Radiology of lung cancer and staging Flashcards
What do you need to include in your systematic review of the CHX?
The hilar of the lungs and behind the heart
The 3 sections of the lungs (upper/middle/lower)
Behind the diaphragm and the costophrenic angles
Bones
Soft tissue
Lines/metal work
What would blunting of the costophrenic angle mean?
Pleural thickening/fluid
What do you look for in the mediastinum
That there is equal densities in both sides, no distortion or pulled in either direction
What do you look at when looking at the heart?
Behind the heart
Do you need to check behind the diaphragm
Yes, because the lungs extend below in front and behind (its a 2d image of 3d thing)
What can cause a hemithorax white out and what can you check for to help with your decision?
Large amount of pleural effusion
Pneumonectomy
Complete Lung collapse
you can check for mediastinal shift:
Towards the whiteout could be complete lung collapse or pneuonectomy
Away from mediastinum shift is probably large effusion pushing away the mediastinum from the fluid.
Lobar collapse, what will you see?
Everything shifted up, reduced hemithorax volume. Other lobes can be hyper inflated s wider spaces between ribs.
What can an apex tumour be called?
Pancost tumour
What are the key points to check?
Behind heart and diaphragm,
Lung apices
Hila
What can help spot abnormalities?
Comparing with older X Rays
Which hila is usually higher and why?
Left Hilum usually little higher than right becasue left main pulmonary artery arches over left main bronchus.
Can be horizontal but right should NEVER be higher than the left!
How do you differentiate Nodule vs Mass?
Nodule = under 3cm Mass = greater than 3cm
Other than lung cancer, what can cause nodules?
Heratomas or carcinoid (benign lung neoplasm)
Infection bacterial/tuberculosis/fungal
Vascular haematoma, AVMs (Arteriovenous malformations )
What is an AVMs?
Arteriovenous malformations, when the artery-vein is shortcutted, leading to higher pressure through the veins and making them more likely to rupture.
What is the first scan used to stage lung cancer?
Contrast CT
What do the following letters indicate with regards to staging? T, N , M
T = Tumour, so size of tumour/other structures involved N = Nodes, no. lymph nodes it has spread to M = Metastases, so if there have been any metastases away from primary site, eg controlateral lung/elsewhere in the body
Which nodes in lung progression?
Hilar lymph nodes, ipsilateral mediastinal lymph nodes/contralateral mediastinal lymph nodes, supraclavicular nodes,
What is an EBUS scan? And what cna it be used for?
Its a tube with ultrasound and needle that goes down the trachea and using the ultrasound can locate lymph nodes and the needle can then take samples from the nodes. Used to help stage cancer as for how much there has been spread to the lymph nodes.
Why is IV contrast CTs better than a standard CT
Can see blood flow areas more easily and can help differentiate structures.
What is a PET CT
Positron Emmision tomography, Uses F18 -FDG labelled glucose analogue and shows areas of increased metabolic uptake
Is PET CT specific?
No, it will pick up any areas of higher metabolic rates
How long after FDG injection should you have a scan?
45-60 minutes. Half life = 110 minutes
What does Tx mean?
That the size of the tumour is unable to be assessed, eg. lost within a collapsed lung.
T1 means ?
T1 means that the size of the tumour is generally under 3cm:
!a is less than 1cm
1b is under 2cm
1c is under 3cm
