Session 10: Radiology II

Question 1

What is important in order to have an adequate image to assess the lungs?

Answer 1

Projection (Usually PA)

Inclusion

Rotation

Lung volumes

Penetration

Question 2

Inclusion:

What do we need to see on a CXR?

Answer 2

1 st rib

Lateral margin of ribs

Costophrenic angle

Question 3

Rotation:

What is important to see?

Answer 3

The alignment of the spinous process and clavicles.

Question 4

Lung volumes:

What is important to see?

Answer 4

A normal lung volume during the inspiratory phase would show 5th to 7th anterior ribs at the midclavicular line.

Question 5

Why is adequate penetration important?

Answer 5

To make sure the vertebrae are just visible through the heart and so we can see the left hemidiaphragm.

Question 6

Explain the systemic approach to evaluate a CXR.

Answer 6

Check the patients demographics.

Check that projection, rotation, penetration and lung volumes are alright.

ABCD

Airways

Breathing

Circulation

Diaphragm/Bones

and then lastly review areas.

Question 7

What is evaluated in adequacy?

Answer 7

RIP

Rotation

Inspiration

Penetration

Question 8

What is evaluated in airways?

Answer 8

Trachea, bronchi and hila

Question 9

What is evaluated in breathing?

Answer 9

Lungs

Pleural spaces

Lung interfaces

Question 10

What is evaluated in circulation?

Answer 10

Mediastinum

Aortic arch

Pulm vessels

Right heart border, right atrium and middle lobe interface

Left hear border, left ventricle and lingula interface.

Question 11

What is evaluated in diaphragm and bones?

Answer 11

Free gas

Nodules

Fracture/dislocation

Mass

Question 12

What is evaluated in review areas?

Answer 12

Apices (pneumothorax or malignancy)

Thoracic inlet (mass)

Paratracheal stripe (mass)

AP window (LN)

Hila (mass/collapse)

Behind the heart (mass)

Below diaphragm (pneumoperitoneum/mass)

Bones (fracture/mass/missing bones)

Edge of films

Question 13

Answer 13

Question 14

What is the silhouette sign?

Answer 14

Adjacent structures of differing density will form a nice silhouette.

If this silhouette is lost it can locate pathology.

Question 15

What causes a mediastinal shift (push)?

Answer 15

Increase volume or pressure

Question 16

What causes a mediastinal shift (pull)?

Answer 16

Decrease voume or pressure

Question 17

Why might mediastinal shift not be a sign of pathology?

Answer 17

If the image is not adequately centered.

Question 18

What is this?

Answer 18

Pneumothorax

Question 19

Answer 19

Pleural effusion

Question 20

How do pleural effusions show on CXR?

Answer 20

Uniform white area where there is loss of the costophrenic angle and the hemidiaphragm is obscured.

Question 21

What are the generic findings of a lobar lung collapse?

Answer 21

Elevation of the ipsilateral hemidiaphragm.

Crowding of the ipsilateral ribs

Shift of the mediastinum towards the side of the atelectasis.

Crowding of the pulmonary vessels.

Question 22

What is consolidation?

Answer 22

Filling of small airways/alveoli with something.

Question 23

What might consolidation be?

Answer 23

Pus (pneumonia)

Blood (haemorrhage)

Fluid (oedema)

Cells (Cancer)

Question 24

How does consolidation show up on CXR?

Answer 24

Dense opacification

Volume preservation but may be either increased or decreased as well.

Air bronchogram

Question 25

Answer 25

Consolidation of left middle zone

Question 26

When is a space occupying lesion a nodule and when is it a mass?

Answer 26

Nodule <3 cm

Mass >3 cm

Question 27

Give causes of SOL.

Answer 27

Malignancy

Bening mass lesio

Inflammatory

Congenital

Mimics

Question 28

Answer 28

Question 29

Answer 29

Question 30

What is the cardiac index?

Answer 30

A ratio where the heart should be <50%

It must be assessed on PA image

Question 31

What else than CXR can be done in order to assess lung pathology?

Answer 31

Screening Chest CT (low-dose)

CT pulmonary angiogram

Standard chest

Ultrasound

Nuclear medicine