radiology of lung cancer (diagnosis and staging) Flashcards
(52 cards)
steps of systematic review of CXR
name, marker, rotation, penetration
lines, metal work
heart
mediastinum
lungs - upper, middle and lower zones
bones
diaphragm
soft tissues
where do the lungs sit in relation to the diaphragm
they sit in front and behind the diaphragm and hemi-diaphragm?
review of mediastinum on CXR
hilar vascular structures should be crisply defined, compare height and difference between L and R
no widening of mediastinum
trachea should be central
look behind the heart
review of lungs on CXR
compare upper, mid and lower zones
look between ribs for lung detail
remeber to look behind the heart
compare L and R
what is the abnormality in this CXR
mass in the R lung
possible cavity of infection
- peripheral lung carcinoma
what is the abnormality in this CXR
whiteout of the L semi thorax
could be - total collapse of the lung, pneumonectomy, large pleural effusion
- central lung carcinoma which has lead to collapse, potential effusion also
if there is a concern about a central tumour which has caused collapse, a chest and abdominal CT would be done
what is the abnormality in this CXR
right upper lobe collapse
movement of the hilum
hyper-inflation of the lung - darker colour
BEWARE the lobar collapse which fails to resolve in 2-3wks in a smoker of age>45
what would be seen on a CXR if the lower of middle lobe collapses
lower - double heart border (triangle on both sides)
middle - loss of clear heart border
features of lung cancer on CXR
lesions often more subtle
beware of lesions behind the heart and hila
compare with previous films and always look at review areas
what are the review areas on a CXR
hila
lung apices
behind the heart
behind the diaphragm
what is the abnormality in this CXR
left middle zone abnormality
abnormality of the hilum - bulky
left hilar mass
what is the abnormality on this CXR
abnormality on the R
normal hilum position
rounded structure which is denser than the other side
what is the abnormality on this CXR
left lower zone abnormality
opacity behind the heart
cardiac area should be homogenous in density
mass behind the heart
what is the abnormality on this CXR
mass left costophrenic angle
what is the abnormality on this CXR
much denser on the R around apex
right apical/pancoast tumour
what is the abnormality on this CXR
tumour on R base
lacy like obacity (fibrosis) predominant in mid/lower zones and peripheries
clinical hx: increasing SOB in smoker, hx of pulmonary fibrosis, recent haemoptysis
what are the steps to take following a mass on CXR
always compare with previous imaging
confirm lesion is intrapulmonary
CT: evaluate size, shape, atelectasis, border, density, solid/non-solid, dynamic contrast enhancement >25 HU, growth
what is the abnormality on this CXR
rounded uniform opacity
previous breast cancer, mastectomy and then implant
look for evidence of metastasis
define pulmonary mass
an opacity in lung >3cm with no mediastinal adenopathy or atelectasis
define pulmonary nodule
opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis
potential diagnosis for solitary pulmonary nodule or mass
lung cancer (age, smoking hx)
metastasis (prev hx of breast, renal, seminoma, sarcoma)
benign lung neoplasm e.g. carcinoid, hamartoma
infection (bacterial, TB, fungal)
vascular haematoma, AVM
multiple nodules/masses are much more likely to be mets
if an opacity is longstanding and unchanging is it likley to be malignant?
much less likely to be malignant
take note of clinical hx and compare to prev films
changes to lungs from TB
generally leads to scarring and calcifications in the upper zones
hila can be pulled up as a result of scarring
increased density can be a sign of infection
steps for staging lung cancer
clincal hx/examination
performance status
pulmonary function
TNM international system for staging lung cancer - tumour, nodes, mets, higher stage = poorer prognosis
