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Y3 Medicine > Radiology - CHEST > Flashcards

Radiology - CHEST Flashcards

1
Q

How can you distinguish the different densities on a CXR?

A 
Black - air 
Grey - fat 
Grey/white - soft tissue/muscle 
White - bone 
Bright white - metal
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2
Q

What must you assess to decide whether a CXR is technically adequate?

A

Projection
Inspiration
Rotation
Penetration

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3
Q

What is the ideal projection for a CXR?

A

PA radiograph (travels back to front)

Taken with patient standing to have full inspiration and chest flat against detector for minimal rotation

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4
Q

What is the CTR on a PA chest x-ray and what is a normal measurement?

A

Cardiothoracic Ratio
Ratio of maximal horizontal cardiac diameter to maximal horizontal thoracic diameter (inner edge of ribs/edge of pleura)

Normal = less than 0.5

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5
Q

When should you not measure CTR on a CXR?

A

AP radiograph

Objects nearer x-ray tube (heart) appear artificially enlarged due to divergence of x-ray beam
Heart appears artificially large on AP radiographs

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6
Q

How can you determine whether there is sufficient inspiration on CXR?

A

Anterior ends of at least 6 ribs should be visible

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7
Q

How can you determine whether a CXR is correctly centred?

A

Medial ends of clavicle should be equidistant from spinous processes of upper thoracic vertebrae

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8
Q

What is the Pulmonary Hila?

A

Hila are junctions between the heart and lungs, and where the pulmonary arteries/veins + bronchi exit/enter the lungs

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9
Q

Which hilum normally lies higher?

A

The left hilum normally lies higher than the right (left pulmonary artery comes over the bronchus)

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10
Q

On a normal CXR, where does the right diaphragm lie in relation to the left?

A

Right diaphragm lies about 1.5cm above the left diaphragm

Major deviations from this indicate disease

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11
Q

How are the lungs divided into zones?

A

Upper, Mid and Lower
Way to compare the right and left if cannot define specific lobes from CXR

Mid = rib 2-5 
Upper = above 
Lower = below
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12
Q

List some common Review Areas?

common areas for missed findings

A

Lung apices - masses (pancoast tumour), pneumothorax
Behind the Heart - consolidation, masses, hiatus hernia
Below diaphragm - free gas, lines + tubes, gastric distension, bowel obstruction
Bones + soft tissue - fractures, masses, mastectomy, subcutaneous emphysema

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13
Q

Describe the lobes of the lungs

A

Left - 2 lobes (+ lingula - not separated by fissure, sits next to heart)
Right - 3 lobes

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14
Q

What causes a lobar collapse?

A
  • Occurs when obstruction of lobar bronchus
  • Lobe is no longer ventilated and its air gets reabsorbed
  • Affected lobe loses volume and begins to collapse
  • Density of collapsed lobe increases and adjacent fissures dragged out of position
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15
Q

What are the signs of a Left Lower Lobe Collapse?

A
  • Volume loss on left
  • Elevation of hemidiaphragm
  • Left hemithorax looks small
  • Increased density in left retrocardiac region
  • Loss of clarity of medial aspect left hemidiaphragm
  • Left hilum displaced upwards
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16
Q

What are the signs of a Left Upper Lobe Collapse?

A
  • Volume loss on left
  • Elevation of left hemidiaphragm
  • Loss of clarity of heart shadow (can’t make out heart border)
  • Diffuse opacification of left hemithorax (veil like opacity)
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17
Q

What are the signs of a Right Upper Lobe Collapse?

A
  • Volume loss on right
  • Loss of clarity of upper right mediastinum
  • Density in right upper zone, elevation of horizontal fissure
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18
Q

What are the signs of a Right Middle Lobe Collapse?

A
  • Loss of clarity of right heart border
  • Density in right lower zone
  • Right hemidiaphragm preserved
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19
Q

What are the signs of Right Lower Lobe Collapse?

A
  • Volume loss on the right
  • Loss of clarity of the right hemidiaphragm
  • Density in right lower zone, depression of horizontal fissure
20
Q

What are the signs of a combined Right Middle + Lower Collapse?

A
  • Volume loss on right
  • Loss of clarity of right hemidiaphragm & right heart border
  • Density in right lower zone
  • Depression of horizontal + oblique fissure
21
Q

What pattern does pulmonary consolidation follow?

A

Consolidation follows same patterns in terms of position/obscuring borders, but without the volume loss

22
Q

How can infection of the lingula be recognised on CXR?

A

Causes left heart border to become obscured

23
Q

What are the signs of Right Middle Lobe Consolidation?

A
  • Increased density in R lower zone

- Loss of clarity of R heart border BUT preservation of R hemidiaphragm

24
Q

What are the signs of Left Upper Lobe Consolidation?

A
  • Increased density in left upper + lower zone
  • Loss of clarity of L mediastinum
  • Volume preserved
  • Air bronchograms
25
Q

What is an Air Bronchogram?

A

Tubular outline of an airway made visible by filling of surrounding alveoli by fluid or inflammatory exudates

26
Q

What are some causes of Air Bronchograms?

A 
Lung consolidation 
Pulmonary oedema 
Severe interstitial disease 
Neoplasm 
Non-obstructive pulmonary atelectasis 
Normal expiration
27
Q

When is the pleural cavity visible on CXR?

A

When space is filled with fluid (pleural effusion) or air (pneumothorax)

28
Q

On an erect CXR dense pleural fluid collects where?

A

At the lung bases

Forms curved appearance and can blunt edges of costophrenic angles

29
Q

True or False:

Pneumothorax follows rupture of visceral pleura, allowing air to rush in from lungs when person inspires

A

TRUE

30
Q

What is a Tension Pneumothorax?

A

If large amounts of air accumulates, the pressure will squash the lungs so patient cannot ventilate them

Can displace mediastinum to the opposite side of pneumothorax
Medical emergency –> NEEDS IMMEDIATE DRAINAGE

31
Q

What are the radiological signs of pulmonary oedema? (in order of occurrence/severity)

A
  1. Dilatation of upper lobe vessels/cardiomegaly
  2. Interstitial opacities (peribronchovascular cuffing, septal lines)
  3. Airspace opacification (alveoli filling with fluid)
    - When severe + acute shows perihilar or ‘batwing’ distribution
  4. Pleural effusion
32
Q

What is the useful mneumonic to remember radiological principles of Heart Failure/Pulmonary oedema?

A 
ABCDE
A - alveolar oedema (bat wing) 
B - kerley B lines 
C - cardiomegaly 
D - Dilated upper lobe vessels 
E - pleural Effusion
33
Q

What are the normal positioning landmarks of Endotracheal tubes?

A
  • Tip 5cm above carina
  • Width 2/3 tracheal diameter
  • Cuff should not expand trachea
34
Q

What points may suggest malposition of endotracheal tube?

A
  • Tip extend past carina
  • Tip may be seen in right main bronchus (most common)
  • May have entered oesophagus
35
Q

What is the ideal positioning of a nasogastric tube?

A

Subdiaphragmatic position in stomach
(on CXR - overlying gastric bubble)
Should be at least 10cm beyond gastro-oesophageal junction

36
Q

What are some possible malpositioning of top position?

A
  • Remaining in oesophagus
  • Transversing either bronchus or distally into lung
  • Coiled in upper airway
  • Intracranial insertion
37
Q

Where can central venous line catheters be inserted?

A

Via right and left internal jugular or subclavian veins (CVC)

38
Q

Where can peripherally inserted central catheters be inserted?

A

Via Cephalic, basilic or brachial veins

39
Q

Where should the tip of a central venous line be on a CXR?

A

Cavoatrial Junction

junction of right lateral border of SVC and superior border of right atrium

40
Q

What risks are associated with malposition of central venous catheters?

A

Tip too high (i.e. proximal SVC) - thrombus formation

Tip too low (distal RA or RV) - increased arrhythmia risk

41
Q

What are the different categories of pulmonary growths according to size?

A

Miliary nodules - <2mm
Pulmonary micronodule - 2-7mm
Pulmonary nodule - 7-30mm
Pulmonary mass >3mm

42
Q

What is a Pneumoperitoneum?

A

Abnormal presence of air or other gas in peritoneal cavity

43
Q

What causes a pneumoperitoneum?

A

Perforation of a hollow viscus (stomach, duodenum, small or large bowel) results in gas in peritoneal cavity

44
Q

What investigation can visualise pneumoperitoneum?

A

ERECT chest radiograph
(position allows gas to rise up under diaphragm)
Easier to see under right diaphragm than left

45
Q

What is a classical presentation of Pulmonary Embolism?

A
  • Dyspnoea at rest or exertion
  • Pleuritic chest pain
  • Cough, orthopnoea, haemoptysis

(Caused by DVT = calf/thigh pain and swelling)

46
Q

What investigations may be done if suspicion of Pulmonary Embolism?

A

Determine severity - D-dimers

X-ray - look for alternative causes, usually either normal or nonspecific findings

CTPA - look for clot

V/Q Scan - ventilation perfusion scan to check for defects caused by clots

Y3 Medicine (8 decks)

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