Week 8 Radiology/ Interstitial Lung Disease Flashcards
on a correct CXR what structures do we need to be able to see?
1st rib, lateral margin of ribs, costophrenic angle
allignment of spinous process and clavicles
what can different lung volumes show on a CXR?
inspiratory phase- normal 5th to 7th anterior rib at mid clavicular line
- problems with incomplete inspiration- big heart, increased lung markings
- exaggerated expansion- obstructive airways disease
how do you evaluate a CXR- ABC approach?
pt demographics projection- adequacy- Airways- trachea, bronchi- hila Breathing- lungs, pleural spaces, lung interfaces Circulation- mediastinum- aortic arch, pulmonary vessels (hila), R heart border (R atrium, middle lobe interface), L heart border (L ventricle (lingula interface) Diaphragm/ dem bones- free gas, nodules, fraction/ dislocation, mass review areas: - apices- pneumothorax - thoracic inlet- mass - paratracheal stripe- mass, lymph nodes - AP window- lymph nodes - hila- mass/ collapse - behind heart- mass - below diaphragm- pneumoperitoneum/ mass - bones- fracture, mass, missing - edge of films
what are some silhouette signs to look out for?
structures next to each other of different densities form a crisp silhouette- heart next to lungs (white next to black)
- loss of contour can= pathology
what are the signs of a mediastinal shift?
look at trachea and cardiac shadow
pushed or pulled
- push- increased volume or pressure
- pull- decreased volume or pressure
what is a pneumothorax, what causes it and how is it identified on a CXR?
air trapped in pleural space
spontaneous or as a result of underlying lung disease, most common cause- trauma- laceration of visceral pleura by fractured rib
- lung edge measures more than 2cm from inner chest wall at the level of hilum- said to be large
- tracheal or mediastinal shift away from the pneumothorax and depressed hemirdiaphragm
- signs- visible pleural edge, lung markings not visible beyond this edge
what is a pleural effusion/fluid and how is it shown of a CXR?
collection of fluid in the pleural space
uniform white area, loss of costophrenic angle, hemidiaphragm obscured, meniscus at upper border
what is a lobar lung collapse, what causes it and how is it shown of a CXR?
volume loss within lung lobe
causes:
- luminal- aspirated foreign material, mucous plugging, latrogenic
- mural- brochogenic carcinoma
- extrinsic- compression by adjacent mass
findings:
- elevation of the ipsilateral hemidiaphragm
- crowding of the ipsilateral ribs
- shift of mediastinum towards the side of atelectasis
- crowding of pulmonary vessels
what is consolidation and how is it shown on a CXR?
filling of small airways, alveoli with things: - pus- pneumonia - blood- haemorrhage - fluid- oedema - cells- cancer dense opacificiation volume preserved +/- increased air bronchogram
what is a space occupying lesion (SOL), what are the causes
nodule 3cm single vs multiple causes: - malignant- primary, metastasis - benign mass lesion - inflammatory - congenital mimics- bone lesion, cutaneous lesion, nipple shadow
how does X ray work?
an electromagnetic wave of high energy and very short wavelength which can pass through many materials opaque to light
- photographic or digital image of internal composition of the body
- displayed as levels of contrast on a grey scale
what structures are affected by interstitial lung disease and what cells are involved?
acini, alveoli lumen, bronchiolar lumen, bronchioles
epithelial, endothelial, mesenchymal, macrophages, recruited inflammatory cells
how can you identify cardiac enlargement on a CXR and how do you estimate the cardiac index?
cardiac index- normal
what and how are inflammatory cells associated with interstitial lung disease?
d
what are common causes of interstitial lung disease?
- occupational- asbestosis, silicosis, coal workers pneumoconiosis
- treatment related- radiation, methotrexate, nitrofurantoin, amiodarone, chemo
- connective tissue disease- Rh arthritis, SLE, polymyositis, schleroderma, sjogrens
- immunological- sarcoidosis, hypersensitivity pneumonitis
- idiopathic- idiopathic pulmonary fibrosis
what are the typical clinical features of interstitial lung disease?
SOB, cough
signs of underlying disease- clubbing, raised JVP (RHF), cyanosis, tachycardia (>HR), tachypnoea (rapid breathing), decreased chest movement, course crackles
what affects does inflammation and fibrosis associated with interstitial lung disease have on ventilation and gas exchange?
d
what are the typical lung function results of pts presenting with interstitial lung disease?
d
what a CXR show of a person with interstitial lung disease?
d
list some occupational lung diseases and the environmental factors associated with them
d
describe the structure of the visceral and parietal pleura and the functions of pleural fluid
d
what factors influence the formation and reabsorption of pleural fluid?
d
what is: a pleural effusion, haemothorax, chylothorax, emphema and simple effusion?
d
what is the difference between an exudate and transudate and what are the main conditions to each in the case of pleural effusion?
e
