Chest imaging

Question 1

Checking for good film: is it an adequate breath?

Answer 1

Too shallow–>”crowded” lung…looks pathologic

Should have 10-11 ribs visible

Question 2

Checking for good film: is it over/under penetrated?

Answer 2

Burns through lungs…can’t see vessels

Question 3

Checking for good film: is anything cut off?

Answer 3

That’d be bad

Question 4

Checking for good film: is the patient rotated?

Answer 4

Can distort some anatomy

Question 5

What is the progression in reading a CXR?

Answer 5

Review bones
Evaluate mediastinum
Diaphragm
Lungs

Question 6

How big should the heart appear?

Answer 6

Half of the chest

Question 7

What can make the heart look bigger than it actually is?

Answer 7

Supine view
AP view
Cardiac tamponade–globular shape caused by fluid

Question 8

What can enlarge the heart?

Answer 8

Hypertrophy due to overuse
Cardiomyopathy–CV disease, drugs, infection
Fluid around the heart

Question 9

Why should the contour of the heart be observed?

Answer 9

Massive left atrial enlargement

Question 10

What can be seen of the aorta?

Answer 10

Aneurysm
Aortic dissection
Post traumatic injury with hematoma

Question 11

What can be seen of pulmonary vessels?

Answer 11

Lymph node enlargement–cancer, infection, granulomatous disease (sarcoid)

Question 12

What can be seen of the trachea?

Answer 12

Tracheal deviation

Question 13

What normally causes tracheal deviation?

Answer 13

Enlarged thyroid

Question 14

What can be seen of the diaphragm?

Answer 14

Air in the abdomen
Paralysis (need inspiration and expiration views…also need Sniff test)
Air trapping due to COPD (flat diaphragm and barrel chest)

Question 15

What would interstitial infiltrates look like on CXR?

Answer 15

Lacy

Reticular pattern

Question 16

What do interstitial infiltrates indicate?

Answer 16

Atypical pneumonia
Early CHF
Fibrosis

Question 17

What would alveolar infiltrates look like on CXR?

Answer 17

Fluffy
Consolidating pattern
Air bronchograms present

Question 18

What do alveolar infiltrates indicate?

Answer 18

Bacterial pneumonia
Late CHF
ARDS

Question 19

Lung nodules less than 3cm?

Answer 19

Incidental nodules

Question 20

What are the Fleischner Society Recommendations for incidental nodules based on?

Answer 20

Size
Number
Risk factors

Question 21

Lung nodules greater than 3cm?

Answer 21

Rule out cancer (calcification suggests benign)

Question 22

Multiple lung nodules diagnostic?

Answer 22

Metastatic disease
Infection
Granulomatous disease (sarcoid, Wegner Granulomatosis)

Question 23

Single lung nodule diagnostic?

Answer 23

Lung cancer
Abscess
Infection (TB, blasto)
Benign granuloma
AV malformation
Granulomatous disease

Question 24

What would a CXR of CHF look like?

Answer 24

Interstitial edema if early
Alveolar edema if late
Pleural effusions are common
Cardiomegaly is common
Kerley's B lines or septal lines are strongly suggestive

Question 25

What is the diagnostic of patient presenting with chest pain?

Answer 25

Acute Coronary Syndrome Pneumothorax (PTX) Pulmonary Embolus Aortic Dissection

Question 26

What are examples of Acute Coronary Syndrome?

Answer 26

MI | Angina

Question 27

What tests/labs should be done for ACS?

Answer 27

EKG | Enzymes

Question 28

What is PTX?

Answer 28

Air between parietal and visceral pleura

Question 29

What causes PTX?

Answer 29

30-40% causes by chest trauma (rib fx) | Can be spontaneous or iatrogenic

Question 30

What should be done for PTX?

Answer 30

>20% will need chest tube placement...can be life threatening--one-way valve mechanism leads to impaired venous return

Question 31

What would be found on a CXR of PTX?

Answer 31

Sharp line = visceral pleura No lung markings lateral Mimics: large bullae, skin folds, bedding, tubes

Question 32

Pulmonary Embolus

Answer 32

Really bad...usually diagnosed in autopsy | Often thought...rarely had

Question 33

Non-specific findings of a PE on a CXR?

Answer 33

Hampton's Hump: wedge-shaped opacity corresponding to lung infarct Westermark's sign: relative oligemia

Question 34

Other tests for a PE

Answer 34

VQ scan: nuclear medicine scan with both ventilation and perfusion components

Question 35

What is an aortic dissection?

Answer 35

Tear in intimal layer of vessel separates intima from media or adventia, causing a false channel

Question 36

Is an aortic dissection bad?

Answer 36

YES | Requires immediate surger

Question 37

What are the risk factors for an aortic dissection?

Answer 37

Hypertension Marfans or Ehler-Danlos Cocaine use Pregnancy

Question 38

What would an aortic dissection look like on a CXR?

Answer 38

Wide mediastinum Abnormal arch configuration L>R pleural effusion

Question 39

CT can be used to determine treatment for an aortic dissection

Answer 39

If ascending aorta is involved, it is a surgical case | If descending aorta is involved, patient can be treated medically