19 Radiology 2

Question 1

What do you need for a chest x-ray to be adequate?

Answer 1

• 1st rib
• Lateral margin of ribs
• Costophrenic angle

Question 2

What indicates cardiomegaly on a chest x ray?

Answer 2

• Over 50% cardiac thoracic ratio
• Only on PA film
• Think about situs invertus

Question 3

What are the A and B of the ABCDE approach of looking at a CXR?

Answer 3

A: airway for central trachea and hila

B: breathing: lungs, pleural spaces, lung interfaces (silhouette sign)

Question 4

What are the C and D of the ABCD approach of looking at a CXR?

Answer 4

C: circulation: mediastinum, aortic arch, pulmonary vessels, borders of the heart

D: diaphragm/dem bones: free gas under diaphragm, nodules, fractures, mass

Question 5

Where are some of the important review areas on a CXR and what pathology might we be looking for?

Answer 5

Question 6

What is the silhouette sign?

Answer 6

Structures of differing density eg heart muscle and air in lung form a crisp silhouette so when this is lost there is pathology in an area

Question 7

How can you tell on a CXR if there is mediastinal shift?

Answer 7

• Check the trachea and the cardiac shadow
• Pushed if there is an increase in volume or pressure (pleural effusion)
• Pulled if decrease (consolidation with lung collapse)

Question 8

What are some causes of costophrenic blunting on a CXR? (3)

Answer 8

1. • Consolidation
2. • Fluid
3. • Hyperinflation of lung

Question 9

How do you identify a pneumothorax on a CXR?

Answer 9

• Lung edge more than 2cm from chest wall
• Tracheal or mediastinal shift away from pneumothorax is tension

- Visible pleural edge

-No lung markings beyond this point. Side effected is blacker

Question 10

How do you identify a pleural effusion on a CXR?

Answer 10

• Collection of fluid so uniform white area
• Loss of costophrenic angle
• Hemidiaphragm obscured
• Meniscus at upper border (not when supine)

Question 11

How does a lobar lung collapse look on a CXR?

Answer 11

• Elevation of ipsilateral hemidiaphragm
• Crowding of ipsilateral ribs
• Crowding of pulmonary vessels
• Shift of mediastinum towards atelectasis

Question 12

What are some things that can cause consolidation on a CXR?

Answer 12

Always reassess in 6 weeks to think about cancer

Question 13

How do you spot consolidation on a CXR?

Answer 13

• Increased opacity
• Air bronchograms (pattern of air-filled bronchi on a background of airless lung)

Question 14

What is being shown on this CXR? What could have caused the pathology?

Answer 14

Cavitation

Which could be due to infarction, abscess, TB, malignancy, septic microthrombi

Question 15

What are some causes of a space occupying lesion on a CXR?

Answer 15

Vertebral body height is about 3cm (use as reference)

Question 16

What is being shown on this CXR?

Answer 16

Milliary TB until proven otherwise

(massive lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli)

Question 17

Apart from x-rays, how else can we image the lungs?

Answer 17

• CT angiogram low dose
• Ultrasound for guiding aspiration and biopsy
• Nuclear medicine CTPA (computed tomographic pulmonary angiography)

Question 18

What is the best way to treat small cell lung carcinoma?

Answer 18

Chemo and radiotherapy

Question 19

Identify the abnormalities on this x-ray.

Answer 19

• Space occupying lesion in upper left zone probably due to bronchial carcinoma
• Elevation of right hemidiaphragm due to mass causing a phrenic nerve palsy

Question 20

Which lung cancer is most likely to cause paraneoplastic syndromes and give some examples of the syndromes it can cause?

Answer 20

• Small cell
• Cushings
• SIADH

Question 21

Small cell lung carcinoma is also the most likely to cause SVC obstruction, what are some signs of this?

Answer 21

• Raised JVP
• Oedema
• Feeling dizzy
• Change in eye sight

Question 22

What is the diagnosis and how would you treat this to test for malignancy?

Answer 22

• Right sided pleural effusion
• Aspirate and do cytology to look for malignancy

Question 23

What is the difference between a pleural effusion and lung consolidation?

Answer 23

A pleural effusion is a collection of fluid in the space between your chest wall and lungs. A lung consolidation may also be fluid, but it’s inside your lung, so it can’t move when you change positions.