Week 8 Radiology/ Interstitial Lung Disease

Question 1

on a correct CXR what structures do we need to be able to see?

Answer 1

1st rib, lateral margin of ribs, costophrenic angle

allignment of spinous process and clavicles

Question 2

what can different lung volumes show on a CXR?

Answer 2

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

Question 3

how do you evaluate a CXR- ABC approach?

Answer 3

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

Question 4

what are some silhouette signs to look out for?

Answer 4

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

Question 5

what are the signs of a mediastinal shift?

Answer 5

look at trachea and cardiac shadow
pushed or pulled
- push- increased volume or pressure
- pull- decreased volume or pressure

Question 6

what is a pneumothorax, what causes it and how is it identified on a CXR?

Answer 6

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

Question 7

what is a pleural effusion/fluid and how is it shown of a CXR?

Answer 7

collection of fluid in the pleural space

uniform white area, loss of costophrenic angle, hemidiaphragm obscured, meniscus at upper border

Question 8

what is a lobar lung collapse, what causes it and how is it shown of a CXR?

Answer 8

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

Question 9

what is consolidation and how is it shown on a CXR?

Answer 9

filling of small airways, alveoli with things:
- pus- pneumonia 
- blood- haemorrhage
- fluid- oedema
- cells- cancer
dense opacificiation
volume preserved +/- increased
air bronchogram

Question 10

what is a space occupying lesion (SOL), what are the causes

Answer 10

nodule 3cm
single vs multiple
causes:
- malignant- primary, metastasis
- benign mass lesion
- inflammatory
- congenital
mimics- bone lesion, cutaneous lesion, nipple shadow

Question 11

how does X ray work?

Answer 11

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

Question 12

what structures are affected by interstitial lung disease and what cells are involved?

Answer 12

acini, alveoli lumen, bronchiolar lumen, bronchioles

epithelial, endothelial, mesenchymal, macrophages, recruited inflammatory cells

Question 23

how can you identify cardiac enlargement on a CXR and how do you estimate the cardiac index?

Answer 23

cardiac index- normal

Question 25

what and how are inflammatory cells associated with interstitial lung disease?

Answer 25

d

Question 26

what are common causes of interstitial lung disease?

Answer 26

• 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

Question 27

what are the typical clinical features of interstitial lung disease?

Answer 27

SOB, cough
signs of underlying disease- clubbing, raised JVP (RHF), cyanosis, tachycardia (>HR), tachypnoea (rapid breathing), decreased chest movement, course crackles

Question 28

what affects does inflammation and fibrosis associated with interstitial lung disease have on ventilation and gas exchange?

Answer 28

d

Question 29

what are the typical lung function results of pts presenting with interstitial lung disease?

Answer 29

d

Question 30

what a CXR show of a person with interstitial lung disease?

Answer 30

d

Question 31

list some occupational lung diseases and the environmental factors associated with them

Answer 31

d

Question 32

describe the structure of the visceral and parietal pleura and the functions of pleural fluid

Answer 32

d

Question 33

what factors influence the formation and reabsorption of pleural fluid?

Answer 33

d

Question 34

what is: a pleural effusion, haemothorax, chylothorax, emphema and simple effusion?

Answer 34

d

Question 35

what is the difference between an exudate and transudate and what are the main conditions to each in the case of pleural effusion?

Answer 35

e

Question 36

what are the characteristics of pleurisy and what are the major causes?

Answer 36

d

Question 37

how in principle can congenital abnormalities, injury, motor and neurological diseases affect breathing?

Answer 37

d