Air space disease

Question 1

The lingular section of the left lung is homologue to what ?

Answer 1

the right middle lobe

Question 2

what is the azygous fissure/ lobe?

Answer 2

it is created by downward migration of the azygous vein. as it migrates, it takes a portion of the parietal/ visceral pleura of the upper right lobe. this separates a fraction of the lung into a new lobe

Question 3

What is another name for the anterior mediastinum?

Answer 3

cardiac

Question 4

What is another name for the middle mediastinum?

Answer 4

the vascular & lymphadenopathy of the hilar area

Question 5

What is another name for the posterior mediastinum?

Answer 5

neurogenic

neurofibromas

Question 6

What are the 2 patterns of disease seen in the lung & what are examples of each?

Answer 6

1. interstitial space disease: AS or RA

2. air space disease: MC pneumonia

Question 7

Where is the primary lobule located and what is its purpose?

Answer 7

Aka: acinus
located distal to the respiratory bronchiole
it is the functional unit of respiration

Question 8

Where is the secondary lobule located and what is it comprised of ?

Answer 8

located distal to the terminal bronchile

comprised of 4-5 primary lobules, 1-2 cm

Question 9

How do alveoli communicate?

Answer 9

with each other via Pores of Kohn

with distal bronchioles via Canals of Lambert

Question 10

What is interstitium and what are the 3 spaces of it?

Answer 10

it is the connective tissue support network within the lung

1. axial
2. parenchymal
3. peripheral

Question 11

Where is the axial space of the interstitium?

Answer 11

surrounds the primary bronchi and pulmonary artery

Question 12

Where is the parenchymal space of the interstitium?

Answer 12

surrounds the alveoli

Question 13

Where is the peripheral space of the interstitum?

Answer 13

between visceral pleura and lung parenchyma

Question 14

What is the pattern of interstitial lung disease seen on film?

Answer 14

“toothpick” pattern

Question 15

What is the pattern of alveolar/ airspace lung disease seen on film?

Answer 15

“cloud-like” pattern

Question 16

What causes the “cloud-like” pattern of alveolar lung disease?

Answer 16

normal radiolucent lung tissue becomes white/ radiopaque if air within acini is replaced by BEPT; this leads to consolidation which leads to loss of air in alveolar space without loss in lung volume

Question 17

What type of epithelial cells most commonly line the alveoli?

Answer 17

90% are type I squamous pneumocytes that lack the ability of mitosis

Question 18

What is pnemocystic carinii?

Answer 18

a mix of airspace and interstitial
MC infx in HIV+
caused by P. jiroveci fungus

Question 19

What is the “Silhouette” sign?

Answer 19

it is a loss of radiodense border secondary to a radiodense pathology positioned continuous with normal structure

Question 20

How is the “Silhouette” sign helpful in dx chest pathology?

Answer 20

allows the observer to determine the location or presence of abnormality in relation to normal structure

Question 21

What does a negative Silhouette sign with a dx of pneumonia indicate?

Answer 21

that the cardiac tissues are not touching the pathology. the pathology is either in front or in back of the heart

Question 22

What does a positive Silhouette sign with a dx of pneumonia indicate?

Answer 22

the heart shadow is not seen, this indicates that the pathology is touching the heart

Question 23

If the right heart border is obliterated on film, where is the pathology?

Answer 23

Right middle lobe

Question 24

If the left heart border is obliterated on film, where is the pathology

Answer 24

Lingular section of upper lobe

Question 25

If the right hemidiphragm is obliterated on film, where is the pathology

Answer 25

lower RIGHT lobe

Question 26

If the left hemidiphragm is obliterated on film, where is the pathology

Answer 26

lower LEFT lobe

Question 27

If the ascending aorta is obscured, where is the pathology?

Answer 27

Right UPPER lobe

Question 28

If the aortic arch is obscured, where is the pathology?

Answer 28

LEFT upper lobe

Question 29

What is the "air bronchogram" sign?

Answer 29

air filled bronchi normally not seen because they are surrounded by air filled lung they appear as radiolucent tubular densities if the lung is filled with water

Question 30

What is atelectasis?

Answer 30

incomplete air filling and under expansion of the lung. suggests presence of another disease

Question 31

What are the radiographic findings of atelectasis?

Answer 31

- direct findings = displaced fissures, increased radiodensity - indirect findings = elevated diaphragm

Question 32

What are the 5 types of atelectasis?

Answer 32

1. obstructive/ resorption 2. compressive (extrapulmonary) 3. passive (intrapulmonary) 4. contraction/ cicatrization 5. newborn

Question 33

What is the cause of obstructive atelectasis?

Answer 33

airway obstruction | this is the MC type

Question 34

What is the cause of compressive atelectasis

Answer 34

pulmonary mass/ SOL inside the lung

Question 35

What is the cause of passive atelectasis

Answer 35

pleural mass (pneumothorax)/ SOL external to the lung

Question 36

What is the cause of contraction/ cicatrization atelectasis

Answer 36

scarring & contracture of pulmonary tissue after infection, scleroderma, radiation, etc

Question 37

What is an acceptable diaphragm displacement difference measurement side to side?

Answer 37

2 cm

Question 38

What are the radiographic findings of atelectasis?

Answer 38

superior migration of right minor fissure and increased radiodensity of collapsed right upper lobe

Question 39

What is the Reverse "S" configuration / "S" sign of Golden?

Answer 39

collapse of right upper lobe leads to superior migration of horizontal fissure which then bulges inferiorly near hilar mass

Question 40

What are the radiographic findings of Atelecstasis of the right upper lobe?

Answer 40

high RT hemidiphragm, elevated horizontal fissure, reverse "S" configuration

Question 41

What is Bronchial Asthma?

Answer 41

widespread, REVERSIBLE, episodic narrowing of airways

Question 42

What are the 2 types of Bronchial Asthma and their causes?

Answer 42

1. Extrinsic: due to environmental exposure | 2. Intrinsic: due to immunological response (exercise or infx)

Question 43

What are the radiographic findings of acute Bronchial Asthma?

Answer 43

hyperinflation of the lung, increased radiolucency, possible diaphragm depression, barrel chest appearance

Question 44

What are the radiographic findings of chronic Bronchial Asthma?

Answer 44

normal or prominent interstitium, possible thick bronchi

Question 45

What are the S/S of Asthma?

Answer 45

wheezing, prolonged expiration, dyspnea & cough

Question 46

What is Bronchiectasis & what are the types?

Answer 46

chronic, IRREVERSIBLE dilation of bronchi | types based on appearance: cylindrical, varicose & saccular

Question 47

What are the radiographic findings of Bronchiectasis?

Answer 47

thick bronchial walls, altered lung volume, honey comb appearance

Question 48

What is a congenital bronchiogenic cyst?

Answer 48

anomalous out pouching of the primitive foregut, complete separation from the airway 80% are medialstinal

Question 49

What is a bronchopulmunary sequestration?

Answer 49

congenital malformation of the foregut resulting in separation of a portion of the lung from the bronchial tree appears as a radiodense mass above or below diaphragm

Question 50

Where are extralobular sequestrations located? | intralobular?

Answer 50

extralobular: 90% are on the LEFT intralobular: 60% are on the RIGHT

Question 51

What is emphysema?

Answer 51

chronic dilation of the air space distal to the terminal bronchi (secondary lobule) characterized by acinar wall destruction, large aggregate air spaces

Question 52

How are types of emphysema based and what are they?

Answer 52

Based on region: | centriolobular, panacinar, distal acinar, irregular

Question 53

What are the radiographic features of emphysema?

Answer 53

``` bilaterally flat & slanted, depressed hemidiphragm thin heart shadow lung over inflation / increased radiolucency increased retrosternal space barrel chest increased widened intercostal spaces prominent hilar vasculature bullae ```

Question 54

What is the most reliable radiographic feature of emphysema

Answer 54

increased retrosternal space

Question 55

What is bullous emphysema?

Answer 55

damage & loss of elasticity of the bronchioles & alveolar sacs, chronic dilation that traps stale air in airspace. rupture of small capillaries causes less efficient circulation & gas exchange

Question 56

What is a characteristic radiographic feature of emphysema?

Answer 56

the heart twists and looks more narrow due to diaphragm no supporting it below only moderate to severe forms are detectable on film