Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/90

Click to flip

90 Cards in this Set

  • Front
  • Back
preferred lateral image (left or right)?
left lateral
PA or AP ?
lung fields clearer, heart sharper borders
PA
If you can read the marker, is the film AP or PA?
AP
If you cannot see thru the heart, the film is probably ____
underpenetrated
To determine if you have no rotation in a CXR, look at the medial aspects of what bones?
clavicles
How might the left main stem bronchus get more horizontal?
Left atrial enlargement
First thing katz looks at on CXR
gastric bubble


(lung fields last)
which hemidiaphram is always seen on PA CXR
right hemidiaphragm
which hemidiaphram is always seen on lateral CXR
right hemidiaphragm


(right usually higher than left, but not always)
why is minor fissure more prominent on AP?
parallel with rays
CXR: look at Soft tissues: don’t miss a _____
mastectomy
on lateral CXR, describe lucency of spine.
spine becomes more lucent toward inferior
SILHOUETTE SIGN definition
The elimination of the silhouette or loss of lung/soft tissue interface caused by a mass or fluid in the normally air filled lung.
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.
obscure
material that is most radiopaque to most lucent
C W F A


calcium
water
fat
air
When two objects of the same density touch each other, the edge between them
a)disappears
b)appears
a) disappears
For the heart, the silhouette sign can be caused classically by an opacity in the RML or ____ division of the LUL.
lingula
_____ lobe silhouettes right heart border
Right middle
_____ silhouettes left heart border
Lingula
________ lobe silhouettes right hemidiaphragm
Right lower
_______ lobe silhouettes left hemidiaphragm
Left lower
An air bronchogram is a tubular outline of an airway made visible by filling of the surrounding alveoli by _____
fluid or inflammatory exudates
The visibility of air in the bronchi because of surrounding airspace disease is called an _____
“air bronchogram”
An air bronchogram is almost always a sign of _____
airspace disease
Causes of air bronchograms are (4)
lung consolidation,
pulmonary edema,
nonobstructive pulmonary atelectasis
and normal expiration
density other than air surrounds them
(in this case it is inflammatory exudate from a pneumonia)
The black branching structures are the result of air in the bronchi, now visible because _________
A = intraparenchymal
B = pleural
C = extrapleural
A? B? C?
In most cases the nodules are due to _________
metastases from a primary malignancy in an organ other than the lung.
Diseases with Multiple Nodules (4)
Metastasis
Multiple AVMs
Rheumatoid nodules
Wegener’s Granulomatosis
Disease with Multiple Cystic Structures (3)
Cystic Fibrosis

Bronchiectasis

Tuberculoisis
Parenchymal Lung Disease
2 categories (radiologic categories)
Alveolar

Interstitial
Hallmark of Alveolar lung disease
air bronchograms
Alveolar lung disease characteristics
Has air bronchograms
Fluffy and indistinct
Confluent and homogeneous
May have segmental or lobar distribution
Common Alveolar Lung Diseases (4)
Pneumonia
Pulmonary edema
Pulmonary Hemorrhage
Aspiration
alveolar (airspace)

Pulmonary Edema (non cardiogenic)
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
Aspiration
________ Pneumonia
Interstitial lung disease characteristics
Discrete
Inhomogeneous
No air bronchograms
Made up of lines (reticular) or dots (nodular) or both (reticulonodular)
Common Interstitial Lung Diseases (5)
1)Carcinoma , primary or 2)secondary
3)Sarcoidosis
4)Cystic fibrosis
5)Asbestosis
Cystic Fibrosis - interstitial
What type of lung disease (alveolar or interstitial)
Alveolar disease – fluffy, indistinct, homogeneous, contains air bronchograms
interstitial or alveolar?
Interstitial disease – discrete, inhomogeneous, no air bronchograms
alveolar or interstitial?
Infiltrate:
opacity that is poorly defined. This is airspace disease such as pneumonia

left upper lobe
Mass or infiltrate?
the opacity would best be described as a mass because it is well-defined.

left upper lobe
mass or infiltrate?
Diseaes with Opacified Hemithorax (3)
Pneumonia
Atlectasis
Pleural effusion
Diseaes with Opacified "whatever" in the lungs (3)
Pneumonia
Atlectasis
Pleural effusion
With Opacified Hemithorax and Air bronchograms, what is the key to diagnosing pneumonia?
No shift of mediastinum
Pneumonia of LUL – no shift of the mediastinal structures to either side; multiple air bronchograms
?
Right middle and lower lobes
Where is the pneumonia?
RUL


atelectasis
Where is the pneumonia?
What else is going on?
LUL, LLL pneumonia

BUT, there is shift of mediastinum, so something else is going on.
?
LUL, LLL
Where is Pneumonia?
Atelectasis refers to collapse of a lung or portion of the lung with resorbtion of air from the ______
alveoli
What causes atelectasis?
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
atlectasis:
Almost always associated with a linear increased density on _______
chest x-ray
Atelectasis:
The apex of density tends to be at the _____.
hilum
Atelectasis:
The density is associated with volume _______
loss
Indirect signs of atlectasis:
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
Segmental and subsegmental collapse may show linear, curvilinear, wedge shaped opacities. This is most often associated with post-op patients and those with massive _____
hepatosplenomegaly or ascites
Major fissure
What structure is the arrow pointing to?
right side atelectasis
?
mediastinum shift toward opacity
= atelectasis

vent tube was pushed into right main bronchus and blocked the left bronchus causing atelectasis
What this?
Pneumo, atelectasis, or PE?
There is an increase in volume with a shift of adjacent structures away from the lesion
PLEURAL EFFUSION
PE
?
Air bronchograms in Atelectasis or Pneumonia?
Both Atelectasis and Pneumonia
6th most common cause of death in USA
PNEUMONIA
Highest mortality rate of pneumonia causes
Pseudomonas 75%
In the absence of clinical information the radiologist cannot D/D between pneumonia and other clinical processes.
i.e. _________
ARDS & pulmonary edema
can you diagnose pneumonia with clinical symptoms?
no. You need CXR
Types of Pneumonia:
Lobar or airspace or alveolar pneumonia

What are the causes? (2)
Pneumococcal
Klebsiella
Types of Pneumonia:
Bronchopneumonia

What are the causes?
Staph aureus
Most gram negative bacteria
Some fungi
SARS:Serious Acute Respiratory Syndrome
Begins with _____ of high fever >100.4° with chills and myalgia
prodrome
CXR during SARS febrile prodrome?
normal
Which phase of SARS?
Early focal interstitial infiltrates
Progresses to more generalized, patchy, interstitial infiltrates
Respiratory
Gram Positive Pneumonias (4)
Pneumococcal pneumonia
Staphylococcal pneumonia
Streptococcal pneumonia
Nocardiosis
Most common gram positive pneumonia
Pneumococcal Pneumonia
Pneumococcal Pneumonia:
Inflammatory edema in alveoli spread via pores of ____ to more lateral alveoli
Kohn
Predisposing Conditions for pneumococcal pneumonia
Usually found in compromised hosts

Elderly
Pneumococcal Pneumonia X-ray Findings
Predilection for lower lobes
Extensive infiltrate abutting pleural surface
Prominent air bronchograms
DDX: Staph has no air bronchogram
Does not respect segmental boundaries
air bronchograms in pneumonia
?
Staph Aureus Pneumonia
Overwhelming majority are _______-acquired
hospital
Staph Aureus Pneumonia
Most common cause of death during ________ epidemics
influenza
Staph Aureus Pneumonia X-ray

air bronchogram?
no
Staph Aureus Pneumonia X-ray

points:
Rapid spread through lungs
Empyema, especially in children
No air bronchogram
Pneumothorax, pyopneumothorax
Abscess formation, pneumatocoele
Bronchopleural fistula
Staph Aureus Pneumonia Appearance In Children

Rapidly developing lobar/multilobar consolidation
Pleural effusion (__?__%)
Pneumatocoele
90
How do you rule out a strep cause of pneumonia in children?
pleural effusion
PNEUMATOCELE
What are the rings?
drain the empyema
also use antibiotics
How do you treat this?

(pt is coughing up gunk.)
Staph Aureus Pneumonia Appearance In Adults
Patchy bronchopneumonia, segmental distribution
Frequently bilateral
May be associated with atelectasis since airways are filled

Pleural effusion (50%)
Is pneumococcal pneumonia assoc with atelectasis?
no
pneumonia with atelctasis.

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