Session 10: Radiology II Flashcards

1
Q

What is important in order to have an adequate image to assess the lungs?

A

Projection (Usually PA)

Inclusion

Rotation

Lung volumes

Penetration

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2
Q

Inclusion:

What do we need to see on a CXR?

A

1 st rib

Lateral margin of ribs

Costophrenic angle

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3
Q

Rotation:

What is important to see?

A

The alignment of the spinous process and clavicles.

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4
Q

Lung volumes:

What is important to see?

A

A normal lung volume during the inspiratory phase would show 5th to 7th anterior ribs at the midclavicular line.

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5
Q

Why is adequate penetration important?

A

To make sure the vertebrae are just visible through the heart and so we can see the left hemidiaphragm.

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6
Q

Explain the systemic approach to evaluate a CXR.

A

Check the patients demographics.

Check that projection, rotation, penetration and lung volumes are alright.

ABCD

Airways

Breathing

Circulation

Diaphragm/Bones

and then lastly review areas.

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7
Q

What is evaluated in adequacy?

A

RIP

Rotation

Inspiration

Penetration

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8
Q

What is evaluated in airways?

A

Trachea, bronchi and hila

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9
Q

What is evaluated in breathing?

A

Lungs

Pleural spaces

Lung interfaces

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10
Q

What is evaluated in circulation?

A

Mediastinum

Aortic arch

Pulm vessels

Right heart border, right atrium and middle lobe interface

Left hear border, left ventricle and lingula interface.

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11
Q

What is evaluated in diaphragm and bones?

A

Free gas

Nodules

Fracture/dislocation

Mass

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12
Q

What is evaluated in review areas?

A

Apices (pneumothorax or malignancy)

Thoracic inlet (mass)

Paratracheal stripe (mass)

AP window (LN)

Hila (mass/collapse)

Behind the heart (mass)

Below diaphragm (pneumoperitoneum/mass)

Bones (fracture/mass/missing bones)

Edge of films

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13
Q
A
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14
Q

What is the silhouette sign?

A

Adjacent structures of differing density will form a nice silhouette.

If this silhouette is lost it can locate pathology.

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15
Q

What causes a mediastinal shift (push)?

A

Increase volume or pressure

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16
Q

What causes a mediastinal shift (pull)?

A

Decrease voume or pressure

17
Q

Why might mediastinal shift not be a sign of pathology?

A

If the image is not adequately centered.

18
Q

What is this?

A

Pneumothorax

19
Q
A

Pleural effusion

20
Q

How do pleural effusions show on CXR?

A

Uniform white area where there is loss of the costophrenic angle and the hemidiaphragm is obscured.

21
Q

What are the generic findings of a lobar lung collapse?

A

Elevation of the ipsilateral hemidiaphragm.

Crowding of the ipsilateral ribs

Shift of the mediastinum towards the side of the atelectasis.

Crowding of the pulmonary vessels.

22
Q

What is consolidation?

A

Filling of small airways/alveoli with something.

23
Q

What might consolidation be?

A

Pus (pneumonia)

Blood (haemorrhage)

Fluid (oedema)

Cells (Cancer)

24
Q

How does consolidation show up on CXR?

A

Dense opacification

Volume preservation but may be either increased or decreased as well.

Air bronchogram

25
Q
A

Consolidation of left middle zone

26
Q

When is a space occupying lesion a nodule and when is it a mass?

A

Nodule <3 cm

Mass >3 cm

27
Q

Give causes of SOL.

A

Malignancy

Bening mass lesio

Inflammatory

Congenital

Mimics

28
Q
A
29
Q
A
30
Q

What is the cardiac index?

A

A ratio where the heart should be <50%

It must be assessed on PA image

31
Q

What else than CXR can be done in order to assess lung pathology?

A

Screening Chest CT (low-dose)

CT pulmonary angiogram

Standard chest

Ultrasound

Nuclear medicine