14 - Radiology of the airway

Question 1

A 22 yo male presents with 3 day hx of mild cough. Vital signs are normal and patient is afebrile. What imaging test would you order?

Answer 1

Trick question: NONE (no crackles heard or decreased pulse ox)

Question 2

What are 5 possible reasons for imaging the upper airway? Which are most common?

Answer 2

1. chronic sinusitis and complications
2. acute sinusitis
3. post operative
4. tumors
5. trauma

**1 and 2 most common

Question 3

What imaging test would you order to investigate a patient with thick nasal discharge?

Answer 3

CT (sinuses not well visualized on xray)

Question 4

What do you see on this sinus CT?

Answer 4

Fluid in the maxillary sinus but no bone infiltration

Question 5

What do you see on this sinus CT?

Answer 5

Nasal polyposis (multiple polyps filling the sinuses; no air seen and bone being eroded)

Question 6

What are the reasons to order tracheal imaging?

Answer 6

• trachiitis or bronchitis
• unusual to image for infections except…
  
  • epiglottitis
  • tracheal papillomatosis
  • croup

Question 7

What is tracheomalacia?

Answer 7

• tracheal rings collapse on expiration
• difficulty breathing OUT, especially with increased flow (e.g. coughing, crying)

Question 8

What are the possible views for a chest radiograph? Which is most common?

Answer 8

• PA, lateral (most common; best resolution)
• AP upright (less quality but good in emergencies)
• AP supine
• Decubitus (patient on side; good to determine free flowing versus loculated pleural effusion)
• Oblique
• Lordotic

**views other than PA, lateral are less common now that we have CT scans

Question 9

What structures should be systematically inspected when viewing a chest radiograph?

Answer 9

1. heart/mediastinum
2. lungs (left, right, and both together to see symmetry)
3. bones
4. soft tissue (look for masses, calcification, air in abdomen, etc)

Question 10

What is the difference between these two radiographs?

Answer 10

Left= AP view (heart/mediastinum look wider because detector is further away and distorts the image)

Right= PA view (normal radiograph)

Question 11

Describe the orientation of the lobes of the lung

Answer 11

Right lung= 3 (upper/middle anterior and lower posterior)

Left lung= 2 (upper/lingula anterior lower posterior)

Question 12

What do you see on this chest xray?

Answer 12

Bronchopneumonia (if patient presented with fever and normal O2 saturation, just treat outpatient)

Question 13

What do you see on this lung CT?

Answer 13

Bronchopneumonia “tree in bud” appearance

Question 14

What do you see on this chest xray?

Answer 14

Right upper lobe pneumonia

Question 15

What do you see on this chest CT?

Answer 15

Miliary TB

Question 16

What do you see on this chest CT?

Answer 16

Histoplasmosis (hilum and splenic calcifications)

Question 17

What are 2 important considerations for a patient with persistent repiratory illness/consolidations despite antibiotic treatment?

Answer 17

1. Other organisms (e.g. blastomycosis, aspergiolosis)
2. Lung cancer (e.g. squamous cell carcinoma)

Question 18

What are 4 “types” of aspergillus infection?

Answer 18

**Depends on the immune system function:

1. Invasive aspergillus (severely immunosuppressed patients)
2. Semi-invasive aspergillus (immunosuppressed patients)
3. Aspergilloma (“fungal ball” in normal immune system but abnormal lungs)
4. Allergic bronchopulmonary aspergillosis (hyper-immune)

Question 19

What do you see on this chest xray?

Answer 19

Acute respiratory distress syndrome (ARDS)

**can have many causes

Question 20

What do you see on this chest xray?

Answer 20

Large right pleural effusion