Test 2 (Chest Imaging Dr. Dykstra) Flashcards
Chest Radiographs
- Initial imaging modality used in evaluating patients with CHEST PAIN (Acute or Chronic), SHORTNESS OF AIR (Acute or Chronic), TRAUMA, ABNORMAL PHYSICAL EXAM
- May be obtained as part of a yearly physical in Adults
Radiograph Density Air
- Air in normal or abnormal location?
- Air with the Pleural Space or Mediastinum?
- Air in the Soft Tissues?
- Under the Diaphragm (Suggested Pneumoperitoneum)?
Radiograph Density Fat/ Water
- Both densities outline the Margins of the Organs
- Blood, pus, and water appear as water density on the Radiographs
- Evaluate for additional densities present that are not organs (Ex: Masses, Hematomas, Abscesses)
Radiograph Densities Bones
- Evaluate bones on every radiograph, CT, MRI
- Look for tother Calcific or Ossific densities including stones
METAL:
- Foreign bodies, surgical clips!!!!!
Radiographs
- Standard images obtained in patients are the PA and Lateral Views
- In infants, trauma patients or very sick patients, including those in the ICU, Portable AP Radiographs may be obtained SUPINE or SITTING IN BED
a) Technique cases more MAGNIFICATION and LESS SHARP IMAGES
b) Patient typically unable tot are DEEP INSPIRATION, therefore LESS LUNG is EXPANDED!
Systemic Approach
1) Patient ID, Gender, Age, Indication
2) Technical adequacy of study
3) Lines, Tubes, and Devices
4) AIRWAY (A)
5) Breathing, Borders, and Bones (B)
6) Circulation and Contours (C)
7) Diaphragm (D)
8) Everything Else (E)
Technical Adequacy
1) Alignment
2) Penetration
3) Inspiration
Radiographs Poor Inspiration vs Good Inspiration
- At FULL INSPIRATION, the DIAPHRAGM should be observed at about the level of the 8th to 10th Ribs POSTERIORLY, or the 5th to 6th Rib ANTERIORLY!!!!!
Breathing, Borders, and Bones
- Evaluate the airspace in a Systematic way
- Start at the apices and move LATERAL to MEDIAL in each HEMITHORAX. Then, compare LEFT to RIGHT, TOP to BOTTOM
- Lung marking (Tiny pulmonary vessels) should be visible to the VISCERAL PLEURAL SPACES
- Often, the INTERLOBAR FISSUES can be seen as this White Lines.
IMPORTANT: Do not stop your search at the HEART BORDER or SUPERIOR BORDER of the HEMIDIAPHRAGM. Look through these Structures and make sure its HOMOGENOUS. Remember, Lung Tissue surrounds the HEART and continues INFERIORLY behind the HEMIDIAPHRAGM
- To help with Retrocardiac Pathology, we have the LATERAL AORTIC STRIPE/ INTERFACE and PARASPINAL INTERFACE. Focal Contour abnormalities or Obscuration of this interface is a clue to RETROCARFIAC PATHOLOGY abutting the AORTA or VERTEBRAL BODIES!!!
Breathing, Borders, and Bones Cont
- Right Sides ribs project POSTERIORLY and are SLIGHTLY LAGER than the LEFT!
- Check all vertebral bodies from CRANIAL to CAUDAL. they should progressively “DARKEN”
- The Costophrenic recesses are important to evaluate on the Lateral Radiograph for any potential blunting
- It is important to check the LATERAL view for RETRO-CARDIAC PATHOLOGY or HIATAL HERNIAS
- The RETROSTERNAL CLEAR SPACE is the most sensitive area to evaluate for EMPHYSEMA
- Evaluate the CARDIAC SILHOUETTE. Look for Curvilinear Lucency’s outlining the PERICARDIAL SPACE and the “Fat Stripe Sign”, which suggests PNEUMOPERICARDIUM!!!
Manifestations of Chest Pathology
1) CONSOLODATION: Air filled with Fluid or Pus
- “Airspace Opacity”
- Alveolar Filing
2) RETICULATION: Linear Opacification of the Lungs
- “Ground Glass Opacity”
- “Peribronchovascular”
- “Interstitial”
- “Lace-like”
- “Lymphangitis”
3) ATELECTASIS: Partial Collapse of the Lung
- Volume Loss
- Collapse
4) NODULE:
5) MASS
Consolidation
- The lung is said to be CONSOLIDATED when the ALVEOLI and SMALL AIRWAYS are filled with DENSE MATERIAL
This dense material may consist of:
a) Pus (pneumonia)
b) Fluid (Pulmonary Edema)
c) Blood (Pulmonary Hemorrhage)
d) Cells (Cancer)
Consolidation Cont
- ***S-Sign of GOLDEN!!!!!!!!
- Seen in Right Upper Lobe Consolidations!!!!!
Atelectasis
- Several types of Atelectasis. The term generally means “VOLUME LOSS”
- Better way to think about it is that ALVEOLI are UNABLE to FULLY AERATE for Various Reasons
Post Obstructive (Resorptive) Atelectasis with LOBAR COLLAPSE a) Caused by OBSTRUCTION, from INTRINSIC or EXTRINSIC Compression of the Bronchi
b) Recognized by with DIRECT SIGNS (Displace Interlobar Fissures and Bronchovascular Crowding).
c) INDIRECT SIGNS can help clue you in to the presence of Volume Loss (Diaphragmatic elevation, Mediastinal Shift, Compensatory Hyperinflation of Normal Lung, Hilar Displacement, Crowding of Ribs, Absent Air Bronchograms)
Atelectasis Cont
Other Types:
1) Relaxation (passive)
- From Pneumothorax or Pleural Effusion as the Lung is separated from the NEGATIVE PRESSURES generated by the Chest Wall and Diaphragm during Inspiration
2) ADHESIVE
- From DECREASED SURFACTANT which promotes VOLUME LOSS
3) CICATRICIAL/ SCARRING
- May be form Pulmonary Fibrosis (local or Generalized) causing DECREASED VOLUME
