Katz 10-2-07 Resp Tract

Front 1

preferred lateral image (left or right)?

Back 1

left lateral

Front 2

PA or AP ?
lung fields clearer, heart sharper borders

Back 2

PA

Front 3

If you can read the marker, is the film AP or PA?

Back 3

AP

Front 4

If you cannot see thru the heart, the film is probably ____

Back 4

underpenetrated

Front 5

To determine if you have no rotation in a CXR, look at the medial aspects of what bones?

Back 5

clavicles

Front 6

How might the left main stem bronchus get more horizontal?

Back 6

Left atrial enlargement

Front 7

First thing katz looks at on CXR

Back 7

gastric bubble


(lung fields last)

Front 8

which hemidiaphram is always seen on PA CXR

Back 8

right hemidiaphragm

Front 9

which hemidiaphram is always seen on lateral CXR

Back 9

right hemidiaphragm


(right usually higher than left, but not always)

Front 10

why is minor fissure more prominent on AP?

Back 10

parallel with rays

Front 11

CXR: look at Soft tissues: don’t miss a _____

Back 11

mastectomy

Front 12

on lateral CXR, describe lucency of spine.

Back 12

spine becomes more lucent toward inferior

Front 13

SILHOUETTE SIGN definition

Back 13

The elimination of the silhouette or loss of lung/soft tissue interface caused by a mass or fluid in the normally air filled lung.

Front 14

SILHOUETTE SIGN:
In other words, if an intrathoracic opacity is in anatomic contact with, for example, the heart border, then the opacity will obscure or emphasize? that border.

Back 14

obscure

Front 15

material that is most radiopaque to most lucent

Back 15

C W F A


calcium
water
fat
air

Front 16

When two objects of the same density touch each other, the edge between them
a)disappears
b)appears

Back 16

a) disappears

Front 17

For the heart, the silhouette sign can be caused classically by an opacity in the RML or ____ division of the LUL.

Back 17

lingula

Front 18

_____ lobe silhouettes right heart border

Back 18

Right middle

Front 19

_____ silhouettes left heart border

Back 19

Lingula

Front 20

________ lobe silhouettes right hemidiaphragm

Back 20

Right lower

Front 21

_______ lobe silhouettes left hemidiaphragm

Back 21

Left lower

Front 22

An air bronchogram is a tubular outline of an airway made visible by filling of the surrounding alveoli by _____

Back 22

fluid or inflammatory exudates

Front 23

The visibility of air in the bronchi because of surrounding airspace disease is called an _____

Back 23

“air bronchogram”

Front 24

An air bronchogram is almost always a sign of _____

Back 24

airspace disease

Front 25

Causes of air bronchograms are (4)

Back 25

lung consolidation,
pulmonary edema,
nonobstructive pulmonary atelectasis
and normal expiration

Front 26

density other than air surrounds them
(in this case it is inflammatory exudate from a pneumonia)

Back 26

The black branching structures are the result of air in the bronchi, now visible because _________

Front 27

A = intraparenchymal
B = pleural
C = extrapleural

Back 27

A? B? C?

Front 28

In most cases the nodules are due to _________

Back 28

metastases from a primary malignancy in an organ other than the lung.

Front 29

Diseases with Multiple Nodules (4)

Back 29

Metastasis
Multiple AVMs
Rheumatoid nodules
Wegener’s Granulomatosis

Front 30

Disease with Multiple Cystic Structures (3)

Back 30

Cystic Fibrosis

Bronchiectasis

Tuberculoisis

Front 31

Parenchymal Lung Disease
2 categories (radiologic categories)

Back 31

Alveolar

Interstitial

Front 32

Hallmark of Alveolar lung disease

Back 32

air bronchograms

Front 33

Alveolar lung disease characteristics

Back 33

Has air bronchograms
Fluffy and indistinct
Confluent and homogeneous
May have segmental or lobar distribution

Front 34

Common Alveolar Lung Diseases (4)

Back 34

Pneumonia
Pulmonary edema
Pulmonary Hemorrhage
Aspiration

Front 35

alveolar (airspace)

Pulmonary Edema (non cardiogenic)

Back 35

This disease is fluffy and indistinct in its margins, it is confluent and tends to be homogeneous. In both upper lobes, you can see air bronchograms. This is an __________ disease

Front 36

Aspiration

Back 36

________ Pneumonia

Front 37

Interstitial lung disease characteristics

Back 37

Discrete
Inhomogeneous
No air bronchograms
Made up of lines (reticular) or dots (nodular) or both (reticulonodular)

Front 38

Common Interstitial Lung Diseases (5)

Back 38

1)Carcinoma , primary or 2)secondary
3)Sarcoidosis
4)Cystic fibrosis
5)Asbestosis

Front 39

Cystic Fibrosis - interstitial

Back 39

What type of lung disease (alveolar or interstitial)

Front 40

Alveolar disease – fluffy, indistinct, homogeneous, contains air bronchograms

Back 40

interstitial or alveolar?

Front 41

Interstitial disease – discrete, inhomogeneous, no air bronchograms

Back 41

alveolar or interstitial?

Front 42

Infiltrate:
opacity that is poorly defined. This is airspace disease such as pneumonia

left upper lobe

Back 42

Mass or infiltrate?

Front 43

the opacity would best be described as a mass because it is well-defined.

left upper lobe

Back 43

mass or infiltrate?

Front 44

Diseaes with Opacified Hemithorax (3)

Back 44

Pneumonia
Atlectasis
Pleural effusion

Front 45

Diseaes with Opacified "whatever" in the lungs (3)

Back 45

Pneumonia
Atlectasis
Pleural effusion

Front 46

With Opacified Hemithorax and Air bronchograms, what is the key to diagnosing pneumonia?

Back 46

No shift of mediastinum

Front 47

Pneumonia of LUL – no shift of the mediastinal structures to either side; multiple air bronchograms

Back 47

?

Front 48

Right middle and lower lobes

Back 48

Where is the pneumonia?

Front 49

RUL


atelectasis

Back 49

Where is the pneumonia?
What else is going on?

Front 50

LUL, LLL pneumonia

BUT, there is shift of mediastinum, so something else is going on.

Back 50

?

Front 51

LUL, LLL

Back 51

Where is Pneumonia?

Front 52

Atelectasis refers to collapse of a lung or portion of the lung with resorbtion of air from the ______

Back 52

alveoli

Front 53

What causes atelectasis?

Back 53

An obstructing bronchial lesion
Extrinsic compression
from pleural effusions or bullae
Fibrosis
A loss of surface tension in the alveoli
as in hyaline membrane disease

Front 54

atlectasis:
Almost always associated with a linear increased density on _______

Back 54

chest x-ray

Front 55

Atelectasis:
The apex of density tends to be at the _____.

Back 55

hilum

Front 56

Atelectasis:
The density is associated with volume _______

Back 56

loss

Front 57

Indirect signs of atlectasis:

Back 57

Vascular crowding

Mediastinal shift, towards the collapse

There may be compensatory hyperinflation of adjacent lobes

Segmental and subsegmental collapse may show linear, curvilinear, wedge shaped opacities

Front 58

Segmental and subsegmental collapse may show linear, curvilinear, wedge shaped opacities. This is most often associated with post-op patients and those with massive _____

Back 58

hepatosplenomegaly or ascites

Front 59

Major fissure

Back 59

What structure is the arrow pointing to?

Front 60

right side atelectasis

Back 60

?

Front 61

mediastinum shift toward opacity
= atelectasis

vent tube was pushed into right main bronchus and blocked the left bronchus causing atelectasis

Back 61

What this?

Front 62

Pneumo, atelectasis, or PE?
There is an increase in volume with a shift of adjacent structures away from the lesion

Back 62

PLEURAL EFFUSION

Front 63

PE

Back 63

?

Front 64

Air bronchograms in Atelectasis or Pneumonia?

Back 64

Both Atelectasis and Pneumonia

Front 65

6th most common cause of death in USA

Back 65

PNEUMONIA

Front 66

Highest mortality rate of pneumonia causes

Back 66

Pseudomonas 75%

Front 67

In the absence of clinical information the radiologist cannot D/D between pneumonia and other clinical processes.
i.e. _________

Back 67

ARDS & pulmonary edema

Front 68

can you diagnose pneumonia with clinical symptoms?

Back 68

no. You need CXR

Front 69

Types of Pneumonia:
Lobar or airspace or alveolar pneumonia

What are the causes? (2)

Back 69

Pneumococcal
Klebsiella

Front 70

Types of Pneumonia:
Bronchopneumonia

What are the causes?

Back 70

Staph aureus
Most gram negative bacteria
Some fungi

Front 71

SARS:Serious Acute Respiratory Syndrome
Begins with _____ of high fever >100.4° with chills and myalgia

Back 71

prodrome

Front 72

CXR during SARS febrile prodrome?

Back 72

normal

Front 73

Which phase of SARS?
Early focal interstitial infiltrates
Progresses to more generalized, patchy, interstitial infiltrates

Back 73

Respiratory

Front 74

Gram Positive Pneumonias (4)

Back 74

Pneumococcal pneumonia
Staphylococcal pneumonia
Streptococcal pneumonia
Nocardiosis

Front 75

Most common gram positive pneumonia

Back 75

Pneumococcal Pneumonia

Front 76

Pneumococcal Pneumonia:
Inflammatory edema in alveoli spread via pores of ____ to more lateral alveoli

Back 76

Kohn

Front 77

Predisposing Conditions for pneumococcal pneumonia

Back 77

Usually found in compromised hosts

Elderly

Front 78

Pneumococcal Pneumonia X-ray Findings

Back 78

Predilection for lower lobes
Extensive infiltrate abutting pleural surface
Prominent air bronchograms
DDX: Staph has no air bronchogram
Does not respect segmental boundaries

Front 79

air bronchograms in pneumonia

Back 79

?

Front 80

Staph Aureus Pneumonia
Overwhelming majority are _______-acquired

Back 80

hospital

Front 81

Staph Aureus Pneumonia
Most common cause of death during ________ epidemics

Back 81

influenza

Front 82

Staph Aureus PneumoniaX-ray

air bronchogram?

Back 82

no

Front 83

Staph Aureus Pneumonia X-ray

points:

Back 83

Rapid spread through lungs
Empyema, especially in children
No air bronchogram
Pneumothorax, pyopneumothorax
Abscess formation, pneumatocoele
Bronchopleural fistula

Front 84

Staph Aureus Pneumonia Appearance In Children

Rapidly developing lobar/multilobar consolidation
Pleural effusion (__?__%)
Pneumatocoele

Back 84

90

Front 85

How do you rule out a strep cause of pneumonia in children?

Back 85

pleural effusion

Front 86

PNEUMATOCELE

Back 86

What are the rings?

Front 87

drain the empyema
also use antibiotics

Back 87

How do you treat this?

(pt is coughing up gunk.)

Front 88

Staph Aureus PneumoniaAppearance In Adults

Back 88

Patchy bronchopneumonia, segmental distribution
Frequently bilateral
May be associated with atelectasis since airways are filled

Pleural effusion (50%)

Front 89

Is pneumococcal pneumonia assoc with atelectasis?

Back 89

no

Front 90

pneumonia with atelctasis.

--> probably staph (b/c of atelectasis)

Back 90

?