SM_164a: Radiology Flashcards
Why is the PA view preferred to the AP view?
PA view has heart closer to the detector film so AP view has more accurate view of heart
Consolidation is ______
Consolidation is increased density of lung, obscuring the underlying lung architecture
Ground glass opacity is ______
Ground glass opacity is increased density of lung but preservation of underlying lung architecture
Air bronchogram is ______
Air bronchogram is air-filled bronchi surrounded by lung consolidation
Atelectasis is ______
Atelectasis is collapse of airspaces, encompassing mild (subsegment) to whole lung
Reticulation is ______
Reticulation is thickened linear densities representing lung interstitium
(can be sign of fibrosis)
Honeycombing is ______
Honeycombing is dilated airspaces, usually about 1 cm
(definite sign of fibrosis)
What is this?
Trachea
What is this?
Aorta
What is this?
Pulmonary artery
What is this?
Left atrium
What is this?
Left ventricle
What is this?
Right atrium
What is this?
Azygoesophageal line
What is this?
Costophrenic angle
Describe a systematic approach to looking at X-rays
Inner to outer
- Mildine: trachea/carina, aorta, pulmonary artery, heart, azygoesophageal recess
- Hila
- Lungs
- Pleura
- Bones
- Abdomen
Describe the trachea on x-ray
- Lucent tube extending from top of radiograph to carina
- Aorta deviates trachea to the right
- Thin paratracheal stripes on either side of trachea are where vessels and lymph nodes live
Carina is _______ located at ______
Carina is the division of the trachea into the right and left main bronchi located at the sternal angle (approximately T5)
Right main bronchus has a _____ vertical course compared to left main bronchus
Right main bronchus has a steeper vertical course compared to left main bronchus
Which x-ray is abnormal?
B is abnormal
Which x-ray is abnormal?
B is abnormal
Describe the pulmonary artery on x-ray
- Arises from right ventricular outflow tract
- Positioned inferior to aortic arch on frontal view
- Aortic arch and main pulmonary artery make up the AP window
Pulmonary hypertension is _______ of main and central pulmonary arteries on x-ray
Pulmonary hypertension is marked enlargement of main and central pulmonary arteries on x-ray
(PA pressure ≥ 25 mmHg, multiple causes)
On frontal x-ray, the ________ is the right border of the heart and the _______ and _______ comprise the left border of the heart
On frontal x-ray, the right atrium is the right border of the heart and the left atrial appendage and left ventricle comprise the left border of the heart
(less than half of the width of the thorax)
Describe the hila on x-ray
- Normally, most of opacity in the hila is from pulmonary arteries and veins
- Lymph nodes, bronchial arteries, and nerves also located in hila
- Bronchi are lucent
- Left hilum is slightly higher than right
Which x-ray is abnormal?
A is abnormal
Describe the lungs on x-ray
- Should be of equal density and approximately equal size
- Centrally, bronchi and vessels are very visible
- Outer periphery of lungs are more clear (lucent)
Heart touches the ______ of the right lung and the ________ of the left lung
Heart touches the middle lobe of the right lung and the lingula of the upper lobe of the left lung
What is lobar pneumonia?
Uniform area of lung infection that encompasses an entire lobe or majority of a lobe (bounded by a fissure)
(caused by S. pneumoniae, K. pneumoniae, L. pneumophilia)
Silhouette sign means _______
Silhouette sign means the borders of structures are seen because of differences in density
(two adjacent structures of the same density will look like one structure)
How do you localize pneumonia?
Look at which lung and lobe has its borders obscured
Where is the pneumonia?
Right middle lobe
Where is the pneumonia?
Left lower lobe
Which lobes are collapsed?
Right middle lobe and right lower lobe
Where is the lesion?
Bronchus intermedius
Where is the pneumonia?
Left upper lobe
Secondary pulmonary lobule is _______
Secondary pulmonary lobule is the smallest unit of lung covered by connective tissue
(individual secondary pulmonary lobules can be seen on CT)
Kerley B lines are ________ that represent _______
Kerley B lines are short horizontal lines extending from the pleural space that represent interlobular septal thickening
(usually in the lower lungs)
Describe manifestations of pulmonary edema on x-ray
- Enlarged cardiac silhouette
- Enlarged ill-defined pulmonary vessels
- Bilateral airspace opacities
- Pleural effusions
What is the most likely diagnosis?
Cancer
Lymphangitic carcinomatosis is _______ represented by _______
Lymphangitic carcinomatosis is buildup of fluid in lymphatic channels due to blockage from tumor cells represented by smooth or nodulat interlobular septal thickening
What fissure is this?
Oblique fissure
What would you do first?
Needle decompression
Describe the pleura on x-ray
- Outer lining of the lung and chest wall
- Visceral pleura covers the lung
- Parietal pleura covers the inner chest wall
- Pleural space lies between the two layers
Describe the fissures
- Right lung: minor fissure divides upper and middle lobes, major fissure divides upper/middle and lower lobes
- Left lung: major fissure divides upper and lower lobes
- Fissures commonly incomplete
Major fissure = oblique
Minor fissure = horizontal
The parietal pleura extends to the _____ rib anterior, _____ rib lateral, and _____ posterior
The parietal pleura extends to the 8th rib anterior, 10th rib lateral, and T12 posterior
What is wrong in the image on the left?
Blunted costophrenic angles
Describe the manifestations of pneumothorax on x-ray
- Air in pleural space
- Many causes: ruptured bleb, trauma, iatrogenic, lung disease (e.g. emphysema)
- Look for the visceral pleural line
Describe the manifestations of tension pneumothorax on x-ray
- Shift of mediastinum
- Depression of the diaphragm
- Collapse of the lung
- Vascular compromise (decreased blood return)
- Requires chest tube or decompression
Deep sulcus sign is a ________
Deep sulcus sign is a pneumothorax in a supine patient
- Air collects in inferior hemithorax
- Air dissects potential space between the pareital pleura of the diaphragm and lateral chest wall
- Sulcus will be widened, deeper, and hyperlucent
Where is the consolidation?
Left lower lobe
What is this?
Pulmonary artery
What is wrong?
Bad ET tube
What is the most likely diagnosis?
Pulmonary edema
Where is the abnormality?
Right middle lobe
This line represents how many layers of pleura?
2
This line represents how many layers of pleura?
2
What is the most likely diagnosis?
Pneumothorax
What is the arrow pointing to?
Interlobular septa w/ pulmonary vein and lymphatidc
The hila are usually enlarged in cases of _______ or _______
The hila are usually enlarged in cases of adenopathy or pulmonary artery enlargement
The pleura extend more _______ compared to the lung
The pleura extend more inferiorly compared to the lung
(interventions in the upper abdomen have the potential to injure the pleura)
On x-ray, you ______ see the borders of two adjacent structures of like density
On x-ray, you will not see the borders of two adjacent structures of like density
In the secondary pulmonary lobule, _______ and ______ are at the center, while ______ and ______ are at the periphery
In the secondary pulmonary lobule, bronchioles and pulmonary arteries are at the center, while veins and lymphatics are at the periphery
