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Flashcards in Diagnostic Testing and Imaging Deck (67)
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1

BRONCHOSCOPY gives direct visualization of what? 3

Can be used to sample and treat lesions or abnormalities such as ?
3

Direct visualization of the
1. trachea,
2. bronchi, and
3. segmental airways out to the third generation of branching

1. foreign bodies,
2. bleeding, tumors, or
3. inflammation in those airways.

2

What things may it cause (3) and who is it contraindicated in (2)?

May cause
1. tachycardia,
2. bronchospasm, or
3. hypoxemia.

Contra-indicated in patients with cardiac problems or severe hypoxemia

3

Diagnostic Indications for Bronchoscopy
11

1. Cough
2. Hemoptysis
3. Wheeze
4. Atelectasis/Accumulated secretions
5. Unresolved Pneumonia
6. Positive cytology
7. Biopsy of suspicious tissue
8. Abnormal CXR
9. Bronchial obstruction
10. Diffuse lung disease
11. Pre/post intubation

4

Therapeutic Considerations for bronchoscopy?
6

1. Foreign bodies
2. Accumulated Secretions
3. Atelectasis
4. Aspiration
5. Lung abscess
6. Control of bleeding

5

DIRECT LARYNGOSCOPY AND RIGID BRONCHOSCOPY: advantages over flexible bronchoscopy? 2

1. Better control of the airway
2. Easier to deal with large lesions, foreign bodies

6

Disadvantages of rigid bronchoscopy
2

1. Requires general anesthesia
2. Higher rate of tissue damage/complications

7

Absolute contraindications for rigid bronchoscopy? 5

1. Absolute – inability to adequately oxygenate the patient during procedure
2. Coagulopathy or bleeding diathesis that cannot be corrected.

1. Aneurysm, marked kyphosis.
2. Recent MI or unstable angina.
3. Respiratory failure requiring mechanical ventilation.

8

Complications of rigid bronchoscopy?
4

1. Injury to the teeth
2. Hemorrhage from the biopsy site
3. Hypoxia and cardiac arrest
4. Laryngeal edema

9

What is a major benefits of flexible bronchospy?

Mainly used for what kind of purposes?

1. Does not require general anesthesia
2. Limited intervention (e.g. suctioning)
3. Can be used for intubation

Limited airway control

Mainly for diagnostic purposes

Can do biopsy, minor cautery
Very few complications in healthy patients

10

What is beneficial about flexible fiber optic bronscospy?
5

What do we want to do along with this?

1. Provides magnification and better illumination.
2. Smaller size –permits examination of subsegmental bronchi
3. Easy to use in patients with neck or jaw abnormalities
4. Can be performed under topical anesthesia & useful for bedside examination of critically ill patients
5. Can be easily passed through endotracheal tube or in tracheostomy opening.

Suctioning of biopsy channel helps to remove secretions, inspissated mucus plug and small foreign bodies.

11

Who do we not use flexible fieber optic bronscospy with and why?

Limited utility in children –problem of adequate ventilations

12

What is a VIRTUAL BRONCHOSCOPY?

Benefits? 3

Downsides? 1

Computer generated pictures of the endobronchial tree, which are constructed from computed tomography (CT) images of the thorax

1. Non-invasive,
2. fine detail, and also
3. provides information about structures outside of the airways

Cannot use for biopsy or treatment

13

Limitations of a chest x-ray
4

1. 2 dimensional image of a 3 dimensional structure
2. X-ray findings may lag behind other clinical features
3. Normal x-ray does not rule out pathology
4. Dependent on good quality image

14

The images seen on a chest radiograph result from what?

the differences in densities of the materials in the body.

15

The hierarchy of relative densities from least dense (dark on the radiograph) to most dense (light on the radiograph) include:
5

1. Gas (air in the lungs)
2. Fat (fat layer in soft tissue)
3. Water (same density as heart and blood vessels)
4. Bone (the most dense of the tissues)
5. Metal (foreign bodies)

16

Three Main Factors Determine the Technical Quality of the Radiograph


Inspiration

Penetration

Rotation

17

The chest radiograph should be obtained with the patient in ______ ________ to help assess intrapulmonary abnormalities.

full inspiration

18

At full inspiration, the diaphragm should be observed at about the level of the_______ posteriorly, or the _______ anteriorly.

8th to 10th rib

5th to 6th rib

19

On a properly exposed chest radiograph:

The lower thoracic vertebrae should be visible through the _____?

The bronchovascular structures behind the heart should be seen. What are these?
3

heart

1. trachea,
2. aortic arch,
3. pulmonary arteries,

20

What is the issue in an underexposed chest X-ray?
2

What pathology might it look like?

the cardiac shadow is opaque, with little or no visibility of the thoracic vertebrae.

The lungs may appear much denser and whiter, much as they might appear with infiltrates present.

21

What is the issue in an overexposed chest X-ray?

What pathology might it look like?

With greater exposure of the chest radiograph,
1. the heart becomes more radiolucent and
2. the lungs become proportionately darker.

In an overexposed chest radiograph, the air-filled lung periphery becomes extremely radiolucent, and often gives the appearance of lacking lung tissue, as would be seen in a condition such as emphysema.

22

Patient rotation can be assessed by observing what?

the clavicular heads and determining whether they are equal distance from the spinous processes of the thoracic vertebral bodies.

23

Four major positions are utilized for producing a chest radiograph. What are they?


Posterior-anterior (PA)

Lateral

Anterior-posterior (AP)

Lateral Decubitus

24

The standard position for obtaining a routine adult chest radiograph is what?

How are they positioned? 2

The pt is breathing how for the pic to be taken?

How should it be viewed?

PA

Patient
1. stands upright with the anterior chest placed against the front of the film
2. The shoulders are rotated forward enough to touch the film, ensuring that the scapulae do not obscure a portion of the lung fields

Usually taken with the patient in full inspiration

The PA film is viewed as if the patient is standing in front of you with his/her right side on your left

25

What does the lateral view allow to be seen?

How are they positioned?

Usually ordered with what?


Allows the viewer to see behind the heart and diaphragmatic dome

Patient stands upright with the left side of the chest against the film and the arms raised over the head

usullay ordered with a PA

26

When is AP used?

How are they positioned?

What do you have to remember about the film?


Whats usually seen in the lung field?

Used when the patient is debilitated, immobilized, or unable to cooperate with the PA procedure

The film is placed behind the patient’s back with the patient in a supine position

Because the heart is a greater distance from the film, it will appear more magnified than in a PA

The scapulae are usually visible in the lung fields because they are not rotated out of the view as they are in a PA

27

When is the LD used?



How are they positioned?

How is the xray labeled?

Often useful in revealing a pleural effusion that cannot be easily observed in an upright view, since the effusion will collect in the dependent position

The patient lies on either the right or left side rather than in the standing position as with a regular lateral radiograph

The radiograph is labeled according to the side that is placed down (a left lateral decubitus radiograph would have the
patient’s left side down against the film)

28

Anatomical Structures in the Chest
7

1. Mediastinum
2. Hilum
3. Lung Fields
4. Diaphragmatic Domes
5. Pleural Surfaces
6. Bones
7. Soft Tissue

29

What should be centrally loctaed in the mediastinum?

What is the first convexity on the left side of the mediatstim?

What is the next convexity on the left?

What lies above the right heart border?

The trachea should be centrally located or slightly to the right

The aortic arch is the first convexity on the left side of the mediastinum

The pulmonary artery is the next convexity on the left, and the branches should be traceable as it fans out through the lungs

The lateral margin of the superior vena cava lies above the right heart border

30

How much of the heart lies on the right and left side?

The heart should take up how much of the thoracic cavity?

What creates the left heart border?

What creates the right heart border?

Two-thirds of the heart should lie on the left side of the chest, with one-third on the right

The heart should take up less that half of the thoracic cavity (C/T ratio less than 50%)

The left atrium and the left ventricle create the left heart border

The right heart border is created entirely by the right atrium (the right ventricle lies anteriorly and, therefore, does not have a border on the PA)