Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Respiratory > Week 8 - CXR and Interstitial Lung Disease > Flashcards

Week 8 - CXR and Interstitial Lung Disease Flashcards

1
Q

What should/shouldn’t be included on a chest x-ray?

A
  • Inclusion: (need to see: )
    — 1st rib
    — Lateral margin of ribs
    — Costophrenic angle
  • Rotation assessment:
    — Look at spinous processes and clavicle
    • Should be in the centre
  • Lung volume:
    — Normal = 5th – 7th anterior ribs at mid clavicular line
    • An adequate inspiratory film (i.e. breath!)
    — Problems with incomplete inspiration:
    • Big heart
    • Increased lung markings
    • May be indicative of lung disease but may be that the radiographer has not got the patient to take a big enough breath
    — Exaggerated expansion
    • Obstructive airways disease
    • But some patients can take too big a breath (e.g. men who workout at the gym a lot)
  • Penetration:
    — Degree to which the x-rays have passed through the body
    — Adequate penetration:
    • Vertebrae just visible through heart
    • Complete left hemidiaphragm is visible
    — Can digitally manipulate the x-ray if penetration is not good enough
    • Can make the image a lot clearer
  • Artefact:
    — External/iatrogenic material which obstructs view
    • Clothes
    • Hair
    • Surgical/vascular lines
    • Pacemaker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How should you review a chest x-ray?

A
  • Patient demographics
  • Projection
  • Adequacy
  • – Check rotation
  • – Inspiration
  • – Penetration
  • Airway
  • – Trachea
  • – Bronchi (check hila)
  • Breathing
  • – Lungs
  • – Pleural spaces
  • – Lung interfaces – things that border the lung
  • Circulation
  • – Look at aortic arch
  • – Look at heart
  • – Pulmonary vessel (check hila)
  • – Right heart border
  • – Left heart border
  • Diaphragm and bones
  • – Free gas
  • – Nodules
  • – Fracture/dislocation
  • – mass
  • Review areas that are commonly missed:
  • – Apices
  • – Thoracic inlet
  • – Paratracheal stripe
  • – AP window
  • – Hila
  • – Behind heart
  • – Below diaphragm
  • – Bones
  • – Edge of films
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the silhouette sign?

A
  • Adjacent structures of differing density form a crisp silhouette
  • – Heart next to lung = white next to black
  • Loss of this contour can locate pathology
  • – Loss of silhouette sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is mediastinal shift?

A
  • An adequately centred image, but mediastinum is not central
  • Look at trachea and cardiac shadow
  • Can be pushed or pulled:
  • – Push = increase volume or pressure
  • – Pull = decrease volume or pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a pneumothorax?

A
  • Air trapped in the pleural space
  • Venous return dropped due to high thoracic pressure
  • Spontaneous, or as a result of underlying lung disease
    — Most commonly due to trauma
    • Laceration of the visceral pleura by a fractured rib
  • Large if: lung edge measures more than 2cm from the inner chest wall at the level of the hilum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some signs of a pneumothorax on a x-ray?

A
  • Visible pleural edge
  • Lung markings not visible beyond this edge
  • Tension pneumothorax: tracheal or mediastinal shift away from the pneumothorax and depressed hemidiaphragm
  • – Shift is due to push from the air in the pleural cavity
  • – Affected lung is completely compressed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some x-ray signs of a pleural effusion?

A
  • Uniform white area
  • Loss of costophrenic angle
  • Hemidiaphragm obscured
  • Meniscus at upper border
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a lobar lung collapse?

A 
Volume loss within lung lobe
Causes:
- Luminal
--- Aspirated foreign material
--- Mucous plugging
--- Iatrogenic 
- Mural
--- Bronchogenic carcinoma
- Extrinsic
--- Compression by adjacent mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some x-ray signs of a lobar lung collapse?

A
  • Elevation of the ipsilateral hemidiaphragm
  • Crowding of the ipsilateral ribs
  • Shift of the mediastinum towards the side of atelactasis
  • Crowding of pulmonary vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some x-ray signs of a consolidation?

A
  • Dense opacification
  • Volume preserved +/- increased
  • Air bronchogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a space occupying lesion?

A
  • Nodule (3cm)
  • Single vs multiple
  • Causes:
    — Malignant (primary or metastases)
    — Benign mass lesion
    — Inflammatory (e.g. may be TB)
    — Congenital
    — Mimics
    • Bone lesion
    • Cutaneous lesion
    • Nipple shadow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a consolidation?

A

Filling of small airways/alveoli with:

  • Pus
  • Blood
  • Fluid
  • Cells (tumour)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you calculate the cardiac index?

A
  • Widest part of the heart and ribcage are measured laterally
  • Ratio
  • – Normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is interstitial space?

A

A potential space between alveolar cells and the capillary basement membrane

  • Only apparent in disease states
  • It may contain fibrous tissue, cells or fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the pathophysiology of interstitial lung disease?

A
  • Only apparent in disease states

- It may contain fibrous tissue, cells or fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some causes of interstitial lung disease?

A
  • Occupational:
  • – Asbestosis
  • – Silicosis
  • – Coal workers - pneumoconiosis
  • Treatment related:
  • – Radiation
  • – Methotrexate
  • – Nitrofurantoin
  • – Amiodarone
  • – Chemotherapy
  • Connective tissue disease:
  • – Rheumatoid arthritis
  • – Systemic lupus erythematosis
  • – Polymyositis
  • – Schleroderma
  • – Sjogren’s
  • Immunological:
  • – Sarcoidosis
  • – Hypersensitivity pneumotitis / Extrinsic allergic alveolitis
  • Idiopathic:
  • – Fibrosing alveolitis (IPF = idiopathic pulmonary factor)
17
Q

What is asbestosis?

A
  • Inhalation of asbestos fibres
  • Disease often develops long after exposure
  • Asbestos inhalation is associated with:
  • – Benign pleural plaques
  • – Asbsestosis (pulmonary fibrosis)
  • – Mesothelioma
  • Asbestos fibres that penetrate to the alveoli produce alveolitis
  • History of asbestos exposure
  • Patient breathless on exertion and a dry cough
  • Inspiratory crackles at the lung bases, which rise as the disease advances
  • No treatment
  • Lung function tests show small lungs, reduced compliance and impaired gas transfer
18
Q

What is sarcoidosis?

A
  • Incidence is highest in 30-40 year olds
  • Often asymptomatic
  • – May have cough, breathlessness
  • Non-caseating granuloma
  • Differential diagnosis = lymphoma, TB
  • Disease of unknown cause
  • Fluid is collected by lavage of the airways
  • Alveoli contain lots of cells
  • – Including macrophages and lymphocytes
19
Q

What is hypersensitivity pneumotitis / extrinsic allergic alveolitis?

A
  • Inhalation of organic material triggers an allergic reaction in alveoli and bronchioles
  • May be:
    — Sudden onset and rapidly progressing (acute)
    — Develop gradually and persist (chronic)
  • E.g. farmer’s lung = acute form
    — Antigen = thermophilic actinomycetes found in mouldy hay
    — Influenza like illness 4-9 hours later
    — Fine mid and late inspiratory crackles
    — May be a wheeze
    — The chest x-ray shows a diffuse micro-nodular infiltrate
    • Denser towards the hila
  • E.g. bird fancier’s lung = chronic form
    — Long term antigen exposure = pigeons, budgerigars
    — Insidious malaise
    — Dry cough and breathlessness
    — Inspiratory crackles
    — Chest x-ray may be almost normal, progressing to fibrosis in late disease
  • No finger clubbing
20
Q

What is fibrosing alveolitis?

A
  • Most common type of interstitial disease in 60-80 year olds
  • Progressive inflammatory condition
  • Cause is unknown
  • Evidence of increased numbers of activated alveolar macrophages
    — Attract neutrophils and eosinophils which produce local lung damage
    • Generate reactive oxidant species and proteases
    — Results in tissue destruction and fibrosis
  • Median survival = 3 years
  • Patients present with:
    — Progressive shortness of breath on exercise
    — Non-productive cough
    — Bilateral insiparatory fine crackles
    — Finger clubbing
  • Progresses at different rates in different patients
  • Chest x-ray shows small lungs with micro-nodular shadowing predominating in the lower lobes, with ragged heart borders
  • Can be restrained by treatment with high dose oral steroids
    — Less effective once fibrosis has developed
21
Q

What are the signs and symptoms of interstitial lung disease?

A 
Symptoms:
- Shortness of breath
--- Insidious onset
--- Gradual worsens
- Reduced exercise tolerance
- Dry cough
--- Can cause stomach pain
Signs:
- Tachypnoea
- Tachycardia
- Reduced chest movement
- Coarse crackles
- Cyanosis may be present
- Signs of right heart failure may be present
22
Q

What can interstitial lung disease affect, other than the interstitium?

A
  • Alveoli lumen
  • Bronchioles
  • Acini
  • Bronchiolar lumen
  • Possibly chest wall
23
Q

Describe the typical chest x-ray picture of patients presenting with interstitial lung diseases

A
  • Fibrosing alveolitis:
  • – Small lungs
  • – Micro-nodular shadowing
  • – Ragged heart borders
  • Extrinsic allergic alveolitis – acute
  • – Micro-nodular infiltrate
  • – Denser towards the hila
  • Extrinsic allergic alveolitis – chronic
  • – Almost normal
  • – Progresses to fibrosis in late disease
  • Sarcoidosis
  • – Miliary and nodular shadowing
  • – Diffuse fibrosis
  • Asbestosis
  • – Plaques
  • – Fibrosis
  • – Mesothelioma
24
Q

What occupation and exposure is associated with asthma?

A 
O = lab worker
E = rat urine
25
Q

What occupation and exposure is associated with diffuse fibrosis?

A 
O = boiler/pipe laggers, railway/construction
E = asbestos
26
Q

What occupation and exposure is associated with nodular fibrosis?

A 
O = coal miner, miner, demolition
E = coal dust, silica, asbestos
27
Q

What occupation and exposure is associated with alveolitis?

A 
O = farmer, pigeon fancier
E = fungal spores from hay, avian antigens
28
Q

Describe pleuritic chest pain

A
  • Severe
  • Sharp
  • ‘knife-like’ pain
  • Worse with inspiration
29
Q

How does pleural fluid production occur?

A
  • By capillary filtration at the parietal pleura
  • Increased:
  • – Lung interstitial fluid
  • – Hydrostatic pressure
  • – Permeability
  • Decreased:
  • – Oncotic pressure
30
Q

How does pleural fluid absorption occur?

A
  • Via lymphatic drainage
  • Decreased:
  • – Lymphatic blockage
  • Elevated:
  • – Systemic venous pressure
31
Q

What is a pleural effusion and what are the different types?

A

Any collection of extra fluid in the pleural space

  • Haemothorax = blood
  • Chylothorax = chyle (lymph with fats in it)
  • Empyema = pus
  • Simple effusion = serous fluid
32
Q

What can cause transudate?

A
  • Increased hydrostatic pressure
  • – Cardiac failure
  • Decreased capillary oncotic pressure
  • – Hypoalbimunaemia
  • – Nephritic syndrome
  • Increased capillary permeability
  • – Sepsis
33
Q

What can cause exudate?

A
  • Neoplasms
  • – Cancer involving pleural surface
  • – Secondary’s from breast, lung, ovarian, GI, lymphoma
  • – Primary tumour of pleura
  • Infection
  • – Pneumonia, TB
  • Immune disease
  • – Connective tissue diseases
  • Abdominal disease
  • – Pancreatitis, ascites, subphrenic abscess
34
Q

Describe pleurisy

A
  • Produces a sharp pain worse with large breathing movements
  • – E.g. coughing, sneezing, laughing
  • People take small breaths and often hold the affected side of the chest
  • Involvement of the diaphragmatic pleura causes pain in the shoulder on the same side
  • Characteristic physical sign = Pleura rub
  • – A creaking noise heard through a stethoscope in concert with respiratory movements
35
Q

What are some causes of pleurisy?

A
  • Infection (most common cause)
  • – TB
  • – Pneumonia
  • Autoimmune
  • – Rheumatoid arthritis
  • – Systemic lupus erythematosis
  • Lung cancer
  • Pneumothorax
  • Pulmonary embolism
36
Q

What is pleural fibrosis?

A
  • May develop as a result of unabsorbed pleural effusion
  • A small degree of pleural thickness may produce no effects
  • Wide spread fibrosis restricts the expansion of the lung
  • – There is a measurable reduction in lung volumes and compliance
37
Q

Describe pleural tumours

A
  • Secondary deposits of tumour are not uncommon in the pleura
  • The commonest primary tumour = malignant mesothelioma
    — Practically all victims have been exposed to asbestos 20-40 years before
    — Early symptoms = those of pleural effusion
    • The chest pain is duller and more diffuse than that of pleurisy
    • As the disease progresses, pain and breathlessness become increasingly severe and there is increasing weight loss
    — Physical signs = those of a large pleural effusion
    — Prognosis is poor
38
Q

What are some congenital abnormalities of the chest wall?

A

Deformity of the ribs, sternum and thoracic spine

  • Sternal abnormalities rarely produce functional impairment
  • – Cosmetic impact is considerable
  • Scoliosis and kyphosis may produce significant functional impairment of the thoracic cage
  • – Sometimes congenital
39
Q

What are some acquired abnormalities of the chest wall?

A
  • Trauma, kyphosis, scoliosis and ankylosing spondylitis
  • Trauma:
  • – Broken ribs produce pain and possible underlying lung contusion
  • – There may be a pneumothorax
  • Some old patients may have had surgery for TB
  • – Designed to collapse underlying lung

Respiratory (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions