Chest imaging Flashcards
(32 cards)
rigler’s sign
sign of pneumoperitoneum. air seen on both sides of bowel wall.
deep sulcus sign
pneumothorax on suprine chest radiograph when one costophrenic sulcus appears much deeper and lucent than the other due to air collecting there.
continuous hemidiaphragm sign
sign of pneumomediastinum on chest radiograph when there appears to be a lucent line connecting both hemidiaphragms due to air btw pericardial sac and the diaphragm
preop CXR
pt with Cardiorespiratory sx or >65yo+ stable CRD and no CSR for 6mo
nodule factors
size (>1 incr malign), edge (smooth, lobulated, speculated, ill-defined), calcification, growth
pt factors for nodules
hx of lung fibrosis/ asbestosis, age (>40 incr malign), smoking hx, travel hx (endemic granulomatous disease- 40% in places with endemic histoplasmosis), hx of other malign disease
lung ca screening
mostly detect adenocarcinoma. not good for SCC of central airway or small cell lung ca.
evaluation of lung nodules
1) xray 2) CT 3) PET scan bc most lung ca has high metabolic activity and can assess for metastases (95% sensitive, 85% specific) 4) CT guided needle biopsy if in periphery. can consider bronchoscopy guided if central and flour guided if not close to heart 5) post bx need rescan to evaluate for pneumothorax or hemorrhage for erect expiratory CXR or CL lateral decubitus CXR
tension pneumothorax CXR
mediastinal shift away from pneumothorax, diaphragmatic depression on side of pneumothorax, lung complete collapsed, usually large.
Aunt Minni sign
upper lobe essential cases. faint fail like opacification of 2/3 of hemithorax, tracheal sift to TV
opacification of hemithorax DD
pneumonectomy, huge pleural effusion, total long pneumonia, large mass
pneumonectomy
marked V less with tracheal shift, mediastinal shift and diaphragmatic elevation. ribs closer on ban side. chest is dull to percussion, absent breath sounds and shifted brachia apex beat.
huge pleural effusion
mediastinal shift away from side of effusion. very dense. absent breath sounds, dull to percussion,
total lung pneumonia
air bronchograms, no evidence of volume loss. residual aerated lung. incr breath sounds an inspiratory crakes. no tracheal shift or decr expansion.
visceral pleural white line
seen when air enter pleural space, sep parietal and visceral pleura- white line- needed to dx Ppneumothorax
absence of lung marking dd
pneumothorax, bullous disease, large cyst, PE. important to DD since tx PTX with chest tube but hat can cause intractable PTX in bulla
skin fold
dd from visceral pleural white line by seeing edge between density and lucency white in PTX see line with lucency on both sides
pneumothorax causes
1) spontaneous rupture of apical sub-pleural bleb in tall thin male.
2) trauma: thorugh chest wall- stab wound, internal (rupture of a bronchus from MVA)
3) disease that decr lung compliance (chronic fibrotic disease, disease that stiffen lung),
4) rupture of an alveolus or bronchiole (asthma)
peribronchial cuffing
doughnuts seen distal to hillier area that rep fluid in bronchial walls when seen in connection with other signs of CHF
HF signs
kerley B lines, peribronchial cuff, fluid in fissure (btw visceral pleura and lung parenchyma), pleural effusion, pulmonary alveolar edema-batwing configuration bc outer 1/3 of lung frequently spared
aortic dissection imaging
CTA with contrast. can’t see wo contrast. see crescent of high intensity in wall of aorta which is hard to see w contrast. but then contrast allow id of dissection flap. if have IC, then think CT with lower dose, MRI w/wo gad depending on GFR, TEE if unstable.
PE imaging
CTA unless CI for IV contrast then do VQ scan.
3 Indications for IVC filter
free floating clot in IVC, failure to anticoag (PE or LE clot propagation while anti-coagulated), CI for anticoag, prophylactic in major multi fracture trauma prior to major OR procedure with high thrombotic risk
D dimer v PE
good for healthy outpatient. 95% sensitivity for PE. so neg excludes PE in low risk pt. but very low specificity so in pos test or in high risk pt, do CTA or VQ scan
