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Radiology Block 2 Flashcards

1
Q

What are the 5 factors for determining a chest x-rays adequacy?

A 
Penetration
Angulation
Inspiration
Rotation
Magnification
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2
Q

How are frontal radiographs determined to have adequate penetration?

A

Visualization of thoracic spine through heart shadow

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3
Q

What is a pitfall of an under penetrated/inadequate x-ray?

A

Can not visualize thoracic spine through cardiac shadow

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4
Q

Underpenetrated x-ray= ?

Over penetrated x-ray= ?

A 
Under= too light, hides L lung base, accentuates lung markings
Over= too dark, may mimic emphysema/pnemothorax
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5
Q

What are two errors that can occur from underpenetrated x-rays?

A

L hemidiaphragm no visible on frontal image which mimics/hides diseases in L lower lung
Inc prominence of pulmonary markings leading to incorrect CHF/pulmonary fibrosis diagnosis

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6
Q

What is a pitfall of an over penetrated x-ray?

A

Too dark/absent

Incorrect diagnosis of emphysema/pneumothorax

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7
Q

How is the degree of inspiration assessed in chest x-rays?

A

Counting number of posterior ribs visible above the diaphragm on a frontal x-ray

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8
Q

What are the characteristic appearances of posterior/anterior ribs and an x-ray?

A

Post: inc appearance on frontal x-ray
More/less horizontal
Attach to thoracic vertebrae

Ant: more difficult to ID on frontal image
Angle downward
Attach to sternal cartilage

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9
Q

What are the pitfalls of a x-ray taken with poor inspiration?

A

Crowded lung markings Mistaken for pneumonia/basilar lung disease
Heart appears larger

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10
Q

PT rotation on a chest x-ray affects the appearance of what four structures?

A

Heart contour
Hila
Hemidiaphragm
Great vessels

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11
Q

Virtually all of the lung markings on the chest radiographs are composed of what?

A

Pulmonary blood vessels

Bronchi are too thing to be visible

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12
Q

How does normal pulmonary vasculature appear on radiographs?

A

Tapers gradually from center to peripheral with larger vessel area near base than apex in an upright x-ray

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13
Q

The retrosternal clear space can be filled in with what type of abnormalities?

A

Anterior mediastinal mass

Adenopathy- lymphoma is most common

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14
Q

Pulmonary arteries are normally seen in what region and on what view of an x-ray?

A

Hila on lateral view

Possible tumor or adenopathy

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15
Q

Minor fissure is normally visible on a ____ view

A

Frontal

Major and minor can be seen on a lateral view

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16
Q

Define Spine Sign

A

Increased density that highlights the thoracic spine instead of making it darker

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17
Q

How are the hemidiaphragms seen on lateral views?

A

Left will be silhouetted anteriorly by the heart

Right is higher and can be seen from front to back

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18
Q

What are two examples that would blunt the costophrenic angles?

A

Pleural effusions

Scarring

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19
Q

How are quick assessments of heart size made for adults?

A

Cardiothoracic ratio

Widest transverse diameter compared to widest internal diameter of rib cage

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20
Q

What is the first response to obstructions in the ventricles?

A

Hypertrophy

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21
Q

On plain films, how is cardiomegaly primarily produces?

A

Ventricular enlargement

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22
Q

The most marked chamber enlargement of the heart will be caused by what?

A

Volume overload, not pressure

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23
Q

What are the six levels of the chest for a normal CT anatomy scan of the heart?

A 
Five vessel view
Aortic arch
Aortapulmonary window
Main pulmonary window
Upper cardiac level
Lower cardiac level
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24
Q

What two additional adjuncts are used with cardiac CTs?

A

IV iodine contrast

ECG gated acquisition

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25
Q

Cardiac CT scanning is used to evaluate what structures?

A

Coronary arteries
Cardiac masses
Aorta abnormalities/dissection
Pericardial diseases

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26
Q

How is coronary artery dominance established?

A

The artery that supplies the posterior descending artery

Majority of population- R coronary dominant

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27
Q

PTs presenting with acute chest pain can have an emergent CT scan to search for what abnormalities?

A

Coronary artery disease
Aortic dissection
Pulmonary thromboembolic disease

AKA- Triple Rule out scan

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28
Q

MRIs of the heart can shows what types of damage?

A

MI scarring
Heart perfusion
Anatomic defects/masses
Function of valves/chambers

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29
Q

What are the specific views used on an MRI of the heart to gather data?

A

Horizontal long axis- 4 chamber view
Vertical long axis
Short axis
Three chamber view

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30
Q

Cardiac function is usually evaluated with ?

Cardiac morphology is evaluated with ?

A

MRIs
Function- white blood images
Morphology- black blood

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31
Q

Parenchymal lung disease can be divided into what two categories?

A

Airspace- aveolar

Interstitial- infiltrative

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32
Q

What are the characteristics of airspace diseases?

A

Fluffy
Indistinct margins
Possible air bronchograms/silhouette sign

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33
Q

Air bronchogram is usually a _______ disease

A

Airspace

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34
Q

Define Silhoutette sign

What causes this?

A

Two objects with same radiographic densities contact each other, normal edges disappear

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35
Q

A silhouette sign can be used throughout radiology for what two purposes?

A

Abnormality location

Abnormality density

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36
Q

Give 3 examples of airspace diseases

A

Pulmonary aveolar edema
Pneumonia
Aspiration

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37
Q

What are the seven types of interstitial lung diseases?

A 
Interstitial edema/pneumonia
Bronchogenic carcinoma
Metastases
Pulmonary fibrosis
Sarcoidosis
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38
Q

What is an examples of a disease that demonstrates both airspace and interstitial lung patterns?

A

TB

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39
Q

What are the four differential possibilities for an opacified hemithorax?

A

Altelactasis of entire lung
Large pleural effusion
Entire lung pneumonia
Postpneumonectomy

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40
Q

What are the 3 mobile strctures that can be pulled or pushed in the chest?

A

Trachea
Heart
Hemidiaphragm

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41
Q

What is the direction of shift during atelectasis, pleural effusions, and pneumonia?

A

Atel- toward (vol loss)
Eff- away (acts like mass)
Pneumo- none (bronchogasms may be present)

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42
Q

Shift of malignant effusion may be masked by what other counter-disorder?

A

Balanced from underlying/obstructive bronchogenic carcinoma

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43
Q

What are the four common types of atelectasis?

A

Subsegmental (disc/plate-like)- splinting PT due to deactivation of surfactant
Compressive/passive- collapsed from effusion/pneumo
Obstructive
Round- atelectasis recedes, lung remains uninflated

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44
Q

When is subsegmental atelectasis usually seen?

A

PTs not taking deep breath (splinting)

Produces linear density at lung base

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45
Q

What are the signs of the obstructive atelectasis?

A

Displaced fissures
Inc density of affected lung
Shift of structures to atelectasis
Compensatory over inflation of unaffected lung

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46
Q

Pleural effusions collect in what area and are usually what type?

A

Potential space

Transudate / exudate- depending on LDH and protein content

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47
Q

How much fluid is required to blunt the posterior costophrenic angles?
How much is needed to blunt the lateral angles?
How much opacifies the hemithorax?

A

75mL
200-300mL
2L

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48
Q

Most pleural effusion begin by collecting in what area?

A

Hemidiaphragm/base of lung

Called subpulmonic effusion

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49
Q

Define Loculated

A

Adhesion where fluid assumes abnormal appearance in abnormal location

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50
Q

Define Pseudotumor

A

Type of effusion, transudate, occurs in minor fissure

Frequently secondary to CHF

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51
Q

How are Laminar Effusions best recognized?

What causes them?

A

At lung base above costophrenic angles on frontal xray.
CHF or lymphangitic spread of malignancy
Density on lateral chest wall near angle, wont move with PT shifts

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52
Q

How are Hydrophneumothorax ID’d on xray?

A

Upright view xray with straight air fluid interface instead of meniscus shape of pleural fluid

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53
Q

How does pneumonia present on a chest xray?

A

More opaque
Fluffy and indistinct margins
Homogenous density
Possible air bronchograms and atelectasis

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54
Q

How does segmental pneumonia appear on x-rays?

A

Multi-focal
No bronchograms
Volume loss may be present

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55
Q

Interstitial pneumonia involves what structures and has what type of appearance?

A

Involves airway walls and alveolar septae
Reticular pattern
May produce airway Dz

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56
Q

Round pneumonia effects what PT population and occupies what area?

A

Effects children

Lower, posterior lobes

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57
Q

Cavitary pneumonia is usually caused by ? and occupies what area

A

TB- causes Lucent cavities/necrosis

Postprimary TB- affects upper lobes

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58
Q

Aspiration usually occurs in what areas of the lung?

A

Upright PT- lower lobe

Recumbent PT- superior lower lobes, posterior of upper lobes

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59
Q

How can pneumonia be localized on an x-ray?

A

Silhouette sign

Spine side

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60
Q

Define Vacuolization

A

Pneumonia resolve by breaking up so patchy areas of aerated lung appears in previous pneumonia locations

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61
Q

What types of masses can be seen in the anterior mediastinum

A

Thyroid
Lymphoma
Thymoma
Tertoma

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62
Q

What types of masses can be seen in the middle mediastinum

A

Lymphadenopathy from lymphoma or metastatic disease

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63
Q

What types of masses can be seen in the posterior mediastinum

A

Neurogenic tumors originating from nerve sheaths

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64
Q

Incidental solitary pulmonary nodule less than what size are rarely malignant?
What does this change?

A

4mm

50% over 50 y/o are malignant

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65
Q

What are four pieces of info that can be used for criteria to evaluate a mass’s benignity?

A

Size
Calcification
Margin
Change

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66
Q

Bronchiogenic carcinomas can present in what three ways?

A

Visualize tumor
Effects of obstruction (pneumonia/atelectasis)
ID of direct/metastatic spread to distal organs

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67
Q

Small cell carinoma is what type of cell that is usually associated with what two types of paraneoplastic syndromes?

A

Neurosecretory

Cushing’s
Inappropriate ADH secretion

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68
Q

Multiple nodules in the lung are usually caused by ?

A

Metastatic lesion from hematogenous spread, cannonball appearance

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69
Q

Lymphangitic carcinomas produce patterns that radiologically similar to ?

A

Pulmonary interstitial edema from CHF

EXCEPT, only involves a single segment/lung

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70
Q

Why do conventional radiograph’s have a high false-negative rate in pulmonary thromboembolitic diseases?

A

Inability to demonstrate Hampton’s Hump, Westermark sign, Knuckle sign

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71
Q

What is used to diagnose pulmonary embolsim

A

CT pulmonary angiography

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72
Q

COPD consists of what two disorders?

A

Emphysema- pathologically defined, seen on CT and x-ray

Chronic bronchitis- clinical diagnosis

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73
Q

Bullae and cysts are filled with ?

A

Air filled lesions in lungs

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74
Q

What is the study of choice for evaluating bronchiectasis?

What are the classical findings?

A

CT study of choice

Demonstrates Signet Ring Sign, Tram-Tracks, cystic lesion and tubular densities

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75
Q

PA radiographs have what 4 blind spots

A

Retro sternal
Retro cardiac
Hilar region
Posterior hemi diaphragm

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76
Q

What are the criterias for cardiomegaly on AP/Lat films?

A

PA- 50% of width

Lat- cardiac shadow overlaps spine

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77
Q

What are 3 causes of apparent heart enlargement?

A

Pericardial effusions
Extra cardiac factors
Cardiomegaly

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78
Q

What are the causes of apparent heart enlargement from pericardial effusions?

A 
CHF
Infections
Metastatic malignancy
Uremic pericarditis
Lupus
Trauma
Postpericardiotomy Syndrome
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79
Q

What are the causes of apparent heart enlargement from extra-cardiac factors?

A 
AP projection
Suboptimal inspiration
Chest wall abnormalities
Rotation
Fluid collction
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80
Q

What are causes of apparent heart enlargements from CHF factors?

A

Pulmonary interstitial edema

Pulmonary alveolar edema

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81
Q

Appearance of pulmonary interstitial edema

A

Thickened interlobar septa
Peribronchial cuffing
Fluid in fissure
Pleural effusions

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82
Q

Appearance of alveolar edema

A 
Fluffy/indistinct densities
Batwing/butterfly
Pleural effusions
No bronchograms
Cardiac origin= effusions causing thickened major and minor fissures
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83
Q

5 areas to inspect on lateral images for any general image?

A 
The Fastest Hot Rods Drive Straight
Thoracic
Fissures
Hilum
Retrosternal 
Diaphragms
Sulci
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84
Q

Minor fissure is aka

Major fissure is aka

A

Transverse- visible on frontal

Oblique- not on frontal image

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85
Q

Hypertensive cardiovascular disease will causes what structural change that can be seen on x-rays?

A

Straightened aorta

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86
Q

What are the 3 types of Cardiomyopathy

A

Dilated- most common
Hypertrophic
Restrictive

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87
Q

Dilated cardiomyopathy effects what structures of theheart?

A

Biventricular

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88
Q

Define Parenchymal

A

Effecting the functional tissue of an organ

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89
Q

Mediastinal mass that affects younger PTs

A

Teratomas

Thymomas- middle aged adults, benign

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90
Q

What are the characteristics of Panicenar pattern of COPD?

A

Destruction in distal lobes

PTs w/ A1-Anti-trypsin dysfunction

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91
Q

What structures are hidden in the right lung by what disease location/issue

A

Ascending aorta- R upper lobe
R heart border- R middle lobe
R hemidiaphragm- R lower lobe

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92
Q

What structures are hidden in the left lung by what disease location/issue

A

Descending aorta- L upper/lower lobe
L heart border- Lingula of L lobe
Left hemidiaphragm- L lower lobe

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93
Q

What are the signs of an atelectasis?

A 
Displaced fissure
Inc density of affected lung
Shift of mobile structures
Over inflation
Points towards hilum
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94
Q

What are the 4 types of atelectasis

A

Subsegmental
Compressive
Round
Obstructive

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95
Q

What are the indications to seek further imaging modalities for atelectasis?

A 
Entire lung
Lobular more than 2 days
Segmental more than 2 wks
Round
Mass/tumor findings
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96
Q

What are the causes of pleural effusions?

A

Inc rate of formation:
Inc hydrostatic press
Inc capillary permeability
Dec colloid osmotic press

Dec rate of reabsorption:
Lymph blockage
Dec pressure in pleural space

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97
Q

What are the causes of transudate pleural effusions?

A 
Inc hydrostatic press/dec osmostic press
CHF
Hypoalbuminemia
Cirrhosis
Nephrotic Syndrome
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98
Q

What are the causes of exudative pleural effusions?

A

Malignancy
Empyema
Hemothorax
Chylothorax

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99
Q

What are the visual appearances of pleural effusions?

A 
Subpulmonic effusion
Blunting of angles
Meniscus sign
Opacified hemithorax
Loculated effusions
Laminar effusions
Hydropneumothroax
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100
Q

How do loculated effusions appear on x-rays?

A

Adhesions between pleura trapping fluid in unusual patterns

curves inward into lung space

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101
Q

Fissural pseudotumors are usually associated with ?

A

CHF

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102
Q

What is the most common sign/cause of fissural pseudotumors?

A

Fluid trapped between layers of minor fissure

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103
Q

What are the visual appearances of pneumonia on an x-ray?

A 
More opaque than normal lung
Fluffy/indistinct margins
Interstitial pneumonia= interstitial tissue prominences
Homogenous density
Lobular pneumonia= air bronchograms
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104
Q

What are the patterns of pneumonia?

A 
Lobular
Segmental
Interstitial
Round
Cavitary
Consolidation
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105
Q

What is the pattern of Lobar pneumonia

A

Homogenous consolidation of affected lobe w/ air bronchogram and silhouette sign

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106
Q

What is the pattern of Segmental pneumonia

A

Patch airspace of several segments

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107
Q

What is the pattern of Interstitial pneumonia

A

Diffusely spread early in process

Frequently progresses to airspace Dz

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108
Q

What is the pattern of Round pneumonia

A

Spherical shapes in lower lobes of kids

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109
Q

What is the pattern of Cavitary pneumonia

A

Post-Primary TB

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110
Q

How does aspiration pneumonia differ?

A

Upright- lower lobes

Recumbent- superior lower lobes/posterior upper lobes

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111
Q

What are the differences between Primary and Secondary pneumothorax?

A

Primary- occurs in normal lung

Secondary- diseased lung

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112
Q

What is the difference between Simple and Tesnion pneumothorax?

A

Simple- no shift of structures

Tension- shifted structures

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113
Q

What is the difference between spontaneous and traumatic and diseased pneumothorax?

A

Spontaneous- rupture of apical, subpleural bleb or bulla (tall, thin males)
Trauma- most common cause (accidental/latrogenic)

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114
Q

What is the most important determinant in deciding whether PTs need a chest tubes or not?

A

Assessing clinical status
Greater than 2cm- chest tube
Less than- no tube

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115
Q

What issue presents with a comb-like, striated appearance?

A

Subcutaneous Emphysema- air along muscle bundles

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116
Q

Difference between Nodule and Mass?

A

Nodule- less than 3cm

Mass- greater than 3cm

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117
Q

What are the benign causes of solitary nodules/masses?

A

Granuloma

Hamartomas

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118
Q

Categories of nodules less than 4mm

A

Low- no f/u

High- 12mon f/u

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119
Q

Categories of nodules 4-6mm

A

Low- 12mon f/u

High- CT at 6-12mon and 18-24mon

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120
Q

Categories of nodules 6-8mm

A

Low- CT at 6-12 and 18-24mon

High- CT at 3-6mon and 9-12mon

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121
Q

Categories of nodules greater than 8mm?

A

CT at 3 9 and 24mon

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122
Q

What does calcification of a nodule/mass mean?

A

Benign= central, laminar, diffuse calcification

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123
Q

What do changes in a nodule/mass over a week, mid-range or year mean?

A

Week- inflammatory
Mid- malignant
Year+= benign

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124
Q

What are the characteristics of Squamous Cell Carcinoma?

A

Upper/central location
Segmental/lobar
Cause obstructive pneumonitis/atelectasis
Rapid growth

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125
Q

What are the characteristics of Adenocarcinoma?

A

Small, peripheral growth
Solitary
Slowest grower

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126
Q

What are the characteristics of Small Cell, Oat Cell Carcinomas?

A

Central location, bilateral

Inappropriate secretion of ADH

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127
Q

What are the characteristics of Large Cell Carcinoma

A

Diagnosis of exclusion for lesions that are nonsmall cell and not squamout or adenocarcinoma
Larger peripheral lesion
Extremely rapid grower

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128
Q

Most PTs presenting with air way nodule/mass will have ?

Those presenting with bronchial obstructions usually have?

A

Adenocarcinoma

Squamous cell carcinoma

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129
Q

PTs presenting with direct extension or metastatic lesions will have what identifiers?

A 
Rib destruction
Hilar adenopathy
Mediastinal adenopathy
Pleural effusion
Metastases to bone
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130
Q

Define a Pancoast Tumor

A

Rib destruction from apical lung tumor

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131
Q

Metastatic neoplasms have what characteristics depending on if it was hematogenous or lymph spread

A

Hema- vary in size, sharp margins

Lymph- Kerley B lines, thickened fissures, most common in breast, lung, pancreas

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132
Q

Thromboembolic diseases usually occur in what PT populations?

A

+60y/o
From DVT
Immobilized/post-surgery

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133
Q

Thromboembolic diseases are historically assessed with what modality of imaging?

A

CT

VQ scan

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134
Q

75% of PTs with pulmonary embolism present with what 4 S/Sx?

A

Elevated hemi-diaphragm
Unilateral pleural effusion
Enlarged pulmonary artery
Infiltrate

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135
Q

What are the 2 uncommon findings in PTs with PEs?

A

Westermark’s Sign- region of oligemia

Hamptons Hump

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136
Q

Define Westermark’s Sign

A

Focused decrease blood flow leading to collapse of vessel distal to PE

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137
Q

Define Hapton’s Hump

A

Shallow wedge shaped opacity in peripheral lung tissue with base against pleural surface that represents hemorrhage and necrotic lung tissue

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138
Q

What are the 3 pathological patterns of emphysema

A

Centriacinar
Panacinar
Paraseptal

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139
Q

Define COPD

A

Disease of airflow obstruction caused by chronic bronchitis or emphysema

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140
Q

Define Chronic Bronchitis

A

Productive cough

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141
Q

Define Emphysema

A

Permanent and abnormal destruction of air spaces distal to terminal bronchioles

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142
Q

What are the classic x-ray findings of COPD

A 
Hyperinflation
Flattened Diaphragm
Increased retrosternal clear space
Hyperfluency of lungs
Prominences of pulmonary arteries
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143
Q

Define Centriacinar emphysema

A

Most common, strong association with smoking

Focal destruction to bronchioles and central acinus

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144
Q

Define Panlobular emphysema

A

Entire alveolus distal to terminal bronchiole

Most severe in lower lung zones and develops in PTs with A-1antitrypsin deficiency

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145
Q

Define Paraseptal Emphysema

A

Distal airway structures, alveolar ducts, and sacs

Develops around septae or subpleural surfaces

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146
Q

Centriacinar emphysema usually occurs where in the lung?

A

Upper lobes

Smokers w/ chronic bronchitis

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147
Q

Paraseptal emphysema tends to occur more often in what PT population

A

Young adult w/ history of spontaneous pneumos from formation of bullae
NOT associated with airflow obstruction

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148
Q

Obstructive atelectasis produces what changes to a chest x-ray?

A

Blocked side will be more radiopaque and pulled to that side

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149
Q

Difference between Bullae and Blebs

A

Bullae- central air containing lesions

Bleb- peripheral

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150
Q

Bullae more than 1cm are associated with ?

A

Emphysema

Occur in lung parenchyma

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151
Q

Blebs are small bullae that usually form where?

What are the thought to be associated with?

A

Visceral pleura at lung apex
Seen on CT, not x-ray
Associated with spot pneumos

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152
Q

What are the 3 most common causes of cavities?

A

Carcinoma
Pyogenic abscess
TB

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153
Q

Define Bronchiectasis

A

Localized irreversible dilation of bronchial tree with thickened walls best eval’d by CT

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154
Q

What x-ray sign may be identified with bronchiectasis

A

Tram-tracks

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155
Q

What is the hallmark lesion on CT for bronchiectasis

A

Signet Ring Sign

Bronchus is larger than pulmonary artery

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156
Q

Progressive, bilateral upper love bronchiectasis in children is highly suggestive of what issue?

A

CF

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157
Q

Hollow lung space that is less than 1mm? 1-3mm? Greater than 3mm?

A

Less than 1= bullae/bleb
1-3= cyst
3+= cavity

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158
Q

What are the extracardiac causes that make the heart appear larger than actual size?

A

AP portable
Preventative deep inhalation
Bony thorax abnormalities
Pericardial effusion

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159
Q

What are the 4 key findings in pulmonary interstitial edema?

A

Thickened interlobar septa
Peribronchial cuffing
Fluid in fissures
Pleural effusions

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160
Q

What are the four findings of pulmonary alveolar edema?

A

Fluffy/indistinct patches
Bat wing
Pleural effusions
Bilateral, peripheral

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161
Q

What is more likely to be found with Cardiogenic Pulmonary Edema?

A

Pleural effusion
Kerly B lines
Cardiomegaly
Inc wedge pressures

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162
Q

What are the Noncardiogenic causes of pulmonary edema?

A 
Uremia
Intravascular coagulopathy
Smoke inhalation
Near drowning
Volume overload
Lymph spread of malignancy
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163
Q

ARDS is classified as what type of pulmonary edema?

A

Noncardiogenic

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164
Q

Pulmonary arterial HTN produces what key sign?

A

Pruning of pulmonary vasculature

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165
Q

Aortic stenosis in elderly PTs are most often secondary to what issue?

A

Tricuspid aortic valve degeneration

166
Q

What are the 3 types of cardiomyopathys?

A

Dilated
Hypertrophic
Restricted

167
Q

What are the 3 types of aortic aneurysms?

A

Saccular
Fusiform
Dissection

168
Q

Most thoracic aortic dissections are what type?

A

Stanford type A- surgical treatment

169
Q

What is the leading cause of death worldwide?

A

Coronary artery disease

170
Q

Evaluation of the abdomen should focus on what 4 main areas?

A

Gas pattern
Extralumenal
Abnormal calcification
Soft tissue masses

171
Q

Air is normally present in what are of the colon?

A

Retrosigmoid- highest point of large bowel when PT is prone

172
Q

What does an acute abdominal series consist of?

Which view does not have an optional substitute?

A 
Supine abdomen- no substitute
Prone abdomen (substituted with lateral rectum view)
Upright abdomen (substituted with lateral decubitus)
Upright chest (substituted with supine chest)
173
Q

The supine view of the abdomen is generally a ____ view and is used to look for ? 2 things

A

Scout- looking at gas patterns

Calcifications/masses

174
Q

The prone view is used to identify/rule out ?

A

Air in retrosigmoid- identification of mechanical obstruction of the bowel

175
Q

Upright abdomen film is used to visualize ?

A

Air-fluid levels in bowel

Free intraperitoneal air

176
Q

Upright chest film is used to visualize ?

A

Air beneath diaphragm
Pleural effusion
Pneumonia

177
Q

What information is essential to help determine which imaging study will provide the best info in diagnosing the PT

178
Q

Abnormal gas patterns can be divided into what two groups?

A

Functional ileus- localized, generalized

Mechanical obstruction- small bowel, large bowel

179
Q

How does the guy respond to amechanical obstruction?

A

Distal area dilates as peristalsis increases

180
Q

What are the key findings of localized ileus?

A

2-3 dilated loops of sentinel loops w/ air in retrosigmoid

Underlying irritative process adjacent to dilated loops

181
Q

What are causes of sentinel loops?

A

Pancreatitis
Cholecystitis
Diverticuliits
Appendicitis

182
Q

What are the key findings in a generalized adynamic ileus?

A

Dilated loops of large/small bowel with gas in retrosigmoid

Long air-fluid levels

183
Q

Generalized adynamic ileus is frequently seen in what typ of PTs?

184
Q

What are the key image findings in mechanical small bowel obstructions?

A

Disproportionate dilations

Fluid filled loops of small bowel with no gas in retrosigmoid

185
Q

Mechanical small bowel obstructions are best imaged with ?

186
Q

What is the most common cause of a small bowel obstruction?

A

Adhesion

Post-surgical adhesion- most common

187
Q

Define Closed Loop Obstruction

A

Two points of bowel are obstructed in the same location

188
Q

Define Volvulus

A

Closed loop obstruction of the large bowel

189
Q

What are the key imaging findings of a mechanical large bowel obstruction?

A

Dilation of colon up to the obstruction

No gas in rectum and no dilation of small bowel

190
Q

What are the causes of a lower bowel obstruction?

A

Malignancy
Hernia
Diverticulitis
Intussusception

191
Q

Define Ogilvie Syndrome

A

Loss of peristalsis causing massive dilation of entire colon that resembles a large bowel obstruction

192
Q

What are the four most common sites of extraluminal air?

A

Intraperitoneal
Retroperitoneal
Air in bowel wall
Biliary system

193
Q

What are the three key signs of free air in the abdomen?

A

Air beneath diaphragm
Rigler Sign- visualization on both sides of bowel wall
Visualization of falciform ligament

194
Q

What are the most common causes of free air in the abdomen?

A

Perforated peptic ulcer
Trauma
Perforated diverticulitis
Perforated carcinoma

195
Q

What are the key signs of extraperitoneal air?

A

Streaky linear appearance outlining extraperitoneal structures (kidneys, psoas muscles, aorta, Inf Vena Cava_)

196
Q

What are the key signs of air in the bowel wall?

A

Linear radioluscencies parallel to air in adjacent bowel lumen

197
Q

What are causes of air in the bowel wall

A

Pneumatosis cystoides intestinalis
Necrotic bowel
Ischemic bowel
Obstructing lesions

198
Q

What are the causes of pneumobilia

A

Incompetence of Sphincter of Oddi
Spincterotomy
Gallstone ileus

199
Q

What is the triad of findings in gallstone ileus?

A

Air in biliary system
Small bowel obstruction
ALJ:ALKJLK:

200
Q

Define Barret Esophagus

A

Reflux causes stimulation of metaplasia of squamous to columnar cells

201
Q

Esophageal carcinomas can appear in what forms?

A

Annular constrictions
Polypoid mass
Superficial infiltration

202
Q

What are the radiological signs of a gastric ulcer?

A

Barium that extends along lesser curvature/posterior wall of region

203
Q

What are the key findings in a gastric carcinoma

A

Mass that protrudes into lumen causing defect

Causes rigidity/nondistensibility

204
Q

What are the radiological signs of duodenal ulcers?

A

Collection of contrast seen more on en face view

Healing causes scarring and deformity of duodenal bulb

205
Q

Any image evaluation of the bowel should be done after what actions are taken on the bowel?

A

Filled with air

Filled with contrast

206
Q

What are key abnormal findings of bowel disease on CT?

A

Thickening of bowel wall
Submucosal edema/hemorrhage
Hazy infiltration
Extraluminal air

207
Q

What part of the intestine does Crohn’s Disease effect the most?

A

Terminal ileum

208
Q

What region of the bowel is affected by colonic diverticulitis the most?

A

Sigmoid colon

Almost always asymptomatic

209
Q

What is the imaging modality of choice for diverticulitis?

210
Q

What are the imaging signs of colonic polyps?

A

Filling defect of colon w/ or w/out stalks

211
Q

What are the imaging findings of Colonic Carcinoma?

A

Persistent annular filling defect
Microperforation
Metastases- liver and lungs

212
Q

Define Colitis

A

Thickened bowel wall
Narrowed lumen
Infiltration into surrounding fat

213
Q

What are the imaging modalities of choice for diagnosing appendicitis?

214
Q

Lower GI bleeding is usually caused by ?

A

Diverticulitis

215
Q

What are the two most common causes of pancreatitis?

A

Gallstone

Alcoholism

216
Q

Where does pancreatic adenocarcinoma grow most often?

A

Head of pancreas as hypodense mass

217
Q

Evaluation of liver masses if often done with what imaging modality?

A

Triple phase CT

218
Q

What are the most common hepatic masses?

What is the most common primary malignancy?

A

Malignancy

Hepatocellular carcinoma

219
Q

How do cavernous hemangiomas appear on imaging?

A

More common in females
Asymptomatic
“outside-in” pattern

220
Q

What is a non-invasive way of imaging the biliary tree?

A

MRCP

Demonstrates biliary structures, gallstones and congenital abnormalities

221
Q

How do renal cysts appear on imaging?

A

Multiple bilateral
Do not enhance
Sharp margins
On US- simple cysts are well define anechoic masses

222
Q

What is the most common primary renal malignancy

A

Renal cell carcinoma

US= echogenic masses

223
Q

What is the imaging study of first choice for evaluating the famle pelvis

224
Q

Creation of a sonographic image depends on what 3 components?

A

High frequency sound wave
Reception of reflected wave/echo
Conversion of echo to image

225
Q

Echogenic appears what color on US?

Hypoechogenic appears what color?

A

White

Black

226
Q

Doppler US is used to determine what 2 things?

A

Direction

Velocity

227
Q

How do gallstones appear on US?

How does biliary sludge appear?

A

Echogenic with an acoustic shadow

Echogenic without an acoustic shadow

228
Q

How does obstructive uropathy appear on US?

A

Dilated calyceal system

Fluid filled, dilated hypoechoic system

229
Q

What happens in medical renal disease during an US?

A

Renal parenchyma become more echogenic than the liver and spleen
Normal is reverse

230
Q

What is the image study of choice for AAAs?

231
Q

What are the most common tumors of the uterus?

A

Leiomyomas- fibroids

232
Q

Define Adenomyosis

A

Ectopic endometrial tissue in myometrium

Presents as small cystic space in myometrium of enlarged uterus

233
Q

What is the most common ovarian mass?

A

Functional cyst
Thin wall anechoic structure
Echogenic= hemorrhage

234
Q

Nonfunctional ovarian cysts include what two things?

A

Dermoid cysts

Endometriomas

235
Q

Ovarian tumors most often arise from the _____ and are either ___ or _____

A

Surface epithelium

Serous or mucinous

236
Q

Define PID

A

Infectious diseases of uterus, tubes and ovaries

Begins as transient endometritis

237
Q

How are molar pregnancies suggested?

A

Uterus size is large for date of gestation

Elevated HCG levels +100K

238
Q

How are abdominal hernia diagnosed by US?

A

Intraabdominal contents visualized through abdominal wall

Detection increases if PT stands and performs valsalva maneuver

239
Q

Vascular US uses what two modes to display what two pieces of info?

A

Gray scale and Doppler US

Direction and velocity

240
Q

US can be used to detect arterial narrowing in what two circumstances?

A

Carotid stenosis

Peripheral vascular disease

241
Q

When/why is a pseudoaneurysm formed?

A

Rupture/injury to arterial wall allowing blood to collect under intact outer vessel wall

242
Q

Define Germinal Matrix

A

Microscopic vessels that are at risk of bleeding in premature infant
Appear echogenic in caudothalamic groove

243
Q

How far into development can US be used to detect developmental dysplasia of hips?

244
Q

Define Necrotizing Enterocolitis

A

Life threatening GI in neonates that can cause bowel perforations

245
Q

What causes a gastric outlet obstruction and leads to nonbilious projectile vomiting?

A

Hypertrophic pyloric stenosis

Abnormal thick pyloric muscles and elongated pyloric channel

246
Q

Define FAST and its purpose

A

Focused Assessment with Sonography in Trauma

Detects intraperitoneal bleeding, especially in hemodynamically unstable PTs unable to undergo CT/US

247
Q

Where do pneumothoraces travel to in a supine PT?

A

Most superior part of chest

248
Q

How does a pericardial effusion appear on a US?

A

Hypoechoic/anechoic

249
Q

Cardiac tamponade occurs when fluid accumulates around what chambers of the heart?

A

R atrium and ventricle

250
Q

How is an elevated/decreased central venous pressure depicted on a US?

A

Caliber of Inf Vena Cava during inhale/exhale

251
Q

PT presents with facial trauma and periorbital swelling preventing direct examination of the eye, what can be used?

252
Q

What does the anterior mediastinum encompass?

A

Back of sternum to anterior border of heart/great vessels

253
Q

What does the Middle Mediastinum encompass?

A

Anterior border of heart/aorta to posterior heart border

Contains heart, origins of great vessels, trachea, main bronchi, lymph nodes

254
Q

What does the Posterior Mediastinum encompass?

A

Posterior border of heart to anterior border of the vertebral column

255
Q

What imaging modality has increased accuracy in determining location/nature of mediastinal masses

256
Q

How to remember masses that occupy the anterior mediastinum

A

Terrible Lymphoma
Thyroid
Thymoma
Teratoma

257
Q

Substernal goiter characteristically displace ? and the study of choice is ?

A

Trachea but don’t extend past top of aortic arch

Thyroid scans

258
Q

What are the most frequently encountered anterior mediastinal masses?

A

Substernal thyroids

259
Q

What is the most common causes of mediastinal masses overall and how does it appear on imaging?

A

Lymphadenopathy- present w/ border that is lobulated or polycyclic in contour

260
Q

Thymomas occur most often in what PT population?

A

Middle aged adults, mostly benign

261
Q

What mediastinum mass occurs earlier than thymomas?

262
Q

What is the most common variety of teratomas?

A

Cystic- well marginated mass near origin of great vessels

263
Q

What are the most common types of masses in the posterior mediastinum?

A

Nerve sheath tumors- Schwannoma- benign

Ganglioneuromas/neuroblastomas- neoplasms that arise from nerve elements other than the sheath

264
Q

What issue causes Ribbon Ribs?

A

Plexiform neurofibromas- erodes inferior border of ribs

265
Q

Define Continuous Diaphragm Sign and what causes it

A

Air enters mediastinum causing entire diaphragm under hear to become visible

266
Q

What are the common indications for a FAST exam?

A 
Blunt/penetrating trauma
Trauma in pregnancy
Pediatric trauma
Torso Trauma
Undifferentiated HOTN
267
Q

What are four pathology’s found on FAST

A

Hemopericardium
Hemoperitoneum
Hemothorax
Pneumothorax

268
Q

What are the 5 views of a FAST exam?

A 
RUQ
LUQ
Subxyphoid
Suprapubic- transverse/sagittal
Lungs
269
Q

Define Valvulae Conniventes

A

Muscular folds of small intestine starting at duodenum

270
Q

Define Diverticula

A

Abnormal sac at weak point of wall in the alimentary tract

271
Q

Sefine Sessile

A

Fixed in one place, immobile

272
Q

Define Pedunculated

A

Elongated stalk of tissue

273
Q

What are two types of normal calcifications

A

Phleboliths

Rib cartilage

274
Q

What are the 4 patterns of abnormal calcifications

A

Rimlike- wall of hollow area
Linear/tracklike- wall of tubular structure
Lamellar- around nidus of hollow lumen
Cloud/popcorn like- inside of organ/tumor

275
Q

What are the three rim-like abnormal calcifications?

A

Cysts- renal/splenic
Aneurysm- aorta, splenic, renal
Saccular- gallbladder, bladder

276
Q

What are three examples of structures that can experience linear/tracklike calcifications?

A

Fallopian tube
Vas deferens
Ureter

277
Q

What are three examples of lamellar abnormal calcificatioins

A

Renal calculi
Gallstone
Bladder stone

278
Q

What are four locations that cloud/popcorn like abnormal calcifications can occur?

A 
Pancreas body
Leiomyomas of uterus
Lymph nodes
Kidneys
Mucin-producing adenocarcinomas
279
Q

Define Riedel Lobe

A

Normal variant when tongue-like projection of R lobe of liver reaches down to iliac crest

280
Q

What is the normal location of the spleen on an x-ray?

A

12cm length not projecting below 12th rib

281
Q

What is the normal size of kidneys on an x-ray?

A

Hieght of four lumbar vertebraes

10-14cm

282
Q

How big is the bladder when distended and contracted?

A

Cantaloupe

Lemon

283
Q

What are the normal dimensions of a uterus?

A

8cm x 4cm x 6cm

If enlarged, US

284
Q

What are the risks of injecting iodinated agents?

What PTs are at risk?

A

Contrast induced nephropathy
SrCr inc x 25% or >0.5mg 2-7days later

Diabetes, dehydrated, multiple myelomas

285
Q

What are the four common locations of extraluminal gas?

A

Intraperitoneal
Retroperitoneal
Pneumatosis
Pneumobilia

286
Q

What causes esophagus dilation?

A

Lower sphincter doesn’t relax causing swallowed material to back up and stretch the wall

287
Q

Esophagus constrictions can be caused by what two things?

A

Cancer

Hiatal hernia

288
Q

How does small intestine ulceration appear on imaging?

A

Collar button ulcer- air and barium

Cobblestone appearanc

289
Q

What disease will demonstrate a “String Sign” on imaging?

A

Crohn Disease

290
Q

What pediatric issue will be seen on imaging as a “football” sign?

A

Neonatal pneumoperitoneum

291
Q

What is an “apple core” lesion associated with?

A

Large intestine narrowing from colon cancer

292
Q

A short cervix measurement on US is indicative of what?

A

Intrauterine pregnancy

293
Q

What is cephalization a sign of?

A

Mitral valve stenosis

294
Q

What is the classical triad of symptoms that presents with Aortic Stenosis?

A

Angina
HF
Syncope

295
Q

Aortic stenosis can be 2* to what three issues?

A

Congenital aortic valve
Degenerative tricuspid valve
RHD

296
Q

What is the hallmark of a stenoic lesion on any major artery?
What causes this change?

A

Poststenoic dilation

Eddie Currents and Turbulent Flow

297
Q

What can be used to predict the likelihood of aortic stenosis or mortality from CVD?

A

Aortic valve calcification

298
Q

What are the two hallmarks of Dilated Cardiomyopathy

A

Decreased contractility

Ventricular dilation

299
Q

What type of cardiomegaly is linked to sudden deaths in high profiled athletes?

A

Hypertrophic

300
Q

How can Constrictive and Restrictive cardiomyopathy different?
Why is this differentiation important

A

Restrictive- pericardium is normal (thickened in constrictive) and heart is not enlarged
Constrictive is surgically curable

301
Q

What is the most common caused of aortic aneurysm?

What are Kevin’s Hallmark’s for aortic aneurysm?

A

Atherosclerosis

Loss of aortic knob
Widened mediastinum

302
Q

How does an aortic aneurysm change the vessels location depending on the location?

A

Ascending- anterior/right extension
Arch- middle mediastinal mass
Descending- posterior/left extension

303
Q

What is the modality of choice for diagnosing aortic aneurysms?

A

CT w/ contrast

304
Q

How does a aortic dissection present on radiographs?

A 
Widened mediastinum
L pleural effusion
L apical cap
Loss of aortic knob
Deviation of structures to Right
305
Q

Diagnosis of an aortic dissection rests with what feature?

A

Identification of the intimal flap

306
Q

A normal lateral chest x-ray is called what type of exam?

A

Two-View- upright, frontal and upright, left lateral

307
Q

Most hilar densities are what structures?

A

Pulmonary arteries

308
Q

How do the Major and Minor fissures run along the chest?

A

Major- T5 vertebrae to sternum

Minor- Fourth anterior rib of R side w/ horizontal orientation

309
Q

Compression Fx are most often from ? and usually first involve what structure?

A

Osteoporosis

Depression of superior end-plate of vertebral body

310
Q

Evaluating the thoracic spine on a lateral view can provide great detail/info on what type of issues?

A

Systemic disorders

311
Q

What is the lowest point of the pleural space with an upright PT?

A

Hemidiaphragm indents into base of lungs, creating sulcus- the lowest point

312
Q

On CT, what is smaller: bronchioles or pulmonary artery?

A

Bronchioles

313
Q

What is a favorite window/location for enlarged lymph nodes to appear and grow?

A

Aortopulmonary window- beneath aortic arch but above pulmonary artery

314
Q

What does the Major Fissure separate?

What does the Minor Fissure mark?

A

Upper/lower on left side
Lower/middle on right side

Minor- right middle

315
Q

What are the acute airspace diseases?

A 
PHEAN
Pneumonia
Hemorrhage
Edema
Aspiration
Near-drowning
316
Q

What are the chronic airspace diseases?

A 
APLS
Adenocarcinoma
Proteinosis
Lymphoma
Sarcoidosis
317
Q

What are the Reticular interstitial diseases?

A 
PESS
Pneumonia
Edema
Scleroderma
Sarcoid
318
Q

What are the Nodular Interstitial diseases?

A 
MS BMS
Metastases
Silicosis
Bronchogenic carcinoma
Miliary TB
Sarcoid
319
Q

What are the four components of lung interstitium?

A

CT
Lymph
Vessels
Bronchi

320
Q

What are the characteristics of Interstitial Lung diseases?

A

Inhomogenous
Sharp margins
Focal or diffuse
No bronchograms

321
Q

What are 3 examples of primarily reticular interstitial lung diseases?

A

Pulmonary interstitial edema
Interstitial pneumonia
Non-Specific Interstitial Fibrosis

322
Q

What type of Pt is likely to have Interstitial Pneumonia?

What is a diagnostic issue?

A

Older male who smokes and has reflux

Chest x-ray can appear normal

323
Q

What are the hallmark images for diagnosing Non-Specific Interstitial Fibrosis

A

Ground glass opacities

Traction bronchioectosis

324
Q

Whole lung atelectasis is caused by what?

A

Obstruction of main bronchus

325
Q

What is usually the cause of atelectasis in younger, older, and critically ill PTs?

A

Older- bronchogenic carcinoma
Younger- asthma/inspiration
Critical- mucus plug

326
Q

Massive pleural effusions are usually a result of ?

CHF produces ? type of effusion?

A

Malignancy

Bilateral

327
Q

What two issues are notorious for creating large but clinically silent effusions?

A

Hemothorax

TB

328
Q

Adult PT presents with opacified hemothorax, no shifted of structures, and no bronchogram is indicative of ?

A

Obstructive Bronchiogenic Carcinom

329
Q

What does FAST stand for?

A

Focused Assesment Sonography in Trauma

330
Q

Mobile structures shift in what direction after complete healing process after a pneumonectomy?

A

Towards opacification

331
Q

Which way do fissures move when an atelectasis is present?

How does the hemidiaphragm move?

A

Towards atelectasis

Up on effected side

332
Q

What type of tracheal shift is deemed as normal?

A

Trachea goes to R due to L side of aortic knob

333
Q

Round atelectasis is a form of ____ atelectasis

A

Compressive

334
Q

How fast does a lung collapse when a PT is on room air and on 100% air?

A

Room- 18-24hrs

100%- one hr

335
Q

Where are the fan-like landmarks of an atelectasis facing?

A

Base- pleural surface

Apex- hilum

336
Q

Sign of Golden is associated with atelectasis of what lobe?

337
Q

Critically ill PTs develop atelectasis most frequently in what lobe?

338
Q

Improper ET tube placement causes what atelectasis result?

A

Entire L lung

339
Q

What is the first step in detecting pleural effusions?

340
Q

Two examples of diseases that cause bilateral effusions?

341
Q

Unilateral effusions can be caused by what three things?

A

TB
Thromboembolic Dz
Trauma

342
Q

Left sided effusions are caused by what three things?

A

Pancreatitis
Distal thoracic duct obstruction
Dressler Syndrome

343
Q

Right sided effusions are caused by what three things?

A

Abdominal Dz related to liver/ovaries
RA
Proximal thoracic duct obstruction

344
Q

What three circumstances is a Decubitus View used?

A

To confirm pleural effusion
Determine if it flows freely
Uncover portion of hidden lower lung

345
Q

If a lung is completely opacified by a large effusion, what modality is used to assess the lung?

346
Q

Laminar effusions are a result of what heart issue?

A

Elevated L atrium pressure

347
Q

What are 3 common causes of hydropneumothorax?

A

Surgery
Trauma
Recent thoracentesis

348
Q

Bronchopleural fistula falls under what paragraph/category in the text book?

A

Hydropneumothorax

349
Q

Definition of pneumonia

A

Consolidation of the lung produced by inflammatory exudate from an infectious agent

350
Q

How are most cases of pneumonia acquired?

A

Inhalation

Aspiration

351
Q

Pneumocystitis Carinii pneumonia is seen in what PT population?

A

Most common clinically recognized infection in AIDS PTs

352
Q

Aspiration of bland foods/water produces what type of issues?

A

Not a pneumonia, no infectious agents

353
Q

Define Mendelson’s Syndrome

A

Large quantities of non-neutralized gastric acids are aspirated causing chemical pneumonitis

354
Q

What type of lung disease can be localized with ONLY a frontal image?

355
Q

Define Pneumopericardium

A

Traumatic entry of air into the pericardium

356
Q

What does the term parenchymal tissue mean for the lungs?

A

Gas transfer: alveoli, alveolar duct, respiratory bronchioles

357
Q

What is the function of a throacotomy tube?

A

Remove air/fluid from pleural spaces

358
Q

What is the different placement purposes for pleural drainages?

A

Anterior Superior= Pneumothorax

Posterior Inferior= effusion

359
Q

Rapid drainage of large effusions/pneumothorax can lead to what counter issue?

A

Re-Expansion pulmonary edema

360
Q

If a thoracotomy tube is misplaced, what has more than likely happened to the tube?
What issues can this lead to?

A

Placed into a major fissure

Inadequate drainage
Subcutaneous emphysema

361
Q

What are 3 major issues that can result from inserting drainage tubes into the chest?

A

Lacerated intercostal artery
Lacerated liver/spleen
Re-Expansion Pulmonary Edema

362
Q

What is the difference between distension and dilation?

A

Dilation- abnormal

Distension- normal

363
Q

There is almost always air in the stomach unless ?

A

Recently vomited

Nasogastric tube insertion

364
Q

There is normally air in about ______ loops of non-dilated small bowel?

365
Q

Normally the large intestine can be distended how much?

A

As much as it is during a barium enema study

366
Q

Define Aerophagia

A

Numerous polygonal-shaped, air-containing loops of bowel, none of which is dilated

367
Q

Why would a PT have numerous air-fluid levels in their colon?

A

Recent enema

Taking medication with anticholinergic/antiperistaltic effect

368
Q

What is the most important part of assessing gas patterns in abdominal series?

A

Overall appearance of the bowel gas pattern, including how much air and fluid there is and its most likely location, is more important

369
Q

In order to see an air-fluid level on an x-ray, three criteria have to happen first

A

Air
Fluid
Horizontal x-ray beam

370
Q

What are the two fundamental ways of recognizing the presence and estimating the size of soft-tissue masses or organs on conventional radiographs?

A

Direct visualization of the edges

Pathologic displacement of air-filled loops of bowel

371
Q

A spleen is probably enlarged if what two things are evident?

A

Extends below ribs

Displaces gastric bubble

372
Q

What makes the bladder visible on an x-ray

How is enlargement seen?

A

Fat on dome of bladder

Vertical displacement of bowel

373
Q

Why is a pelvic soft-tissue mass is more likely to be a dilated bladder in a male than a female?

A

Bladder outlet obstruction is much more common in men from enlargement of the prostate

374
Q

What are iodine contrast agents made up of?

A

Nonionic, low-osmolar solutions containing a high concentration of iodine

375
Q

Oral contrast is usually not employed in chest CT scanning unless?

A

Esophagus concerns

376
Q

When is oral contrast not given prior to CT?

A

Trauma
Aorta exam
Stone search study

377
Q

If there is concern for bowel perforation and the possibility that contrast may exit from the lumen of the bowel, what contrast is used?

A

iodine-based, water-soluble contrast is sometimes used Gastrografin

378
Q

What defines a liver’s anatomy?

A

Vascular distribution

379
Q

What are the 3 lobes of the liver?

A

Right
Left
Caudate

380
Q

What structure separates the medial and lateral segments of the left lobe of the liver?

A

Falciform ligament and ligamentum teres (formerly the umbilical vein)

381
Q

A liver’s density on CT is compared to what organ’s density for reference?

382
Q

What part of the pancreas curves around the superior mesenteric vein?

A

Head, placed in the duodenal loop

383
Q

The main pancreatic duct empties into the duodenum as the?

A

Duct of Wirsung, sometimes through an accessory Duct of Santorini

384
Q

What does extraperitoneal mean and what organ is located in it?

A

Continuous with retroperitoneal

Bladder

385
Q

What are three major radiographic signs of free intraperitoneal air?

A

Air below diaphragm
Visualization of both sides of bowel walls
Visualization of Falciform ligament

386
Q

IF PT is unable to be upright for x-ray, what position are they placed in to capture imaging to evaluate for free air in abdomen?

A

Left lateral decubitus view- PT lays on right side

387
Q

What is the most common cause of free intraperitoneal air?

A

Rupture of an air-containing loop of bowel, either stomach, small or large bowel

Perforated peptic ulcer- most common cause of perforated stomach/duodenum and is most common cause of free air

388
Q

Hos is a pneumomediastinum created?

A

Extraperitoneal air may extend through a diaphragmatic hiatus into the mediastinum

389
Q

Air in the bowel wall is most easily recognized on abdominal radiographs when

A

Seen in profile producing a linear radiolucency whose contour exactly parallels the bowel lumen

390
Q

Pneumatosis intestinalis can be divided into what two major categories

A

A rare, primary form called pneumatosis cystoides intestinalis that usually affects the left colon

Chronic obstructive pulmonary disease, presumably secondary to air from ruptured blebs dissecting through the mediastinum to the abdomen

391
Q

Gas in the biliary system may be a “normal” finding if ?

A

Incompetent Sphincter of Odi

392
Q

What is the study of choice for abdominal trauma?

A

CT w/ contrast

393
Q

What are the most commonly affected solid organs in blunt abdominal trauma in order of decreasing frequency are?

A

Spleen, liver, kidney, and urinary bladder

Liver is most frequently (right posterior lobe) injured in penetrating and blunt trauma and causes most deaths in PTs from abdominal trauma

394
Q

How is the spleen usually injured?

A

Deceleration injuries since its the most vascular organ in the abdomen

395
Q

Kidney trauma is most commonly caused by ?

396
Q

Define Shock Bowel

A

Blunt force trauma causing hypovolemia/ HOTN

397
Q

What are the two types of bladder ruptures?

A

Extraperitoneal- pelvic Fx w/ direct puncture of bladder

Intraperitoneal- pelvic Fx w/ blow to distended bladder

398
Q

Urethral injuries are investigated in what two circumstances?
What imaging modality used?

A

Straddle Fx
Puncture/penetration injury
Retrograde urethroscopy

399
Q

What is the most common urethral injury?

A

Rupture of posterior urethra through urethrogenital diaphragm

400
Q

Define Collar Sign

A

Intra-abdominal contents may be constricted where they pass through the diaphragm foramen

401
Q

What criteria is needed to DEFINITIVELY Dx a tension pneumothorax?

A

Visual identification of visceral pleural line

402
Q

How is a pneumothorax identified on a supine chest x-ray?

A

Deep sulcus sign

403
Q

What are the 3 pitfalls of diagnosing a pneumothorax on x-rays?

A

Cysts in lungs
Skin folds
Scapula border

404
Q

What method may be helpful in demonstrating a pneumothorax in an infant

A

Lateral decubitus films of the chest with the affected side “up” and the x-ray beam directed horizontally

405
Q

Delayed films are sometimes obtained about how long after penetrating injuries?

406
Q

What are the most frequent parenchymal complications of blunt chest trauma?
What do they represent?

A

Pulmonary contusions

Hemorrhage into lung

407
Q

Pulmonary laceration is also called what two names?

A

Traumatic pneumatocele

Hematoma

408
Q

Presumably because of the looser connective tissue in the lungs of children and young adults, pulmonary interstitial emphysema is more likely to occur in those under what age

409
Q

Define Boerhaave’s syndrome

A

Pneumomediastinum

Rupture of the distal esophagus, usually the left posterolateral wall, can occur with increased intraesophageal pressure from retching

410
Q

Pneumopericardium is usually due to direct penetrating injuries to ? and tend to be more common in ? PTs

A

Pericardium

Peds

IPAP (212 decks)

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