Chapter 12: Methods of examination; Normal Anatomy, and Radiographic findings of Chest Disease

Question 1

Four basic features of proper radiographic technique:

Answer 1

Penetration
Inspiration
Rotation
Motion

Question 2

How is rotation assessed?

Answer 2

relationship between a vertical line drawn midway between the medial cortical margins of the clavicular heads and one drawn vertically through the spinous processes of the thoracic vertebrae

Question 3

How is appropriate inspiration assessed?

Answer 3

present when the apex of the right hemidiaphragm is visible below the tenth posterior rib.

Question 4

How is proper penetration of xray assessed?

Answer 4

when there is faint visualization of the intervertebral disk spaces of the thoracic spine and discrete branching vessels can be identified through the cardiac shadow

Question 5

the focus to film distance in AP technique

Answer 5

40 inches: results in magnification of intrathoracic structures

Question 6

The apparent cardiac diameter in AP techniques increases by?

Answer 6

15 to 20% bringing the upper limit of normal CT ratio from 50% to 57% in AP

Question 7

normal CT ration in AP xray?

Answer 7

57%

Question 8

Result of AP projection on chest xray?

Answer 8

1. Elevates the diaphragm-> compressing the lower lobes and decreasing lung volumes
2. Gravitational effect evens the blood flow between upper and lower zones in supine patients- difficult to assess Pulmo HPN
3. Widening of the upper mediastinum or “vascular pedicle”
4. gravitational layering hides small effusions and pneumothorax

Question 9

what is Dual energy subtraction?

Answer 9

a form of computed radiography that utilizes low-energy (60 keV) and high energy (120 keV) photons to produce selective bone and soft tissue images

Question 10

position that that detects small effusions, characterize free flowing effusions on decubitus side and small pneumothorax on contralateral side

Answer 10

Lateral decubitus

Question 11

Can detect focal or diffuse air trapping and eases detection of a small pneumothorax

Answer 11

Expiratory radiograph

Question 12

Improves visualization of the apiceswhich are obscured on routine PA xray by the clavicles and first costochondral junctions

Answer 12

Apical lordotic view

Question 13

used to mainly assess chest dynamics on patients with suspected diaphragmatic paralysis now replaced by CT

Answer 13

chest flouroscopy

Question 14

the major advantages of MRI?

Answer 14

1. superior contrast resolution between tumor and fat
2. ability to characterize tissues on the basis of T1 and T2 relaxation times
3. the ability to scan in direct sagittal and coronal planes
4. the lack of need for IV iodinated contrast

Question 15

the major disadvantage of MRI?

Answer 15

unable to distinguish benign masses from malignant masses or lymph node

Question 16

is an imaging modality based on he metabolic activity of neoplastic and inflammatory tissues

Answer 16

PET: Flourodeoxyglucose (FDG) PET

Question 17

flat band of muscle and connective tissue of the cartilage

Answer 17

posterior tracheal membrane

Question 18

lining epithelium of tracheal mucosa

Answer 18

Pseudostratified, ciliated columnar epithelium which contains scattered neuroendocrine cells (APUD)

Question 19

The trachea is approximately __ cm long in adults

Answer 19

12 cm

Question 20

the coronal tracheal diameter is __mm in men and __mm in women?

Answer 20

25 mm in men and 21 mm in women

Question 21

in cross section the trachea is oval or horseshoe shaped with a coronal to sagittal diameter ratio of __?

Answer 21

0.6:1.0

Question 22

A narrowing of the coronal diameter of the trachea with coronal-sagittal ratio of

Answer 22

saber sheath trachea seen in patients with COPD

Question 23

A slight tracheal deviation to the right after entering the thorax can be a normal radiographic finding?

Answer 23

YES

Question 24

the interface of the RUL with the right lateral tracheal wall is called ?

Answer 24

the right paratracheal stripe

Question 25

the right paratracheal stripe should be uniformly smooth and should not exceed __mm in width

Answer 25

4mm in width

Question 26

the left lateral tracheal wall is surrounded by mediastinal vessels and fat and is not normally visible in xray?

Answer 26

YES

Question 27

the presence of air in the esophagus produces the ? represents the combined thickness of the tracheal and esophageal wall and intervening fat.. t

Answer 27

tracheoesophageal stripe

Question 28

tracheoesophageal stripe thickness?

Question 29

the ___ main bronchus is shorter than the ___ main bronchus (mean length of 2.2 and 5 cm respectively)

Answer 29

Right | Left

Question 30

bronchioles bearing alveoli in their walls are termed?

Answer 30

respiratory bronchioles dividing into alveolar ducts and sacs

Question 31

the airway just before the first repiratory bronchiole is the

Answer 31

terminal bronchiole= the smallest bronchiole without respiratory exchange structures

Question 32

the lungs are divided by these invaginations of the visceral pleura?

Answer 32

interlobar fissures

Question 33

Branches of the RUL

Answer 33

branches into 3 segmental branches: anterior, apical, posterior

Question 34

Branches of the RML; arises from the intermediate bronchus

Answer 34

divided into medial and lateral branches. Blood supply by a branch of the right interlobar pulmonary artery

Question 35

The RLL is supplied by the RLL bronchus and pulmonary artery. it is subdivided into .. segments

Answer 35

superior segment and 4 basal segments: anterior, lateral, posterior, and medial basal segments.

Question 36

the LEFT lung is divided into upper and lower lobes by the what?

Answer 36

left major fissure

Question 37

The LUL is analogous to the combined ___ lobes

Answer 37

RUL and RML

Question 38

The LUL is subdivided into __ segments: namely?

Answer 38

4 segments namely: anterior, apicoposterior and the superior and inferior lingular segments

Question 39

Blood supply of LUL?

Answer 39

anterior and apicoposterior segments= left main pulmonary artery. Superior and inferior= superior and inferior lingular arteries are proximal branches of the left interlobar pulmonary artery analogous to the middle lobes blood supply.

Question 40

The LLL segments?

Answer 40

superior segment and 3 basal segments: anteromedial, lateral, and posterior

Question 41

gas exchanging units of the lungs?

Answer 41

alveolar ducts and sacs

Question 42

pneumocytes that are flattened squamous cells covering 95% of alveolar surface

Answer 42

type 1

Question 43

this pneumocytes are cuboidal cells capable of mitosis; source of new type of pneumocytes and provide mechanism for repair following alveolar damage. source of surfactant

Answer 43

type 2

Question 44

the left major fissure begins more superiorly and has a slightly more vertical course than the right major fissure

Answer 44

YES

Question 45

The minor fissure projects at the level of the right __th rib and is seen as a thin undulating line on frontal xray.

Answer 45

right 4th rib

Question 46

the ___fissure is the most common accessory fissure and is found in 10 to 20% of individuals

Answer 46

inferior accessory fissure

Question 47

the ___ fissure has been misidentified as the inferior pulmonary ligament and is responsible fro the juxtaphrenic peak(tenting) described in upper lobe volume loss.

Answer 47

inferior accessory fissure

Question 48

the __ fissure is seen in 0,5% of individuals, represents the invagination of the right apical pleura by the azygos vein.

Answer 48

Azygos fissure

Question 49

The __ fissure separates the superior segment from the basal segments of the lower lobe. On lateral it extends xray it extends posteriorly from the major fissure to the chest wall.

Answer 49

superior accessory fissure

Question 50

The __ fissure is rarely seen normal variant that separates the lingula from the remaining portions of the upper lobe.

Answer 50

left main fissure

Question 51

is a sheet of connective tissue that extends from the hilum superiorly to a level at or just above the hemidiaphragm, on CT it is a small laterally directed beak of mediastinal pleura adjacent to the esophagus

Answer 51

inferior pulmonary ligament

Question 52

the inferior pulmonary ligament contains this vein superiorly

Answer 52

inferior pulmonary vein

Question 53

This septum has been mistaken for the inferior pulmonary ligament. seen on CT near the inferior pulmonary ligament

Answer 53

sublobar septum

Question 54

this ligament is a triangular density extending toward the lung that is seen along the posterior aspect of the right heart border on lung windows on chest CT

Answer 54

periocardiophrenic ligament

Question 55

is an elastic artery that arises from the right ventricle at approximately 1 oclock position relative to the ascending aorta.

Answer 55

pulmonary arteries

Question 56

are the primary nutrient vessels of the lung. They supply blood to the bronchial walls to the level of the terminal bronchiole

Answer 56

bronchial arteries

Question 57

the two major lymphatic pathways in the lung and pleura

Answer 57

1. The visceral pleural lymphatics | 2. the parenchymal lymphatics

Question 58

Is the scaffolding of the lung an as such provides support for the airways and pulmonary vessels

Answer 58

pulmonary interstitium

Question 59

Edema involving this interstitium is recognized radiographically as peribronchial cuffing

Answer 59

axial interstium

Question 60

Edema of this interstitium accounts for Kerley B Lines

Answer 60

peripheral and subpleural interstitium

Question 61

is seen as a thin vertical line that overlies the thoracic spine

Answer 61

anterior junction line

Question 62

a radio-lucent region regpresenting contact of the posterosuperior portions of the upper lobes

Answer 62

retrotracheal triangle