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CD III > Lecture 3- Chest Imaging: > Flashcards

Lecture 3- Chest Imaging: Flashcards

1
Q

Label the first few slides of the ppt.

A

ok

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2
Q

describe basics of mediastinal widening

A

basically; too much heart on R side, not enough on L side

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3
Q

describe sarcoidosis

A
  • rheumatologic condition where the body attacks itself
  • will show on chest imaging as bilateral, well-circumscribed, round lymphadenopathy in the hilum
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4
Q

which side of the diaphragm is usually higher?

A

R is higher than L because you need to make room for the liver on the R

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5
Q

Lung Disease

how should the costophrenic angle appear?

A

sharp

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6
Q

Pneumothroax

describe traumatic pneumothorax

A
  • penetrating or blunt chest trauma
  • latrogenic
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7
Q

Pneumothroax

describe spontaneous pneumothroax

A
  • primary (young, healthy patients)
  • secondary to underlying lung disease (COPD, pneumonia, sarcoidosis)
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8
Q

Pneumothroax

simple vs tension pneumothorax

A

tension: trachea has shifted

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9
Q

Pneumothroax

tension pneumothorax findings CXR

5 components

A
  • shift of mediastinum, hilum, and heart
  • tracheal deviation
  • deep sulcus sign
  • visceral pleural line
  • absent vascular markings
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10
Q

COPD

what can form in COPD

A
  • large bullae and blebs can form
  • rupture of these can lead to spontaneous pneumothorax
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11
Q

COPD

characteristics on conventional radiograph

5

A
  • lung hyperinflation
  • hyperlucent upper lobes
  • flattening of diaphragm
  • increase in size of retrosternal air space
  • barrel chest
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12
Q

what is pneumoperitoneum?

A

free air in the abdomen

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13
Q

Pleural Effusions

define

A

fluid in pleural space

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14
Q

Pleural Effusions

what is diagnostic of pleural effusion?

A

thoracentesis (removal of fluid from cavity relives sx)

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15
Q

Pleural Effusions

how to idenfity?

3

A
  • blunting of costophrenic angles
  • filling of fissures (pseudotumor)
  • meniscus sign
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16
Q

Pleural Effusions

how much fluid is required to show up on PA or AP view? Lateral view? Decubitus?

A
  • PA/AP: 250 mL pleural fluid
  • Lateral: 75 mL
  • Decubitus: 15 mL
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17
Q

Pleural Effusions

describe meniscus sign

A

abnormal lung density that demonstrates meniscoid-shape

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18
Q

Pseudotumor

describe

A
  • fluid in minor fissure
  • almost always associated with CHF
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19
Q

Pericardial Effusion

define

A

fluid around the heart

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20
Q

Pericardial Effusion

radiographic signs

A
  • rapid increase in heart size (increase to old films)
  • “water bottle” heart signs
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21
Q

Atelectasis

define

A
  • partial lung collapse in a specific area of the lungs?
22
Q

Atelectasis

tx?

A

deep breathing

23
Q

Atelectasis

what is splinting

A

restriction of deep breathing

24
Q

Atelectasis

what is characteristic of atelectasis?

A

rapid shift and clearance of fluid build up

25
Q

radiologist terminology for “idk what that is but it shouldn’t be there”

A
  • consolidation
  • air space opacity
  • fluffly density
  • infiltrate
26
Q

Pneumonia

how to differentiate atelectasis and pneumonia

A
  • atelectasis: will resolve within a few days w/ deep breathing
  • pneumonia: requires tx

both are water densities, hx is important

27
Q

Pulmonary Edema

define

A
  • exudation of fluid from capillaries into interstitial tissues and air spaces of lungs
  • most common cause is L sided CHF
28
Q

Pulmonary Edema

Radiographic Signs of Pulmonary Edema

A
  • increased prominence of upper lobe vessels
  • Kerley B lines
  • indistinct parahilar vessels (shaggy heart)
  • patchy infiltrates (bat wing)
  • pleural effusions
29
Q

Pulmonary Edema

what are Kerley B lines actually?

A
  • represent thickening of interlobular septae
  • fluid leaked out of space
  • horizontal lines commonly seen in lateral bases of lungs
30
Q

Pulmonary Edema

go to slide 64 on ppt and label the CXR

A

okay :(

31
Q

Pulmonary Embolism

over 90% develop from?

A

DVTs, esp above level of popliteal veins

32
Q

Pulmonary Embolism

usually a complication of?

3

A
  • surgery
  • bedrest
  • cancer
33
Q

Pulmonary Embolism

sx of PE

6

A
  • CP
  • DOE
  • wheezing
  • hemoptysis
  • syncope
  • arrhythima
34
Q

Pulmonary Embolism

why are PE easily missed?

A
  • non specific sx
  • non specific labs
  • huge ddx
35
Q

Pulmonary Embolism

describe CXRs in pulmonary embolism

3 components

A
  • high false negative rate
  • nonspeific findings (subsegmental atelectasis, small plueral effusions, elevation of hemidiaphragm)
  • classic findings not common
36
Q

Pulmonary Embolism

describe CT Pulmonary Angiogram

CTPA

A
  • imaging study of choice
  • 83% sensitive, negative predictive value 95%
37
Q

Pulmonary Embolism

advantages of CTPA

4

A
  • filling defects in pulm arteries can be directly visualized
  • rapid/accurate
  • allows for making alternative dx
  • can evaluate legs in same study as needed
38
Q

Pulmonary Embolism

disadvantages of CTPA

4

A
  • requires iodinated contrast
  • high radiation dose
  • pts need to be supine w/ breath held for 3-10 sec
  • may be difficult in obese pts
39
Q

Pulmonary Embolism

describe Ventilation/Perfusion Lung scan

A
  • nuclear medicine scan
  • requires a clear CXR (no asthma/COPD)
  • does not require breath hold/contrast
  • good in obese pts
  • results are reported as high, intermediate, low probability of PE (intermeidate scans are not useful)
40
Q

Bronchiectasis

image of choice?

A

high resolution CT

41
Q

Bronchiectasis

hallmark sign?

A
  • Signet ring sign
  • bronchus becomes larger than its associated pulmonary artery
42
Q

Pulmonary Nodules

size?

A

focal lesion less than 3cm in diameter

43
Q

Pulmonary Nodules

cancerous?

A

benign, primary malignancy, metastatic malignancy

44
Q

Pulmonary Nodules

indications of malignancy for nodules

6

A
  • non calcification
  • poorly defined margins
  • associated pleural effusion
  • associated atelectasis
  • growth over time
  • hx of smoking
45
Q

Granulomas

describe

A

benign calcified nodules usually less than 1 cm in size

46
Q

Granulomas

go to slide 83 and answer the question

A

okay

47
Q

Metastatic Disease

what are the most likely primary tumors for lung metastases?

A
  • kidney
  • breast
  • colon
  • female GU
  • skin CA
48
Q

Metastatic Disease

what to do if you see a nodule?

A

chest CT to look for other nodules w/ biopsy

49
Q

Metastatic Disease

if the nodule is stable for 2+ years it is likely….

A

benign

50
Q

Metastatic Disease

what better shows nodules?

A

CT!

51
Q

Metastatic Disease

what can CT be used to measure?

A

density of a nodule or mass if the calcification is not clear on chest radiograph

CD III (12 decks)

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