Imaging of the Soft Tissues Week 5

Why do you have to take pneumothorax x-rays in an erect position?

If taken supine, the air will overlap with the anterior lung fields

What projection is used to see the retrocardiac and retrosternal clear spaces?

Latteral projections

What density are the retrocardiac and retrosternal clear spaces?

Air density

What does opacification of the retrosternal clear space indicate?

Anterior mediastinal mass

What are the 5 anterior mediastinal masses?

Thymoma

Terrible lymphoma

Thoracic aortic aneurysm

Teratoma (germ cell tumors)

Thyroid (goiter) (substernal lesions)

What is the most common posterior mediastinal mass?

Neurogenic tumors

What type of pressure is found in the pleural space, maintaining the volume of the lungs?

Negative pressure

T or F: The left and right pleural spaces are directly connected

False (no communication)

What is formed by the visceral pleura separating lobes?

Pleural fissures (not commonly seen on x-ray)

What are the pleural lesions?

Plaques, masses, fibrosis, inflammation

What are the extra pleural lesions?

Ribs

intercostal nerve

chest wall lesions

What is the term for deflection of the pleura?

Extra-pleural / cat under the rug sign

What is the term for air/gas in pleural space?

Pneumothorax

What ar the 3 subtypes of pneumothorax?

Primary spontaneous

Secondary spontaneous

iatrogenic/traumatic

What is the main radiographic finding of pneumothorax?

Visible visceral pleural edge - thin sharp white line

No lung markings peripheral to pleural line

What is the only type of pneumothorax to cause mediastinal shift?

Tension pneumothorax

What is the term for spontaneous pneumothorax with no known lung disease?

Primary spontaneous pneumothorax

What is the finding of Primary spontaneous pneumothorax when prone?

Tall thin habitus

What disease are associated with primary spontaneous pneumothorax?

Marfan syndrome (connective tissue disorder)

Ehlers danlos syndrome (connective tissue disorder)

What is the term for spontaneous pneumothorax with underlying lung pathology

Secondary spontaneous pneumothorax

What are the 3 main predisposing conditions for Secondary spontaneous pneumothorax?

bullae/blebs

emphysema/asthma

Pulmonary neoplasm

What is the difference between a bulla and a bleb?

Size (bulla is larger)

What are the causes of Iatrogenic spontaneous pneumothorax?

Percutaneous biopsy

Barotrauma (divers), ventilator

What are the causes of traumatic spontaneous pneumothorax?

Pulmonary laceration

Tracheobronchial rupture

Esophageal rupture

What is the term for intrapleural air progressive accumulation

Tension pneumothorax

What are the complications of Tension pneumothorax?

Compression of mediastinum and cardiorespiratory arrest

What is the term for Accumulation of fluid in pleural space?

Pleural effusion

What is the name sign of pleural effusion?

Meniscus sign

How much fluid is needed to visualize pleural effusion?

250-600 mL

What are the three types of pleural effusion?

Hydrothorax (transudate/exudate)

Hemothorax (blood)

Chylothorax (lymph)

What are the 5 tumors of the lung?

Fibroma (B)

Lipoma (B)

Mesothelioma (M)

Metastasis (M)

Lymphoma (M)

What is the most common plaque of the lung?

Asbestosis calcification

What is the AKA of cat under the rug sign?

extrapleural sign

What is the appearance of cat under the rug sign?

Opacity along chest wall with obliquely tapered margins

What can cause cat under the rug sign?

Pleural lesions (benign and malignant)

Ribs: fracture, neoplasm

Nerves (intercostal): schwannoma, neurofibroma

What are the most common benign tumors of the ribs?

Fibrous dysplasia

Aneurysmal bone cysts

What are the most common malignant tumors of the ribs?

Ewing's

osteosarcoma

Metastasis

What is the most common intercostal nerve tumor disease?

Neurofibromatosis 1 (von recklinghausen disease)

What type of disease is Neurofibromatosis 1 (von recklinghausen disease)?

phakomatosis /neurocutaneous disorder

What type of tumor is created in NF-1?

Intercostal nerve neurofibromas

What is the name sign of Intercostal nerve neurofibromas?

Ribbon rib deformity / rib notching