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CLASP > Radiology: Chest > Flashcards

Radiology: Chest Flashcards

1
Q

describe types of common emergency conditions seen on chest XR

A
  • misplaced nasogastric or endotracheal tube
  • misplaced central venous catheter
  • simple/tension pneumothorax
  • pleural effusion
  • lung/lobar collapse
  • lung consolidation
  • HF
  • foreign body
  • pneumoperitoneum (on erect XR)
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2
Q

what colour is air?

A

black

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3
Q

what colour is fat?

A

grey

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4
Q

what colour is soft tissue/muscle?

A
  • grey/white
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5
Q

what colour is bone?

A
  • white
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6
Q

what colour is metal?

A
  • bright white
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7
Q

ideal position for chest XR for a patient?

A

PA chest XR
- cardiothoracic ratio should be 0.5

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8
Q

how many ribs should you be able to see if CXR is adequately inspired?

A
  • at least 6 ribs visible
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9
Q

how do you know if a CXR is correctly centered?

A
  • medial ends of the clavicles should be equidistant from spinous processes of upper thoracic vertebrae
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10
Q

what can you visualise as mediastinal borders

A

along with
- aorta
- trachea
- hemidiaphragm
- stomach bubble in left hemidiaphragm
- horizontal fissure of right lung

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11
Q

what is the pulmonary hila?

A
  • hila are junctions between heart and lungs, where pulmonary arteries and bronchi enter and pulmonary veins exit the lungs
  • left hilum normally lies higher than the right
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12
Q

which diaphragm lies higher?

A
  • right side
  • should be able to visualise both from costophrenic angle to midline
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13
Q

common areas of missed findings?

A
  • lung apices - pancoast tumour, pneumothorax
  • behind the heart - consolidation, masses, hiatus hernia
  • below diaphram - free gas, lines and tubes e.g. nasogastric, gastric distension, bowel obstruction
  • bones and soft tissues - fractures, masses, mastectomy, sub emphysema, evidence of prev surgery
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14
Q

what parts of lung are adjacent to heart?

A
  • RML on right side
  • lingula of LUL on left side
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15
Q

why does lobar collapse occur?

A
  • obstruction of a lobar bronchus
  • due to tumours, aspirated food, mucus, impaction etc
  • as affected lobe loses volume it begins to collapse like a balloon deflating
  • the collapsed lobe’s density increases and adjacent major fissure is dragged out of position
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16
Q

what is a sail sign on chest XR?

A
  • suggests left lower lobe collapse
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17
Q

what do you see on left upper lobe collapse

A
  • when upper lobe collapses it collapses forward
  • makes heart look like it’s dissapeared
  • white density
  • less vol in left lung
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18
Q

what do you see right upper lobe collapse?

A
  • displacement of horizontal fissure
  • curvy line at top
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19
Q

does RML collapse more commonly alone or with RLL?

A
  • occurs with right lower lobe
  • profound loss of right hemidiaphragm and right heart border
  • density in right lower zone
  • occurs due to obstruction of both middle and lower lobe bronchi due to common origin at bronchus intermedius!
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20
Q

what do you see in a RML collapse?

A
  • loss of heart border
  • preservation of hemidiaphragm
  • density in right lower zone
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21
Q

what do you see in a RLL collapse?

A
  • loss of hemidiaphragm border
  • heart border preserved
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22
Q

pulmonary consolidation

A
  • less vol loss
  • similar to lobar collapse but lobe hasnt collapsed
  • can see air bronchogram
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23
Q

what is an air bronchogram?

A
  • air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white)
  • usually caused by pathogenic airspace/alveolar process, in which something other than air fills the alveoli
  • if persist for weeks despite antimicrobial therapy -> suspicion of a neoplastic process
24
Q

describe this chest XR

A

Dx: consolidation of lingular segment of left upper lobe

  • loss of left heart silhouette
  • blunting of costophrenic angle
  • consolidation seen in left upper lobe
25
Q

what is the pleural cavity?

A
  • the pleural space - space between parietal and visceral pleurae
  • it is a potential space only
  • contains only a few ml of fluid
  • thin layer of mucoid fluid lies between parietal and visceral pleurae for easy slippage of moving lungs
26
Q

when is the pleural cavity visible on chest radiographs?

A
  • when it is filled by fluid (pleural effusion) or air (pneumothorax)
27
Q

what is seen on a chest XR with a pleural effusion?

A
  • blunting of the costophrenic angles
  • as the pleural fluid collects at the lung bases formed the ‘curved’ appearance of a meniscus
28
Q

what is a pneumothorax?

A

a pneumothorax follows rupture of the visceral pleura, allowing air to rush in from lungs every time the patient inspires
- pleural air accumulates in this way, impairing resp function
- a small pneumothorax is subtle

29
Q

how can you spot a small pneumothorax?

A
  • look for a dark crescent without lung markings bounded medially by the lung edge
  • often at the lung apex
30
Q

complications of a tension pneumothorax?

A
  • cardiac arrest
  • if the pneumothorax accumulates large amounts of air it will squash the lungs so patient cannot ventilate them thus it is a medical emergency and must be drained immediately
31
Q

what will you see in a tension pneumothorax?

A
  • mediastinal shift due to gas pushing lung into the contralateral hemithorax
  • diaphragm is pushed down
  • lower down than left
32
Q

signs of heart failure

A
  • elderly
  • multiple MI’s
  • IHD
  • valvular HD
  • hypertension
  • arrhythmias (AFib)
  • breathlessness worsened by exertion
  • cough - frothy white/pink sputum
  • orthopnoea - using multiple pillows to sleep at night
  • peripheral oedema
  • paroxysmal nocturnal dyspnoea (suddenly waking up during the night SOB)
33
Q

what will you see in a heart failure patient on chest XR

A

radiological signs of pulmonary oedema in order of severity
1. dilatation of upper lobe vessels/cardiomegaly (v white chest XR)
2. interstitial opacities
- peribronchovascular cuffing
- septal lines (kerley B lines)
3. airspace opacification
- filing of alveoli w fluid
- when severe and acute - perihilar or batwing distribution
- air bronchograms - air filled bronchi running through fluid filled alveoli

34
Q

what is this?

A
  • Kerley B lines
35
Q

mnemonic for heart failure?

A

A - alveolar oedema (bat wing opacities)
B - Kerley B lines
C - cardiomegaly
D - dilated upper lobe vessels
E - pleural Effusion

36
Q

where should the endotracheal tube sit?

A
  • tip 5cm above carine
  • cuff should not expand the trachea
37
Q

how should a NG tube be positioned?

A
  • go into nostril
  • over back of nasopharynx
  • pass through oesophagus
  • and enter stomach
  • tip should be in stomach (subdiaphragmatic position)
38
Q

what are some common malposition’s of NG tube?

A
  • remaining in oesophagus
  • transversing either bronchus or more distally into the lung
  • coiled in upper airway
  • intracranial insertion i.e. enter skull
39
Q

most common entry point for a central venous catheter and why?

A
  • right internal jugular - it is straightest line to the SVC
    -> other options are left internal jugular or left and rght subclavian veins
  • all tip lines should be the same… junction of the SVC and right atrium
  • peripherally inserted central catheters (PICC) are inserted via cephalic, basilic, or brachial veins
40
Q

where is an appropriate location for a central venous catheter?

A
  • tip is somewhere around anterior end of right 2nd rib
  • (cavoatrial junction)
41
Q

what is some potential malposition’s of a central venous cather?

A

tip too high - proximal SVC
- increased risk of thrombus formation

tip too low - distal right atrium or right ventricle
- inc risk of arrythmia

coiled and displaced in another vein

42
Q

where will you find mets in the lung?

A
  • more often at the bases
43
Q

pulmonary mass in right upper zone? new, haemopytsis

A
  • lung cancer
  • often associated lobar collapse in lung cancer. so if patient is not septic highly suspicious for cancer
44
Q

pulmonary mass in right lower zone? about to start tx for RA

A
  • benign hamartoma
45
Q

what imaging is used for standard staging for a lung cancer?

A
  • contrast enhanced CT
    allows you to assess tumour size
    mets - nodal, lung, liver, adrenal, skeletal
    guiding a biopsy of peripheral lesions
  • FDG-PET CT
    metabolic test
    nodal mets
    distant mets
46
Q

what is a pneumoperitoneum?

A
  • perforation of a hollow viscus (stomach, duodenum, small or large bowel) results in gas in peritoneal cavity
47
Q

what will you see on chest XR of a pneumoperitoneum

A
  • radiograph taken with patient in erect position allows gas to rise up under diaphragm therefore you will see a thin black line between diaphragm and sub diaphragmatic structures
48
Q

presentation of a PE

A
  • dyspnoea either at rest or at exertion
  • pleuritic chest pain, cough, orthnopnoea and haemoptysis
  • causes: DVT, calf/thigh pain and swelling may occur
49
Q

what is gold standard to look for a PE?

A
  • CTAP

CT pulmonary angiogram to look for clot
- injecting dye into upper limb
- V/Q scan perfusion scan to look for defects caused by clots but not very appropriate. But is used in pregnant women.

50
Q

60 yr old women, weight loss, cough >6 weeks, haemoptysis
finger clubbing
20 pack year smoking hx

Ddx?

A
  • lung cancer
  • TB
  • exacerbation of COPD
  • not sepsis as normal sats and BP
51
Q

suspected lung cancer. what do we do next?

A
  • urgent CT scan (w contrast) and resp referral
52
Q

why do smokers get big black areas in lung?

A
  • emphysema
53
Q

what is bronchiectasis

A
  • dilatation of a bronchus and has to be bigger than vessel it sits next to
54
Q

patient w lung cancer what other organs are you wanting to focus on?

A
  • liver for mets
  • brain for mets
  • adrenal for mets
  • bone - skeletal
  • lymph nodes - left hilum, and supraclavicular and internal mammary
55
Q

trauma setting: you want to know about blood or strokes what scan?

A
  • non contrast CT scan
56
Q

when you want to know about brain mets what scans?

A

non contrast and contrasted CT scans

CLASP (5 decks)

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