radiology Flashcards
What is a saggital view
longitudinal view
What is a coronal view
latitudinal view
What is a transverse view
axil view
pros of CT
- excellent bone/anatomy detail
- good soft tissue/air contrast
- CT angiography ( cardiac, neuro, peripheral)
- 3D image
cons of CT
- radiation
- weight limit
- contrast reactions
- artifact with metal and bone
pros of MRI
- no radiation
- superior to CT for soft tissue
cons of MRI
- timely
- expensive
- contraindicated in pts with pacemakers, intraoccqular metals ect
- poor imaging of the lungs
- doesn’t accurately show calcium
pros of ultrasound
- realtime
- repeatable
- portable
- inexpensive
- doppler will show blood flow
cons of ultrasound
- operator dependent
- difficult in obese pts
- view often obscured by bone or air
10 steps of x-ray interpretation
- Pt ID
- prev. images
- technique (eg AP supine)
- adequacy (see all structures, inspiration)
- heart
- mediastinum
- lungs and boarders
- soft tissue
- bones
- lines/tubes
how do you gauge adequacy of a chest x-ray
- penetration: are lower vertebrae visible through heart
- rotation: spinous process centred between clavicular heads
- inspiration: posterior 10 or anterior 6 at right cadiophrenic sulcus
what is a normal and abnormal cardio thoracic ratio
normal: within diameter of inner rib margins
abnormal: PA > 0.5
AP >0.6
how do you assess the mediastinum
should be midline between the pleura of each lung and extend from the sternum to the vertebral column. Divided into superior and inferior mediastinum (anterior, middle,posterior)
What does the superior mediastinum include?
- aortic arch and great vessels
- upper SVC
- lymph nodes
- trachea
- esophagus
- thymus
What is the normal width of the mediastinum and what will cause an enlarged mediastinum
- width> 6cm on PA
- width>8cm on AP
causes of enlargement: widening of vessels, mass
Is the right lower lobe visible on AP view
yes, barely in the right costophrenic angle
What does silhouette sign mean
the pathological loss of boarders between adjacent structures
Cause of opacities on chest x-ray
- ARDS
- pneumonia
- neoplasm
- pulmonary edema
- hemothorax
What is an air bononchogram and what are it’s causes
water filled lung with air filled airway. air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white). It is almost always caused by a pathologic airspace/alveolar process, in which something other than air fills the alveoli. Air bronchograms will not be visible if the bronchi themselves are opacified (e.g. by fluid) and thus indicate patent proximal airways.
causes pulmonary consolidation pulmonary edema: especially with alveolar edema non-obstructive atelectasis severe interstitial lung disease neoplasms: bronchioloalveolar carcinoma; pulmonary lymphoma pulmonary infarct pulmonary hemorrhage normal expiration
radiographic stages of CHF
1- cephalization: abnormal thickening of upper vasculature relative to lower
2- interstitial pulmonary edema: increased interstitial markings, pulm vascular hypertension (upper zone hilar venous distension)
3- airspace pulmonary edema: diffuse patchy distribution (bat-wing), peripheral haze
signs of interstitial edema
1- peribronchvascular- connective tissue thickening(peri-bronchial cuffing)
2- septal connective tissue thickening (kersey-B line)
3- interlobular thickening
definition of ARDS
- resp symptoms within 1 wk of known clinical insult
- bilateral opacities not explained by other pulmonary disease
- resp failure not explained by cardiogenic pulmonary edema
- decreased P/F
Proper Et tube location
5cm above carina with neck neutral
proper central line placement
tip in SVC or CAJ
proper chest tube placement
between visceral and parietal pleura, anterosuperiorly to drain a PTX, posterorinerferiorly to drain a hemo
What is riglers sign
suggesting free intraperitonal air
approach to c-spine x-ray
- alignment
- bone
- cartilage
- soft tissue
assessing alignment of the cervical spine
smooth line along the outside of the anterior, posterior, spinolaminar and spinous process
assessing soft tissue on cervical spinal
normal pre-vertebral spaces:
at C3 <7mm
at c7 <21mm
approach to CT head
ABBCS asymmetry blood brain CSF space skull/scalp
what will an acute hemorrhage look like on a head CT
hyperdense
what does hypodensity indicate on a head CT
edema, infarct, air
what will a subdural hematoma look like on CT
concave inner margin, convex outer margin following normal curve of skull, won’t cross midline
what will a epidural hematoma look like on CT
biconvex hyper dense elliptical collection with sharp edges. doesn’t cross sulcus unless # present
what will a subarachnoid hemorrhage look like on CT
hyper dense blood in subarachnoid spaces (such)
what does peribronchial cuffing look like and what is it
dark spot in an opacity. It is a sign of a bronchus with edema in the wall…common in CHF
what is cephalization
where the superior pulmonary vasculature appears the same or larger in diameter as the inferior vasculature….normally the superior vasculature is less dilated than inferior. Sign of CHF
What is the left atrial appendage
a small, muscular out-pocketing of theleft atrium, one of the upper chambers of the heart. It fills with and empties blood when theleft atriumrelaxes and contracts.
Where clots can for in the setting of a-fib
what is deep sulcus sign
costophernic angles pulled downwards when pt is supine. Common in pneumothorax
signs of lung consolidation or pleural effusion of ultrasound
- spine sign
- hepatotization
- lack of anechoic line, indicating fluid (consolidation)
