Chest Flashcards
(39 cards)
28-yo man with a 10 day history of mild cough and low fever. No significant PMH and otherwise healthy. No sputum production or hemoptysis. Chest exam is normal. Next best step in management?
Symptomatic management
In which patients should you order f/u imaging in pneumonia?
older, current/former smokers, recurrent pneumonias
Atypical pneumonias on CXR appear with which of the following characteristics?
1) B/L
2) Ground glass appearance
3) Kerley B Lines (septal lines- thickening of interlobular septa)
4) Relative sparing of bases and apices
Which imaging modalities can be used for radiographic diagnosis of pleural effusions?
CXR Right lateral decubitus
US
CT (for loculated and complex pleural collections)
Which patients need preoperative CXR?
1) Patients with cardiorespiratory signs and symptoms
2) Patients over 65 with stable cardiorespiratory disease and no CXR for six months
Single pulmonary nodules management?
Comparison important to assess stability >2yrs
CT if suspicious for malignancy or many risk factors
Single pulmonary nodule concerning characteristics
size: greater than 1cm or increasing in size
edge: lobulated, spiculated, ill-defined
pattern of calcifications
Single pulmonary nodule patient risk factors
h/o lung disease >40 yrs smoking history granulomatous disease h/o malignancy
Lung cancer screening?
low dose CT, current/former smokers or other high risk pts
f/u in-determinants with pet before bx
Best choice of imaging to evaluate for a subtle pneumothorax?
erect expiratory CXR (Increased lung density and decreased thoracic volume)
right lateral decubitus CXR
CXR signs of a tension pneumothorax:
- Mediastinal shift AWAY
- Diaphragmatic depression on side of pneumothorax
- Complete lung collapse typical
Clinical signs of tension pneumothorax:
- Hypoxia
- Hypotension
- Pulsus paradox
- Hyper-resonance on side
- Decreased respiratory excursions on side
- Absent breath sounds on side of pneumothorax
Management of tension pneumothorax:
IMMEDIATE temporary relief of by inserting a large-bore needle into the second left interspace in the mid-clavicular line
What pathophysiology correlated to the CXR finding: faint “veil-like” opacification of the middle 2/3 of the left hemithorax?
Atelectic left upper lobe that retracts anteriorly
What pathophysiology correlated to the PA CXR finding: Tracheal shift to the left, diaphragmatic elevation, and loss of the left heart border
Volume loss in the left hemithorax
What pathophysiology correlated to the lateral CXR finding: Sharp edge with opacification over the anterior chest/heart
Left upper lobe collapses against the anterior chest wall
Differential diagnosis of complete opacification of a hemithorax?
complete lobe atelectasis (collapse) Hemi-pneumonectomy (look for clues: rib resections, clips, volume shift) large pleural effusion large mass large pneumonia
What is a typical x-ray ‘trauma series’?
AP supine CXR
Lateral C-spine
AP supine pelvis
Common radiographic findings seen in traumatic aortic injury (TAI)?
Widening mediastinum (>8cm)
Mediastinal deviation to the right
No ‘lateral aortic silhouette’
No aortic knob
What is a typical CT ‘trauma series’?
CT w/o Head
CT C-spine
CT Chest/Abd/Pelvis with contrast
Appropriate radiologic aorta evaluation?
CT with Contrast
Transesophageal echo (if contrast contraindicated)
MRI (time permitting, if contrast contraindicated)
Recognition of a pneumothorax on supine CXR?
Deep Sulcus Sign- one costophrenic angle appears much ‘deeper’ and more lucent than the other
Radiographic evaluation of chest tube placement?
anterior and apical for a pneumothorax
posterior and basal for a pleural effusion
Radiographic evaluation of endotracheal tube placement?
3-5 cm above the carina
