Thorax/lung radiographs Flashcards

1
Q

what are the indications for thoracic radiography?

A

metastasis exam
respiratory dysfunction
cardiac disease
esophageal or issues with deglutition
post-surgical complications
establish baseline/normalcy

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2
Q

thorax radiographs tend to have _____ inherent contrast. because of this, we have to use _____ kVp and _____ mAs to ________ latitude.

A

a lot of
high kVp, low mAs, raise latitude

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3
Q

if you can, take radiographs during ______ (phase of ventilation)

A

inspiration

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4
Q

ideally, _____ (#) views is best for thoracic radiographs. Which views are these? if you had to do only the bare minimum, what would you do? (small animal)

A

3
both laterals and VD

bare min: one lateral and VD or DV (2 views)

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5
Q

how do you position the animal for a thoracic radiograph? (small animal)

A

thoracic limbs pulled forward, rib heads/sternebrae/vertebrae superimposed, limbs out of way, avoid patient rotation, hemithorax’s symmetrical

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6
Q

Lateral views are better for certain things with thoracic radiographs. Tell me about them

A

R lateral: cardiac assessment and L pulmonary lobes
L lateral: R pulmonary lobes (asp. pneumonia)

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7
Q

what structures can you evaluate on a thoracic radiograph?

A

resp: lungs/trachea
CV: heart + vessels
pleural space
mediastinum: lymph nodes, esophagus, trachea, vessels
extra thoracic structures: ribs, limb, diaphragm, SQ

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8
Q

VD vs DV are better for different things in thoracic radiography. what are they? which is more common?

A

VD more common
- cranial mediastinum, pleural effusion easier to evaluate
- allows better inflation

DV
- evaluation of caudal lung lobes (met check)
- less resp restriction
- pulmonary edema

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9
Q

What is the vertebral heart score? What is the mean?

A

used to evaluate cardiac size, compares heart to mid-thoracic vertebrae (ID enlargement, monitoring change)
place length of both short and long axes along vertebrae, starting at T4 and going caudally. number of vertebrae along measurement (add together short and long axes) –> VHS

mean: 9.7 ± 0.5 (dogs), <8 (cats)

short axis: middle 3rd of heart (incl. R atrium & L chambers)
long axis: tracheal carina to cardiac apex (incl. L atrium + ventricle)

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10
Q

how do LA differ from SA in terms of thoracic radiographs?

A

only lateral projections, done standing, named by surface adjacent to plate (like other lateral views), may require 4-5 images to acquire entire thorax

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11
Q

caudal lobar vessels best seen in _____. cranial lobar vessels best seen in ____ - non-dependent lung best

A

DV
lateral

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12
Q

what are the 3 main pulmonary patterns? how are these defined?

A

alveolar
bronchial
interstitial (structured/nodular and unstructured)

defined by the primary location of parenchymal disease

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13
Q

alveolar patterns arise because … why?

A

alveoli are no longer air filled
air is replaced by ST opacity/fluid, or collapsed
occurring within alveoli ± extension into bronchi

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14
Q

in an alveolar pattern, what could be filling the alveoli?

A

consolidation - air replaced by fluid/ST (edema, blood, purulent material, neoplasia)

atelectasis - air absent but not replaced, tissue vol is lost = collapse

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15
Q

how is an alveolar pattern defined?

A

air bronchogram
effacement
lobar sign
soft tissue/fluid opaque lung when extensive

not all components required!

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16
Q

alveolar patterns are associated with…

A

pneumonia
cardiogenic (common) and noncardiogenic (less common) pulmonary edema
hemorrhage (traumatic or coagulopathy)
atelectasis

17
Q

if investigating aspiration pneumonia, what should you do?

A

L lateral to outline R middle lung lobe
retake in 24-48 hours (changes can lag)
pleural effusion = good indicator of progressive disease

18
Q

Tell me the differences between atelectasis and consolidation

A

atelectasis: increased soft tissue opacity, decrease in lung lobe size, mediastinal shift

consolidation: increase ST opacity, vol of lung lobe maintained, no mediastinal shift

19
Q

what is mediastinal shift? how to see this best on radiograph?

A

heart shifts toward lung of reduced vol
VD/DV
the atelectasis may be seen on lateral view as an area of increased opacity, or alveolar pattern
if its shift due to a lung mass, or fluid, movement is often contralateral side

20
Q

tell me the differences between pneumonia and non-cardiogenic pulmonary edema on radiograph

A

pneumonia: ventrally distributed, alveolar pattern, aspiration, viral, fungal

Non-CPE: peripherally distributed, w/o ventral predilection, associated with post-obstructive edema, vasculitis, altitude, neurogenic

21
Q

what is a bronchial pattern? how does it appear radiographically? associated with what?

A

thickening of bronchi, or fluid/mineralization in tissue immediately adjacent to the bronchi, resulting in progressive conspicuity of smaller bronchi

radiopaque rings (bronchi in cross section) or radiopaque “tram lines” (bronchi in long axis)

associated with inflammatory airway diseases (viral, parasitic, fungal, bacterial, allergic airway diseases, chronic bronchitis, neoplasia)

22
Q

what are the two classifications of interstitial pattern and what do they mean?

A

structured (nodular): nodules (< 2cm) or masses (> 2cm) – basically things look like nodules/masses, discrete structures
- beware costochondral junctions, end on vessels, osteomata

unstructured: not structured things in lung, lung will overall have increase opacification

23
Q

what are osteomata/osseous metaplasia?

A

small, 2-4mm pulmonary mineralization/mineral opacity
incidental, benign, usually on periphery of lung

24
Q

what causes unstructured interstitial pattern? why does this happen?

A

age related scar tissue/fibrosis, infectious (viral, bacterial, fungal, parasitic, FIP, toxoplasmosis), neoplasia (round cell/lymphoma), allergic airway disease, early edema, inhaled toxin and radiation pneumonitis

disease has progressed to involve the parenchyma and connective tissue b/t the bronchi/alveoli/vascular tissue