SG 29 Pulm Imaging

Question 1

What is a SOAP note for medicine?

Answer 1

Subjective - pertinent clinical history
Objective - vitals, PE, testing
Assessment
Plan

Question 2

What is a SOAP note for radiology?

Answer 2

S “ “
Objective - anatomy + imaging patterns
Assessment - differential + leading dx
Plan - recommendations

Question 3

What is the sternal angle?

Answer 3

Jt bet manubrium and sternum
= plane of the sup and inf mediastinum
Marks level of aortic arch -> pulm art bifurcates below this level

Question 4

What is in the anterior mediastinum?

Answer 4

Thymus, fat, LNs

Question 5

What is in the post mediastinum?

Answer 5

Spine, neural foramina

Question 6

What is the pneumonic for assessing a CXR?

Answer 6

Technical *reason for study*
Heart, hilum, mediastinum 
Osseous + ST structures 
Respiratory 
Abdomen 
Extras + edges

Question 7

Why do we prefer a PA chest film?

Answer 7

Minimal heart shadow magnification

Question 8

How many ribs should you be able to ct on a normal CXR?

Answer 8

10

Question 9

What is the R heart border? L?

Answer 9

R = RA
L = LV + atrial appendage

Question 10

How do you measure heart size?

Answer 10

Cardiothoracic ratio

In comparison to the entire diaphragm

Question 11

What does an alveolar imaging pattern look like? Causes.

Answer 11

"Fluffy, cloud like"
Due to filling of alveolar space
Causes:
Pus - pna
Fluid - edema
Blood - hemorrhage 
Cellular material - cancer 
Iatrogenic - aspiration

Question 12

What is atelectasis? Cause.

Answer 12

Blockage of the airway -> all the lung behind it is not airated
Volume loss due to alveolar collapse -> this lung is more opaque
Causes:
Mucus plugs - asthma
Malpositioned ET tube
Kid swallows foreign body
Bonchial carcinoma in smokers

Question 13

What are some clues for atelectasis on CXR?

Answer 13

The affected area should be lighter than rest of lung since lung is w/o air
+/- tenting of diaphragm
+/- S sign if R upper lobe = bronchogenic carcinoma
**also check heart borders - if obscured could be due to this

Question 14

Describe interstitial CXR pattern. Causes

Answer 14

Pulm veins + lymphatics are prominent -> web like, grainy
Cause:
1. Accumulation of fluid
2. Increased lymph drainage
3. Fibrosis - asbestos, silica, MTX, amiodarone
4. Sarcoid

Question 15

Describe nodular CXR pattern. Causes

Answer 15

Multiple small round opacities- generally extending in a line
*Look this up, hard to see*
Causes:
- Sarcoid
- Silica
- RA
- Cancer
- TB

Question 16

What is the diameter for a solitary pulm nodule?

Answer 16

Defined, well marginated rounded opacity

Question 17

Differential for lung mass

Answer 17

Cancer
OP
Granuloma
Abscess

Question 18

Cyst vs cavitation

Answer 18

Cyst = thin walled airspace 3 mm thick

Question 19

CXR signs of bronchiectasis - cause

Answer 19

= abnormally dilated airways
C/ring shapes +/- mucous plugs
Top causes: 
Infection 
CF

Question 20

What pattern will usual interstitial fibrosis have?

Answer 20

Reticular

Question 21

What is the sign for interstitial edema?

Answer 21

Kerly lines = straight lines at the very periphery

Question 22

Where should you always check for lung masses?

Answer 22

Perihilar - look for the LNs

Question 23

What pattern will pneumoconiosis due to silica inhilation show on CXR?

Answer 23

Mass + alveolar
Multiple nodular opacities
Upper + post lobe dominate

Question 24

What will sarcoid present w/ on CXR?

Answer 24

Perihilar masses

Garland’s triad = LN enlargement on either side and above (forms a triangle)