Radiologic Anatomy of Thorax

Question 1

What are the anatomical structures of the upper airway?

Answer 1

1. Sinuses
2. Nasopharnx
3. Oropharynx
4. Proximal Trachea
5. Middle ear
6. Mastoids/Temporal Bone

Question 2

When is imaging appropriate for:

1. Sinuses
2. Temporal bone

Answer 2

1. Sinuses (most common)
   
   • Chronic sinusitis and complications
   • Acute sinusitis
   • Post operative
   • Tumors
   • Trauma
2. Temporal Bone
   
   • Hearing loss
   • Trauma
   • Infection

Question 3

What is used for imaging sinuses?

Answer 3

1. Radiographs
   
   • Less commonly used than in past
2. CT
   
   • Axials with reformatted images
   • Direct Coronals

Question 4

What can be suggestive of acute sinusitis?

Answer 4

mucosal thickening within a nasal sinus

Question 5

What is the most likely diagnosis?

Answer 5

Nasal Polyposis

Question 6

When would the trachea imaged for an infection?

Answer 6

• Unusual to image for infections
• ‘Trachiitis’ or ‘bronchitis’
• Exceptions:
  
  1. Epiglottitis
  2. Tracheal papillomatosis
  3. Croup

Question 7

Trachitis

Answer 7

Epiglotitis

Question 8

What can cause the trachea to collapse during expiration?

Answer 8

weak tracheal rings

Question 9

What are the different views for a chest radiograph?

Answer 9

1. PA, lateral
2. AP - upright
3. AP-Supine
4. Decubitus
   
   • pt. lays on their side
5. Oblique views
   
   • for rib fx
6. Lordotic
   
   • pt. leans back
   • looks for lesion underneath clavicle

Question 10

AP or PA?

Answer 10

AP view

• enlarged heart
• widened mediastinum
• reduced lung volumes (possibly did not inspire properly)

Question 11

AP or PA?

Answer 11

PA view

• all features are normal (compared to the AP view)

Question 12

Identify the lung structures:

Answer 12

Question 13

Identify the lung structures:

Which lung is this?

Answer 13

Right lung

Question 14

Why is an MRI not good for imaging the lung parenchyma?

Answer 14

1. Cannot image lung parenchyma well
2. Motion artifact

Question 15

• How are pulmonary infections evaluated through imaging?
• Are there any clues that can point to a specific infection?

Answer 15

• Often, the pattern of disease can be described
  
  • Usually, the individual pathogen is difficult to discern on imaging
• Any clues?
  
  • Non-resolving pneumonia
  • High clinical suspicion
  • Unique features
  • Chest wall invasion

Question 16

What is the pattern for bronchopneumonia?

Answer 16

“tree in bud” pattern

• Look for patchy densities

Question 17

What is a silhoutte sign?

Answer 17

Dense lung and cardiac parenchyma leads to:

• Loss of cardiac border
• Consolodation

Question 18

What is an air bronchogram?

Answer 18

Patent bronchi in an area of collapsed and consolidated lung

Question 19

Excluding cancer, what is the most likely diagnosis?

Answer 19

Lobar pneumonia (in RUL)

Question 20

What is seen in this radiograph?

Answer 20

Multifocal Infiltrates

Question 21

What is seen in this radiograph?

Answer 21

Lobar consolidation (in RML)

Question 22

What can be seen on CT if there is lobar consolidation?

Answer 22

Air bronchogram

Question 23

What is the most likely diagnosis?

Answer 23

Miliary TB

• nodular densities throughout the entire lung

Question 24

Granulomas that result from histoplasmosis heal by ….

Answer 24

calcification

Question 25

**Blastomycosis**

Answer 25

**Histoplasmosis**

Question 26

If the lung has a **"dirty"** appearance, what pathogen is most likely the cause of this?

Answer 26

**Aspergillosis**

Question 27

What can be done clinically to tell the difference between **cancer vs. aspergilloma**?

Answer 27

**Aspergillomas move** and cancer does not * Have the patient imaged in two different postions

Question 28

Describe how Aspergillus presents in the following patients: 1. Severely immunosuppressed 2. Imunosuppressed 3. Normal immunity, abnormal lungs 4. Hyperimmune

Answer 28

1. **Severely immunosuppressed** * Invasive aspergillus 2. **Immunosuppressed** * Semi invasive aspergillus 3. **Normal immunity, abnormal lungs** * Aspergilloma 4. **Hyper immune** * ABPA - Allergic bronchopulmonary aspergillosis

Question 29

What will be seen on **CT** in **immunosuppressed patients** with a lung infection?

Answer 29

**extensive infiltrates** of the lung parenchyma

Question 30

What are radiologic findings for viral infections?

Answer 30

Wide spectrum of non specific findings: * Normal * Patchy infiltrates * Diffuse, severe infiltrates * Superimposed bacterial pneumonia

Question 31

How is **varicella pneumonia** different from miliary TB (as far as imaging is concerned)?

Answer 31

Miliary pattern with **calcified lesions** instead of soft tissue (unlike TB)

Question 32

**Acute Respiratory Distress Syndrome (ARDS)**

Answer 32

**Bilateral Pleural Effusions**

Question 33

What is the most likely diagnosis?

Answer 33

**Right pleural effusion**