Respiratory - finished Flashcards
What are the normal projections of the Chest
PA Lateral - usually Left
When is an inspiration and expiration study taken?
For pneumothorax
Are other chest films taken on inspiration or expiration?
Full Inspiration
What is the system for interpreting chest xrays?
- Request form
- name, age, sex, date and clinical information - Technical
- centering, position, degree of inspiration, exposure (finger held behind black area should just be visible) - Trachea
- Position (midline?), outline
- Bifurcation - Heart and Mediastinum
- Size, shape and displacement
- Check great vessels (arch and asc. aorta)
- Cardiac diameter=less than half width of chest - Diaphragms:
- Right side is 2.5cm higher than left (liver) - Pleura:
- Costo-phrenic and cardiophrenic angles (sharp and clear bilat and in both PA and lateral - Lung fields:
- Compare bilat for markings and translucency - Hidden areas:
- apices of the lungs
- diaphragms, mediastinum and bones - Hila:
- Left is higher than right
- Should be able to see individual vessels - Below diaphragm
- gas shadows
- any calcification
- splenomegaly/hepatomegaly - Soft tissues:
- density changes - Bones:
- should see 9-10 ribs above the diaphragm
- check for scoliosis
What colour is an overexposed film
Blacker
What colour is an underexposed film?
Paler
What are the 2 types of metastatic carcinoma in the chest
Haematogenous metastasis
Lymphangitic metastasis
What is the commonest type of primacy malignant cancer in the lungs?
Bronchogenic carcinoma
What % of primary lung tumours does bronchogenic carcinoma account for?
90%
What is the clinical presentation of bronchogenic carcinoma?
90% of male and 70% female patients (35% of cause of death in males)
Cough or wheezing
Sputum may be bloody
Weight loss and weakness are late signs
Beware of pneumonia that clears with antibiotic treatment but then reoccurs.
What are the radiographical features of bronchogenic carcinomas?
Most are endobronchial - apical primary carcinoma = Pancoast
Atelectasis is the most common sign
- collapse or closure of a lung resulting in reduced or absent gas exchange
Opacity of non-aerated lung tissue
May alter size/shape of lobes or segments
May cause an elevated hemidiaphragm
May see a solitary mass of nodule almost always without calcification
Often assoc. with unilateral hilar enlargement.
Describe pneumonia
A viral or bacterial infection of the alveolar epithelium
Many types of pneumonia - commonest = lobar pneumonia.
May spread to entire lobe
What % of pneumonias are caused by Streptococcus pneumonia?
75%
What is the clinical presentation of pneumonia?
Acute onset (days to week) with a productive cough, haemoptysis common, with pleuritic chest pain, chills and high fever. Often features tachycardia (120bpm), headaches and malaise. Percussion of dullness, tactile fremitus and bronchial breath sounds.
What are the radiographical features of lobar pneumonia?
Confluent airspace opacification
Focal spherical consolidation
Lobar enlargement - caused by oedema
Fissue bulges away from the involved lobe
Lobar pneumonia superimposed on emphysema resemble necrosing pneumonia (numerous small lucencies within consolidated area of lung.
Define tuberculosis
Infectious agent is the mycobacterium. Incidence declined in 80’s but since then has slowly increased. Children, elderly and immuno-compromised populations vulnerable to primary TB.
An airborne infection which favourites sites for seeding are
1) in lungs (lower lobes first then spread to apices),
2) in the skeleton (long bone metaphyses and vertebral bodies) and
3) in other organs (as kidneys and brain cortex).
What is the clinical presentation of tuberculosis
Often asymptomatic, may see general malaise, night sweats, cough (early morning, minimal productive), dyspnoea may result from spontaneous pneumothorax or pleural effusion, haemoptysis is a late manifestation.
What are the radiological features of tuberculosis?
Primary:
- parenchymal consolidation (usually lower lobe)
- hilar and mediastinal lymphandenopathy
- pleural effusion (rare), with healing consolidation may regress to a clearly defined nodule, which may be resorbed or which may calcify
- Ghon tubercle: calcified tubercular granuloma in the lung field (coin lesion), and
- Rhanke complex: enlarged hilar lymph node with ipsilateral calcified granuloma (Ghon tubercle) in the peripheral lung field.
What is a pneumothorax?
Free air between the visceral and parietal pleura
What are the aetiologies for pneumothorax
1) Trauma (penetrating injury to chest wall, fracture rib)
2) Pulmonary barotrauma from mechanical ventilators
3) Spontaneous (no antecedent trauma, may be due to localised disease)
4) Tension pneumothorax where air can enter the pleural space but not leave unless the pressure within the spaces rises above atmospheric pressure
What is a primary pneumothorax? How does it differ from a secondary
is one that occurs without an apparent cause and in the absence of significant lung disease, while a secondary pneumothorax occurs in the presence of existing lung pathology.
What is an open pneumothorax
occurs when there is a pneumothorax associated with a chest wall defect, such that the pneumothorax communicates with the exterior.
What is a closed pneumothorax?
results when the chest wall is punctured or air leaks from a ruptured bronchus (or a perforated oesophagus) and eventually ruptures into the pleural space.
What is the clinical presentation of pneumothorax?
Varies depending on extent of involvement and aetiology.
May see sudden:
- sharp chest pain
- dry hacking cough
- may develop severe dyspnoea
- shock
- respiratory failure
- circulatory collapse
Referral of pain to shoulder, chest and abdomen, diminished voice and breath sounds, hyperresonant percussion sounds, diminished absent tactile fremitus, and diminished chest excursion on affected side.
What is the radiological appearance of a pneumothorax?
- Mediastinum shifts to unaffected side with large pneumothorax
- Tension pneumothorax results in complete lung collapse and contralateral mediastinal shift, with hemi-diaphragm depressed or inverted.
- Pneumothorax is usually at lung apex, and lateral to lung; but air may accumulate medially or inferior to lungs.
- PA film taken on full expiration may detect a small pneumothorax. Lateral decubital with affected side uppermost (display air along lateral borders).
Sail sign**
Define COPD
Emphysema is a lung disease that involves damage to the air sacs (alveoli) in the lungs.
What are the causes, incidence and risk factors of COPD
Cigarette smoking is the most common cause of emphysema. Tobacco smoke and other pollutants are thought to cause the release of chemicals from within the lungs that damage the walls of the air sacs.
This damage becomes worse over time. Persons with this disease have air sacs in the lungs that are unable to fill with fresh air. This affects the oxygen supply to the body.
What is the radiological appearance of COPD
- Hyperinflation
- Hyperlucency
- Low set flat diaphragm
- Vertical heart
- Pre and infracardiac lungs
- Barrel shape chest
- Hyperlucent lung fields
- Multiple blebs (small air-containing space - radiolucent)
- Avascular zones
- Prominent pulmonary arteries
