SM 164a - Radiology Flashcards
What usually causes blunting of the costophrenic angles?
Pleural Effusion
What heart abnormality might cause unilateral left hilar enlargement?
Pulmonary valve stenosis
What are the chest x-ray findings of pulmonary edema?
- Enlarged cardiac silhouette
- Enlarged, ill-defined pulmonary vessels
- Bilateral airspace opacities
- Pleural effusions
Where are the borders of the secondary pulmonary lobule (SPL)?
Interlobular septa, containing pulmonary veins and lymphatics
What is atelectasis?
Collapse of airspaces.
The term encompasses mild (subsegment) to whole lung collapse
List some common examples of lung pathologies that cause with centrilobular opacities on chest x-ray.
What structures are affected by these diseases?
- Pulmonary edema
- Bronchiolitis
- Hypersensitivity pneumonitis
These pathologies affect the bronchioles and intralobular artery (structures in the central portion of the SPL)
What is lobular pneumonia?
What would you see on a chest x-ray?
Pneumonia that encompasses an entire lobe/majority of a lobe of the lung
- Uniform area of lung infection (no patchiness)
- Infection is bound by a fissure
Which structures in the hila is enlarged in sarcoidosis?
Lymph nodes
What structure is arrow #4 pointing to?
Pulmonary Arteries
Describe the appearance of a pleural effusion on chest x-ray
Blunting of the costophrenic angles on the frontal or lateral view
What is structure E?
Pulmonary Hila
What would you see on a chest radiograph if there were a pneumonia or mass in the medial aspect of the lingula?
The left heart border (left ventricle border) would be obscured
Which lobes can be thought of as the posterior lobes?
Lower lobes
Which structures in the hila are enlarged in pulmonary hypertension?
Main and central pulmonary arteries
What is the most likely diagnosis?
A. Pneumonia
B. Pulmonary edema
C. Lobar collapse
D. Pneumothorax
D. Pneumothorax
What chest x-ray findings are you looking for when you assess the pleura?
- Costophrenic angles on frontal and lateral view
- Should be sharp; blunted in pleural effusion
- Lateral view is more sensitive for the detection of pleural fluid
List some common pathologies that cause with interlobular septal thickening (on CT) and Kerley B lines (on Chest x-ray).
Interlobular septal thickening is caused by thickening of the outer connective layer of the secondary pulmonary lobule
- Interstitial pulmonary edema
- Lymphatic carcinomatosis
Affect structures in the periphery of the SPL (pulmonary veins and lymphatics)
Describe the appearance of a tension pneumothorax on a chest x-ray
- Shift of the mediastinum
- Depression of the diaphragm
- Collapse of the lung
In which direction is a lateral view chest x-ray taken?
From right to left
How can one differentiate the interlobular septal thickening in pulmonary edema vs. lymphangitic carcinomatosis?
Pulmonary edema = bilateral, smooth
Lymphangitic carcinomatosis = unilateral, smooth early, nodular later on
Which lobe(s) are collapsed?
Right middle lobe and right lower lobe
The right heart border and diaphragm border are obscured; caused by a lesion in the bronchus intermedius
In a normal, healthy person, on an inspiratory frontal radiograph, the lungs extend to the ____th rib posteriorly and the ___th rib anteriorly
In a normal, healthy person, on an inspiratory frontal radiograph, the lungs extend to the 10 th rib posteriorly and the 6th th rib anteriorly
List 3 key features of a normal lung x-ray
- Equal density, approximately equal size
- The bronchi and vessels are very visible centrally
- The outer peripher of the lungs are clearer than the center
- You should not see the peripheral bronchioles clearly
What pathology might cause the fissures of the lungs to be seen easily?
Lobar pneumonia
Describe the appearance of a pneumothorax on a chest x-ray
Discrete visualization of the pleural line
If the patient is upright: air collects at the apex of the hemithorax
If the patient is supine: Air collects in the anterior, inferior hemithorax -> deep sulcus sign (sharper/invaginated costophrenic angle on one side)
In a chest x-ray, is the PA view superior to the AP view?
The PA view more closely approximates the size of the heart
AP view artificially accentuates the heart size
What structure is arrow #1 pointing to?
Interlobular septa
contains pulmonary veins and lymphatics
What are the yellow arrows pointing to?
What might be causing this?
Kerley B lines
Caused by interlobular septal thickening due to pulmonary edema or lymphangitic carcinomatosis
How many layers of pleura are in the junction lines (between lobes of the lung)?
4
One visceral and one parietal for each lobe
What would you see on a chest radiograph if disease were present in the lower lobes of the lung?
The diaphragm would be obscured
Which picture shows reticulation?
Which one shows honeycombing?
- A = Reticulation
- Thickened linear densities
- Can be a sign of fibrosis
- B = Honeycombing
- Dilated airspaces (rounder), usually ~1cm
- A definite sign of fibrosis
Which x-ray is abnormal?
A (on the left)
Where is the pneumonia?
Right middle lobe
The right heart boarder is obscured because there is consolidation in the right middle lobe due to pneumonia
What pathology is shown in this chest x-ray?
Pleural effusion
Blunted costophrenic angles are a classic chest x-ray finding in pleural effusion
What abnormalities might leftward tracheal deviation indicate?
Right aortic arch or mediastinal mass
What would you see on a chest radiograph if there were a pneumonia or mass in the middle lobe of the right lung?
The border between the lung and the right atrium will be obscured
What is the most likely diagnosis?
A. Pulmonary edema
B. Cancer
C. Pneumonia
D. Pneumothorax
B. Cancer
Lymphangitic carcinomatosis - unilateral pulmonary edema. Fluid builds up due to blockage from tumor cells.
What structure is this?
Costophrenic angle
Which hilum is usually slightly higher?
Left hilum is usually slightly higher than the right
What is structure D?
Descending aorta
What is the CT analog for Kerley B lines on a chest radiograph?
What diseases might they indicate?
CT analog = interlobular septal thickening
These findings indicate pulmonary edema (if bilateral) or lymphangitic carcinomatosis (if unilateral)
Interlobular septal thickening becomes nodular later on in the disease process of lymphangitic carcinomatosis (stays smooth the whole time in pulmonary edema)
What is an air bronchogram?
Air-filled bronchi surrounded by lung consolidation
What is the difference in the appearance of consolidation and ground glass opacity on chest x-ray?
Both have increased density (brighter)
Consolidation obscures underlying structures
Ground glass preserves underlying structures
List 2 diseases that could cause enlargement of the hila on chest x-ray?
- Pulmonary hypertension:Enlarged central pulmonary arteries
- Sarcoidosis: enlarged hilar lymph nodes
What structure is this?
Left Ventricle
Which lobes of the lung are the anterior lobes?
Upper lobes
What structure is this?
Left atrium
What structures are at the center of the secondary pulmonary lobule?
Pulmonary veins and lymphatics
Which lobes of the lung touch the heart?
- Middle lobe of the right lung
- Lingula of the left lung
What is a deep sulcus sign?
What does it indicate?
Hyperluscency of the diaphragm
Caused by pneumothorax in a patient who is supine; air collects in the inferior hemithorax
May also see deepened, hyperluscent costophrenic angles
What is the smallest unit of the lung that has a connective tissue covering?
Secondary pulmonary lobule (SPL)
What does thickening of the interlobular septa indicate?
- Fluid in the septa (in pulmonary veins and lymphatics)
- This appears as Kerley B lines on chest X-ray!
What structure is this?
Pulmonary Artery
When would you order a chest x-ray with an AP view?
If the patient cannot sit or stand upright
Usually, you would want to ordern a PA view to minimize false magnification of the mediastinum in the chest cavity
What structure is arrow #2 pointing to?
Pulmonary veins + lymphatics
What is structure A?
Trachea
Which section contains “ground glass opacity?”
Which section contains consolidation?
- A = Consolidation
- Increased density that obscures the underlying architecture of the lung
- B = Ground glass opacity
- Increased density, but the underlying architecture of the lung is preserved
Which lung is aspirated material most likely to enter?
Why?
The right lung
The right mainstem bronchus is shorter and more vertically oriented than the longer, more horizontal left mainstem bronchus.
Where is the pneumonia?
Left lower lobe
Can see the left heart border => not in the left upper lobe
The left hemidiaphragm is obscured => pneumonia in the left lower lobe
Which fissure is the yellow arrow pointing to?
Oblique fissure, aka major fissure (this is the right lung)
What are paratracheal stripes?
Slightly brighter lines on either side of the trachea, where vessels and lymph nodes live
They are a normal finding on a chest x-ray
What structure is this?
Right atrium
What structure is the yellow arrow pointing to?
Pulmonary vein in the interlobular septa
What creates a silhouette sign?
The silhouette sign is created by differences in density. Tehse differences allow us to see the boarders of structures
Structures of the same density where one is behind the other will be visible
Structures of the same density where one is surrounding the other will not be visible
What structure is arrow #3 pointing to?
Bronchioles
Which hilum will be enlarged in pulmonary valve stenosis?
Left hilum
Which 4 structures can be found in the pulmonary hila?
- Bronchi
- Pulmonary arteries
- Pulmonary veins
- Lymph nodes
What causes the normal, slight-rightward deviation of the mid-thoracic trachea?
The arch of the aorta
Support devices like endotracheal tubes are more likely to be abnormally placed into the [right/left] mainstem bronchus
Support devices like endotracheal tubes are more likely to be abnormally placed into the right mainstem bronchus
Where is the abnormality in this chest x-ray?
The trachea - Deviated to the left due to a right aortic arch
The lungs are normal
What is structure B?
Carina
Where is the pneumonia?
Left upper lobe (lingula)
Left heart boarder is obscured
What is structure C?
Aortic Arch
The segmental bronchi arise from the ________
The segmental bronchi arise from the Lobular bronchi
