Dx Imaging III > Midterm > Flashcards

Midterm Flashcards

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1
Q

name the 2 major fissures and 1 minor fissure

A

R oblique fissue (major), L oblique fissure (major), and R horizontal fissure (minor)

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2
Q

what lobes does the R oblique fissure separate

A

R upper and middle lobes from the R lower lobe

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3
Q

what level does R oblique fissure begin, where does it extend, where does it end

A

begins T5

extends obliquely down and forward

ends at anterior pleural gutter of diaphragm

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4
Q

Which is more vertical: right oblique fissure or left oblique fissure

A

left oblique fissure

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5
Q

describe the radiology of the R oblique fissure

A
  • May be visible on the lateral film
  • Will NOT be seen on PA chest film
  • Identify which side oblique fissure by which diaphragm it intersects with
  • Horizontal fissure will run into Right Oblique fissure but will not cross it
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6
Q

what does the right horizontal fissure separate

A
  • separates Anterior segment of R Upper Lobe from R Middle Lobe
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7
Q

beginning, extension, and ending of R horizontal fissure

A
  • begins at R Oblique Fissure at mid-axillary line
  • runs horizontally anteriorly to sternal end of 4th costal cartilage
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8
Q

R horizontal fissure radiology

A
  • Absent or incomplete on 25% of individuals
  • Seen in ~54% of PA chest x-rays
  • Runs from anterior 4th rib posteriorly to the R oblique fissure
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9
Q

what does the L oblique fissure separate

A
  • separates L Upper Lobe from Left Lower Lobe
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10
Q

beginning, extension, and end of L oblique fissure

A
  • begins at level of T5
  • extends obliquely down and forward
  • ends at anterior pleural gutter of diaphragm
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11
Q

To Differentiate Right from Left:

A
  • use other landmarks
  • Magenblasse = gas in the fundus of the stomach
  • Which diaphragm the fissure crosses
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12
Q

location of RUL

A

apical, anterior, & posterior

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13
Q

locate RML

A

lateral & medial

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14
Q

locate RLL

A

superior, medial basal, anterior basal, lateral basal, & posterior basal

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15
Q

locate LUL

A

apical-posterior, anterior, superior lingular, & inferior lingular

o corresponds to RML

o LUL is analogous to RUL and RML combined

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16
Q

locate LLL

A

superior, medial basal, anterior basal, lateral basal, posterior basal

o LLL is the same as LRL

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17
Q

location of lingular lobes

A

located in left upper lobe, bordering the heart

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18
Q

anatomical parts responsible for the cardiac contours on the PA chest film

A

anterior: Right heart border, left heart border, ascending aorta
posterior: Descending thoracic aorta, aortic knob (posterior portion of aortic arch)

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19
Q

Which views are included in routine plain film examination of the chest?

A

Minimum Diagnostic Series (both on full inspiration):

  • PA
  • Left Lateral
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20
Q

How does a thoracic spine plain film study differ from a chest study?

A

Chest Technique: 72” FFD, High kVp, Low mA and short time

• Chest films must include all air spaces of the lungs vs. tightly collimated thoracic spine film

Positioning: PA Chest vs. AP Thoracic

Left Lateral Chest vs. Either Lateral Thoracic

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21
Q

What condition or anatomical region is best demonstrated by the apical lordotic view?

A

Lung Apices: apical refers to the anatomy and lordotic refers to the patient position/technique

  • can Dx a Pancoast tumor, Tuberculosis
  • can be used to demonstrate the middle lobe of the right lung and the lingula segment of the left upper lobe.
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22
Q

Is the routine chest x-ray taken with inspiration or expiration?

A

Routine CXR = Full inspiration

o Breath held on inspiration

o Expands lung fields
o depresses diaphragm
o Provides contrast (air vs. tissue)

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23
Q

Describe the difference in appearance between inspiration and expiration chest films.

A

Need good inspiration for chest film. You should see first 10 ribs posteriorly and a breath in will lower the diaphragm. Without a deep inspiration the heart will look enlarged and the lungs will be condensed and more radio-opaque.

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24
Q

What condition is better demonstrated upon expiration than inspiration?

A

Pneumothorax – upright expiration is more sensitive. Look for mediastinal displacement. (Atelectasis maybe though too?)

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25
What is the appearance of interstitial disease?
Thickened interlobular septa, alveolar walls. Usually a diffuse pattern of involvement. Often combined with consolidation.
26
What is the appearance(s) of alveolar/air-space disease?
Air space disease, or alveolar lung disease, is a process in which there is a filling of the lung's alveoli / acini. Radiographic features: lobar or segmental distribution, poorly marginated, airspace nodules, tendency to coalesce, air bronchograms, bat's wing (butterfly) distribution, rapidly changing over time
27
4 patterns of “white lung” disease (lung opacification on chest films) and a differential list for each.
1. Diffuse 2. Localized/Lobar 3. Solitary mass/nodule 5. Multiple masses/nodules
28
describe Diffuse "white lung" disease
Diffuse – usually bilateral and symmetric; suggests more systemic/widespread dz DDx: Pulmonary edema, Unusual infections (Pneumocysitis carinii, opportunistic, immune compromised) Sarcoidosis, Histoplasmosis, TB, Bronchiolaveolar carcinoma, Idiopathic pulmonary hemorrhage
29
describe Localized/Lobar "white lung"
* Usually only a portion of one lung * Most common presentation of infection •DDx: Acute bacterial pneumonia, Pulmonary TB, Pulmonary infarct, Bronchopulmonary sequestration, Pancoast tumor, Atypical pneumonia (viral, mycoplasma)
30
describe Solitary mass/nodule "white lung"
Smaller, fairly well defined area. Common presentation of neoplasm. •DDx: Bronchogenic carcinoma, Hematogenous metastasis, Hamartoma, Tuberculoma (and other granulomas), Lung abscess, Hydatid cyst, Hematoma, Bronchopulmonary sequestration
31
describe Multiple masses/nodules "white lung"
* Multiple fairly well defined areas * Common presentation of metastasis DDx: Pulmonary metastasis, Lymphoma, Granulomatous infection, Tuberculosis, histoplasmosis, coccidioidomycosis, Rheumatoid nodules, Wegener’s granulomatosis
32
What is the silhouette sign?
When 2 structures of the same radiographic density are in anatomic contact, the margins of those structures will be obliterated. The obliteration of a normal anatomical shadow due to a water density (structure or lesion) in anatomic contact with that structure. Structures that may show silhouette sign: •Mediastinal structures: Heart, Aorta, Diaphragms, Chest Wall Water densities that may cause a silhouette sign include: Pneumonia, Tumors, Pleural Effusion
33
What are the causes of atelectasis and examples of diseases for each?
1. Obstructive (Resorptive) Bronchogenic carcinoma, Bronchial adenoma, Foreign body, TB, LA 2. Compression (Passive) Intrathoracic space-occupying process: pneumothorax, hydrothorax, hemothorax, any mass 3. Contraction (Cicatrization) TB, Interstitial pulmonary fibrosis, silicosis, radiation therapy 4. Surfactant abnormality (adhesive) Respiratory distress syndrome, acute radiation pneumonitis
34
Which is the most common cause of atelectasis?
Obstruction (Resorptive atelectasis)
35
What are the signs of atelectasis?
Displaced fissure, elevated hemidiaphragm, displaced hilus, mediastinal shift, increased density, approximation of the ribs, vascular bronchial crowding, compensatory emphysema, lung herniation
36
What is the direction of the collapse in the different types of atelectasis (towards or away from collapsed lung)?
Right and left lower lobe: posteriorly, medially, inferiorly RUL and LUL: superiorly, medially, anteriorly Adhesive: structures shift toward collapsed lung Passive: structures shift away from collapsed lung
37
What is an air bronchogram sign and what does it indicate?
• Most bronchi/bronchioles are not visible on normal chest x-ray -An air bronchogram happens when the air spaces are filled with a fluid that is similar in density to water so the bronchi become visible
38
Which condition commonly demonstrates as a mass in the pulmonary apex or hilar area and may cavitate?
Bronchogenic carcinoma (pancoast tumor)
39
Which condition commonly demonstrates pleural plaques in the lung bases?
Mesothelioma – asbestos related diseases (asbestosis)
40
What are the radiographic signs of pulmonary emphysema?
- Flattened, depressed hemidiaphragms - Hyperlucency - Increased retrosternal clear space - Increased AP chest diameter - Decreased peripheral vascular markings
41
What is an air filled bulla?
Emphysematous space larger than one cm, usually located in the lung periphery; can reach large diameter and cause symptoms by compression of normal lung tissue
42
Describe the appearance of pleural effusion and name some causes.
Meniscus sign (blunted costophrenic angles), posterior costophrenic angle deeper than lateral. Some causes include CHF, pneumonia, neoplasm, infection, trauma, embolism, connective tissue disease, TB, abdominal disease
43
What are the different types of pneumothorax?
Spontaneous, traumatic, and tension
44
What is the appearance of pneumothorax with pleural effusion?
Visceral pleura visible, no lung markings peripheral to pleura, possible signs of atelectasis, upright expiration PA more sensitive, lateral decubitus may be helpful
45
What is the difference in appearance between spontaneous and tension pneumothorax?
1. Spontaneous - towards the side of collapse - underlying lung disease 2. Tension (= medical emergency) - shift of mediastinum AWAY from the collapsed lung (pushes away from side of collapse)...shrunken down to hilum - leads to vascular compromise
46
What is pancoast tumor?
Squamous cell or adenocarcinoma mass in the apex
47
Are multiple pulmonary masses of varying sizes suggestive of primary bronchogenic or metastatic carcinoma?
Metastatic carcinoma = multiple Bronchogenic carcinoma = solitary mass (mediastinal, apical, or lung fields)
48
Is calcification common in a malignant pulmonary mass?
No.. most of the calcifications are BENIGN.
49
List 4 conditions that demonstrates elevation of the hemidiaphragm.
Atelectasis, phrenic nerve palsy, obesity, pregnancy, hepatosplenomegaly, ascites
50
What is the butterfly/bat wing appearance?
- pattern of pulmonary edema which involves perihilar regions and spares cortex of lung - indicative of bilateral diffusive alveolar disease (also called medullary istribution) -Mechanism: capillary permeability, increased hydrostatic capillary pressure, blocked by lymph channels
51
What is the normal relation between the transverse diameter of the heart and the thoracic cage on the PA chest film?
Located in the middle mediastinum, 1/3 to the right of midline, 2/3 to the left og midline. Cardiothoracic ratio: on PA upright full inspiration chest film – widest coronal diameter of heart (not the best evaluation for cardiomyopathy)
52
List 2 causes of left ventricle hypertrophy.
- High Blood Pressure - Aortic stenosis - Congenital - Exercise (athletic heart)
53
Describe the divisions and boundaries of the mediastinum, their contents, and possible pathologic processes.
1. Anterior – sternum to anterior cardiac silhouette Contents: thymus, lymph nodes Pathologies: thyroid goiter, hodgkin’s lymphoma, thymic mass, germ cell tumor 2. Middle – anterior to posterior cardiac silhouette Contents: pericardium, heart, great and pulmonary vessels, phrenic nerve, upper vagus nerves, trachea, primary bronchi, lymph nodes Pathologies: lymphadenopathy, bronchogenic carcinoma, aneurysm, bronchogenic cyst, CHF 3. Posterior – posterior cardiac silhouette to posterior border of lung field Contents: descending thoracic aorta, esophagus, thoracic duct, azygous and hemiazygous veins, sympathetic ganglia, lower vagus nerves, lymph nodes Pathologies: hiatal hernia, neurogenic tumors, paravertebral masses, meningocele, esophageal masses, aneurysm
54
What is the most common retrocardiac mass?
Hiatal Hernia
55
What view is this?
Apical lordotic view
56
What is circled here?
Costophrenic angle. The image below is an example of when they are blunted.
57
What lobes are separated by the horizontal fissure of the right lung?
Upper and middle right
58
What lobes are separated by the oblique fissure of the right lung?
Lower from middle and upper right
59
What is this?
Azygous fissure
60
What is this and what are two common causes?
Extra-pleural sign. Causes: Trauma and metastatic cancer
61
What is this?
Pneumothorax
62
Resorptive vs. passive mediastinal shift
Resorptive shift toward the collapsed lung (CA and pneumonia) Passive shifts away from collapsed lung (pneumothorax)
63
How can you identify a benign or malignant mass in a film?
Diffusely dense is a benign mass
64
What is of most concern when multiple masses are seen in the chest?
Metastasis
65
Types of pneumothorax
Spontaneous, traumatic, and tension
66
What disease is this?
Emphysema
67
What lung disease is associated with calcified pleural plaques?
Asbestosis
68
What is a common anterior mediastinal mass that often originates from the neck?
Goiter
69
What are the major pathologies that present as a mediastinal mass?
3 T’s and a H: Thyroid Goiter, Thymoma, Teratoma, Hodgkin’s Lymphoma
70
What's going on here?
Hiatal hernia
71
Sup with this?
Enlarged heart
72
Significance of retrosternal space?
The retrosternal airspace is seen as a normal lucency between the posterior aspect of the sternum and anterior aspect of the ascending aorta on lateral chest radiographs. This is space normally measures less than 2.5cm in width. Increased retrosternal airspace is a sign of pulmonary emphysema, while obliteration of the retrosternal airspace is an indication of an anterior mediastinal mass.
73
What disease is seen here? Hint: Look at the retrosternal area. Is it normal, increased, or obliterated?
Emphysema. Retrosternal space is increased.
74
What disease is seen here? Hint: Look at the retrosternal area. Is it normal, increased, or obliterated?
Lymphoma. Obliterated retrosternal space.
75
What pathology is this?
Hiatal hernia.
Dx Imaging III
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