Radiology part 2

Question 1

Check google images of each of these X-rays ella

Answer 1

Do it :)

Question 2

What projection are all trauma CXR?

Answer 2

AP - pt too unwell for PA

Question 3

What makes up the right and left heart borders in CXR?

Answer 3

Right - right atrium
Left - left ventricle

Question 4

How does pneumonia present on CXR?

Answer 4

Air space shadowing - fluffy white consolidation suggesting alveoli filled with pus/fluid/blood

Air bronchograms - lucent areas that are darker than surrounding consolidation meaning the bronchi are air filled

Bulging/thickening of lung fissures - can suggest that pneumonia is lobar and isolated to lobe etc

Question 5

History: 1 week of lethargy, myalgia, fever and cough with brown sputum

What condition does this suggest

Answer 5

Pneumonia

Question 6

What do we refer to lungs as when describing areas of consolidation?

Answer 6

ZONES - NOT LOBES unless you can see pneumonia is isolated to lobe by fissure thickening
Upper, middle and lower zones
(as lower lobe of lung is actually mostly posterior and CXR is 2D)

Question 7

History: 65 year old female, cough, haemoptysis, weight loss

What does this suggest?

Answer 7

Lung cancer

Question 8

Appearance of lung cancer on CXR

Answer 8

Rounded opacity - more dense than pneumonia and no air bronchograms through opacity, defined margin, often central - hilar region
+/- pleural effusion
+/- lymphadenopathy (easier to see in CT)

Question 9

What would you do following CXR suggesting lung cancer?

Answer 9

Do CT - can see how invasive cancer is, see other nodules, see if compression of SVC has occurred

Question 10

History: 60 year old male, 1 day of increasing shortness of breath and frothy white sputum

What condition is suggested?

Answer 10

Pulmonary oedema

Question 11

What is the appearance of pulmonary oedema on CXR?

Answer 11

“Bats wing” perihilar shadowing - fluffy widespread shadowing fanning out bilaterally from hilum, usually spares upper zones, affects middle and lower

Interstitial fluid - peripheral sharp lines

Upper lobe venous distension - plump vein

Question 12

What else to check when looking at CXR other than the image itself?

Answer 12

Labels - is it acute setting? resus? how unwell is the pt likely to be?
If very unwell could be PE or pulmonary oedema

Question 13

History: 25 year old male, fit and well, CXR for immigration reasons

What could be found?

Answer 13

Situs inversus totalis

(tbf this ones a bit out there)

Question 14

What is situs totalis inversus?

Answer 14

Entire structures in CXR have been flipped - have to make sure it not a processing error and that the CXR label is in the right supraclavicular fossa

Question 15

Specific signs on CXR of sinus totatlis inversus?

Answer 15

Dextrocardia - heart pointing to right
Aortic knuckle/arch on right
Stomach on right - gastric bubble on right

Question 16

Ascending and descending aorta on CT

Answer 16

Ascending is more anterior
Then forms arch of aorta
Descending is posterior

Question 17

How can we make lungs more clear when looking at CT via editing?

Answer 17

Change CT window - can have soft tissue windows better for soft tissue or lung windows better for lungs etc

Question 18

Covid appearance on CXR

Answer 18

Most normal/clear but if there is a sign:
Multifocal peripheral opacities - not as dense as pneumonia, edges are fluffy

Question 19

CT for Covid appearance

Answer 19

Ground glass appearance - can see the lung through the opacification

Question 20

What do we have to do alongside CXR if suspect covid?

Answer 20

Angiogram - covid is prothrombotic

Question 21

History: 25 year old female, known chronic lung disease, cough and lots of sputum production.

What is the condition?

Answer 21

Cystic fibrosis causing bronchiectasis

Question 22

CXR signs of bronchiectasis

Answer 22

Thickened parallel bronchial walls - tramtrack sign, esp on upper lobes
Airway plugging - filled with mucus (can cause lobar collapse)
+/- venous catheter as these patients often need abx regularly so have central line into subclavian for this

Question 23

History: 85 year old male, syncope, postural dizziness, hypoxia and tachycardia

Whats the diagnosis?

Answer 23

Pulmonary embolism

Question 24

PE CXR - WHY?

Answer 24

To rule out pneumonia or other causes - NOT good imaging if actually PE
Can have peripheral opacity due to infarction (vague shadow in corner)

Question 25

CT appearance of PE and what type CT

Answer 25

CTPA is used!!! Need contrast to see vessels

Can have saddle embolism of pulmonary artery - appears as grey patch filling white vessel
Straightening of interventricular septum showing right sided heart strain

Question 26

History: 20 year old male, retching followed by sudden onset of sharp central chest pain

Diagnosis?

Answer 26

Pneumomediastinum

Question 27

What is pneumomediastimum?

Answer 27

Gas within the soft tissues of mediastinum (space between each lung) in this case, due to oesophageal tear (pressure increased when retching)

Question 28

CXR of pneumomediastinum

Answer 28

Streaky linear lucencies (black lines) parallel to mediastinum (lines going up neck)
Gas in neck and axillae

Question 29

What is an oesphageal tear due to forceful nature of for example retching, known as?

Answer 29

Boerhaave syndrome

Question 30

What can pneumomediastinum lead to?

Answer 30

Pneumothorax
Mediastinitis
Usually need abx and rest, sometimes surgery

Question 31

History: 70 year old male, retired factory worker, intermittent shortness of breath

Diagnosis?

Answer 31

Pleural plaques
Form along pleural surface edge

Question 32

CXR appearance of pleural plaques

Answer 32

Calcified usually - bright white
Front on shows holly leaf shaped opacification
Diaphragm surface - thick and bright

THESE are OK alone

Question 33

What can often cause pleural plaques?

Answer 33

Asbestos exposure

Question 34

History: 70 year old male, retired factory worker, worsening SOB, weight loss, fatigue

Diagnosis?

Answer 34

Mesothelioma - malignancy of pleural of lung
Often secondary to asbestos exposure, often presents late meaning it is difficult to ressect tissue

Question 35

CXR of mesothelioma

Answer 35

Lung encased by rind of soft tissue
History of asbestos exposure