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SOM 302 > WEEK 4: CHEST XRAYS WORKSHOP > Flashcards

WEEK 4: CHEST XRAYS WORKSHOP Flashcards

1
Q

How do x-rays work?
Why can we see the separate structures?
* Lungs
* Mediastinum
* Bones
* Abdomen

A

The more X-rays that pass through the body, the darker the image
2. X-rays are stopped (attenuated) by tissues of the body.
* More attenuation - lighter
* Less attenuation - darker
3. X-ray attenuation is primarily dependent on: physical density.
* Denser (bones) - lighter
* Less dense (lungs) -darker
* Intermediate dense (soft tissues) –intermediate gray

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2
Q

Darker =
Lighter =

A

Darker = less dense (attenuation)
Lighter = more dense (attenuation)

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3
Q

Describe how to review a chest x ray.

A
  1. Scan lungs
    * Behind heart
    * Through diaphragms
    * Apices
  2. Scan costophrenic angles (pl effusions) (red
    arrows)
  3. Heart
    * Size (<1/2 thorax)
    * Shape
  4. Mediastinal borders
    * Great veins
    * Aorta
    * Esophagus
    * Lymph nodes
    * Thymus
  5. Hilum
    * Pul. artery, pulmonary veins, bronchi & LN
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4
Q

Define Focal & Multifocal diseases.

A

*Single location
*Multiple locations with normal intervening lung

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5
Q

State the 5 causes of Focal Airspace Opacities.

These 5 causes account for > 95% of all focal airspace opacities!!

A
  1. Pneumonia– Infection
  2. Atelectasis – Lung Collapse
  3. Contusion–Trauma (laceration, hematoma)
  4. Neoplasm- Cancer
  5. Infarction-Lack blood flow
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6
Q

Describe the 5 types of atelectasis.

A

Types of Atelectasis
1. Passive………………… collapse due to elastic recoil
2. Obstructive (resorptive)..collapse due to airway obstruction
3. Cicatricial…………….. collapse due to retraction by scarring
4. Compressive………..…. collapse due to compression
5. Adhesive…………..….. collapse due to surfactant deficiency

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7
Q

Describe the mechanism of passive atelectasis.

State the causes of passive atelectasis.

A

Mechanism
* Diminished respiration
* Elastic recoil of the lung
* Passive dependent collapse
Causes
* Pain Related
* Neuromuscular Diseases.
* Space Occupying Pleural Distention

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8
Q

Outline pain related causes that result in small breaths which is a risk factor for passive atelectasis.

A

*Post operation
*Trauma
*Pleuritis
*Diseases below the diaphragm
*PE

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9
Q

Outline Neuromuscular Diseases that result in small breaths which is a risk factor for passive atelectasis.

A

*Loss of consciousness
*Phrenic nerve damage: Damage to the phrenic nerve can lead to a paralyzed diaphragm.
*Myasthenia gravis: A neuromuscular disorder that leads to weakness of skeletal muscles.

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10
Q

Outline Space Occupying Pleural Distention that results in small breaths which is a risk factor for passive atelectasis.

A

*Pleural effusion
*Pneumothorax

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11
Q

CASE 1
32M status epilepticus with new onset fever and
transmitted breath sounds on physical examination.

Which cause is most likely in our patient?

A

Bacterial Pneumonia
* Focal airspace opacity–Most common
cause
* Typical signs/symptoms

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12
Q

CASE 2
57M HIV+ cd4 298 presents with cough, chest pain and fever (39C).

What are the causes?

A

Pseudomonas Pneumonia
* Focal airspace opacity– Most common cause
* Typical signs/symptoms

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13
Q

CASE 3
21M was pursued by police and fell 3 stories.
What are the causes?

A

Lung Contusion

Trauma-related focal airspace opacities
1. Contusion/laceration
* Most common
2. Aspiration pneumonia
* Sometimes

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14
Q

CASE 4
61M man with severe abdominal pain due to pancreatitis.

Cause of the opacities?

A

Passive Atelectasis due to Abdominal Pain.

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15
Q

State Pulmonary Masses: Causes

A
  1. Neoplasm
  2. Infection
  3. Congenital
  4. Inflammatory mass
  5. Trauma
  6. Other
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16
Q

State neoplasms that can cause pulmonary masses.

A
  • Bronchogenic CA
17
Q

State infections that can cause pulmonary masses.

A

*Granulomatous infection: TB
*Echinococcus
*Lung abscesses

18
Q

State congenital abnormalities that can cause pulmonary masses.

A
  • CPAM: (Congenital Pulmonary Airway Malformation): CPAM is a congenital (present at birth) abnormality in the development of the fetal lung tissue. It results in the formation of cystic lesions within the lungs, which can vary in size and severity.
  • AVM: AVM (Arteriovenous Malformation): An AVM is an abnormal connection between arteries and veins, typically in the circulatory system. These connections can be congenital or acquired and can occur in various parts of the body. AVMs can cause problems by disrupting normal blood flow and can lead to various symptoms, including bleeding, pain, and, in severe cases, complications.

Sequestration (Pulmonary Sequestration): Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract. It involves a piece of lung tissue that is not connected to the normal airway, and it receives its blood supply from an abnormal source, often a systemic artery.

19
Q

State inflammatory abnormalities that can cause pulmonary masses.

A
  • GPA (Wegener’s)
  • Organizing pneumonia
  • Rheumatoid nodule
  • Lipoid pneumonia
20
Q

State trauma that can cause pulmonary masses.

A

Hematoma

21
Q

State other abnormalities that can cause pulmonary masses.

A
  • Rounded atelectasis
  • Amyloidosis
  • Conglomerate masses of silicosis
22
Q

Case 5

28F heroin addict with 3 weeks of fever and back pain.

What is the cause in our patient?

A

Infection

Lung Abscess in a Heroin Addict
* Pulmonary mass – Air-fluid level common
* Associated with loss of consciousness –alcohol, drugs, debilitated, elderly

23
Q

Case 6

50-woman Hx DM, HTN c/o fever, headache,
malaise and cough x 3 months.

Which cause in our patient?

A

A diffuse lung disease made up of tiny nodules.

Miliary Tuberculosis

24
Q

State the acute causes of diffuse Interstitial Lung Pattern.

A
  • Interstitial pulmonary oedema
    *“Interstitial” pneumonia
    • PJP: Pneumocystis jirovecii pneumonia.
    • Viral
    • mycoplasma
25
Q

State the chronic causes of diffuse Interstitial Lung Pattern.

A
  1. Smoking related
    * IPF (UIP)
    * RBILD/DIP
    * Langerhans cell histiocytosis
  2. Idiopathic
    * Sarcoidosis
    * iNSIP
  3. Miliary infection (TB. fungi)
    * Hypersensitivity pneumonitis
  4. Pneumoconiosis
    * Silicosis
    * Asbestosis
    * Coal-workers pneumoconiosis
    * Talcosis
    * Berylliosis
  5. Connective tissue disorders
    * Rheumatoid arthritis
    * Scleroderma (PSS)
    * Polymyositis/dermatomyositis
    * MCTD
    * SLE
  6. Metastasis
    * Micronodular (thyroid)
    * Lymphangitic carcinomatosis
    * Lymphangioleiomyomatosis
26
Q

What is the most common focal opacity in an outpatient?

A

Pneumonia is the most common focal opacity in an outpatient.

27
Q

What is the most common focal opacity in an ICU or post op patient?

A

Passive atelectasis is the most common focal opacity in an ICU or post op patient.

28
Q

What are the 4 things to be taken into account when coming up with probability of disease?

A
  1. Clinical history
  2. Imaging findings
  3. Patient demographics (age/sex/other)
  4. Relative frequency of disease

SOM 302 (27 decks)

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