[05.43] Radiology in Chest Diseases V2.2.pdf

Diagnosis of pulmonary disease

What is one essential reason for using imaging in pulmonary health?

Monitoring disease progression and treatment response

What is one essential reason for using imaging related to disease management?

Guiding interventions (e.g., thoracocentesis and biopsies)

What is one essential reason for using imaging related to procedures?

Cough, Chest Pain, Difficulty breathing, Fever

Name two usual reasons for requesting an imaging study.

Pre-operative clearance

What specific indication requires a Chest X-ray for very young or very old patients before an operation?

Chest X-ray (CXR)

What is the first-line imaging tool for pulmonary complaints?

Initial evaluation of chest pain or dyspnea

What is one role of CXR in initial assessment?

Pneumonia, Pleural effusion, Pneumothorax, Tuberculosis (TB)

Name two common chest diseases screened by CXR.

Ultrasound

What imaging tool is used for the assessment of suspected pleural effusion, chest wall lesions, masses, or trauma?

Pulmonary congestions

What specific condition, besides pleural effusion and pneumothorax, can be assessed by ultrasound?

Computed Tomography (CT) Scan

What imaging tool is used for more detailed evaluation of abnormalities?

Characterization of lung masses or nodules

What is one specific use of CT scan regarding lesions?

Staging of lung cancer

What is one specific use of CT scan in oncology?

Evaluation of interstitial lung disease

What specific use of CT scan involves chronic lung conditions?

CT angiography

What specific CT procedure assesses pulmonary embolism?

Magnetic Resonance Imaging (MRI)

What imaging tool is rarely used for chest imaging, mostly reserved for mediastinal or vascular pathology?

Positron Emission Tomography (PET) Scan

What imaging tool is used in cancer staging and evaluation of metabolic activity (functional)?

PET/CT

What combination imaging tool is used for staging malignancies?

V/Q scan

What specific nuclear medicine application is used for diagnosing pulmonary embolism?

CT is more expensive and exposes patients to unnecessary radiation

Why is CT not chosen as the initial test for imaging of the lungs?

Girls and children

What two patient groups are specifically mentioned as being exposed to unnecessary radiation from CT?

Bright structures

How do fluids appear in an X-ray?

Blood (fills up the heart), Pleural effusion, Metal, Bone, Soft tissues

Name two structures that appear bright in an X-ray.

Dark/lucent structures

How does air appear in an X-ray?

Pleural effusion

What abnormality is characterized by the presence of fluid outside the lung parenchyma?

Visceral (inner layer stuck to the lung parenchyma), Parietal (outer layer stuck to bones)

Name the two layers of pleura surrounding the lungs.

Mediastinum

What structure separates the right and left lungs along with the heart?

Similar but not symmetrical

How are the right and left lungs described regarding appearance?

Asymmetry

What is the initial indicator for identifying and recognizing abnormalities in the lungs?

Three (3) lobes

How many lobes does the right lung have?

Two (2) fissures

How many fissures separate the lobes of the right lung?

Ten (10) segments

How many segments does the right lung have?

Two (2) lobes

How many lobes does the left lung have?

One (1) fissure

How many fissures separate the lobes of the left lung?

Eight (8) segments

How many segments does the left lung have?

Right Upper Lobe (RUL), Right Middle Lobe (RML), Right Lower Lobe (RLL)

Name the three lobes of the right lung.

Left Upper Lobe (LUL), Left Lower Lobe (LLL)

Name the two lobes of the left lung.

Major/Oblique and Minor/Horizontal

Name the two fissures of the right lung.

Major/Oblique

Name the fissure of the left lung.

Upper, middle, and lower zones or fields

How are the lungs assessed and described when X-rays are read?

Zones are NOT THE SAME as lobes

What is the critical distinction between lung zones and lobes?

Gives attention to other sides of the lungs

What is one benefit of using 'zones' instead of 'lobes' in a 2D X-ray?

Surgical clamping

What surgical scenario requires the differentiation between zones and lobes?

Lower zones

What specific zones are involved in COVID-19 pathology?

Upper zones

What specific zones are involved in Tuberculosis pathology?

Superior segment of the lower lung

What part of the lung extends all the way to the middle lung zone (e.g., RLL)?

Covers all three zones (upper, middle, and lower)

How many zones does the Left Upper Lobe (LUL) cover?

Posteroanterior (PA), Anteroposterior (AP), Lateral (LAT), Oblique

Name two general identified types of CXR views.

PA and LAT view

What are the mainstays of thoracic imaging?

Gives a 3D view of the structure you want to see

What is the benefit of pairing PA and LAT views?

PA View

What is the most commonly requested CXR view?

PA View

What is the ideal view to screen for lung pathologies?

Standing upright and Scapulae are winged out

What is the ideal patient position for a PA view?

Less magnification of the heart

What is the advantage of the PA view regarding the heart?

LAT View

What view is used for the identification of a specific location of a lesion?

View of choice if the lesion is behind a cardiac shadow

What is a specific indication for the LAT view?

Retrosternal Space (Posterior to the sternum) and Retrocardiac Space (Posterior to the heart)

Name two anatomical spaces that the LAT view helps visualize.

AP View

What CXR view is obtained when patients cannot be safely mobilized (e.g., lying down)?

Portable X-Ray

What type of equipment is typically used for the AP view in cases where the patient cannot be moved?

Longer exposure, greater motion artifacts, View is often rotated, Magnification of intrathoracic structures

Name two disadvantages of the AP view.

Magnification of intrathoracic structures

What disadvantage of the AP view is caused by the source of X-Ray being too close to the film?

Right side of patient is left of image and vice versa

What is the convention for imaging interpretation regarding patient sides?

Asymmetry

What characteristic should be checked first in the overall image during interpretation?

Normally, both lungs should be symmetric in densities

What is the baseline expectation when comparing the left and right lungs?

Increased densities

What pattern appears white and more opaque in an X-ray?

Opacities

What is the term for increased densities?

Decreased densities

What pattern appears abnormally black in an X-ray?

Lucencies

What is the term for decreased densities?

Increased densities

Which pattern is most common in clinics, due to lungs already being dark?

Consolidation, Interstitial, Nodular, Atelectasis

Name the four patterns of increased lung densities.

Consolidation

What pattern refers to any air space disease?

Pathologic process that fills the alveolar sac

What specific process defines consolidation?

Dark/black

What is the normal appearance of the alveolar sac in an X-ray?

Water (transudate from heart failure/renal failure), Pus (exudate from pneumonia), Blood (hemorrhage/trauma), Cells (eosinophilic pneumonia/sarcoid)

Name two substances that can fill the alveolar sac, causing consolidation.

Increased density

What is the primary X-ray finding for consolidation in terms of brightness?

Ill-defined borders

What is a key X-ray finding for consolidation, distinguishing it from atelectasis?

Air bronchograms

What is the pathognomonic sign for consolidation?

Branching radiolucent columns of air

How do air bronchograms appear on an X-ray?

Lobar Consolidation, Diffuse Consolidation, Multifocal Consolidation

Name the three forms of consolidation.

One entire lobe

What area is affected by Lobar Consolidation?

Lobar pneumonia

What is the most common example of Lobar Consolidation?

Lung contusion

What example of Lobar Consolidation involves the alveolar sac being filled with blood?

Diffuse opacities in a CXR; affects both lungs/multiple lobes

What is the manifestation of Diffuse Consolidation?

Pulmonary edema, Bronchopneumonia, Hemorrhage (from SLE/HSP)

Name two examples of Diffuse Consolidation.

Multiple number of consolidations (borders are not sharp or appear fragmented)

What characteristic defines Multifocal Consolidation?

Staphylococcus aureus, tuberculosis, Klebsiella, Septic emboli, Metastases

Name two examples of Multifocal Consolidation.

Interstitial

What pattern is the opposite of consolidation, involving support structures?

Interstitial support structures

What structures are involved in the Interstitial pattern?

Water, blood, tumor, cells, or fibrous tissue

Name two substances that can thicken the interstitial component.

COVID-19

What disease is mentioned as an interstitial disease that may progress to consolidation?

Septal/Linear, Reticular, Fine Nodular, Ground Glass

Name two forms of Interstitial Patterns.

Kerley A lines

What is the specific name for Interstitial Septal/Linear markings thickened by abnormal fluid?

Pulmonary edema

What is an example of a condition showing Kerley A lines?

Cobweb-like or Mesh-like

What is the appearance of the Interstitial Reticular pattern?

Edema, Interstitial pneumonia (viral or Mycoplasma sp.)

Name two examples of the Interstitial Reticular pattern.

Multiple tiny and diffused nodules involving the interstitium

What defines the Interstitial Nodular pattern?

Less than 1 cm in size

What is the typical size characteristic of interstitial nodules?

Metastases, TB

Name two examples of Interstitial Nodular pattern.

Frosted glass-like appearance

What is the appearance of the Interstitial Ground Glass pattern?

Retains translucency, but structures within are visible (details not clear)

What characteristic allows structures to be visible despite the opacity in Ground Glass pattern?