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Flashcards in Chest Radiology Deck (50):
1

What is shown on the radiograph on the right?

Enlarged right ventricle

2

What is the silhouette sign? (e.g. where is the disease when the right and left heart borders are obscured? the hemidiaphragms?)

The absence of a silhouette suggests a disease process

e.g.

  • when you can't see the left heart border, there is disease in the lingula
  • when you can't see the right heart border there is disease in the right middle lobe
  • when you can't see the hemidiaphragms there is disease in the lower lobes

3

What makes up the technical quality of a radiograph?

  1. Rotation: spinous processes should be equidistant from clavicular heads
  2. Inspiration: diaphragm crosses 6th interspace anteriorly or 10th interspace posteriorly in the midclavicular line
  3. Penetration (exposure): should be able to see vertebral disks through the heart

Also, make sure you can see everything (nothing is cut off)

4

What is the suggested approach for reviewing a chest radiograph?

  1. Technical factors
  2. written data
  3.  
  4. chest wall/soft tissues
  5. abdomen
  6. diaphragm
  7. pleura
  8. heart
  9. mediastinum
  10. hila
  11. lung parenchyma

5

What to pay attention to in written data?

  • Name (ethinicity?)
  • Sex
  • Ward (ICU, CCU?)

6

What to check for when you check soft tissues?

Clavicles

vetebrae

  • become more lucent inferiorly

ribs

  • should be able to see 10 posterior ribs on inspiration

breast shadows

  • absence of one indicates masectomy

soft tissue masses

7

On a lateral film, does the lucency of the veterbrae change?

inferior vertebrae should become more lucent compared to superior vertebrae

8

What do you check when you check the abdomen?

gastric bubble

liver shadow

bowel distention

calcifications (?gall stones)

9

What do you check for when you check the diaphragm?

Convexity (vs. flat in emphysema)

Costophrenic angle

Right should be higher than left

10

Is it easier to detect pleural effusion on lateral or PA films?

Lateral (need 75 cc of fluid) vs. PA (need 200 cc fluid)

11

What are you checking when you check the pleura?

separation of the two pleura (pneumothorax)

pleural effusions (will see a meniscus)

pleural calcifications (e.g. asbestos)

pleural thickening (e.g. mesothelioma from asbestos exposure)

12

Where does the pleura extend in the midclavicular, midaxillary lines and posteriorly?

8th rib, 10th rib and 12th rib

13

What are you checking for when you check the mediastinum?

masses (need lateral view to localize)

retrosternal space (as in emphysema)

14

What are you checking for when you check the heart

Cardiomegaly (<0.5 is PA or 0.6 AP is normal)

visible heart borders

15

What are you checking for when you check the hila?

Left side is normally higher than right

check for enlargement (lymph nodes, arteries, veins...)

Check for masses

16

What do the blue and orange arrows show?

Enlarged pulmonary arteries (blue) with peripheral pruning of arteries (orange). Pulmonary hypertension.

17

What are you checking when you check the lung parenchyma?

Air space disease (fluid in the alveoli)

  • diffuse, confluent opacities with air bronchogram sign
  • ground glass opacity if combined with interstitial disease.

 

Interstitial disease

  • reticulation/lace-work
  • ground glass opacity if combined with air space disease

 

Nodular disease

  • e.g. miliary TB

 

Lucent lung disease

  • emphysema- flat diaphragm and increased AP diameter

18

What is the air bronchogram sign?

It indicates that alvoeli are filling up with something (pus, 

19

What does ground glass opacity signify?

A combination of alveolar and interstitial disease.

It is increased density that doesn't obscure the vessels

20

What is this lung filled with?

cystic spaces ( >1cm)

21

What does this lung have?

Honeycombing: peripheral stacked, small cystic spaces

22

What does this lung have?

some kind of micro-nodular process (e.g. miliary TB, silicosis)

 

*can also have macronodular (>8mm) where nodules can cavitate

23

Advantages and disadvantages of CXR vs. CT vs. MRI vs US vs. PET

(when they are good to use)

CXR

  • cheap
  • low-dose
  • 2D representation

CT

  • expensive
  • higher radiation
  • excellent spatial resolution
  • good for bone, lung

MRI

  • expensive
  • no radiation
  • slow
  • good spatial resolution
  • good for soft tissue (lung neoplasm, cardiac)

US

  • no radiation
  • cheap
  • portable
  • user-dependent
  • cannot see through air or bone
  • can see pneumothorax and pleural effusion better than CXR

PET

  • low resolution
  • neoplasm
  • pulmonary embolism assessment

24

25

What does this radiograph show?

An endotracheal tube pushed into the right bronchus (too far..). That's why you should xray after the tube has been placed.

26

What does PACS stand for?

Picture archiving and communication system

27

What are Kerley B lines and when would you see them?

They are ~1cm long markings on the periphery of the lungs indicating thickening of interlobular septae.

Seen when lymphatics are distended as in interstitial pulmonary edema, interstitial disease.

28

Name the lymphatics of the lung

29

What does the L and the RP signify?

L signifies the patient's left side

RP is the initials of the technologist

The patient's identifying information would be on the other side (top left of picture)

30

What does this show?

A right-side pleural effusion

31

What does the arrow show?

An enlarged hilar focal mass

32

enlarged hila/lobulated lymphadenopathy

33

What do red and orange arrows show?

34

What might the diagnosis be?

End stage interstitial fibrosis

35

Find the hilar points (and what are they?)

Hilar points are the angle formed by the descending upper lobe veins, as they cross behind the lower lobe arteries. Not every normal patient has a very clear hilar point on both sides

36

Define consolidation

When the alveoli and small airways fill with fluid/pus

37

How to spot a tension pneumothorax?

-pneumothorax

+

-trachea deviated AWAY from involved side (i.e. pushed away)

38

Find the horizontal fissure

39

What is the abnormality?

Azygous fissure (when the azygos vein runs more deeply in the lung than usual). Occurs normally in 1-2% of the population

40

What do the left and right heart borders represent?

41

Where is the aorto-pulmonary window?

Between the aortic knuckle and the left pulmonary artery

42

Is the costphrenic angle blunted?

No. The patient is rotated so there is more breast tissue overlying the costophrenic recess. 

43

What is happening here?

-proper rotation

-trachea is deviated to the left

-large soft tissue mass PUSHING trachea

44

What is the differential for consolidation?

Pneumonia

  • alveoli filled with pus

Cancer

  • alveoli filled with cells

Pulmonary edema

  • alveoli filled with fluid

Pulmonary hemorrhage

  • alveoli filled with blood

45

How to characterize this radiograph?

bilateral lung nodules

46

What's wrong?

This patient has a pneumothorax. Because the trachea is midline, it is not a tension pneumothorax.

47

What's wrong?

48

What's wrong?

pleural plaques from asbestos exposure

49

What's wrong?

cavitation in the left lung

50

Lateral chest radiograph anatomy