Respiratory imaging Flashcards
Reticular fibrosis throughout both lungs both pronounced in the mid and lower lobes
Honeycomb change is apparent most pronounced at the right base
Pleural thickening
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)
Upper lobe venous diversion
Increase in left atrial pressure (10-15mmHg) typically as a result of left heart failure or mitral valve disease.
Perihilar consolidation (due to pulmonary edema)
Classical batwing apperance (in very severe congestive heart failure)
What is the classical sign of consolidation?
How does it happen?
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.
What are the causes of consolidation?
Pus (pneumonia)
Fluid (pulmonary edema)
Blood (pulmonary hemorrhage)
Cells (cancer)
What abnormality
Potential ddx?
Patient is IVDU and presented with high fever
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
What is the appearance of empyema vs pleural effusion?
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)
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.
Collapse of L lung and right pleural effusion
Use gatric bubble to locate the level of L hemidiaphragm
Patch of opacification, air space consolidation
Its not fissure/lobar distribution (not lateral)
Well defined straight borders: Radiation fibrosis
Haziness on right side
Shadows not related to fissure
Asbestos exposure with pleural and pericardial plaques –> look out for asbestosis and lung cancer too
cardiomegaly
Absence of breast tissue on right side: right mastectomy
MS mechanical valve replacement
Sternotomy wires
4 humps on L cardiac border –> LA enlargement + PHT
Mitral valve located most posteriorly hence in difficult patients (e.g. obese) TEE is prefered to TTE in assessing mitral valve
- LLZ haziness overlapping the diaphragm
Heart moved to the left so increased opacity in RLL may be normal as more lung exposed
dx: acute exacerbation of chronic lung disease - CBC (leukocytosis), Sputum for bacterial culture, AFB smear and culture, blood culture (if high fever)
- HRCT (due to volume loss)
ILD will be bilateral
- Dilated bronchioles
Right hilar shadow
Apical part of lower lung opacification
mass encompassing bronchi (lung CA)
Start empirical antibiotics
What complication may she be having?
What is ur next step of mx?
Lost of costophrenic angle
Pleural effusion
Pneumonia causing parapneumonic effusion or loculated empyema (will require fibrinolytics + antibiotics)
Decubitus XR (to see if pleural effusion changes to rule out loculated pleural effusion)
USG guided Pleural tapping
Left upper opacity
Below CT: cavitation (black air)
Cavitation causes: TB, CA (SCC, AD, SCLC), abscess (if fluid level present: pus)
Hyperinflated lung
Compressed heart
Thin cardiac shadow
Hyperinflated lung
Normally diaphragm may be flattened
COPD
Right heart dilatation
Prominent left hilar shadow (pulmonary vessel)
- Opacification of right lung (homogenous density): can be right lung collapse/obstruction of right main bronchi
- Ipsilateral deviation of trachea
- Heart shadow closer to spine
Mx
* O2 supplement
Pleural effusion
Contralateral deviation of trachea
Left XR shows calcified aortic knuckle
There may be concomitant lung collapse
bony lesion (rib gone)
Left lower zone mass (overlapping with diaphragm)
Hypertrophic osteoarthropathy/clubbing in below pic
Take XR of wrist/ankle –> periosteal thickening
- Left mass on lower lung
- Left pulmonary vasculature are increased
- Small left pleural effusion (fluid level seen)
- Phrenic nerve palsy: Higher left hemidiaphragm
- May also effect left RLN (LN compression normally)
Dont comment on lateral XR diaphragm level (as direction of beam can be altered)
- EGFR: gefitnib
- T790M mutation: erlotinib
Deviation of trachea to the left (LN causing pressure)
ILD due to TKI (TKI induced pneumonitis) –> stop TKI
Not RT pneumonitis (will be focal lesion in radioportal)
Need HRCT
Diffuse ground glass opacity
- Bilateral reticonodular shadowing
- Thickened interstitium
- Honeycombing
dx: connective tissue associated pulmonary fibrosis
- Bilateral diffuse haziness
- Pneumocystis jirovecii (BAL with methanamine silver stain)
- CMV pneumonitis
- hemorrhage
- portable photo: so variable size
Post bronchoscopy day 1
Right pneumothorax (common post bronchoscopy)
- Left upper lobectomy
- Chest drain in situ on left side
- Left diaphragm elevated due to left lung volume loss
- Surgical emphysema on left (gas under subcutaneous tissue outside rib cage)
