Radiology -Ross

Question 1

What is eventration? What is this due to?

Answer 1

• abnormally high or elevated position of one leaf of the intact diaphragm as a result of paralysis, aplasia or atrophy of varying degree of mm fibers (ie phrenic nerve damage)
• can be congenital or from a thin, abnormal diaphragm at birth

Question 2

What x-ray findings will be seen with COPD and asthma pts?

Answer 2

• hyperinflation of the lungs

- smaller heart size (relatively)

Question 3

What is a pleural effusion? What are the potential causes?

Answer 3

• When fluid accumulates when the rate at which it is formed is greater than the rate it is removed
• can also occur when fluid in abdomen crosses through diaphragm
• The rate of formation may be increased by:
  i. Increasing hydrostatic pressure (left sided heart failure)
  ii. Decreasing colloid osmotic pressure (hypoproteinemia)
  iii. Increasing capillary permeability (toxic disruption of membrane with pneumonia or hypersensitivity reaction)
• The rate of resorption may be decreased by:
  i. Decreased absorption or fluid by lymphatics from tumor blockage or increased venous pressure…decreases rate of fluid transport thru thoracic duct.
  ii. Decreased pressure in pleural space (atelectasis of lung in bronchus obstruction)

Question 4

What is a silhouette sign?

Answer 4

when 2 objects of the same density touch and the edge between them disappears (ex: heart and PNA in lung –> non-sharp border)

Question 5

What findings will be seen on an x-ray of a pneumothorax?

Answer 5

You must see the visceral pleural white line

Question 6

What two x-ray findings will be seen in a pt with CHF?

Answer 6

• Kerley B lines-thickening of the interlobular septa—1-2 cm long horizontal lines at bases**
• Peribronchial cuffing—little “doughnuts” seen distal to hilar area***

(Also, Cephalization– vessels are bigger in the apex than in the base)

Question 7

What are the main x-ray findings associated with a pleural effusion?

Answer 7

• a. Blunting of Costophrenic angle
• b. Meniscus sign**
  c. Layering—haziness seen in the supine position
• d. Loculated—2ndary to adhesions which form between visceral and parietal pleura (loculated=like an abscess)
  e. Laminar effusion—fluid collects between lung and visceral pleura…CHF, lymphangitic spread of malignancy
  f. Opacified hemithorax
  g. Air fluid levels

Question 8

What is the normal heart size in a chest x-ray? What two things can alter this appearance?

Answer 8

-In most people the cardiothoracic ratio is less than 50%

• Try not to be fooled by pectus excavatum
• And a large thymus in a child may cause the heart to look enlarged

Question 9

What things should be taken into consideration when evaluating a chest x-ray?

Answer 9

a. Penetration (should barely see the vertebrae through the heart)
b. Inspiration
c. Rotation
d. Magnification (A-P will magnify the heart)
e. Angulation

Question 10

What color do dense objects appear on x-ray?

Answer 10

white