Week 4- Thorax imaging

Question 1

What key areas should you review on CXR?

Answer 1

• Lung apicies
• Heart
• Diaphragm
• Bones & soft tissue
• Lines/wires

Question 2

Name some main visible structures on a CXR

Answer 2

• Trachea
• Hila
• Lungs
• Diaphragm
• Heart
• Aortic knuckle
• Ribs
• Scapulae
• Breasts
• Bowel gas

Question 3

Name some importnant obscured structures on CXR

Answer 3

• Sternum
• Oesophagus
• Spine
• Pleura
• Fissures
• Aorta

Question 4

What shape should the aortopulmonary window be?

What should you consider if it is not that shape?

Answer 4

Normally: concave

If straightened or convex consdier Mediastinal lymphadenopathy

Question 5

Name some structures in the AP window

Answer 5

• Left phrenic nerve
• Left recurrent laryngeal nerve
• Left vagus nerve
• Left bronchial arteries
• Ligamentum arteriosum
• Fat
• Lymph nodes

Question 6

Consolidaiton VS Collapse

Answer 6

Consolidation: Alveolar airspaces filled with fluid/ tissue/other matrial

Lobar collapse: Signs of volume loss & absences of air bronchograms

You may see the fissues and hilar having moved up or down

Question 7

Which lung hilum is normally higher

Answer 7

left lung hilum

Question 8

What is (loss of) silhouette sign indicate? (very broad)

Answer 8

Pathology

Question 9

What imaging features should you look for on CONSOLIDATION?

Answer 9

A2BC3

• Acinar rosettes- fluffy appearance of parenchyma distal to terminal bronciole
• Air bronchograms (tubular outline of airways made visible due to alveolar filling of fluid/ inflammatory exudates)
• Bat wing distibution
• Confluent ill-defined appearance
• Consolidation
• Change occurs rapidly

Question 10

PA CXR

What is this showing? Collapse or consolidation?

Answer 10

Consolidation. Hilar are equal levels. Ill defined appearance

Question 11

What is this showing?

AP errect

Answer 11

LUL collapse- collapses anteirorly becoming a thin sheet of tissue –> “Veil sign”

Loss of silhouette sign of aortic knuckle

General opacity on the left

Question 12

What is this AP CXR showing?

Answer 12

Left Lower Lobe collapse –> Sail sign

Loss of silouette sign of left demidiaphragm and descending aorta

Inferior displacement of left hilum

Inferior displacement of oblique fissue

Question 13

What is the PA CXR showing?

Answer 13

Right middle lobe collapse. Child has inhaled foreign body

Loss of horizontal fissure

Loss of silhouette sign of right hear boarder

Question 14

What is this PA CXR showing?

What should you be suspicious of?

Answer 14

Right upper lobe collapse –> Golden S sign

Consider: carcionma. The mass can block the bronchus to right upper lobe causing it to collapse and the lung rotates backwards

Question 15

What should you never XRAY if you have suspicions of?

What is the treatment for this?

Answer 15

Tension pneumothorax

Tx: 14G cannular –> 2nd ICS MCL

Question 16

For an ETT placement what are the rules of placement

Answer 16

• Assess mandible position: flexed, extended or neutraul (over C5/6)
• Desired position when neck is neutral: 5+/-2cm above carina

Flexed neck- 3cm (+/- 2 cm)

Extended neck- 7cm (+/- 2cm)

If incorrectly places can cause right lung hyperinflation and left lung collapse

Question 17

What are the rules of NG tube placement?

Answer 17

• Descends thorax in midline
• Bisects carina
• Crosses diaphragm in midline
• Tip sits below diaphragm

Question 18

What is this HRCT showing?

What is it indicative of?

Answer 18

HONEYCOMBING indicative of pulmonary fibrosis

Question 19

What is the CXR showing?

Answer 19

Reticular shadowing- looks course, nodular type pattern unlike consolidation/ pulmonary oedema

“Reticular nodular” is typical of a fibrotic lung condition

Then do high resolution CT scan

Question 20

What is this CTPA showing?

Answer 20

Pulmonary embolism. Areas of radiolucency are the PE

Question 21

What blood test should you never do in pregnant women who you suspect have a pulmonary embolism

Answer 21

D-Dimer. Already in a hyper-coaguable state

Question 22

What is this CXR showing?

Answer 22

Radio opacity and miniscus present thus PLEURAL EFFUSION