Radiology 1

Question 1

How to calculate the estimated height of a child?

Answer 1

1. Add mother and father’s height in cm
2. Add 13 cm for boys or subtract 13 cm for girls
3. Divide by 2

Child (at the puberty) should fall into the centile that is above or below 8 cm from the above target/estimated height

*children with parents having very different heights (e.g. very short and very tall) tend to go either way

Question 2

Ix in case of suspected congenital hypothyroid

Answer 2

If TSH elevated on skin prick test:

1. If elevated >10 → start treatment with thyroid hormone

2. If elevated but no too much → test for T3 and T4 and if low then start treatment

*also radiological Ix e.g. USS scan in order to detect any anatomical abnormalities of thyroid gland

Question 3

What’s a depression of diaphragm sign of on CXR?

Answer 3

Tension pneumothorax

Question 4

What’s that?

Answer 4

Pneumomediastinum

Thin parietal pleural layer stripped of mediastinum as gas gets into mediastinal compartment

Causes: ruptured oesophagus, asthma, barotrauma, hyperventilation (e.g. in metabolic acidosis)

Question 5

What’s continuous diaphragm sign?

Answer 5

If gas between heart and diaphragm → sign of pneumomediastinum

Question 6

What’s that?

Answer 6

Middle lobe consolidation → pneumonia

Question 7

What’s that?

Answer 7

Right lower lobe consolidation e.g. in pneumonia

We know it’s R lower lobe, as lower lobe has the same radiographic density as hemidiaphragm

Question 8

What’s that?

Answer 8

Lingular consolidation pneumonia

Obscuration of a heart border with a diaphragm intact

Question 9

What’s the diagnosis?

Answer 9

Bilateral perihilar airspace shadowing

Pneumocystic jiroveci pneumonoa

Question 10

What’s that?

Answer 10

Ground glass perihilar airspace shadowing = pneumocystis jiroveci pneumona

• tends to spare peripheries and bases
• no lymphadenopathy
• no pleural effusions

Question 11

What’s that?

describe CXR

Answer 11

COVID-19 pneumonia

• bilateral consolidation (either symmetrical or asymmetrical)

*but diagnosis should be made by PCR

Question 12

Diagnosis

Answer 12

Miliary TB

• lots of nodules (no larger than 3 mm)

*but diagnosis made together with clinical features

Question 13

What are Kerley B lines?

Answer 13

Areas of the interlobular septum (so the gaps between individual lobules) which fill with fluid that oozes out of pulmonary veins

• sign of HF

Question 14

(2) findings on this CXR

Answer 14

• Kerley B lines
• early alveolar and interstitial pulmonary oedema

Question 15

How do Kerley B lines happen?

Answer 15

Oozing out from pulmonary veins into interlobular septa

Question 16

What’s Bat’s wing sign?

Answer 16

It’s alveolar pulmonary oedema

*usually with small bilateral pleural effusions

Question 17

(2) findings

Answer 17

• Bat’s wing → pulmonary oedema
• wrongly placed NG tube

Question 18

What’s lamellar ‘pleural’ effusion?

Answer 18

Lamellar ‘pleural’ effusion

It’s actually not a pleural effusion, it’s a fluid oozing out of intralobular septa into the gap between visceral pleura and the lung

*sign of a HF

Question 19

What’s that?

Answer 19

Left Lower Lobe collapse

• Sail sign behind cardiac shadowing
• Remaining lung looks less dense than on the R

*most likely cause in an adult pt is endobronchial cancer

Question 20

What’s that?

Answer 20

Left upper lobe collapse

• increased density over the lung field

Question 21

What’s that?

Answer 21

R MIDDLE lobe collapse

Middle lobe collapse is:

• denoted by a shallow, wedge-shaped opacity
• R heart border is lost
• often seen in asthmatics (mucous plague), possible in an endobronchial tumour

Question 22

What’s that?

Requirements for that

Answer 22

Correctly placed NG tube

• it should go through oesophageal junction into the stomach
• it should bisect carina

*x-ray quality needs to be good, it needs to be well-centered and not rotated

Question 23

Requirements for confirmation of correct NG tube placement (CXR)

Answer 23

• it should go through oesophageal junction into the stomach
• it should bisect carina
• it should take a left turn as it enters gastro-oesophageal junction

*x-ray quality needs to be good, it needs to be well-centred and not rotated

*if we are not sure → NEVER feed the patient, eek advice from radiologist, senior doctor

Question 24

What’s that?

Answer 24

Misplaced NG tube

*there is also a pulmonary oedema

• it goes to R main bronchus and R lower lobe bronchus
• it needs to be pulled out immediately and replaced

Question 25

Is that NGT placed correctly?

Answer 25

There is a deviation to the R at the level of the carina

(always be suspicious if NGT is not bisecting carina and heading to the left)

Another exposure: tube is in R lower lobe

Question 26

What may happen if NGT is placed incorrectly and when it went too far?

Answer 26

Be prepared to expect PNEUMOTHORAX

Question 27

Describe + possible causes

Answer 27

‘Whiteout‘→ opacification of L hemithorax

Look at the previous film it that was + know the history:

• Actue change: pneumonia, pleural effusion (including hemothorax), and collapse/atelectasis
• Longstanding possible pneumonectomy

Question 28

Interpret

Answer 28

Subtle pneumoperitoneum on erect CXR

*surgical clips can be seen so the possible cause is laparotomy

Question 29

Interpret

Answer 29

Flail segment → fracture of two or more ribs in two or more places

Question 30

What’s that?

Answer 30

Large pleural effusion