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MEDIMAGE 302 > Thorax > Flashcards

Thorax Flashcards

1
Q

What key features distinguish thoracic vertebrae from cervical and lumbar vertebrae?

A

Thoracic vertebrae have ribs attaching to them, which is a defining characteristic. They also have costal facets on the vertebral body and transverse processes for rib articulation.

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2
Q

How can you differentiate an intervertebral disc from a vertebral body on an axial CT scan?

A

Intervertebral discs are less dense than bone, appearing darker than the surrounding vertebral bodies on a CT scan.

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3
Q

How many pairs of ribs are there in the human body?

A

There are 12 pairs of ribs.

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4
Q

Why do axial CT scans only show partial slices of the ribs?

A

Ribs descend and then ascend again slightly, making it difficult to capture their full structure in a single slice.

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5
Q

What should be done if only 5 pairs of ribs are seen on an axial CT?

A

Scan up and down to ensure the ribs have not moved back into the slice.

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6
Q

What three elements of the vertebral column do typical ribs (2-9) articulate with posteriorly?

A

Vertebral body of the same level, Transverse process of the same level, Vertebral body of the level above.

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7
Q

What are the three parts of the sternum?

A

Manubrium (superior part), Mesosternum (body of the sternum), Xiphoid process (inferior part).

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8
Q

Why is it difficult to get a complete view of the sternum in a coronal scan?

A

The sternum slopes posteriorly from the xiphoid process to the manubrium.

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9
Q

How can you determine if a coronal image is showing the manubrium, mesosternum, or xiphoid process?

A

If the scan is beneath the aortic arch and the carina of the trachea (which sit at the transthroacic plane), the visible part of the sternum is likely the mesosternum.

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10
Q

What characteristic feature helps distinguish the trachea from surrounding soft tissues on CT or MRI?

A

The trachea contains air, making it appear hypodense (black) on CT and hypointense on MRI compared to surrounding soft tissues.

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11
Q

At what vertebral level does the trachea bifurcate?

A

The trachea bifurcates at T4/T5, known as the trans-thoracic plane.

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12
Q

How can you determine whether an axial image is above or below the tracheal bifurcation?

A

Above T4/T5: The trachea appears as a single air-filled structure in the midline.
At T4/T5: The trachea splits into the left and right main bronchi.
Below T4/T5: Two separate main bronchi are visible instead of a single tracheal lumen.

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13
Q

How far superiorly does the lung apex extend?

A

The lung apex extends above Rib 1 and behind the clavicles into the lower neck region.

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14
Q

On an axial chest CT or MRI, how can you differentiate the upper lobes from the lower lobes?

A

The upper lobes are positioned anteriorly, while the lower lobes are more posterior.

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15
Q

Which pulmonary vessels are more superior: pulmonary veins or pulmonary arteries?

A

Pulmonary arteries are more superior, while pulmonary veins are lower and enter the left atrium, the most posterior part of the heart.

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16
Q

How does the pulmonary trunk (PT) and pulmonary arteries (PAs) appear on imaging?

A

The pulmonary trunk (PT) splits into pulmonary arteries (PAs) in an upside-down Y-shape.
The PT is the most anterior vessel of the heart.
Pulmonary veins (PVs) are four in number and drain into the left atrium.
The PT and PAs cross beneath the arch of the aorta.

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17
Q

What is the first chamber seen when scrolling left to right in a sagittal plane?

A

Left Ventricle (LV)

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18
Q

What is the first chamber seen when scrolling right to left in a sagittal plane?

A

Right Atrium (RA)

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19
Q

What is the last chamber seen when scrolling front to back in a coronal plane?

A

Left Atrium (LA)

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20
Q

What is the first chamber seen when scrolling front to back in a coronal plane?

A

Right Ventricle (RV)

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21
Q

In an axial scan from top to bottom, do you encounter the atria or ventricles first?

A

Atria more so than ventricles

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22
Q

What basic feature helps differentiate ventricles from atria in an otherwise normal heart?

A

Thick, muscular walls = ventricles; thinner walls = atria

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23
Q

How does the right ventricle (RV) compare to the left ventricle (LV) morphologically?

A

RV wall is thinner than LV wall.
RV pumps to the lungs (low pressure), so it requires less force.
LV pumps to the whole body (high pressure), so it has a thicker muscular wall.

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24
Q

Which important internal structures divide the atria from the ventricles?

A

Atrioventricular (AV) valves

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25
The Inferior Vena Cava (IVC) is (Entering/Exiting) which chamber?
Entering the Right Atrium (RA)
26
The Superior Vena Cava (SVC) is (Entering/Exiting) which chamber?
Entering the Right Atrium (RA)
27
The Aorta is (Entering/Exiting) which chamber?
Exiting the Left Ventricle (LV)
28
The Pulmonary Trunk is (Entering/Exiting) which chamber?
Exiting the Right Ventricle (RV)
29
The Pulmonary Veins are (Entering/Exiting) which chamber?
Entering the Left Atrium (LA)
30
Why might the Aorta's position relative to the Pulmonary Trunk be confusing in cross-sectional imaging?
The Aorta exits the LV but appears on the right of the Pulmonary Trunk, which exits the RV. This is due to the twist of the heart, making the Aorta appear right-sided despite originating from the LV.
31
How does the Aorta course through the body, and how can you use this to distinguish its Ascending vs. Descending portions in an Axial slice?
The Aorta arches from anterior to posterior. ## Footnote Anterior = Ascending Aorta Posterior = Descending Aorta
32
In what cross-sectional imaging plane can you see the entire length of the Aorta from Ascending to Descending?
Sagittal view (if imaged far enough left from the heart).
33
What is the first major vessel encountered when scrolling inferiorly in an axial chest CT?
Arch of the Aorta (appears as a straight tube).
34
What vessel appears after the Aortic Arch in an axial slice?
Pulmonary Arteries (Y-shaped branching from the Pulmonary Trunk).
35
What vessel appears after the Pulmonary Arteries in an axial slice?
Ascending Aorta and Descending Aorta (both appear as circular cross-sections).
36
What vessel appears after the Ascending Aorta in an axial slice?
Pulmonary Veins (1–2 per side entering the Left Atrium from the back of the heart).
37
What is the last major vessel encountered when scrolling inferiorly in an axial chest CT?
Inferior Vena Cava (IVC) (appears as an ellipsoid structure beneath the Right Atrium).
38
The Inferior Aspect of the Aortic Arch and the Pulmonary Trunk bifurcation both lie at which vertebral level?
T4/T5 (Trans-thoracic Plane).
39
Why is the Trans-thoracic Plane (T4/5) an important landmark in imaging?
Many key structures lie on this plane, helping to orient anatomical relationships in axial imaging.
40
How do the airways appear on an Axial slice at or around the Trans-thoracic Plane?
Trachea widens (left-right) as it bifurcates. ## Footnote If slightly below the Carina → Two separate structures (L & R Main Bronchi).
41
Where are the airways located in relation to most of the Great Vessels?
Posterior to them.
42
Which is usually the most anterior vessel emerging from the heart?
Pulmonary Trunk.
43
When should you use contrast agents in vascular imaging?
When assessing vascular structures or looking for tissue enhancement, e.g., tumors, pulmonary embolism (PE).
44
What slice thickness should be used for chest/lung mass detection?
Thick slices (5-10mm).
45
What slice thickness should be used for lung parenchyma assessment?
Thin slices (1-2mm).
46
How can windowing help in CT imaging?
Adjusting image windows maximizes contrast to enhance visualization of different tissues.
47
What are the consequences of an Atrial Septal Defect (ASD) / Patent Foramen Ovale (PFO)?
Right-sided heart failure Pulmonary hypertension Increased risk of stroke
48
What are the complications of a Ventricular Septal Defect (VSD)?
Heart failure Pulmonary hypertension Valve disease Rhythm disorders
49
What is coarctation of the aorta?
A narrowing of the aortic arch, typically near the ductus arteriosus, leading to obstructed blood flow.
50
What are the main complications of coarctation of the aorta?
Hypertension (upper body) Aneurysm formation Increased risk of stroke Heart failure
51
What is Patent Ductus Arteriosus (PDA)?
A persistent connection between the pulmonary artery and the aorta that should close after birth.
52
What are the main complications of PDA?
Pulmonary hypertension Infective endocarditis Heart failure
53
What is a bicuspid aortic valve (BAV)?
A congenital condition where the aortic valve has two cusps instead of three.
54
How common is BAV, and what are its risks?
1-2% of the population Most common congenital cardiac abnormality Increased risk of aortic dissection
55
What is Cystic Fibrosis (CF)?
A genetic disorder (autosomal recessive) that causes thick, sticky mucus buildup, affecting the lungs, pancreas, and other organs.
56
What are the key complications of Cystic Fibrosis?
Chronic lung infections (due to mucus retention) Difficulty clearing sputum Progressive lung damage, often leading to transplantation
57
What is Alpha-1 Antitrypsin Deficiency?
An inherited condition leading to early-onset emphysema due to lack of alpha-1 antitrypsin, which protects lung tissue from damage.
58
What is Esophageal Atresia?
A malformation of the esophagus, where it fails to connect properly to the stomach.
59
What is Achalasia of the Esophagus?
A disorder where the lower esophageal sphincter fails to relax, causing food to get stuck in the esophagus.
60
What is a Broncho-Pleural Fistula (BPF)?
An abnormal connection between the bronchi/lungs and the pleural space, often occurring after a pneumothorax or lung surgery.
61
What is a Tracheo-Esophageal Fistula?
An abnormal connection between the trachea and esophagus, often due to esophageal malignancy or congenital abnormalities.
62
What is a Diaphragmatic Hernia?
A defect in the diaphragm that allows abdominal contents to enter the chest cavity, potentially causing respiratory issues.
63
What is Traumatic Aortic Injury and how can it present?
Injury to the aorta, often subtle and caused by a deceleration injury (e.g., motor vehicle accidents). May require CT to identify.
64
What is the importance of subcarinal nodes in tumor staging?
The subcarinal nodes are located below the carina of the trachea and are often important for staging malignancies in the chest, especially lung cancer.
65
What features are commonly seen in malignant lung lesions?
A spiculated appearance, often seen in malignant tumors like lung cancer.
66
What are the imaging features of Mesothelioma?
Pleural thickening, calcification, and pleural effusions, often seen with a history of asbestos exposure.
67
What can cause Pulmonary Embolism (PE)?
Most commonly caused by a Deep Vein Thrombosis (DVT), and is more common in individuals with malignancy or immobility.
68
What is Emphysema and how is it imaged?
A lung disease characterized by centrilobular emphysema and air trapping. HRCT with thin slices (1-2mm) and lung windows is best for assessment.
69
What are the imaging features of Fibrosing Alveolitis?
Low lung volumes, thickened septae, and 'stiff' lungs. It is a condition with many types and causes, often requiring HRCT to diagnose.
70
What are the imaging features of Asthma?
Air trapping and bronchial wall thickening, often visible on HRCT.
71
What are the imaging features of Heart Failure?
Kerley B lines (indicating interstitial pulmonary edema) ## Footnote Pleural effusions

MEDIMAGE 302 (3 decks)

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