Q1 Soft tissue Flashcards
(33 cards)
What does ABCs stand for?
A- Abdomen (and tissues outside Tx cage)
B- Bone
C- Cardiovascular
S- Soft tissues of Tx cavity
What should you look for with A (abdomen)
-Abnormal Densities
-Gas Patterns
-Organ outlines below the hemidiaphragms.
Remember parts of the lung bases are below the margin of the hemidiaphragm.
What should you look for with B (Bone)
- Osseous structures
- Size
- Shape
- Location
- Density
- Cortical margins
- Trabeculae
- Joint spaces
- Alignment
What should you look for with C (Cardiovascular) (Heart)
- Heart/Mediastial shadow
- Upper portion midline (esp trachea) Heart mostly on left
- Cardiothoracic ratio: width of heart is no bigger than 1/2 of Tx cavity.
- Mediastinal contours normal
- Cardiac Fat pads are present at left and right cardiophrenic angles.
What should you look for with C (Cardiovascular) (Pulmonary vasculature)
- Pulmonary vasculature
- Hila similar bilaterally, L higher than R; R slightly oblong, vertically oriented; L more round, horizontally oriented
- Vessels more prominent, larger caliber to lower than to upper lung field
- Vessels branvh and taper
- Central 1/3 vessels < 1 cm diameter
- Middle 1/3 = 7-8mm diameter
- Peripheral 1/3 vessels < 5mm diameter
What should you look for with S (soft tissues) pt 1.
-Examine pleura by following margins of lung field; pay attention at costophrenic angles (air filled lung should extend to inside margin of ribs;) fissures appear as thin, even white lines.
What films should you see horizontal fissures
May be seen on PA and lateral;
PA - it extends medial to lat at level ant. 4th rib.
Lat- It extends from oblique fissure to ant chest wall.
-Oblique fissures NOT seen on PA film; on Lat films they extend from T4-5 to ant portions of the hemidiaphragms.
What is Apical Pleural capping?
It is the presence of extra fibrous tissue at the apex of the lung. It should be Bi. The density of the tissue should be concave inferiorly.
What should you look for with S (soft tissues) pt 2.
- Compare lung fields Bi
- Lungs should be close in size
- Lungs should have a similar density which may change superiorly to inferiorly d/t overlaying ribs, clavicles, pec muscles, breast tissue, ect.
- Compare Bi R to L from Inf of rib 1 to Inf of rib 2, then Inf of rib 2 to Inf of rib 3 etc.
- dont forget protions of lung base behind heart and hemidiaphragms.
Define a Silhouette sign
- When two structures of the same radiographic density are in anatomic contact, the margins of those structures will be obliterated.
- Normally found with Heart on the left hemidiaphragm
List some lung lobes involved and structure silhouetted. (8)
- RUL: (ant) Ascending arota
- RML: R heart border
- RLL: R hemidiaphragm
- LUL: (apical-post) Aortic knob
- LUL: (ant) Pulmonary trunk
- LUL(lingula) L heart border
- LLL: (sup) Decending aorta
- LLL: L hemidiaphragm
What MC findings for Resorptive Atelectasis?
- Displaced fissure
- Elevated hemidaphragm
- Displaced hilus
- Mediastinal shift
What are some Central causes for Resorptive Atelectasis?
- Bronchogenic carcinoma
- Bronchial adenoma
- Foreign body
- Bronchial TB
- Lymphadenopathy
- Mediastinal mass
- Aneurysm
What are some Peripheral causes of Resorptive Atelectasis?
- Pneumonia
- Mucous plugging
- Post-operative
Which Atelectasis is most common?
Resorptive, Passive, Cicatrization, Adhesive?
Resorptive.
What are some causes of Passive Atelectasis?
- Intrathoracic space occupying process**
- Pneumothorax
- Hydrothorax
- Hemothorax
- Any mass
What causes Cicatrization Atelectasis?
- Local or generalized fibrosis**
- TB
- Especially apices
- Interstitial pulmonary fibrosis
- Silicosis
- Radiation therapy
What causes Adhesive Atelecatasis?
- Surfactant abnormality**
- Respiratory distress syndrome
- Acute radiation pneumonitis
Which types of Atelectasis go TOWARD the collapsed lung?
- Resorptive
- Cicatrization
- Adhesive
Which tyes of Atelectasis shift AWAY from a collapsed lung?
Passive
What is a Meniscus sign?
Blunting of the costophrenic angles d/t pleural fluid accumulation
What would be your DDX for pleural effusion?
- CHF
- Pneumonia
- Neoplasm
- Infection (empyema)
- Trauma
- Embolism
- CT dz
- TB
- Abdominal Dz
- Pancreatitis, Cirrhosis
What are some Pleural Effusion Sx
- Dyspnea
- Pleuritic chest pain
- Dry cough
- Tactile fremitus increased
- Dullness to percussion
- Decreased breath sounds
- small effusions usually asymptomatic
List Pleural effusion Managment
- Thoracentesis
- Reduces sx;s
- Provides tissue for lab eval
- Culture and sensitivity
- Histology
- Chemistry
- Tx of underlying dz
