CXR Common Pathologies

Question 1

How does pneumonia show on CXR?

Answer 1

dense or patchy consolidation

Question 2

What can you confuse pneumonia with?

Answer 2

in lower zones hard to distinguish from effusion (mention in differentials)

Question 3

How do you know which lobes are affected by the pneumonia?

Answer 3

loss of clarity of borders indicates lobes affected

Question 4

If diaphragm border is affected which lobe has pneumonia?

Answer 4

left or right lower lobe

Question 5

If the right heart border is not as clear which lobe is affected by pneumonia?

Answer 5

RML

Question 6

If the left heart border is not as clear which lobe is affected by pneumonia?

Answer 6

linguila

Question 7

How would you describe a pleural effusion?

Answer 7

a homogenous opacification of (right middle and lower zones) of chest

Question 8

What are the 4 features of a pleural effusion?

Answer 8

1. Loss of costophrenic angle
2. Homogenous opacification
3. Fluid level (manifests as meniscus)
4. Exudates vs Transudates

Question 9

When is it a transudate?

Answer 9

bilateral effusion

Question 10

When is it an exudate?

Answer 10

unilateral effusion

Question 11

How do you really determine if it is an exudate or transudate?

Answer 11

pleural aspiration

Question 12

How can you tell if pneumothroax and which side?

Answer 12

1. trachea central
2. darker and less vasculature
3. loss of lung markings in peripheral lung field

Question 13

How can you tell if tension penumothorax?

Answer 13

1. tracheal/mediastinal deviation away from pneumothorax (darker side)
2. Flattening of ipsilateral dome of diaphragm

Question 14

How do you treat tension pneumothorax?

Answer 14

immediately (insert cannula into 2 ICS)

Question 15

What could the 4 causes of a single coin lesion be?

Answer 15

1. Malignancy
2. Infection
3. Infarction
4. Inflammation

Question 16

What could the malignancy causes of a single coin lesion be?

Answer 16

1. bronchial

2. single pulmonary metastasis

Question 17

What could the infection causes of a single coin lesion be?

Answer 17

1. pneumonia
2. abscess
3. TB
4. hydatid cyst

Question 18

What are the inflammatory causes of a single coin lesion?

Answer 18

rheumatoid nodule

Question 19

What are the two types of causes for hilar lymphadenopathy?

Answer 19

1. Neoplastic

2. Infective

Question 20

What are the neoplastic causes of hilar lymphadenopathy?

Answer 20

1. Spread from bronchial cancer

2. Lymphoma

Question 21

What are the infective causes of hilar lymphadenopathy?

Answer 21

TB

Question 22

What are the inflammatory causes of bilateral hilar lymphadenopathy?

Answer 22

sarcoidosis

Question 23

What are the tumour causes of bilateral hilar lympahdenopathy?

Answer 23

1. mets
2. bronchial cancer
3. lymphoma

Question 24

What are the infection causes of bilateral hilar lymphadenopathy?

Answer 24

1. tb
2. aids
3. recurrent chest infection

Question 25

What are the features of heart failure on a CXR?

Answer 25

1. Patchy heterogenous opacification bilaterally (sparing of upper lobes) 2. Cardiac borders blunted and cardiomegaly 3. Cardiophrenic angle and costophrenic angle blunted 4. Bat wings (type peri-hilar haziness)

Question 26

What is an ABCDEF description of heart failure?

Answer 26

- A: alveolar (interstitial) shadowing - B: Kerley B lines - C: cardiomegaly (cardiothoracic ration >50%) - D: upper lobe diversion (prominent upper lobe vasculature) - E: effusion - F: fluid in horizontal fissure

Question 27

What are Kerley B lines?

Answer 27

little white horizontal dashes usually in lateral lower edge

Question 28

How migh interstitial lung disease (pulmonasry fibrosis) show up on CXR?

Answer 28

diffuse bilateral reticular shadowing

Question 29

How does surgical empysema show up on CXR>

Answer 29

air between skin and subcart tissue

Question 30

What is surgical emphysema usually caused by?

Answer 30

trauma

Question 31

What latrogenic trauma can cause surgical emphysema?

Answer 31

1. chest drains 2. surgery 3. thoracotomy

Question 32

What blunt trauma can cause surgical emphysema?

Answer 32

1. stab | 2. gunshot wound

Question 33

How can you determine pneuoperitoneum?

Answer 33

patient usually needs to have sat upright for more than 15 mins to allow air to rise

Question 34

What are the causes of pneumoperitoneum?

Answer 34

1. laparoscopic surgery | 2. perforated viscus

Question 35

What are causes of enlarged heart?

Answer 35

1. Congestive cardiac failure 2. Pericardial effusion 3. Cardiomyopathy

Question 36

What does a right sided pleural effusion to mediastinum?

Answer 36

pushes mediastinum to left

Question 37

What does a right sided tension pneumothorax do to the mediastinum?

Answer 37

pushes mediastinum to left

Question 38

What does a right-sided lung collapse + pneumonectomy do to mediastinum?

Answer 38

pulls the mediastinum to right