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20 Cards in this Set

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Posterio-anterior xray
Patient standing facing xray plate.

Twice as much flow to bottom as top of lungs so there should be many more markings in the lung base than in the apex.
Anterior-posterior xray
lying in bed. these are not as good as PA or lateral exams
Silhouette sign
in the chest in particular, you get this due to the juxtaposition of air space adjacent to soft tissue structures. It is defined as an obstruction of normal structure by pathology
Long smooth lines vs fluffy borders in lung disease
Long smooth lines are usually due to a process occurring adjacent to the pleura while fluffy borders are due to affecting the alveolar lobules
You see a meniscus on chest film
This is an effusion. It is fluid around the lungs and looks like a smiley face. If it is around the heart borders, it can produce a silhouette sign.

Effusions do not damage the lung

They can be caused by cardiovascular disease, heart failure, trauma, hemothorax, infections, tumor
Define the mediastinums
Anterior- everything anterior to the heart and great vessels. Thymus and a few lymph nodes are here. Think lymphoma and embryologic remnants

Posterior- from the anterior 1/3 of the vertebral bodies. Contains mostly nerves and some lymph nodes. Think neurogenic mass here (neuroma or schwannoma)

Middle- very busy. Great vessel, trachea, esophagus, most of the lymph nodes

Superior- everything above the aortic arch
Patterns of lung disease
Alveolar disease
Interstitial disease
Masses and nodules
Bronchial
You see small air-filled bronchi surrounded by consolidated lung
These are air bronchograms. They indicate alveolar disease. You will see an irregular white opacity with little black lines in the middle. They can only be seen in PA or lateral xrays reliably
Alveolar disease differential
Edema, infection, hemorrhage, tumor, alveolar proteinosis
You see fine reticular lung markings prominent in the periphery
This is interstitial disease. It looks like a net. Best seen near the pleural surface. They can be reticular (lots of little lines) or nodular (birdseed scattered around)
You see nodular interstitial lung disease
could be blastomycosis
Characteristics of lung masses and nodules
They are usually solid, spherical, well-defined borders, and less than 3 cm in diameter
Nodules differential
Lung cancer, metastasis, infection, benign tumor
Most common benign masses
hamartomas and amyloidosis
Criteria to call a lung nodule benign
patient under 35 with no history of malignancy

Calcified benign pattern

radiographic stability over 2 yrs
What would you see on xray with obstructive lung disease
over inflated lungs (hyperlucent - too black)

Diaphragm would be black

disorganized vessels and/or bullar
You see upper lobe emphysema in a smoker
Think centriacinar
What do you see with xray of restrictive lung disease
lungs are too small

increase in pulmonary markings, especially near periphery

usual interstitial pneumonitis produces peripheral honeycombing
Describe cardiogenic edema
Known heart disease

Heart is enlarged

Effusions are common

Pattern begins to develop in the perihilar region and it is worse in the lung base because it reflects lung flow
Describe ARDS
This is non-cardiogenic. It is usually from a known cause such as sepsis, trauma, transfusions, smoke inhalation.

Heart size stays normal

Pleural effusions are rare

Equally bad effusions in the upper and lower parts of the lungs due to capillary leak. Doesn't follow distribution of blood flow because of the number of capillaries all over the lung.