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Respiratory: Radiology > Respiratory Imaging > Flashcards

Respiratory Imaging Flashcards

1
Q

What normal structures can be seen on a CXR?

A
  • Heart
  • Great vessels
  • Pulmonary hila
  • Trachea and bronchi
  • Lungs
  • Pleura & pulmonary fissures
  • Diaphragms
  • Bones
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2
Q

What are the pulmonary hila?

A

The hila are the junctions between the heart and lungs, where the pulmonary arteries and bronchi enter the lungs and the pulmonary veins exit the lungs

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3
Q

Why is the anatomical relationship of the right main bronchus and pulmonary artery different from that of the left main bronchus and pulmonary artery?

A

The normal lift hilum lies superior to the right

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4
Q

Why are the hila an important CXR site?

A
  • They are a common place for bronchial carcinoma to arise

* Lymph nodes located there may become visibly enlarged due to disease

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5
Q

Are trachea and bronchi visible on a CXR?

A

Trachea is visible but major and minor bronchi are poorly shown

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6
Q

When are minor and major bronchi visible?

A

When they are calcified, as may occur in older people

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7
Q

Where is a majority of the lower lung lobe located?

A

Posteriorly

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8
Q

What the anatomical relationship between the right and left hemi-diaphragm on a normal CXR?

A

The right diaphragm lies about 1.5cm above the left diaphragm

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9
Q

What diseases can cause diaphragmatic depression?

A
  • Emphysema
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10
Q

Name the structures labelled A-I

pic

A 
A - spinous process
B - aortic arch
C - left lower lobe pulmonary artery 
D - Left ventricle
E - gastric air bubble
F - Right hemidiaprhagm
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11
Q

Name the structures labelled A-I

pic

A 
A - spinous process
B - aortic arch
C - left lower lobe pulmonary artery 
D - Left ventricle
E - gastric air bubble
F - Right hemidiaphragm 
G - right atrium 
H - right ventricle 
I - Medial end of clavicle
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12
Q

What colour should the retro sternal and retro cardiac spaces be on a CXR?

A

Dark - if they are not, disease is present

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13
Q

What respiratory disease processes can be detected on a CXR?

A
  • Pneumonia
  • Lobar collapse
  • Pneumothorax
  • Pleural effusion
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14
Q

How can the outline of a structure be discriminated from its neighbour on CXR?

A

If it has a different radiographic density
e.g. the right heart border (soft tissue density) can be seen because it is adjacent to the right middle lobe (air) and the outlines of the diaphragms can be seen because they are adjacent to the air filled lower lobes

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15
Q

When would they outline of a structure adjacent to the lungs not be seen?

A

Diseases can cause an increase in lung density - structure cannot be seen because it shares the same density as the diseased lung

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16
Q

How can right middle lobe pneumonia be diagnosed form a CXR?

A
  • The right heart border opposite can no longer be discerned, so we can predict that the right middle lobe is involved
  • Right diaphragm remains visible
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17
Q

What happens to lung density in pneumonia?

A

In pneumonia, airspaces are filled by inflammatory exudate and affected lung becomes of soft tissue density

18
Q

How can lingular pneumonia be diagnosed from CXR?

A

Infection of the lingula causes the left heart border to become obscured

19
Q

What is the lingula of the left lung anatomically equivalent to?

A

The right middle lobe

20
Q

When does lobar collapse occur?

A

When there is obstruction of the lobar bronchus

21
Q

What are causes of bronchial obstruction?

A
  • Tumours
  • Aspirated foodstuffs
  • Mucous impaction
22
Q

Explain the process of lobar collapse

A

The lobe supplied by an obstructed bronchus is no longer ventilated and its air gets resorbed. As the affected lobe loses volume it begins to collapse, like a balloon deflating

23
Q

What is the appearance of a collapsed lobe on CXR?

A

The collapsed lobe’s density increases and the adjacent major fissure is dragged out of position

24
Q

What is a distinct nature of left lower lobe collapse on CXR?

A

Sail sign

25
Q

Describe the appearance of a left lower lobe collapse on CXR

A
  • Sail sign
  • Displaced left olibque fissure
  • Obscured medial part of left hemidiaphragm
26
Q

What are the features of a left upper lobe collapse?

A
  • Left oblique fissure is pulled anteriorly
  • Left heart border becomes obscured
  • Reduced left lung size
  • Trachea displaced towards left side
27
Q

What are the features of a right upper love collapse?

A
  • Displaced right horizontal fissure

* Trachea displaced towards right side

28
Q

When is the pleural cavity visible on CXR?

A

When filled with fluid (pleural effusion) or air (pneumothorax)

29
Q

What are the features of pleural effusion on a CXR?

A

On an erect CXR, dense pleural fluid collects at the lung bases and often forms the curved appearance of a ‘meniscus’ at the lung edges (meniscus sign)

30
Q

Will pleural effusion always show a ‘meniscus sign’ on a CXR?

A

Only when erect - not supine, etc

31
Q

What is a common cause of pneumothorax?

A

Spontaneous rupture of the visceral pleura, allowing air to rush in from the lungs every time the patient inspires

32
Q

What are the features of a pneumothorax on CXR?

A

A dark crescent without lung markings bound medially by the lung edge. It is often at the lung apex.

33
Q

What is an iatrogenic cause of pneumothorax?

A

Complication of a medical procedure, such as insertion
of a cardiac
pacemaker

34
Q

What is tension pneumothorax?

A

If the pneumothorax accumulates large amounts of air, it will squash the lungs so that the patient cannot ventilate them

35
Q

Is tension pneumothorax serious?

A

It is a medical emergency and the pneumothorax must be drained immediately

36
Q

What does the treatment of pneumothorax involve?

A

Creating a channel of air in affected lung to relieve pleural pressure

37
Q

What are the features of tension pneumothorax on a CXR?

A
  • Large air filled pleural space (dark)
  • Displaces the mediastinum away from affected lung and depresses the affected hemi-diaphragm
  • The collapsed lung is squashed against the heart
38
Q

What are examples of lines and tubes inserted into patients by doctors?

A
  • Endotracheal (ET) tubes
  • Nasogastric tubes
  • Central venous lines
39
Q

What is used to confirm the correct placement of lines and tubes?

A

Chest x-rays (can detect complications such as iatrogenic pneumothorax)

40
Q

Where should the tip of an endotracheal (ET) tube be positioned?

A

2cm proximal to the carina

41
Q

What happens if ET tube is inserted too far and enters the right main bronchus?

A
  • Collapse of unventilated left lung

* Pneumothorax of right lung as twice the resistance

42
Q

Why is it more common for ET tube to be incorrectly inserted into right main bronchus than left main bronchus?

A

There is a more obtuse angle between trachea and right main bronchus

Respiratory: Radiology (4 decks)

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