Radiology

Question 1

What does tracheal deviation to the left suggest?

Answer 1

right aortic arch or mediastinal masses

Question 2

Which bronchus is more horizontal and long?

Answer 2

left

Question 3

What can cause enlarged hila?

Answer 3

pulmonary hypertension or sarcoidosis

Question 4

Identify these structures:

Answer 4

a) trachea
(b) carina
(c) aortic arch
(d) descending aorta
(e) pulmonary hila

Question 5

In a normal healthy person where doe the lungs exten posteriorly and anteriorly?

Answer 5

posterior: 10 th rib
anterior: 6th rib

Question 6

If two structures of equal density are next to each other, what can you see?

Answer 6

When two structures of the same density are next to each other, the borders of that structure will not be visible. In other words, to visualize the borders of a structure, it has to be next to to a structure of a different density.

Question 7

Where is the pneumonia?

Answer 7

Right middle lobe: right heart border obscured

Question 8

Where is the pneumonia?

Answer 8

The lingula, left heart border obscured

Question 9

What is the deep sulcus sign?

Answer 9

In a supine patient, air usually collects in the anterior, inferior hemithorax

Question 10

Blunting of the costophrenic angle in the frontal or lateral view suggests what?

Answer 10

pleural effusion

Question 11

What is the hallmark of a pneumothorax on xray?

Answer 11

The hallmark of a pneumothorax is the ability to discretely visualize the visceral pleural line. In an upright patient, air in the pleural space collects at the apex of the hemithorax. In a supine patient, air usually collects in the anterior, inferior hemithorax (deep sulcus sign).

Question 12

Where does the pleura extend to posteriorly? anteriorly? laterally?

Answer 12

posterior: t12

lateral : 10th rib

anterior: 8th rib

Question 13

On the right, what is the major fissure?

Answer 13

the oblique

Question 14

On the right, what is the minor fissure?

Answer 14

horizontal

Question 15

Where can yousee the major fissures?

Answer 15

Because of the obliquity of the major fissures, these are not typically seen on the frontal radiograph. The minor fissure is visible on both the frontal and lateral chest radiograph. The fissures can be easily seen in patients with lobar pneumonia.

Question 16

How many lobar bronchi are there on the right?

Answer 16

3

Question 17

How many lobar bronchi are there on the left?

Answer 17

2

Question 18

What gives rise to the middle and lower lobar bronchi?

Answer 18

1. On the right side, the upper lobe bronchus branches first. The bronchus intermedius courses inferiorly for a short distance before giving rise to the middle and lower lobar bronchi.

Question 19

What is the smallest unit of the lung with a connective tissue lining?

Answer 19

secondary pulmonary lobule

Question 20

What structures are central to the secondary lobules?

Answer 20

bronchus, interlobular artery

Question 21

What structures are at the periphery of the secondary lobule?

Answer 21

pulmonary veins and lymphatics

Question 22

pulmonary edema (alveolar edema), bronchiolitis, and hypersensitivity pneumonitis are all commonly associated with what secondary lobule finding?

Answer 22

Diseases with centrilobular nodules are those which affect the structures in the central portion of the secondary pulmonary lobule (i.e. the bronchioles and intralobular artery).

Question 23

interstitial pulmonary edema and lymphangitic carcinomatosis both can cause what secondary lobule finding?

Answer 23

Diseases with interlobular septal thickening are those which affect structures in the periphery of the secondary pulmonary lobule (i.e. the pulmonary veins and lymphatics).

Kerley B lines are visible on the chest radiograph as short (~1cm) horizontal lines extending from the lung periphery, usually better seen in the lower lungs. The analog on CT is interlobular septal thickening. Kerley B lines are a good sign of interstitial pulmonary edema although other diseases can produce Kerley B lines.

Lymphangitic carcinomatosis is a disease in which tumor cells lodge within the lymphatic system and cause backup of lymphatic fluid. This is also manifested by interlobular septal thickening on the chest CT. Early in the disease process, interlobular septal thickening is smooth (mimicking pulmonary edema), but can become nodular later on.

Question 24

How many layers of pleura are in the junction lines?

a. 2
b. 4
c. 6
d. 8

Answer 24

B. 4 Each junction line is composed of 4 layers of pleura, two layers of visceral pleura and two layers of parietal pleura (one for each lung).

Question 25

. True or False: an ET tube that is pushed in too far is more likely to enter the left mainstem bronchus than the right mainstem bronchus

Answer 25

False: Because of the more vertical orientation of the right mainstem bronchus, aspirated material and malpositioned support devices are more likely to enter the right mainstem bronchus.

Question 26

Find the abnormality

Answer 26

The trachea in this image is deviated to the left. This is because of a right aortic arch. The hila, lung, and pleura are normal in this image.

Question 27

What is the source of Kerley B Lines seen below?

Answer 27

a. interlobular septa - Kerley B lines are due to interlobular septal thickening. Both the intralobular pulmonary artery and bronchiole are centrilobular structures. Intralobular septal thickening is a finding on chest CT in which the interstitial structures inside the secondary pulmonary lobule are thickened, not the outer connective layer.