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Respiratory: Radiology > Radiology of the Thorax 2 > Flashcards

Radiology of the Thorax 2 Flashcards

1
Q

When is imaging indicated for pulmonary thromboembolism?

A
  • If CXR normal, do V/Q scan
  • If radiation to be avoided/leg swollen consider ultrasound scanning Leg for DVT
  • If CXR abnormal/massive PE suspected, do CT pulmonary angiogram
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2
Q

What is the appearance of an abnormal VQ scan?

A

If blockage in one of the branches, will tend to be a wedge shape downstream from that

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3
Q

What does the abnormal wedge shape in a CTPA result from?

A

Blood will not be sent to non-ventilated area as blood sent to that area will not be oxygenated - this is called matched V:Q defect

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4
Q

What is mismatched V:Q defect indicative of?

A

Pulmonary embolism - where a segment of the lung receives ventilation, but the blood flow to that ventilated area is blocked by a blood clot

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5
Q

Is matched ventilation:perfusion indicative of PE?

A

No, mismatched V:Q is

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6
Q

What is the appearance of a benign pulmonary nodule on a CXR?

A
  • High attenuation indicates calcification

* Mass is also very well defined (sharp)

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7
Q

What are the characteristics of a hamartoma on CT?

A
  • Mass resembles popcorn

* Benign

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8
Q

What are the clinical features and pathology of lung cancer?

A
  • 15-20% are asymptomatic - especially peripheral tumours
  • Symptoms: cough, wheeze, haemoptysis, recurrent pneumonia, hypercalcemia
  • Weight loss, hoarseness, finger clubbing, persistent supra-clavicle nodes
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9
Q

What is the prevalence of haemoptyisis and the likelihood of someone with haemoptysis having lung cancer?

A
  • 20% of lung cancer sufferers have haemoptysis

* People with haemoptysis 13 times more likely to have lung cancer

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10
Q

Why is it difficult to screen for lung cancer?

A
  • Cough is prevalent (65%) in lung cancer suffers - however, a cough can be indicative of many things (those with a cough are only 2 times more likely to have lung cancer)
  • People with haemoptysis are 13 times more likely to have lung cancer - however, only 20% of lung cancer sufferers present with haemoptysis
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11
Q

What are predisposing conditions to lung cancer?

A
  • Inhalation of carcinogens e.g. cigarette smoke, asbestos, radon gas
  • Bronchioalveolar adenoma
  • Lipoid pneumonia
  • Interstitial pulmonary fibrosis
  • Previous lung cancer (tumours can be synchronous and metachronous)
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12
Q

What are synchronous tumours?

A

More than 1 tumour at the same time

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13
Q

What are metachronous tumours?

A

Second tumour at a later time

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14
Q

What is the appearance of asbestosis on a HRCT scan?

A
  • Sub-pleural nodulation

* Large chunks of white – calcification is hallmark of previous asbestos exposure

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15
Q

What is the most common cause of interstitial fibrosis?

A

Usual interstitial pneumonia

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16
Q

What is the appearance of pulmonary fibrosis on a HRCT?

A
  • Honeycombing
  • Peripheral disease
  • Towards bases
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17
Q

What are peripheral tumours?

A

Tumours arising beyond the hilum

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18
Q

What are central tumours?

A

Tumours arising at or close to the hilum

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19
Q

What are features of peripheral tumours?

A
  • Rarely visible on chest X-ray if < 1cm diameter
  • Usually spherical or oval
  • Volume doubling time varies between 40 and 400 days (for solid tumours)
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20
Q

Why is it significant that the volume doubling time for solid peripheral tumours varies between 40 and 400 days?

A

If see somehting on CXR that has doubled in size in less than 40 days, more likely to be infection, fluid (etc) rather than cancer

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21
Q

What percentage of bronchial cancers are peripheral tumours?

A

40% bronchial cancers rise beyond segmental bronchi

22
Q

What are cardinal signs of central tumours?

A
  • Hilar enlargement
  • Distal collapse/consolidation
  • Much harder to spot
23
Q

What is the appearance of a central mass in the left lung on CXR?

A
  • Elevation of left hemi-diaphragm and loss of outline
  • Triangular-shaped opacity behind heart
  • Left lower lobe collapse

(pic)

24
Q

What abnormalities are seen on this CT? (pic)

A
  • Calcification in wall of aorta
  • Lobulated mass at left hilum
  • Left lower lobe collapse
25
Q

What is the international tumour staging system?

A
  • T - tumour size
  • N - Lymph node staging
  • M - metastases
26
Q

What is contrast enhanced CT useful for?

A
  • Assessing tumour size
  • Showing intracranial metastases
  • Guiding a biopsy of peripheral lesions
27
Q

What is a PET CT scan good at detecting?

A
  • Nodal metastases
  • Distant metastases (not brain metastases)
  • Delineating tumour in an area of collapse
28
Q

Why is a PET CT not good at detecting brain metastases?

A
  • PET uses a glucose analogue (FDG - fluorodeoxyglucose) which can cross blood-brain barrier
  • Organ that uses most glucose is the brain which has high metabolic activity
  • Tumours also have high metabolic activity so it is very hard to pick up brain metastases on PET CT
29
Q

What is used instead of PET CT using FDG to detect metastases in the brain?

A

Inundated contrast CT

30
Q

What are the advantages of MRI staging of tumours?

A
  • Does not require IV contrast to see vessels
  • 3 planes valuable at apex, aortopulmonary window and supradiaphramtic regions
  • Better soft tissue differentiation
31
Q

What are the disadvantages of MRI staging of tumour?

A
  • Costly
  • Time-consuming
  • Spatial resolution better with CT
  • Need gating to reduce motion artefacts
32
Q

What are the components of this image? (pic)

A

PET fused with CT

shows metabolic activity in one of the thoracic vertebrae

33
Q

What is the staging of brain, liver, bone and adrenal metastasis from the lung?

A

M1b

34
Q

What is the staging of lung metastasis from the lung?

A

M1a

35
Q

What is a feature of small cell lung cancer?

A

Medistinal lymphadenopathy

36
Q

What is the treatment for small cell lung cancer?

A

Mainly by chemotherapy

37
Q

What are the different stages of small cell carcinoma?

A

M1 - only in hilum
M2 - only on one side of mediastinum
M3 - both sides of mediastinum

38
Q

What are radiological interventions for small cell lung cancer?

A
  • CT guided lung biopsy
  • Pleural fluid drain
  • SVC stenting
39
Q

What are possible complication of CT guided biopsy?

A
  • Pneumothorax
  • Blood in bronchi (can cause bronchospasm and patient can effectively “drown” from blood in the airways)
  • Air embolus of the heart - very high mortality
40
Q

What can ultrasound be used for?

A
  • To detect pleural effusion
  • Subphrenic collection
  • Movement of diaphragm
  • US guided drainage
41
Q

What is the black mass in this image? (pic)

A

Pleural effusion

42
Q

What is a SVC stenting?

A

A palliative method of alleviating discomfort caused by lung cancer

43
Q

What is the diagnosis of this 68 y/o male who is a smoker and has right chest pain? (pic)

A
  • CXR shows chunk of right rib missing
  • CT shows mass destroying rib
  • Lung cancer
44
Q

What view should be taken in CXR for a sternal injury?

A

Lateral - as will not see sternal fracture in AP view

45
Q

What are the indications of left lower lobe collapse?

A
  • Elevation of left hemi-diaphragm
  • Loss of hemi-diaphragm outline
  • Trinagular-shaped opaity behind heart
46
Q

What is the likely diagnosis of this man with SOB and unequal air entry? (PIC 1 + 2 showing metabolic)

A

Mesothelioma

  • Bilateral calcified pleural densities – associated with asbestos exposure
  • Pleural thickening - mesothelioma highly associated with previous asbestos exposure
47
Q

What is the appearance of radiation fibrosis on CXR?

A
  • Straight lines that are not anatomical - look iatrogenic
48
Q

What is a sale embolus?

A

Goes across bifurcation of pulmonary trunk

49
Q

On a CXR, what does a nodule projected from inside lung to outside lung indicate?

A

Not a lung lesion - it is a skin nodule

50
Q

What is a thoracoplasty?

A
  • Treatment for TB in the past

* Crushes ribs on affected side

51
Q

What is the likely diagnosis of this woman?

pic

A

Recurrent disseminated breast cancer

  • Only has breast on one side - has had mastectomy so assuming she has had breast cancer
  • Pulmonary nodules are likely to be secondary
  • Pleural effusion is malignant effusion

Respiratory: Radiology (4 decks)

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