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(LUSUMA) Respiratory System > S10) Radiology of the Chest > Flashcards

S10) Radiology of the Chest Flashcards

1
Q

Penetration refers to the degree to which the x-rays have passed through the body.

What indicates adequate penetration in a normal CXR?

A
  • Vertebrae just visible through heart
  • Complete left hemidiaphragm is visible
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2
Q

Identify 5 external/iatrogenic material which obstructs the view in a CXR

A
  • Clothes
  • Buttons
  • Hair
  • Surgical/vascular lines
  • Pacemaker
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3
Q

Identify the structures 1-5 in the CXR below:

A
  1. Trachea
  2. Hila
  3. Lungs
  4. Diaphragm
  5. Heart
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4
Q

Identify the structures 6-10 in the CXR below:

A
  1. Aortic knuckle
  2. Ribs
  3. Scapulae
  4. Breasts
  5. Bowel gas
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5
Q

Identify the lung zones in the CXR below:

A
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6
Q

Identify the pleura in the CXR below:

A
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7
Q

Identify the costophrenic angles in the CXR below:

A
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8
Q

Identify the cardiophrenic angles in the CXR below:

A
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9
Q

Identify the cardiac contours in the CXR below:

A
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10
Q

Outline the systematic ABC approach used to evaluate a CXR

A
  • Patient demographics
  • Projection
  • Adequacy
  • ABCDE (airway, breathing, circulation, diaphragm, dem bones)
  • Review areas
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11
Q

What does one look for in the ‘adequacy’ component of the CXR evaluation?

A
  • Rotation – alignment of spinous processes and clavicles
  • Inspiratory volume – look for diaphragm between 5th and 7th ribs, incomplete inspiration, hyperinflation, costo-phrenic recesses and angles, flat diaphragm
  • Penetration – vertebrae just visible through the heart, complete left hemidiaphragm visible
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12
Q

What does one look for in the ‘airway’ component of the CXR evaluation?

A
  • Trachea
  • Bronchi (hila)
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13
Q

What does one look for in the ‘breathing’ component of the CXR evaluation?

A
  • Lungs
  • Pleural spaces
  • Lung interfaces
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14
Q

What does one look for in the ‘circulation’ component of the CXR evaluation?

A
  • Aortic arch
  • Pulmonary vessels (hila)
  • Right heart border: right atrium, middle lobe interface
  • Left heart border: left ventricle, lingula interface
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15
Q

What does one look for in the ‘diaphragm’ component of the CXR evaluation?

A
  • Free gas
  • Nodules
  • Fracture/dislocation
  • Mass
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16
Q

Identify the 8 review areas in a CXR evaluation as well as the abnormalities one looks for

A
  • Apices – pneumothorax
  • Thoracic inlet – mass
  • Paratracheal stripe – mass/lymph nodes
  • AP window – lymph nodes
  • Hila – mass/collapse
  • Behind heart – mass
  • Below diaphragm – pneumoperitoneum/mass
  • Bones – fracture/mass/missing
17
Q

What abnormality can one observe in the following CXR?

A

Pneumothorax

18
Q

Describe 4 radiological findings observed in a pneumothorax

A
  • Tracheal/mediastinal shift away from the pneumothorax (if tension)
  • Depressed hemidiaphragm
  • Visible pleural edge

- Radiolucent field around collapsed lung

19
Q

What abnormality can one observe in the following CXR?

A

Pleural effusion

20
Q

Describe 4 radiological findings observed in a pleural effusion

A
  • Uniform white area
  • Loss of costophrenic angle
  • Hemidiaphragm obscured
  • Meniscus at upper border
21
Q

What abnormality can one observe in the following CXR?

A

Lobar lung collapse

22
Q

Describe 4 radiological findings observed in a lobar lung collapse

A
  • Elevation of the ipsilateral hemidiaphragm
  • Crowding of the ipsilateral ribs
  • Mediastinal shift towards the side of atelectasis
  • Crowding of pulmonary vessels
23
Q

Consolidation is the filling of small airways/alveoli various substances.

Identify 4 possible substances as well as their associated conditions

A
  • Pus – pneumonia
  • Blood – haemorrhage
  • Fluid – oedema
  • Cells – cancer
24
Q

What abnormality can one observe in the following CXR?

A

Lung consolidation

25
Q

Describe 3 radiological findings observed in a lung consolidation

A
  • Dense opacification
  • Volume preserved ± increased
  • Air bronchogram
26
Q

What abnormality is observed in the following CXR?

A

Space occupying lesion

27
Q

What are the two different kinds of space occupying lesions (single/multiple)?

A
  • Nodule < 3 cm
  • Mass > 3 cm
28
Q

What abnormality is observed in the following CXR?

A

Cardiac enlargement

29
Q

What is the cardiothoracic ratio?

A
  • CTR, measured on a PA chest x-ray, is the ratio of maximal horizontal cardiac diameter to maximal horizontal thoracic diameter
  • A normal measurement should be <0.5
30
Q

What abnormality is observed in the following CXR?

A

Pulmonary cavitation

31
Q

What is cavitation in a CXR?

A

A pulmonary cavity is a gas-filled area of the lung in the centre of a nodule or area of consolidation due to infectious and non-infectious diseases

32
Q

Mike, 60 years old, came into A&E with a 3-day history of fever, cough with greenish sputum and pleuritic chest pain.

Referring to the CXR below, answer the following questions:

  • CXR abnormalities?
  • Right side percussion?
  • Right side breath sounds?
  • Diagnosis?
A
  • CXR abnormalities: right-sided opacity in middle zone
  • Right side percussion: dull
  • Right side breath sounds: crepitus & bronchial breathing
  • Diagnosis: pneumonia
33
Q

John, 55 years old presents to his GP with worsening breathlessness of 4 weeks in duration

Referring to the CXR below, answer the following questions:

  • CXR abnormalities?
  • Right side percussion?
  • Right side breath sounds?
  • Diagnosis?
A
  • CXR abnormalities: loss of right heart border & right costophrenic angle
  • Right side percussion: stony dull
  • Right side breath sounds: absent/diminished
  • Diagnosis: pleural effusion
34
Q

Darren, 22 years old, develops sudden onset, sharp right sided chest pain while jogging. This worsens on inspiration and is associated with SOB

Referring to the CXR below, answer the following questions:

  • CXR abnormalities?
  • Right side percussion?
  • Right side breath sounds?
  • Diagnosis?
A
  • CXR abnormalities: right lung collapse, artefact (ECG tag)
  • Right side percussion: hyperresonance (more air)
  • Right side breath sounds: absent/diminised
  • Diagnosis: Spontaneous right-sided pneumothorax
35
Q

Mr Singh, 50 years old, presents with a cough of 3 months in duration, recent haemoptysis, weight loss, night sweats and low grade fever in the evenings.

Referring to the CXR below, answer the following questions:

  • CXR abnormalities?
  • Abnormality at arrow?
  • Diagnosis?
A
  • CXR abnormalities: bilateral consolidation, patchy distribution in left upper and middle zones, slightly obscured left heart border
  • Abnormality at arrow: cavitating lesion
  • Diagnosis: tuberculosis
36
Q

Joseph, 64 years old, increasing SOB for 2 years, chronic cough with productive mucoid sputum, 40 pack year history of smoking.

Referring to the CXR below, answer the following questions:

  • CXR abnormalities?
  • Right side percussion?
  • Auscultation?
  • Diagnosis?
  • Complications?
A
  • CXR abnormalities: flattened diaphragm, hyperinflated lung fields, two ECG tags
  • Right side percussion: diffused hyperresonance
  • Auscultation: wheezing, stridor
  • Diagnosis: COPD
  • Complications: pneumonia, pneumothorax
37
Q

Stephen, 50 years old, presents with dry cough of 3 months duration, recent haemoptysis, 30 pack year history of smoking and finger clubbing.

Referring to the CXR below, answer the following questions:

  • CXR abnormalities?
  • Diagnosis?
  • Other investigations?
  • Complications?
A
  • CXR abnormalities: irregular dense opacity in upper left lobe
  • Diagnosis: lung cancer
  • Other investigations: tumour markers, lung biopsy
  • Complications: compression of left phrenic nerve by lung tumour (elevation of left hemidiaphragm, left mediastinal shift)
38
Q

Michael, 70 years old, presents with loss of appetite, weight loss of 1 month duration, looks emaciated and unwell.

Referring to the CXR below, answer the following questions:

  • CXR abnormalities?
  • Diagnosis?
  • Origin?
  • Investigations?
A
  • CXR abnormalities: obscured right cardiophrenic angle, slightly obscured heart borders, wide bilateral soft tissue nodules (irregular edges, size varies)
  • Diagnosis: multiple lung metastases (cannonball metastases)
  • Origin: primary renal cancer
  • Investigations: full body CT, FBC, tumour biopsy
39
Q

George, 75 years old, presents with increasing SOB for 2 months duration on minimal exertion, SOB at night, previous AMI at 69 years old, past smoker (gave up after heart attack).

Referring to the CXR below, answer the following questions:

  • CXR abnormalities?
  • Apex beat change?
  • Auscultation?
  • Diagnosis?
  • Accumulation of fluid?
A
  • CXR abnormalities: bilateral hilar shadowing, loss of left costophrenic angle, slightly enlarged heart
  • Apex beat change: laterally shifted apex beat
  • Auscultation: fine crackles
  • Diagnosis: heart failure
  • Accumulation of fluid: pulmonary, saccral and peripheral oedema

(LUSUMA) Respiratory System (19 decks)

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