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75 Cards in this Set
- Front
- Back
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Describe what cardiac features form the left and right heart borders on the CXR.
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The right heart border is created by the right atrium. The left heart border is the left ventricle.
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How much higher may the right diaphragm be compared to the left and still be within normal limits?
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The right diaphragm tends to be 1.5-2cm higher than the left.
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How many ribs can be seen on a good quality, full-inspiratory effort CXR?
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10 posterior ribs can be visualized or 6 anterior.
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Describe the normal aortopulmonary measurement.
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The left pulmonary artery should be less than the width of the aortic knob.
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Describe the normal azygotracheal measurement.
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The azygous vein should be no greater than 1/2 the width of the trachea and its height should be no greater than the width of the trachea.
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Describe the hilar height dimension.
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The left hilus should be 2 cm higher than the right. This is because the left pulmonary artery has to go over the left hilus.
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Describe the tracheobronchial wall to lumen measurement.
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The wall of the trachea/bronchus should be <1/8th the measurement of its lumen. The tracheal diameter should also be equal on PA & lateral views & less than the width of the vertebral bodies.
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Describe the arteriobronchial measurement.
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An artery and its accompanying bronchus should be the same size (when seen end-on).
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Describe the right lower lobe artery to bronchus dimension.
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The right lower lobe artery should be no greater than the width of the trachea.
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Describe the cardiohepatic density.
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The heart should be about 1/2 as dense as middle lobe of the liver. This is because it is about 1/2 as thick normally.
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Identify the structures.
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A. Esophagus, B. Trachea, C. hilum, D. heart silhouette, E. lung apices, F. scapulae, G. thoracic vertebrae, H. thoracic intervertebral foramen, I. superimposed posterior ribs, J. costophrenic angles, K. diaphragm
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Identify the structures.
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1: Trachea, 2: Carina, 3: 1st rib, 4: Scapula, 5: Minor (aka Horizontal) Fissure, 6: Right Hemidiaphragm, 7: Left Hemidiaphragm, 8: Ascending Aorta, 9: Clavicle, 10: Superior Vena Cava, 11: Azygos Vein, 12: Right Pulmonary Artery, 13: Left Atrial Appendage, 14: Border of Right Atrium, 15: Inferior Vena Cave, 16: Aortic Arch, 17: Left Pulmonary Artery, 18: Border of Left Ventricle, 19: Descending Aorta
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Name this structure.
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This is the Azygos Vein. In patients lacking an IVC, this vein serves as the primary means of returning blood from the lower extremities to the heart. In this situation the vein will become dilated and may mimic lymphadenopathy on a chest xray.
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Name the structures located in the regions indicated. What is the differential for an abnormal appearance of this region?
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The space indicates the Aortopulmonary Window, formed between the aortic arch and the left pulmonary artery. This area should be concave. Straight may be normal unless prior CXRs showed a concave window. It should never be convex.
Structures found in this region include the recurrent laryngeal nerve, left vagus nerve, ligementum arteriosum, mediastinal fat, lymph nodes, and left bronchial arteries. Paralysis of the left vocal cord or diaphragm should prompt a search for disease in this region. Convexity in this region may be caused by prominent mediastinal fat, lymph-adenopathy, bronchial artery aneurysms, or nerve sheath tumors. Disease of the structures forming the border (such as aortic aneurysms) may also change the window's appearance. Also seen in this image is the aortic-pulmonary stripe where the pleura comes in contact with the vascular structures in this region. Elevation of this stripe can be seen in pneumomediastinum. Lateral convexity may be caused by anterior mediastinal disease as described above. |
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Describe the structure indicated. What would an abnormal appearance of this structure indicate?
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Anterior Junction Line. This is the point at which the pleura from both lungs meet. It is normally separated by a small amount of mediastinal fat, but may appear as a mediastinal stripe with increased amount of fat between the pleura. Normally courses the upper 2/3 of the sternum, never extends above the clavicles.
Obliteration or abnormal convexity of the lines may be caused by anterior mediastinal disease. This includes thyroid masses, lymphadenopathy, neoplasms, thymic masses, or lypomatosis. Volume loss or hyperinflation of the surrounding lung may also change the appearance of the line. |
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Identify the structure. An abnormality of this structure would be concerning for what underlying disease processes?
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Posterior Junction Line. Formed by apposition of the posterior medial aspect of the lungs posterior to the esophagus and anterior to the 3rd-5th vertebrae. This line is located more superiorly to the anterior line and does project above the clavicles. It is either straight or has a slight leftward convexity.
Abnormal bulging or convexity may indicated a Posterior Mediastinal disease process including esophageal masses, lymphadenopathy, aortic disease or neurogenic tumors. Volume loss or hyperinflation of the surrounding lung may also cause the course of the line to deviate. |
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Identify the structure labelled "A." What underlying disease may result in abnormalities of this structure?
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This is the right paratracheal stripe. It is formed by the boundry of the trachea where it comes in contact with the pleura of the right lung. It is the most commonly seen line on a CXR and should measure no more than 4mm. It begins at the level of the clavicles and should extend to the right tracheobronchial angle at the level of the azygos arch.
Many diseases can cause abnormalities in this structure, including paratracheal lymphadenopathy, thyroid/parathyroid masses, and tracheal carcinoma/stenosis. Pleural disease including effusions or thickening are among the most common causes for abnormal thickening of the right paratracheal stripe. |
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The left paratracheal stripe is demonstrated above. What types of underlying disease processes may cause abnormalities of this structure?
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Seen less frequently than the right paratracheal stripe, abnormal thickening of the left paratracheal stripe (>4mm) may be caused by many of the same processes. The most common of these being pleural effusion/thickening. Other causes include neoplasm, paratracheal lymphadenopathy or mediastinal hematoma.
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Identify the structures indicated. Abnormality of these structures may indicate what underlying disease processes?
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The arrows indicate the left and right paraspinal lines. These lines are formed by the interface between the pleura and the posterior mediastinal soft tissues.
The "Mach Band Phenomenon" makes it appear that there is a white line that does not really exist along the paraspinal lines. This is a visual illusion caused by the well-defined interface. These lines may be displaced laterally by osteophytes or increased mediastinal fat. However, abnormal displacement or contour may also be due to a posterior mediastinal abnormality, including a hematoma, mass, extramedullary hematopoiesis or esophageal varices. Displacement of the left paraspinal line may also be caused by tortuosity of the descending aorta. |
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Identify the structure indicated by the arrow. Abnormalities in this structure may indicate what underlying pathology?
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This is the posterior tracheal stripe (aka the tracheoesophageal stripe). It is formed by air within the trachea and the right lung, which outlines the tracheal wall and intervening soft tissues. It typically measures up to 2.5mm in thickness. However, if the tracheal wall directly comes in contact with the anterior wall of the esophagus, it may measure up to 5.5mm.
This line indicates the anterior border of the retrotracheal space (with the posterior border being the spine, the inferior border being the aortic arch, and the superior border the thoracic inlet). Abnormal thickening of this stripe may be due to acquired vascular lesions, esophageal lesions, lymphatic malformations, mediastinitis, and post-traumatic hematomas. |
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Identify the structure indicated. Abnormalities of this structure may indicate what underlying pathology?
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This is the azygoesophageal recess, which is not a true line/stripe but is cause by differences in density between the mediastinum and the posteromedial portion of the right lower lobe.
Abnormal contour and convexity may be due to lymphadenopathy, hiatal hernias, bronchopulmonary-foregut malformations, esophageal neoplasms, pleural abnormalities, and cardiomegaly with left atrial anlargement. |
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Identify the structure indicated. Identify the abnormality. What possible underlying pathology could cause the abnormality pictured?
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This is the posterior wall of the bronchus intermedius. It is typically seen on the lateral CXR as a stripe where the posterior wall of the bronchus intermedius (a branch off the right mainstem bronchus) abuts the right lung within the azygoesophageal recess. It should be vertical or slightly oblique and measure between 0.5 - 3.0 mm in thickness.
Abnormal thickening may be bandlike or lobulated (as in the photo shown). Pulmonary edema due to CHF is the most common cause of this finding. Other causes include primary neoplasm, lymphadenopathy, metastatic disease, TB and sarcoidosis. |
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Identify the structures.
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1: right hemidiaphragm (not obscured by the heart anteriorly), 2: left hemidiaphragm, 3: stomach bubble, 4: retrosternal clear space, 5: Minor Fissure, 6: Major Fissure, 7: trachea
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Identify the structures forming the secondary pulmonary lobule as seen here on CT.
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The straight arrows indicate the interlobular septae that form the boundaries of each secondary pulmonary lobule. The curved arrows indicate the lobular and terminal bronchioles with their accompanying pulmonary artery, located near the center of each lobule.
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Identify the structure indicated by the arrow.
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This is an accessory azygos fissure. It is a normal variant seen in about 1% of the population. It contains the azygos vein (located higher than its usual location in this patient population).
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Identify the structures indicated.
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1: Trachea, 2: Left Mainstem Bronchus, 3: Right Mainstem Bronchus, 4: Left Pulmonary Artery, 5: Right Pulmonary Artery, 6: Right Interlobular Artery, 7: Azygos Vein, 8: Aortic Knob, 9: Sternum, 10: Carina
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Identify the arteries in the diagragm.
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Need to look these up in Netter
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Identify the structure indicated by the arrow.
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This is the aortic nipple. It is the point as which the left superior intercostal vein comes in contact with the aorta. This vein receives blood from the accessory hemiazygous vein and drains into the left brachicephalic vein.
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Identify the structure indicated by the arrow.
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This is the superior pericardial recess.
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Name and define the 3 zones of the airway.
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1: Conductive (trachea, bronchi and non-alveolated bronchioles), 2: Transitory Zone (respiratory bronchioles, alveolar ducts & alveolar sacs), 3: Respiratory Zone (alveoli)
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Label the bronchi.
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A: Right Mainstem Bronchus,
B: Right Upper Lobe Bronchus, B1: Apical Segmental Bronchus, B2: Anterior Segmental Bronchus, B3: Posterior Segmental Bronchus, C: Bronchus Intermedius D: Right Middle Lobe Bronchus, E: Right Lower Lobe Bronchus, E/I-6: Superior Segmental Bronchus E/I-7: Medial Basal Segmental Bronchus E/I-8: Anterior Basal Segmental Bronchus E/I-9: Lateral Basal Segmental Bronchus E/I-10: Posterior Basal Segmental Bronchus **Remember SMALP** F: Left Mainstem Bronchus G: Left Upper Lobe Bronchus G1-2: Apicoposterior Segmental Bronchus G3: Anterior Segmental Bronchus H: Lingular Bronchus H4: Superior Lingular Segmental Bronchus H5: Inferior Lingular Segmental Bronchus I: Left Lower Lobe Bronchus I 6-10 as above |
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Identify the structures indicated.
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1: Coracoid, 2: Right Clavicle, 3: Right Common Carotid artery, 4: Thyroid, 5: Internal Jugular Vein, 6: Left Clavicle, 7: Left Subclavian Vein, 8: Left Humeral Head, 9: Scapular Spine, 10: Spinous Process
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Identify the structures indicated.
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1: Right Humeral Head, 2: Esophagus, 3: Trachea, 4: Left Subclavian Vein, 5: Scapular Spine, 6: Glena
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Identify the structures indicated.
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1: Right Lung, 2: Rib, 3: Esophagus, 4: Trachea, 5: Left Brachiocephalic Vein, 6: Left Common Carotid Artery, 7: Left Axillary Vein, 8: Left Lung, 9: Transverse Processes, 10: Scapula
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Identify the structures indicated.
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1: Trachea, 2: Rib, 3: Brachiocephalic Artery, 4: Left Brachiocehalic Vein, 5: Pectoralis Major Muscle, 6: Pectoralis Minor Muscle, 7: Left Common Carotid artery, 8: Left Subclavian artery, 9: Esophagus, 10: Scapula
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Indentify the structures indicated.
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1: Right Lung, 2: Rib, 3: Trachea, 4: Left Brachiocephalic Vein, 5: Brachiocephalic Artery, 6: Left common carotid artery, 7: Left subclavian artery, 8: Scapula, 9: Esophagus, 10: Spinous Process
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Identify the structures indicated.
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1: Esophagus, 2: Rib, 3: Trachea, 4: Superior Vena Cava, 5: Brachiocephalic artery, 6: Left Common Carotid artery, 7: Aorta, 8: Scapula, 9: Spinal Canal
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Identify the structures indicated.
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1: Right Lung, 2: Trachea, 3: Superior Vena Cava, 4: Aortic Arch, 5: Left Lung, 6: Scapula, 7: Vertebral Body, 8: Rib
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Identify the structures indicated.
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1: Right Lung, 2: Superior Vena Cava, 3: Thoracic Ascending Aorta, 4: Thoracic Descending Aorta, 5: Rib, 6: Left Lung, 7: Esophagus, 8: Trachea
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Identify the structures indicated.
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1: Right Lung, 2: Right Pulmonary Vein, 3: Superior Vena Cava, 4: Thoracic Ascending Aorta, 5: Left Pulmonary Artery, 6: Left Pulmonary Vein, 7: Left Lung, 8: Scapula, 9: Spinal Canal, 10: Rib
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Identify the structures indicated.
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1: Right Pulmonary Artery, 2: Right Lung, 3: Superior Vena Cava, 4: Thoracic Ascending Aorta, 5: Pulmonary Trunk, 6: Left Pulmonary Vein, 7: Left Pulmonary Artery, 8: Scapula, 9: Rib, 10: Left Lung
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Identify the structures indicated.
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1: Right Lung, 2: Right Pulmonary Artery, 3: Superior Vena Cava, 4: Thoracic Ascending Aorta, 5: Pulmonary artery root, 6: Left Pulmonary Vein, 7: Left Pulmonary artery, 8: Rib, 9: Thoracic Descending Aorta
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Identify the structures indicated.
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1: Right Atrium, 2: Aortic root, 3: Pulmonary Outflow Tract, 4: Left Atrium, 5: Thoracic Descending Aorta
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Identify the structures indicated.
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1: Right Atrium, 2: Aortic Root, 3: Right Ventricles, 4: Left Atrium, 5: Thoracic Descending Aorta
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Identify the structures indicated.
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1: Right Lung, 2: Right Atrium, 3: Right Ventricle, 4: Left Ventricle, 5: Left Lung, 5: Thoracic Descending Aorta
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Identify the structures indicated.
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1: Right Lung, 2: Right Ventricle, 3: Left Ventricle, 4: Left Lung, 5: Thoracic Descending Aorta, 6: Rib
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Identify the structures indicated.
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1: Esophagus, 2: Right Lung, 3: Right Ventricle, 4: Left Ventricle, 5: Left Lung, 6: Thoracic Descending Aorta, 7: Spinous Process
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Identify the structures indicated.
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1: Right Lung, 2: Inferior Vena Cava, 3: Right Ventricle, 4: Left Ventricle, 5: Esophagus, 6: Left Lung, 7: Thoracic Descending Aorta, 8: Spinal Canal
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Identify the structures indicated.
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1: Right Lung, 2: Liver, 3: Inferior Vena Cava, 4: Right Ventricle, 5: Left Ventricle, 6: Esophagus, 7: Left Lung, 8: Thoracic Descending Aorta, 9: Vertebral Body
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Identify the structures indicated.
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1: Inferior Lobe of Right Lung, 2: Liver, 3: Inferior Vena Cava, 4: Esophagus, 5: Left lung, 6: Aorta
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Identify the structures indicated.
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1: Inferior Lobe of Right Lung, 2: Liver, 3: Inferior Vena Cava, 4: Inferior Lobe of Left Lung, 5: Aorta
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Identify the structures indicated.
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1: Superior Lobe of Right Lung, 2: Right Middle Lobe of Lung, 3: Inferior Lobe of Right Lung
Black Arrow: Minor Fissure Red Arrow: Major Fissure |
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Identify the structures indicated.
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1: Superior Lobe of the Left Lung, 2: Inferior Lobe of the Left Lung
Red Arrow: Major Fissure |
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Identify the structures indicated.
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1: Trachea, 2: Left Main Bronchus, 3: Right Main Bronchus, 4: Apical Subsegmental Bronchus Upper Lobe, 5: Right Lower Lobe Bronchus
Red Arrows: Major Fissure |
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Identify the structures indicated.
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1: Trachea, 2: Superior Lobe of the Right Lung, 3: Right Middle Lobe, 4: Inferior Lobe of the Right Lung, 5: Superior Lobe of the Right Lung, 6: Inferior Lobe of the Left Lung
Black Arrow: Minor Fissure Red Arrow: Major Fissure |
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Identify the structures indicated.
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1: Apical Segment Bronchus Upper Lobe, 2: Division of Trachea, 3: Superior Lobe of the Left Lung, 4: Inferior Lobe of the Left Lung
Red Arrow: Major Fissure |
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Identify the structures indicated.
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1: Posterior Segmental Bronchus Upper Lobe, 2: Anterior Segmental Bronchus Upper Lobe, 3: Right Main Bronchus, 4: Left Main Bronchus, 5: Superior Lobe of the Left Lung, 6: Inferior Lobe of the Left Lung
Red Arrow: Major Fissure |
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Identify the structures indicated.
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1: Bronchus Intermedius, 2: Anterior Junction Line, 3: Left Main Bronchus, 4: Left Upper Lobe, 5: Left Lower Lobe
Red Arrow: Major Fissure |
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Identify the structures indicated.
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1: Right Lower Lobe Bronchus, 2: Right Lower Lobe, 3: Right Middle Lobe Bronchus, 4: Right Middle Lobe, 5: Right Upper Lobe, 6: Left Upper Lobe, 7: Left Lower Lobe
White Arrow: Minor Fissure Red Arrow: Major Fissure |
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Identify the structures indicated.
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1: Brachiocephalic Vein
2: Superior Vena Cava 3: Right Pulmonary Artery 4: Right Pulmonary Vein 5: Right Auricle 6: Aortic Arch 7: Left Pulmonary Artery 8: Left Pulmonary Vein 9: Left Auricle 10: Pulmonary Trunk |
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Identify the structures indicated.
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Long Arrow: Minor Fissure
Short Arrow: Inferior Accessory Fissure. This is a normal variant which, when present, separates the medial basal segment from the other basal segments in the lower lobe. |
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Identify the fissures in this Thoracic CT.
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Visible and the right major & minor fissures. This patient also has a superior accessory fissure, which is horizontally located just below the minor fissure. When present it separates the superior segment from the basal segments in either lower lobe.
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Identify the structures indicated.
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1: Superior Vena Cava,
2: Right Pulmonary Artery 3: Right Pulmonary Veins 4: Pulmonary Trunk 5: Pulmonary Valva 6: Right Atrium 7: Tricuspid Valve 8: Right Ventricle 9: Inferior Vena Cava 10: Left Common Carotid Artery 11: Innominate (Brachiocephalic) Artery 12: Left Subclavian Artery 13: Aorta 14: Left Pulmonary Artery 15: Left Pulmonary Veins 16: Left Atrium 17: Mitral Valve 18: Aortic Valve 19: Left Ventricle |
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Identify the 4 heart valves shown in this axial view above from top to bottom, left to right.
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Pulmononary Valve, Aortic Valve
Mitral Valve, Tricuspid Valve |
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Identify the structures indicated.
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A: Anastomosis
B: Left Main Coronary Artery C: Right Main Coronary Artery D: Left Circumflex Artery E: Posterior Interventricular Artery F: Anterior Interventricular Artery (AKA Left Anterior Descending Artery) |
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Identify the structures indicated.
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1: Superficial Temporal artery
2: Facial artery 3: Right Brachiocephalic Vein 4: Right Subclavian Artery 5: Right Axillary Vein 6: Cephalic Vein 7: Superior Vena Cava 8: Basilic Vein 9: Brachial Vein 10: Left Axillary Artery 11: Left Subclavian Artery 12: Left Brachiocephalic Vein |
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Identify the structure indicated by the arrows.
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Normal Thymus. This structure is typically only seen in children and resides in the anterior mediastinum between the sternum and the ascending aorta.
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What is the smallest amount of pleural fluid that can be detected on a lateral decubitus chest xray?
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5 cc
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What is the smallest amount of pleural air (pneumothorax) that can be seen on a lateral decubitus chest xray?
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15 cc
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What is the name of a trachea with a <0.6 coronal/sagittal diameter ratio, seen in patients with COPD?
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Saber Sheath Trachea
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Name the segments of the left upper lobe.
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1. Anterior
2. Apicoposterior 3. Superior Lingular Segment 4. Inferior Lingular Segment |
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Name the segments of the left lower lobe.
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1. Superior Segment
2. Anteromedial Segment 3. Lateral Segment 4. Posterior Segment |
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Name the segments of the right upper lobe.
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1. Anterior
2. Apical 3. Posterior |
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Name the segments of the right middle lobe.
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1. Lateral
2. Medial |
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Name the segments of the right lower lobe.
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1. Superior
2. Lateral Basal 3. Anterior Basal 4. Posterior Basal 5. Medial Basal |
