SG 29 Pulm Imaging Flashcards
What is a SOAP note for medicine?
Subjective - pertinent clinical history
Objective - vitals, PE, testing
Assessment
Plan
What is a SOAP note for radiology?
S “ “
Objective - anatomy + imaging patterns
Assessment - differential + leading dx
Plan - recommendations
What is the sternal angle?
Jt bet manubrium and sternum
= plane of the sup and inf mediastinum
Marks level of aortic arch -> pulm art bifurcates below this level
What is in the anterior mediastinum?
Thymus, fat, LNs
What is in the post mediastinum?
Spine, neural foramina
What is the pneumonic for assessing a CXR?
Technical *reason for study* Heart, hilum, mediastinum Osseous + ST structures Respiratory Abdomen Extras + edges
Why do we prefer a PA chest film?
Minimal heart shadow magnification
How many ribs should you be able to ct on a normal CXR?
10
What is the R heart border? L?
R = RA L = LV + atrial appendage
How do you measure heart size?
Cardiothoracic ratio
In comparison to the entire diaphragm
What does an alveolar imaging pattern look like? Causes.
"Fluffy, cloud like" Due to filling of alveolar space Causes: Pus - pna Fluid - edema Blood - hemorrhage Cellular material - cancer Iatrogenic - aspiration
What is atelectasis? Cause.
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
What are some clues for atelectasis on CXR?
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
Describe interstitial CXR pattern. Causes
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
Describe nodular CXR pattern. Causes
Multiple small round opacities- generally extending in a line *Look this up, hard to see* Causes: - Sarcoid - Silica - RA - Cancer - TB
What is the diameter for a solitary pulm nodule?
Defined, well marginated rounded opacity
Differential for lung mass
Cancer
OP
Granuloma
Abscess
Cyst vs cavitation
Cyst = thin walled airspace 3 mm thick
CXR signs of bronchiectasis - cause
= abnormally dilated airways C/ring shapes +/- mucous plugs Top causes: Infection CF
What pattern will usual interstitial fibrosis have?
Reticular
What is the sign for interstitial edema?
Kerly lines = straight lines at the very periphery
Where should you always check for lung masses?
Perihilar - look for the LNs
What pattern will pneumoconiosis due to silica inhilation show on CXR?
Mass + alveolar
Multiple nodular opacities
Upper + post lobe dominate
What will sarcoid present w/ on CXR?
Perihilar masses
Garland’s triad = LN enlargement on either side and above (forms a triangle)
