Respiratory imaging

Question 1

Answer 1

Reticular fibrosis throughout both lungs both pronounced in the mid and lower lobes
Honeycomb change is apparent most pronounced at the right base

Question 2

Answer 2

Pleural thickening

Question 3

Answer 3

Kerley A lines are linear opacities extending from the periphery to the hila caused by distention of anastomotic channels between peripheral and central lymphatics
Kerley B lines are small, horizontal, peripheral straight lines demonstrated at the lung bases that represent thickened interlobular septa on CXR. They represent edema of the interlobular septa and though not specific, they frequently imply left ventricular failure
Kerley C lines are reticular opacities at the lung base, representing Kerley’s B lines end on

Kerley’s A lines (arrows); Kerley B lines (white arrowheads); Kerley C lines (black arrowheads)

Question 4

Answer 4

Upper lobe venous diversion
Increase in left atrial pressure (10-15mmHg) typically as a result of left heart failure or mitral valve disease.

Question 5

Answer 5

Perihilar consolidation (due to pulmonary edema)

Classical batwing apperance (in very severe congestive heart failure)

Question 6

What is the classical sign of consolidation?
How does it happen?

Answer 6

If an area of lung is consolidated it becomes dense and white. Larger airways are spared, they are relatively lower density (blacker).
Dark lines through the area of white are classical air bronchograms.

Question 7

What are the causes of consolidation?

Answer 7

Pus (pneumonia)
Fluid (pulmonary edema)
Blood (pulmonary hemorrhage)
Cells (cancer)

Question 8

What abnormality
Potential ddx?
Patient is IVDU and presented with high fever

Answer 8

Unilateral right middle zone abnormality

dx: septic embolus

Ddx
* Lung abscess: TB, klebsiella or staph aureus
* Lung cancer
* Fungal infection (if immunocompromised): mycetoma (aspergilloma)
* Granulomatosis with polyangiitis

Question 9

What is the appearance of empyema vs pleural effusion?

Answer 9

Empyemas
* Form an obtuse angle with the chest wall
* Unilateral or markedly asymmetric whereas pleural effusions are usually bilateral and similar in size
* Lenticular in shape (biconvex), whereas pleural effusion are crescentic in shape (concave towards the lung)

Question 10

Answer 10

Hampton hump refers to a dome-shaped, pleural-based opacification in the lung most commonly due to pulmonary embolism and lung infarction. Opacification occurs secondary to haemorrhage due to the dual blood supply from the bronchial arteries.