Diagnostic Imaging MT I

1. Only time dont take tangential views

a. If patient is <40 and asymptomatic then dont need to take a lateral chest
x-ray with the A-P
2. Number ribs seen on full inspiration
a. 10 pos, 6 ant on R side
3. If chest wider than tall
a. See 9 pos ribs, x-ray is horizontal
4. Reasons cant fully inspire
a. Pain
b. Obesity, chronic restrictive lung disease
5. Lateral chest x-ray
a. Minimize heart shadow by having left side closest to film
6. DDx with P-A expiratory chest x-ray
a. Pneumothorax
b. Paralysis of hemidiaphram (usually CA)
c. Air trapped in lung (Ball/Valve)
d. Shifting of mediastinum
7. Heart size
a. Should be less than 50% of chest cavity from A-P view taken at 72 in
with full inspiration
8. CT
a. Lung window can see lungs (& bones)
b. Mediastinal window lungs pitch black
9. MRI
a. Good for chest wall not lung diseases
b. no ionizing radiation
10. Bronchoscopy
a. Use fiber-optic camera
b. Looks at trachiobronchial tree, cell sampling, biopsies

11. Tomography/Laminography
a. Outdated to CT
b. Blurry image except whats at the fulcrum
c. Tube and film move synonymously
12. Mediastinum
a. Radiographically only look at ant, middle, pos to help DDx
b. Tortuous med and lat walls of aorta are parallel
c. Aneurysm med and lat walls of aorta are bulged and not parallel
13. Pulmonary edema
a. Interstitial
i. Looks like network reticular, nodular, linear, miliary
ii. Kerleys septal lines thin, non-branching linear densities
running through lung to chest wall
b. Avelolar/acinar
i. Fluffy margins, butterfly or batwing shadow
ii. Air bronchogram
14. Radiographic signs of consolidation
a. Air bronchogram sign
i. Within consolidation are branching radiolucent lines
ii. The absence of ABS doesnt mean there isnt consolidation
15. Lobar pneumonia
a. Usually strep pneumoniae (pneumococcus or diplococcus)
16. Congestive heart failure
a. Cardiomegaly
b. Cephalization of blood flow more branching in upper lung lobes
relative to lower lung lobes
c. Pleural effusion
d. Pulmonary edema
17. Atelectasis types
a. Obstructive (air in alveoli reabsorbed & lung collapses)
i. most common
ii. associated with pneumonia
iii. tumor, mucous, debris
b. compressive
i. tumor
c. cicatrisation
i. scar tissue
ii. secondary to TB, pulmonary fibrosis

d. adhesive
i. surfactant inactivity
ii. neonates
e. passive
i. airway is patent
ii. pneumothorax
18. Masses
a. >3 cm
b. solitary - lung cancer most common, round pneumonia, large solitary
metastasis, lung abscesses
19. Nodules
a. <3 cm
b. solitary granuloma most common, lung cancer, benign lung tumor,
metastasis
c. multiple granuloma, metastasis, septic emboli
20. Malignant
a. Irregular shape, speculated margins, large size, no calcification, possible
cavitation
21. Benign
a. Smooth edges, calcified, popcorn ball (clusters), regular shape, small, no
cavitation
22. Caviated lesion
a. MC cause = Lung cancer (> 1 inch), abcess, hematoma
23. Types of lung cancer
a. Adenocarcinoma
i. Most common
ii. Peripheral location
b. Squamous cell carcinoma
i. Most common cavitates
c. Small cell, large cell, pancost
24. S sign of Golden
a. Highly suggestive of obstructive atelectasis due to hilar bronchogenic
cancer
25. Honey comb lung
a. Reserved for end stage pulmonary fibrosis
b. Water density in lung is more obvious than air density
c. Swiss cheese appearance

26. Healing of primary TB

a. Calcification of hilar nodes and Ghon focus and granulomas which
produce the primary Ranke Complex.
b. Similar to histoplasmosis
27. Healing of secondary TB
a. Fibrosis, atelectasis, cavities, calcifications fibrocalcific TB
28. Sarcoidosis x-ray findings
a. Potatoe nodes bilateral lymphadenopathy of hilar areas
29. Pneumoconiosis
a. Interstitial disease due to dust particles inhaled
b. Active
i. Fibrogenic, malignant nodules chronic
ii. Asbestos, silica, coal
c. Inactive
i. Iron-oxide
ii. Not as destructive to lungs
30. Asbestosis
a. Calcified pleural scars, bilateral = pathogneumonic
i. Diaphragm, chest walls
31. Anterior mediastinal masses lat view crowds ant clear space
a. 3 Ts and L
i. thyroid goiter, substernal
ii. teratoma benign
iii. thymoma thymus gland tumor
iv. lymphoma lymph nodes
32. Hodgkins lymphoma
a. 20-40 year old
b. fatigue, fever, weight loss
c. Redd-Sternberg cells pathogneumonic
d. X-ray
i. Lympnadenopathy, mediastinal widening, infiltrate, pleural masses
e. Sarcoidosis looks similar
33. Pericardial effusion
a. Collection of fluid in pericardial sac
b. Seen best with echocardiogram

34. Free effusion

a. Blunt costophrenic angle
b. Meniscus sign fluid level curves upward
c. Thickened fissures
35. Loculated effusion
a. Pseudotumors/phantom tumors
i. Masses along chest wall
b. Mass is elliptical
36. Pleural fibrosis
a. Permanent thickening and opacification of pleura
b. Usually in the periphery
37. Extrapleural pathology
a. Extrapleural sign
i. Lesion in pleura that tapers at end when reaches chest wall
ii. Convex appearance
38. Tension pneumothorax
a. Mediastinal shift away due to air building up in pleural cavity
b. Can compress heart ER
39. Emphysema
a. Enlarged air spaces
b. X-ray
i. Sabre trachea (thin), hyperinflation, decrease vascularity,
tapering of peripheral vessels, flat diaphragm
40. Abdominal conditions
a. Hiatal hernia
i. Looks like a hole in the heart but gas from stomach is
superimposed on heart