Week 2- Cardiac & Vascular imaging

Question 1

3 Main areas of CXR interpretation?

Answer 1

• Image details
• Image quality (RIPE)
• System/ structures (ABCDEFGHI)

Question 2

Image details- what is included?

Answer 2

• Name
• DOB
• Image acquisition date & time
• Type of study:
  
  • Front/ lateral
  • AP/PA
  • Supine/ Erect

Question 3

What should you look for in image quality?

Answer 3

• Rotation (clavicular heads in line w/ spinous processes)
• Inspiration (10 to 11 posterior ribs)
• Penetration (should see vertebrae)
• Entire field covered

Question 4

What are you looking for with systems and strucutres?

Answer 4

• Airway
• Bones and tissue
• Cardia
• Diaphragm
• Edges of pleura
• Fields of lung
• Gastric bubble
• Hila
• Instruments & wires

Question 5

What things are you looking at in airways?

Answer 5

• Trachea
• Carina

Is this in the midline? Can you see the split of the trachea?

Question 6

What can you see?

Answer 6

• tracheal deviation to the patient’s right due to tension pneumothorax

Question 7

What has happened here?

Answer 7

A: Pneumothorax

B: Posterior rib fracture

Question 8

Cardia: what areas of the heart are the different colour blobs?

Answer 8

Oranage: Left atrium

Purple: Left atrial appendage

Green: Right atrium

Red: Left ventricle

Blue: Right ventricle

Question 9

What do the arrows show?

Answer 9

In relation to heart

Question 10

What is this showing?

Answer 10

Left hemi-diaphragm

Surgical clips which indicate it’s due to left phrenic nerve palsy asa surgical complicaiton

Question 11

What is this showing

Answer 11

No lung markings on the patients left lung in the apical area thus pneumothorax

Question 12

What is this showing in fields of lungs and is the gastric buble normal?

Answer 12

Cavitation/ abscess

Gastric buble is normal

Question 13

What is this showing in the Hila region?

What is it suggetstive of?

Answer 13

Hila is more rounded and some areas of hyperdensity (calcification)

This is hilar lymphadenopathy suggestive of TB, Sarcodosis, or lymphoma

Question 14

What tubes/ wires and lines can you see here?

Answer 14

Central line but an incorrectly sited site into the right subclavian. Should come down internal jugular vein into the SVC

Question 15

What is this showing?

What are the symptoms?

What are the two catagories of causes?

Answer 15

Pleural effusion- not the concave shape of hemidiaphragm

Symptoms: SOB

Catagories of causes based on compotision of fluid:

• Trasudate (systemic complem): CCF, Low albumin state
• Exudate (local problem): Pneumonia, Empyema, Malignancy

Question 16

What is this showing?

What are the common symptoms?

Answer 16

• Cardiomegaly,
• More prominent hilar vessels
• Generalised opacitiy

Thus could be pulmonary oedema or CCF

Symptoms: Fatigue, SOB especially on exertion

Question 17

What is abnormal here?

What would you request next?

Answer 17

Enlarged aorta

Request CT and here you see that the Aortic dissection. Some renal cysts in the kidneys

Question 18

What types of imaging could be done if someone presents with MI aside Xray?

What treatments?

Answer 18

• CT with contrast
• Fluroscopy

Tx:

• PCI (stent insertion)

Question 19

What is going on here?

Patient presents with abdo pain

Answer 19

Perforated diverticultis

Look at the free air under the right hemidiaphragm

Question 20

A lady presents with right leg pain and swelling. Also had some lower back pain for the last year so been off work. Which imaging modality would you use and why?

What do you think diagnosis is? And which symptoms would you expect

Answer 20

USS

Consider DVT

Symptoms: Painful, swollen, erythematous limb

On USS: normally on compression vein will compress but with DVT it isn’t really compressed (as shown on USS)