Soft Tissue Quiz 1

Question 1

How is quality of a chest film evaluated?

Answer 1

1. Adequate inspiration? (mid R hemidiaphragm at rib 10 posterior)
2. Entire lung field (apex, lateral CP angles)
3. Adequate film density/contrast (IVD spaces thru heart shadow)

Question 2

What is the ABCs search pattern for chest films?

Answer 2

Abdomen
Bone
Cardiovascular
Soft Tissue of the Thoracic cavity

Question 3

First steps in evaluation of a PA chest film?

Answer 3

1. Lung fields ~same size?
2. R hemidiaphragm slightly HIGHER than left (= is okay)
3. Left hilum slightly higher than right (= is okay)
4. Cardiac silhouette mostly left of spine
5. Trachea is midline

Question 4

A in ABCs

Answer 4

Abdomen: abnormal densities, gas patterns, organ outlines below hemidiaphragms

Question 5

B in ABCs

Answer 5

Evaluate all osseous structures: size, shape, location, density, cortical margins, trabeculae, joint spaces, alignment

Question 6

Heart eval (C in ABCs)

Answer 6

1. Upper portion midline, heart mostly left
2. Cardiothoracic ratio (~1/2 cavity) only on upright films
3. Mediastinal contours normal
4. Cardiac fat pads at L/R cardiophrenic angles

Question 7

What may the cardiophrenic angles do to the cardiac fat pads?

Answer 7

Blur them, especially on the left

Question 8

Lung eval (C in ABCs)

Answer 8

1. Hila similar density (L higher)
2. Vessels more prominent, larger caliber to lower than to upper lung fields
3. Vessels branch and taper

Question 9

How are the hila different

Answer 9

1. LEFT: more round, horizontally oriented, not lobulated

2. RIGHT: slightly oblong, vertically oriented

Question 10

How do lung vessels branch and taper?

Answer 10

1. Central 1/3 are <1cm diameter
2. Middle 1/3 are = 7-8 mm
3. Peripheral 1/3 < 5mm

Question 11

How do you examine pleura?

Answer 11

1. Follow margins of lung field (may only be visible at fissures)
2. Pay special attention to costophrenic angles (P and L)
3. Air filled lung should extend inside margins or ribs
4. Fissures are thin, even, white lines

Question 12

Horizontal fissure

Answer 12

1. Seen on PA and lateral films
2. PA: extends medial to lateral at level of 4th anterior rib
3. Lateral: extends from oblique fissure anteriorly to chest wall

Question 13

Oblique fissure

Answer 13

1. Not visible on PA

2. Lateral: extends from T4-5 to anterior portions of the hemidiaphragms

Question 14

Apical pleura

Answer 14

1. Capping = the presence of extra fibrous tissue at the apex
2. Should be bilateral
3. Should be concave inferiorly

Question 15

What is consolidation?

Answer 15

1. A broad descriptive term which indicates an increase in density
2. Often described as patchy and ill-defined

Question 16

What disease processes will show consolidation?

Answer 16

Those that put: blood, water, pus, protein or cells in the lungs

Question 17

What are the patterns of opacification?

Answer 17

1. Diffuse
2. Localized/Lobar
3. Solitary Mass/Nodule
4. Multiple masses/nodules

Question 18

Diffuse pattern

Answer 18

1. Usually bilaterally symmetric
2. Suggestive of more systemic disease
3. Air bronchogram more likely
4. Silhouette signs likely
5. Little to no atelactasis

Question 19

Localized/lobar pattern

Answer 19

1. Usually only a portion of one lung

2. MC presentation for infection

Question 20

Solitary Mass/Nodule Pattern

Answer 20

1. Smaller, well defined area

2. Common presentation for neoplasm

Question 21

Multiple Masses pattern

Answer 21

1. Multiple well defined areas

2. Common presentation for metastasis

Question 22

Diffuse pattern DDx

Answer 22

1. Pulmonary edema
2. Unusual infections (PCC, immune compromised, oportunistic)
3. Sarcoidosis
4. Histoplasmosis, TB
5. Bronchioalveolar carcinoma
6. Idiopathic pulmonary hemorrhage