveoli (grey/white). Happen when something other than air fills the bronchi. This makes the tubular outline of airway visible.
What is lung consolidation
This occurs when air that usually fills the small airway in your lungs is replaced with something else. This may be by fluid or solids.
What is bilateral hilar lymphadenopathy
Enlargement of the lymph nodes of pulmonary hila
Anterior heart border on x-ray
Right atrium
Right middle lobe pneumonia
Right heart border isn’t very visible however the right diaphragm is visible
Lingular pneumonia
Causes left heart border to become obscured
Left heart border in x-ray is
Left ventricle
Left lower lobe collapse
Displaced left oblique fissure demarcates dense collapsed lobe. Medial part of left hemidiaphragm is obscured
Left upper lobe collapse
Left oblique fissure is pulled anteriorly, well defined lobar edge is visible on lateral view. Left heart border gets obstructed with veil like opacity Trachea pulled to side of collapse
Right upper lobe collapse
Trachea pulled to side of collapse. Right horizontal fissure gets displaced. Opague right upper lobe on anterior view
Pleural effusion general features
Visible when filled with fluid (pleural effusion) or air (pneumothorax). Pleural fluid collects at the bases and gives a curved appearance of meniscus. May track into horizontal and oblique fissures obscuring features
Pneumothorax
Dark crescent without lung markings bounded medially by lung edges. Often at lung apexes
Diaphragm in tension pneumothorax
Often squashed down and mediastinal shift
Common cause of pneumothorax
Iatrogenic
Why is it easier for tubes and other foreign bodies to pass into the right main bronchus than left
As there’s a more obtuse angle and the right main bronchus is more straight compared to the left
Where should the endotracheal tube (ET) be placed
2cm proximal to carina
Inverted D sign on chest xray
Classic sign of loculated empyema
Ultrasound vs CT scan for empyema
Ultrasound for empyma shows loculations whereas CT scan show’s presence of pleural effusion but not loculations
Antibiotics for empyema?
Yes, broad spectrum IV such as Amoxicillin and Metronidazole initially. Oral antibiotics directed towards cultured bacteria for 14 days
A young African man presents with a cough and night sweats. His chest x-ray shows dense consolidation in the right upper lobe with cavity formation.
This is Tuberculosis
Hallmarks of asbestosis on CT scan
Large chunks of white - Calcium bilateral pleural plagues
Sign on x ray doesn’t double in size less than 40 days or more than 400 days
Might be infection as cancer takes 40-400 days to double
Advantage of PET-CT
Can detect nodal metastases, distant metastases, delineating tumour in an area of collapse. Metabolically active areas shown up as bright red
Spiculated appearance on CT scan
Mostly seen in primary carcinoma
Disadvantage of PET-CT
Can’t assess brain metastases as glucose doesn’t cross blood-brain barrier
Can we ultrasound guide in pleural effusion removal
No as we can’t see past fluid using ultrasound
Complications of CT biopsy
Pneumothorax, haemoptysis if a vessel is injured, air embolus in heart
Importance of previous images
Can be used to compare changes, especially minute ones around the hilar
Left elevated hemidiaphragm making a triangular shape
Left lower lobe collapse
Young patient with tumour like sign on chest x-ray
Teratoma a possibility
Narrow tube like lungs are often seen in
COPD patients
Bilateral dark shadows indicative of
Pulmonary oedema, singular shadow maybe pneumonia
What can V/Q scans be used for
Generally for PE but also COPD and cancer.
V/Q scan over CT scan?
V/Q scan allows early detection of gas-exchange changes prior to structural change detection in CT
Also has lower dose of radiation
