Chest Radiology

Question 1

Indications for CXR

Answer 1

1. Dyspnea, Cough, Hemoptysis 2. Chest pain 3. Fever 4. Weight loss 5. Suspected pulmonary or CV involvement from systemic disease 6. Monitoring of previously defined Pulmn or CV abn 7. ‘Routine’

Question 2

ABC CXR Mnemonic

Answer 2

A – Address B – Bony Cage C – Cardiac silhouette D – Diaphragm E –ETT, Esophagus, Lines etc F – Fields of the lung G – General impression

Question 3

Four basic densities in XR

Answer 3

bone fat soft tissue air

Question 4

(PA/AP) is for normal, healthy patients who can stand.

Answer 4

PA

Question 5

What is the lantern effect?

Answer 5

due to the AP view of the XR, the heart appears larger (hand in front of a flashlight)

Question 6

What lobe does not extend posteriorly? What lobe does not extend anteriorly?

Answer 6

RML RLL

Question 7

Which lobe has the lingula?

Answer 7

LLL

Question 8

Airspace disease shows up as…

Answer 8

acinar shadows, which appear as “cotton ball” patterns or dots

Question 9

Interstitial disease shows up as…

Answer 9

lines or reticulations; web-like

Question 10

Air bronchograms occur classically in what condition?

Answer 10

pneumonia

Question 11

What condition? CXR shows cardiomedaly with perihilar infiltrate

Answer 11

CHF

Question 12

2 abnormalities seen on this CXR

Answer 12

Cardiomegaly

perihilar infiltrate

Question 13

What is this abnormality called? What’s the related condition?

Answer 13

bat wing infiltrate

pulmonary edema

Question 14

Radiologic signs of CHF

Answer 14

1. Cephalization
2. Cardiomegaly
3. Perihilar infiltrates
4. Peribronchial cuffing
5. R. Pleural effusion
6. Enlarged Azygos vein
7. Kerley B lines (lymphatics containing excess fluid)

Question 15

Earliest radiologic sign of CHF?

Answer 15

cephalization

Question 16

What’s wrong with this guy?

Answer 16

cardiomegaly

Question 17

What is cephalization?

Answer 17

LV dysfunction causes increased pressure in pulmonary veins; upper lobe vasculature is more prominet and blood flows cephalic instead of caudal

Question 18

How is the CXR on the R abn?

Answer 18

cephalization

Question 19

What is abn?

Answer 19

Fluid in the fissures

Question 20

5 air space diseases, and what substance you see in CXR:

Answer 20

• Pulmonary edema – fluid
• Pneumonia - Exudate, or WBCs
• Pulmonary hemorrhage – blood
• Tumor/ Broncho alveolar cell carcinoma
• Idiopathic – e.g., Pulmn Alveolar proteinosis

Question 21

What do you see on CXR in a patient with sarcoidosis?

Answer 21

interstitial lung disease with reticulonodular infiltrates

bilateral hilar adenopathy

Question 22

What conditionas cause bilateral hilar and mediastinal lymphadenopathy?

Answer 22

• Lymphoma
• Histoplasmosis
• Phenytoin use
• Tuberculosis
• HIV
• Sarcoidosis
• (Castleman’s Disease)

Question 23

What does honeycomb pattern indicate?

Answer 23

advanced stage interstitial dz

Question 24

What are 2 conditions that will show a honeycomb pattern?

Answer 24

IPF

rheumatoid lung

Question 25

What is abnormal about CXR in COPD?

Answer 25

flattened hemidiaphragm increased lung markings hyperinflation narrow vertical heart (if no CHF) (\*also, bullous disease possible)

Question 26

What is this condition?

Answer 26

COPD | (you shouldn't see ribs 11 and 12!)

Question 27

Answer 27

1. asc aorta 2. SVC 3. PA (pulm artery?) 4. D. Aorta 5. carina

Question 28

What is bronchiectasis?

Answer 28

persistent dilation of terminal bronchi

Question 29

What is the most common CXR pattern for a patient with a pulmonary embolus?

Answer 29

most common = normal (but pleural effusions may be present when PE is small; atelectasis may be present)

Question 30

Possible CXR associated with pulm embolus:

Answer 30

elevated L hemi diaphragm hampton's hump westermark sign (no vasc markings, not pneumo)

Question 31

What % of solitary pulm nodules are malignant?

Answer 31

30-40%

Question 32

Features of benignity in solitary pulm nodules

Answer 32

* Well defined nodules * No associated lymph node or mediastinal masses * No satellite lesions * Calcified nodules

Question 33

Types of Benign calcifications

Answer 33

Dense Popcorn Lamellar

Question 34

Features of Malignancy in solitary pulm nodules

Answer 34

Spiculated nodules Non-calcified nodules Associated mediastinal or Lymph node masses Presence of Cavitation Large nodules

Question 35

What would cause a R silhoutte sign? L?

Answer 35

RML infiltrates (cannot see R border) lingula infiltrate

Question 36

The RV enlarges towards the \_\_\_\_\_; the LV enlarges towards the \_\_\_\_\_.

Answer 36

sternum vertebral bodies

Question 37

An obtuse carina demonstrates:

Answer 37

LA enlargement

Question 38

Air fluid levels are seen with: No air fluid level (meniscus) is seen with:

Answer 38

1. hydropneumothorax 2. pleural effusion