Lecture 3- Chest Imaging:

Question 1

Label the first few slides of the ppt.

Answer 1

ok

Question 2

describe basics of mediastinal widening

Answer 2

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

Question 3

describe sarcoidosis

Answer 3

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

Question 4

which side of the diaphragm is usually higher?

Answer 4

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

Question 5

Lung Disease

how should the costophrenic angle appear?

Answer 5

sharp

Question 6

Pneumothroax

describe traumatic pneumothorax

Answer 6

• penetrating or blunt chest trauma
• latrogenic

Question 7

Pneumothroax

describe spontaneous pneumothroax

Answer 7

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

Question 8

Pneumothroax

simple vs tension pneumothorax

Answer 8

tension: trachea has shifted

Question 9

Pneumothroax

tension pneumothorax findings CXR

5 components

Answer 9

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

Question 10

COPD

what can form in COPD

Answer 10

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

Question 11

COPD

characteristics on conventional radiograph

5

Answer 11

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

Question 12

what is pneumoperitoneum?

Answer 12

free air in the abdomen

Question 13

Pleural Effusions

define

Answer 13

fluid in pleural space

Question 14

Pleural Effusions

what is diagnostic of pleural effusion?

Answer 14

thoracentesis (removal of fluid from cavity relives sx)

Question 15

Pleural Effusions

how to idenfity?

3

Answer 15

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

Question 16

Pleural Effusions

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

Answer 16

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

Question 17

Pleural Effusions

describe meniscus sign

Answer 17

abnormal lung density that demonstrates meniscoid-shape

Question 18

Pseudotumor

describe

Answer 18

• fluid in minor fissure
• almost always associated with CHF

Question 19

Pericardial Effusion

define

Answer 19

fluid around the heart

Question 20

Pericardial Effusion

radiographic signs

Answer 20

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

Question 21

Atelectasis

define

Answer 21

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

Question 22

Atelectasis

tx?

Answer 22

deep breathing

Question 23

Atelectasis

what is splinting

Answer 23

restriction of deep breathing

Question 24

Atelectasis

what is characteristic of atelectasis?

Answer 24

rapid shift and clearance of fluid build up

Question 25

radiologist terminology for "idk what that is but it shouldn't be there"

Answer 25

* consolidation * air space opacity * fluffly density * infiltrate

Question 26

# Pneumonia how to differentiate atelectasis and pneumonia

Answer 26

* atelectasis: will resolve within a few days w/ deep breathing * pneumonia: requires tx both are water densities, hx is important

Question 27

# Pulmonary Edema define

Answer 27

* exudation of fluid from capillaries into interstitial tissues and air spaces of lungs * most common cause is L sided CHF

Question 28

# Pulmonary Edema Radiographic Signs of Pulmonary Edema

Answer 28

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

Question 29

# Pulmonary Edema what are Kerley B lines actually?

Answer 29

* represent thickening of interlobular septae * fluid leaked out of space * horizontal lines commonly seen in lateral bases of lungs

Question 30

# Pulmonary Edema go to slide 64 on ppt and label the CXR

Answer 30

okay :(

Question 31

# Pulmonary Embolism over 90% develop from?

Answer 31

DVTs, esp above level of popliteal veins

Question 32

# Pulmonary Embolism usually a complication of? | 3

Answer 32

* surgery * bedrest * cancer

Question 33

# Pulmonary Embolism sx of PE | 6

Answer 33

* CP * DOE * wheezing * hemoptysis * syncope * arrhythima

Question 34

# Pulmonary Embolism why are PE easily missed?

Answer 34

* non specific sx * non specific labs * huge ddx

Question 35

# Pulmonary Embolism describe CXRs in pulmonary embolism | 3 components

Answer 35

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

Question 36

# Pulmonary Embolism describe CT Pulmonary Angiogram | CTPA

Answer 36

* imaging study of choice * 83% sensitive, negative predictive value 95%

Question 37

# Pulmonary Embolism advantages of CTPA | 4

Answer 37

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

Question 38

# Pulmonary Embolism disadvantages of CTPA | 4

Answer 38

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

Question 39

# Pulmonary Embolism describe Ventilation/Perfusion Lung scan

Answer 39

* 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)

Question 40

# Bronchiectasis image of choice?

Answer 40

high resolution CT

Question 41

# Bronchiectasis hallmark sign?

Answer 41

* Signet ring sign * bronchus becomes larger than its associated pulmonary artery

Question 42

# Pulmonary Nodules size?

Answer 42

focal lesion less than 3cm in diameter

Question 43

# Pulmonary Nodules cancerous?

Answer 43

benign, primary malignancy, metastatic malignancy

Question 44

# Pulmonary Nodules indications of malignancy for nodules | 6

Answer 44

* non calcification * poorly defined margins * associated pleural effusion * associated atelectasis * growth over time * hx of smoking

Question 45

# Granulomas describe

Answer 45

benign calcified nodules usually less than 1 cm in size

Question 46

# Granulomas go to slide 83 and answer the question

Answer 46

okay

Question 47

# Metastatic Disease what are the most likely primary tumors for lung metastases?

Answer 47

* kidney * breast * colon * female GU * skin CA

Question 48

# Metastatic Disease what to do if you see a nodule?

Answer 48

chest CT to look for other nodules w/ biopsy

Question 49

# Metastatic Disease if the nodule is stable for 2+ years it is likely....

Answer 49

benign

Question 50

# Metastatic Disease what better shows nodules?

Answer 50

CT!

Question 51

# Metastatic Disease what can CT be used to measure?

Answer 51

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