19- Chest Flashcards
View the normal chest X-ray on slide 3
yep
What is COAD: Emphysema
4
What is it?
what sort of stuff would you expect to see?
A. Lung overinflation (Panlobular)
- indiscriminate destruction of the acinar walls leading to air trapping
- vascular obstruction peripherally, may lead to pulmonary hypertension
- little or no fibrosis
- bleb = small, usually peripheral, interstitial collection of air
- bulla = large parenchymal collection of air
B. Increased markings (Centrilobular)
- focal destruction of the respiratory bronchioles with intact alveoli and ducts
- Vascular enlargement peripherally and centrally, commonly associated with pulmonary hypertension
What would you radiographic Findings be for Emphysema?
Panlobular:
6
Panlobular:
- hyperaeration of the lungs, with reduced vascular markings peripherally
- low, flat hemidiaphragms
- limited diaphragm excursion (if expiration views done)
- focal areas of oligemia seen with bullae
- hilar vessels may be normal or enlarged, heart may be narrowed or slightly enlarged
- “barrel chest”
What are the radiographic features you would see with Centrilobular findings?
7
- “dirty lungs” due to increased yet hazy vascular markings
- hilar pulmonary arteries enlarged
- may see right ventricular enlargement from cor pulmonale
- overinflation of lungs is not a characteristic finding
view photos on slide 9 and 10
and read slide 8
Pneumonia
slide 11
what is it, what causes it?
- Inflammation of the alveolar parenchyma
- consolidation of lung tissue
- causes:
- infection (MC)–> viral, bacterial, mycoplasmal, yeast, fungal
- chemical inhalation, chest wall trauma
Whats the radiographic findings of Pneumonia?
- depends on causative agent
- may be hazy, ill-defined opacities
- may show complete consolidation with air-bronchogram
- may be unilateral or bilateral
- usually respect pleural boundaries
Consolidation ddx:
-Blood, pus, water, protein, cells
view slides 13, 14, 15
Tuberculosis
slide 16
What is it, what is its radiographic findings?
Primary and reactivation
View slides 18-22
-Chronic caseating granulomatous disease cause by Mycobacterium tuberculosis
Radiographic findings - primary
-right side more commonly involved
-hilar lymphadenopathy is common
-Ghon tubercle (parenchymal granuloma associated with TB)
-Ranke complex
(a Ghon tubercle and hilar lymph node calcification)
Radiographic findings - reactivation
progressive infection
poorly defined, incomplete consolidations which coalesce into radiopacities
interstitial disease, fibrosis, and calcification (pulmonary, pleural) can be seen late stage
What is a solitary Pulmonary Nodule?
23
- Pulmonary radiopacities less than 3cm = nodules
- Most common causes: bronchogenic carcinoma and granuloma
- Many other lesions fall into this category, or if they enlarge, the “mass lesion” category.
Doubling time: an important evaluator of the nature of nodules (and masses)
-if the size (volume) of a lesion doubles in less than one month, or more than 2 years, it is probably benign
view image on slide 24
What is a Granuloma?
associated with what?
Slide 25?
- Well-defined calcified lesion, under 6cm in diameter
- calcification can be central, peripheral rim, or solid (benign)
- Usually associated with slow growing infections (tuberculosis is the most common)
- Size of lesion remains stable for a long period of time (doubling time > 2 years)
view image on slide 26
Mass lesion
slide 27
causes?
- pulmonary radiopacity greater than 3cm
- bronchogenic carcinoma (m.c)
- may have a fuzzy or lobulated boarder
- may have a peripheral (eccentric) calcification
- cell types include small cell and non-small cell
- subtype: Pancoast tumor :
- squamous cell carcinoma of the lung apex
- may be associated with Horners syndrome
- See thick pleural cap with convex, irregular border; adjacent bone destruction is classic.
Causes of pulmonary masses?:
-abscess, arteriovenous malformation, bronchial carcinoid tumors, bronchogenic cystes, carcnioma, chest wall lesions, granuloma, hematoma, metastasis
Multiple nodules/masses:
- think metastasis first
- infectious/ non-infectious granulomatous
- other causes are uncommon
View images on slides 29-32
Asbestosis and Asbestos- related disease
33
due to?
How long before clinical manifestations happen?
- Due to inhalation of inorganic dust particles, resulting in irreversible damage to the lungs (pulmonary fibrosis, carcinoma) and pleura (calcification, fibrosis, malignant mesothelioma).
- It often takes 2-3 decades before clinical manifestations of exposure become apparent.
What are the radiographic features of Asbestosis and asbestosis-related Disease?
Pulmonary disease
Pleural disease
Malignant mesothelia
Radiographic:
-manifestations depend on the type of asbestos inhaled, chronicity of exposure, and lifestyle (especially smoking)
- pulmonary disease
- interstitial; Fibrosis
- diffuse, irregular white lines predominately affecting the lower lung zones until late in the disease
- Shaggy heart boarder
Pleural disease
-Pleural plaques, diffuse pleural thickening, pleural calcification – seen along the rib contours and over the domes of the diaphragm, and/or small pleural effusions
What is Atelectasis?
what are the 4 types?
43
Loss of volume of some portion of a lung
4 types:
-Resorptive / obstructive
-Obstruction from within the lumen, within wall, or outside the wall of a bronchi
-May see consolidation without air-bronchogram
- Passive / compressive
- Pneumo(hemo)thorax, focal mass
- Adhesive
- Inactivation of surfactant
- Cicatrization
- Scarring / fibrosis. Common with TB
Atelectasis
What are the direct radiographic signs?
what are the indirect radiographic signs?
Direct:
-displaced interlobular fissure most reliable
Indirect radiographic signs:
- Local increase in opacity
- Crowding of pulmonary vessels
- Elevation of hemidiaphragm
- Mediastinal shift to side of collapse
- Hilar shift towards area of collapse
- Compensatory overinflation
- Rib crowding
View image on slide 45
Pleural Effusion 47 What is it? Radiographic features? Underlying causes?
-Large collection of transudate, exudate, blood or chyle
Radiographic:
- costophrenic blunting with meniscus sign
- hemithorax opacification
Some underlying causes:
-abdominal disease, collagen disease, CHF, empyema, malignancies
0pneumonia, pulmonary infarct, renal disease, trauma, tuberculosis
View image on slide 48
