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pulm cram deck > SM 164a - Radiology > Flashcards

SM 164a - Radiology Flashcards

1
Q

What usually causes blunting of the costophrenic angles?

A

Pleural Effusion

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2
Q

What heart abnormality might cause unilateral left hilar enlargement?

A

Pulmonary valve stenosis

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3
Q

What are the chest x-ray findings of pulmonary edema?

A
  • Enlarged cardiac silhouette
  • Enlarged, ill-defined pulmonary vessels
  • Bilateral airspace opacities
  • Pleural effusions
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4
Q

Where are the borders of the secondary pulmonary lobule (SPL)?

A

Interlobular septa, containing pulmonary veins and lymphatics

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5
Q

What is atelectasis?

A

Collapse of airspaces.

The term encompasses mild (subsegment) to whole lung collapse

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6
Q

List some common examples of lung pathologies that cause with centrilobular opacities on chest x-ray.

What structures are affected by these diseases?

A
  • Pulmonary edema
  • Bronchiolitis
  • Hypersensitivity pneumonitis

These pathologies affect the bronchioles and intralobular artery (structures in the central portion of the SPL)

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7
Q

What is lobular pneumonia?

What would you see on a chest x-ray?

A

Pneumonia that encompasses an entire lobe/majority of a lobe of the lung

  • Uniform area of lung infection (no patchiness)
  • Infection is bound by a fissure
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8
Q

Which structures in the hila is enlarged in sarcoidosis?

A

Lymph nodes

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9
Q

What structure is arrow #4 pointing to?

A

Pulmonary Arteries

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10
Q

Describe the appearance of a pleural effusion on chest x-ray

A

Blunting of the costophrenic angles on the frontal or lateral view

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11
Q

What is structure E?

A

Pulmonary Hila

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12
Q

What would you see on a chest radiograph if there were a pneumonia or mass in the medial aspect of the lingula?

A

The left heart border (left ventricle border) would be obscured

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13
Q

Which lobes can be thought of as the posterior lobes?

A

Lower lobes

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14
Q

Which structures in the hila are enlarged in pulmonary hypertension?

A

Main and central pulmonary arteries

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15
Q

What is the most likely diagnosis?

A. Pneumonia

B. Pulmonary edema

C. Lobar collapse

D. Pneumothorax

A

D. Pneumothorax

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16
Q

What chest x-ray findings are you looking for when you assess the pleura?

A
  • Costophrenic angles on frontal and lateral view
    • Should be sharp; blunted in pleural effusion
    • Lateral view is more sensitive for the detection of pleural fluid
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17
Q

List some common pathologies that cause with interlobular septal thickening (on CT) and Kerley B lines (on Chest x-ray).

A

Interlobular septal thickening is caused by thickening of the outer connective layer of the secondary pulmonary lobule

  • Interstitial pulmonary edema
  • Lymphatic carcinomatosis

Affect structures in the periphery of the SPL (pulmonary veins and lymphatics)

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18
Q

Describe the appearance of a tension pneumothorax on a chest x-ray

A
  • Shift of the mediastinum
  • Depression of the diaphragm
  • Collapse of the lung
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19
Q

In which direction is a lateral view chest x-ray taken?

A

From right to left

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20
Q

How can one differentiate the interlobular septal thickening in pulmonary edema vs. lymphangitic carcinomatosis?

A

Pulmonary edema = bilateral, smooth

Lymphangitic carcinomatosis = unilateral, smooth early, nodular later on

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21
Q

Which lobe(s) are collapsed?

A

Right middle lobe and right lower lobe

The right heart border and diaphragm border are obscured; caused by a lesion in the bronchus intermedius

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22
Q

In a normal, healthy person, on an inspiratory frontal radiograph, the lungs extend to the ____th rib posteriorly and the ___th rib anteriorly

A

In a normal, healthy person, on an inspiratory frontal radiograph, the lungs extend to the 10 th rib posteriorly and the 6th th rib anteriorly

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23
Q

List 3 key features of a normal lung x-ray

A
  • Equal density, approximately equal size
  • The bronchi and vessels are very visible centrally
  • The outer peripher of the lungs are clearer than the center
    • You should not see the peripheral bronchioles clearly
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24
Q

What pathology might cause the fissures of the lungs to be seen easily?

A

Lobar pneumonia

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25
Q

Describe the appearance of a pneumothorax on a chest x-ray

A

Discrete visualization of the pleural line

If the patient is upright: air collects at the apex of the hemithorax

If the patient is supine: Air collects in the anterior, inferior hemithorax -> deep sulcus sign (sharper/invaginated costophrenic angle on one side)

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26
Q

In a chest x-ray, is the PA view superior to the AP view?

A

The PA view more closely approximates the size of the heart

AP view artificially accentuates the heart size

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27
Q

What structure is arrow #1 pointing to?

A

Interlobular septa

contains pulmonary veins and lymphatics

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28
Q

What are the yellow arrows pointing to?

What might be causing this?

A

Kerley B lines

Caused by interlobular septal thickening due to pulmonary edema or lymphangitic carcinomatosis

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29
Q

How many layers of pleura are in the junction lines (between lobes of the lung)?

A

4

One visceral and one parietal for each lobe

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30
Q

What would you see on a chest radiograph if disease were present in the lower lobes of the lung?

A

The diaphragm would be obscured

31
Q

Which picture shows reticulation?

Which one shows honeycombing?

A
  • A = Reticulation
    • Thickened linear densities
    • Can be a sign of fibrosis
  • B = Honeycombing
    • Dilated airspaces (rounder), usually ~1cm
    • A definite sign of fibrosis
32
Q

Which x-ray is abnormal?

A

A (on the left)

33
Q

Where is the pneumonia?

A

Right middle lobe

The right heart boarder is obscured because there is consolidation in the right middle lobe due to pneumonia

34
Q

What pathology is shown in this chest x-ray?

A

Pleural effusion

Blunted costophrenic angles are a classic chest x-ray finding in pleural effusion

35
Q

What abnormalities might leftward tracheal deviation indicate?

A

Right aortic arch or mediastinal mass

36
Q

What would you see on a chest radiograph if there were a pneumonia or mass in the middle lobe of the right lung?

A

The border between the lung and the right atrium will be obscured

37
Q

What is the most likely diagnosis?

A. Pulmonary edema

B. Cancer

C. Pneumonia

D. Pneumothorax

A

B. Cancer

Lymphangitic carcinomatosis - unilateral pulmonary edema. Fluid builds up due to blockage from tumor cells.

38
Q

What structure is this?

A

Costophrenic angle

39
Q

Which hilum is usually slightly higher?

A

Left hilum is usually slightly higher than the right

40
Q

What is structure D?

A

Descending aorta

41
Q

What is the CT analog for Kerley B lines on a chest radiograph?

What diseases might they indicate?

A

CT analog = interlobular septal thickening

These findings indicate pulmonary edema (if bilateral) or lymphangitic carcinomatosis (if unilateral)

Interlobular septal thickening becomes nodular later on in the disease process of lymphangitic carcinomatosis (stays smooth the whole time in pulmonary edema)

42
Q

What is an air bronchogram?

A

Air-filled bronchi surrounded by lung consolidation

43
Q

What is the difference in the appearance of consolidation and ground glass opacity on chest x-ray?

A

Both have increased density (brighter)

Consolidation obscures underlying structures

Ground glass preserves underlying structures

44
Q

List 2 diseases that could cause enlargement of the hila on chest x-ray?

A
  • Pulmonary hypertension:Enlarged central pulmonary arteries
  • Sarcoidosis: enlarged hilar lymph nodes
45
Q

What structure is this?

A

Left Ventricle

46
Q

Which lobes of the lung are the anterior lobes?

A

Upper lobes

47
Q

What structure is this?

A

Left atrium

48
Q

What structures are at the center of the secondary pulmonary lobule?

A

Pulmonary veins and lymphatics

49
Q

Which lobes of the lung touch the heart?

A
  • Middle lobe of the right lung
  • Lingula of the left lung
50
Q

What is a deep sulcus sign?

What does it indicate?

A

Hyperluscency of the diaphragm

Caused by pneumothorax in a patient who is supine; air collects in the inferior hemithorax

May also see deepened, hyperluscent costophrenic angles

51
Q

What is the smallest unit of the lung that has a connective tissue covering?

A

Secondary pulmonary lobule (SPL)

52
Q

What does thickening of the interlobular septa indicate?

A
  • Fluid in the septa (in pulmonary veins and lymphatics)
  • This appears as Kerley B lines on chest X-ray!
53
Q

What structure is this?

A

Pulmonary Artery

54
Q

When would you order a chest x-ray with an AP view?

A

If the patient cannot sit or stand upright

Usually, you would want to ordern a PA view to minimize false magnification of the mediastinum in the chest cavity

55
Q

What structure is arrow #2 pointing to?

A

Pulmonary veins + lymphatics

56
Q

What is structure A?

A

Trachea

57
Q

Which section contains “ground glass opacity?”

Which section contains consolidation?

A
  • A = Consolidation
    • Increased density that obscures the underlying architecture of the lung
  • B = Ground glass opacity
    • Increased density, but the underlying architecture of the lung is preserved
58
Q

Which lung is aspirated material most likely to enter?

Why?

A

The right lung

The right mainstem bronchus is shorter and more vertically oriented than the longer, more horizontal left mainstem bronchus.

59
Q

Where is the pneumonia?

A

Left lower lobe

Can see the left heart border => not in the left upper lobe

The left hemidiaphragm is obscured => pneumonia in the left lower lobe

60
Q

Which fissure is the yellow arrow pointing to?

A

Oblique fissure, aka major fissure (this is the right lung)

61
Q

What are paratracheal stripes?

A

Slightly brighter lines on either side of the trachea, where vessels and lymph nodes live

They are a normal finding on a chest x-ray

62
Q

What structure is this?

A

Right atrium

63
Q

What structure is the yellow arrow pointing to?

A

Pulmonary vein in the interlobular septa

64
Q

What creates a silhouette sign?

A

The silhouette sign is created by differences in density. Tehse differences allow us to see the boarders of structures

Structures of the same density where one is behind the other will be visible

Structures of the same density where one is surrounding the other will not be visible

65
Q

What structure is arrow #3 pointing to?

A

Bronchioles

66
Q

Which hilum will be enlarged in pulmonary valve stenosis?

A

Left hilum

67
Q

Which 4 structures can be found in the pulmonary hila?

A
  • Bronchi
  • Pulmonary arteries
  • Pulmonary veins
  • Lymph nodes
68
Q

What causes the normal, slight-rightward deviation of the mid-thoracic trachea?

A

The arch of the aorta

69
Q

Support devices like endotracheal tubes are more likely to be abnormally placed into the [right/left] mainstem bronchus

A

Support devices like endotracheal tubes are more likely to be abnormally placed into the right mainstem bronchus

70
Q

Where is the abnormality in this chest x-ray?

A

The trachea - Deviated to the left due to a right aortic arch

The lungs are normal

71
Q

What is structure B?

A

Carina

72
Q

Where is the pneumonia?

A

Left upper lobe (lingula)

Left heart boarder is obscured

73
Q

What is structure C?

A

Aortic Arch

74
Q

The segmental bronchi arise from the ________

A

The segmental bronchi arise from the Lobular bronchi

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