Radiology of Upper and Lower airway Flashcards
What structures are included in the upper airway for X-ray?
sinuses, nasopharnyx, oropharnxy, proximal trachea, middle ear and mastoids
What do we most commonly x-ray in the upper airway?
Sinuses most commmon: chronic sinusitus+complications, acute sinutisis, post op, tumors, trauma
Temporal bone for hearing loss/trauma/infection
What imaging do we use for sinuses?
radiographs=less common
CT
-get direct coronals and axials with reformatted images
What are the arrows pointing to in the CT below?
Mucosal thickening
What do you see on the image below?
Nasal polyps… results in bony destruction and mouth breathing
What do you see in the image below? What is concerning about this?
Trachiitis, worry about compromised airway. Get thickening and sloughing of trachea. More common in children.
What do we see on this CT?
Epiglotitis. See thumbprint sign, blocks airway and is medical emergency
What imaing is good for seeing epiglotitis, tracheal papillomatosis, croup and trachitis?
Tracheal imaging
What issue do we see on image below?
tracheal collapse during expiration shouldn’t happen
What are the ‘steps’ to read a chest radiograph?
Views
technical aspect/considerations
Steps–‘Pattern’
Projectional anatomy
Important signs to identify and further characterize the lesion
When we first look at a chest xray, what aspects do we need to look at?
- Look at mediastinum and heart (check for adenopathys) and size
- Look a each lung individually
- Compare each section of lung back and forth
*should have crisp borders with diaphram all the way across the bottom
What is the benefit of getting an xray fromt he side?
If you have a nodule that appears on the border of where the upper and lower lobe meet, it will be hard to tell which lobe it is in, when you switch to the side view, you can see which lobe
You see somthign that looks like a nodule. Located btwn 4th adn 5th intercostals. What else could this be?
nipple shadow
Again, there is overlap of lobes when viewing AP, one view is no view.
have an idea of how lobes overlap
Note the bronchial tree on the next image
Which is used more for cross sectional imaging: MRI or CT and why
Use CT of chest more bc allows for movements of lungs during breathing
MRI doesn’t image lung parenchyma well and has issues with motion artifacts
Below is picture of ind with bronchopneumonia in the RLL, what clincial findings would patient most likely have?
productive cough and fever for several days
What pattern do we see on CT in pt with bronchopneumonia?
Tree in bud
little foci of infection at end of bronchioles
What’s going on in the silouette sign?
Loss of cardiac border and consolidation
Whats going on in this image?
There is lobar pneumonia with extensive inflitrates
What’s happening in this here image?
What pt population is most at risk for this?
multifocal infiltrates
immunosuppresed patients most at risk
What are we seeing in this image?
lobar pneumonia, need to use pt history as well as imaging to dx
*** also note patent bronchi in an area of collapsed and consolidated lung
What are the white nodules on this xray?
TB
miliary pattern
What is the hallmark of pt with TB?
miliary pattern of disease
its hematogenous spread
How does histoplasmosis show up on CT?
What is it?
Shows up as bright white calcified lesions
from early infection in youth and heals into those calcifications, lots of people have them
Pt had a lung infiltrate and was treated for pneumonia, the infection didn’t clear up. This is what you saw on CT.
Dx?
Blastomycosis; fungal infection
If pt is treated for pneumonia and infection doesn’t clear up need to work up
You see the CT below with a halo sign, dx?
Invasive aspergilosis
pts that are immune compromised
nodules in lung
What do you expect to see on chest xray in pt with invasive aspergillosis?
diffuse nodules all over chest
Whats this gnarly little dude?
Aspergilloma = fungal ball seen in pts that are immune compromised
you can see it’s freely floating– different from cancer which would not be mobile
Pt below has varicella pneumonia, how is that different on xray then what we see in pt with tb?
Varicella presents with calcifid lesions throughout. The TB lesions aren’t calcified
What are some causes of ARDS
many causes,
in this pt we have overwhelming infection with limited area in lung where we are getting airation
