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68 Cards in this Set
- Front
- Back
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Radiographic Imaging of the Chest
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For quality images:
-know the patient's condition and/or diagnosis -Patient should be erect -Need 72" SID -PA and lateral projections are best -adequate and consistent technique |
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Alternative Projections of the chest
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-AP only
-Lordotic (to move the clavicles out of the way of the apices of the lungs) -Lateral Decubitus (air fluid levels) -Obliques -Inspiration/expiration comparison -Fluoroscopy of the chest -Tomography |
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Fluoroscopy of the chest
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This type of imaging shows movement of the tissues during regular breathing. Also helps to define internal vs. external structures.
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Tomography of the chest
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May be useful in identifying a specific section or location of a lesion or nodule.
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Lateral Decubitus of the Chest
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This demonstrates air/fluid levels and allows visualization of trapped air or movement of fluid. Patient must be lying of his/her side for 15 min before the exposure is taken.
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Chest CT
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Provides information without superimposition. CT images in the third dimension which may provide additional information that a regular CXR may not. High Resolution CT images use more slices and thinner slices to provide even more information.
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Pulmonary CT angiogram
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Used to evaluate the vessels coming off of the heart and into the lungs. Useful to rule out pulmonary embolism (PE). This exam helps to determine the location, significance of the complications and mechanisms for treatment.
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MRI Chest Imaging
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Useful for evaluating the mediastinal structures. May use "gating" which involves taking images at specific set points during the heartbeat. MRI is not as useful in imaging the lungs due to the inability to hold a breath for a long period of time.
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Pulmonary Angiogram
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Useful in visualizing the residual effects within the lungs (at the periphery). May also treat an embolism at this time.
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Nuclear Medicine
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Allows visualization of lung perfusion and vascular supply. Look for symmetry during ventilation.
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Bronchography
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Old exam, not often used anymore due to the danger of using contrast media in the air passages. This involves the injection of contrast media into the bronchioles to visualize the bronchiole tree.
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Bronchoscopy
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This involves putting a scope down the patient's throat to visualize the mainstem bronchi. May also remove a blockage during this procedure or take biopsies of the bronchiole tissue.
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Major role of the respiratory system
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Oxygenation of blood and the removal of the body's waste products in the form of carbon dioxide.
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Upper respiratory system
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Consists of the nasopharynx, oropharynx, and larynx which provide structure for the passage of air into the lower respiratory system.
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Lower respiratory system
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Consists of the trachea, bronchi and bronchioles. Composed of tubular structures responsible for conducting air from the upper respiratory structures. The smallest unit where gas exchange occurs consists of the terminal bronchiole, alveolar ducts and alveolar sacs.
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Inflammatory Disorders
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Pneumonia
Lung Abscess Tuberculosis |
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Pneumonia
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May be alveolar, lobular, interstitial or aspiration.
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Alveolar pneumonia
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May also be called "air space" pneumonia. It is caused by pneumococcal bacteria, an organism that produces an inflammatory exudate that replaces air in the alveoli. This inflammation may then spread to other alveoli and may progress into the bronchioles. Treatment: inspirometer to encourage deep breathing, opening the alveolar sacs. This will help prevent proliferation of the bacteria.
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Radiographic appearance of Alveolar pna
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May visualize the air bronchogram sign. This appears as black markings within a white area of the lung, indicating an obstruction caused by the buildup of the bacteria and an area of complete consolidation.
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Bronchopneumonia
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This type of pna is caused by the staphylococcal infection. It originates in the bronchi or bronchiolar mucosa and spreads to adjacent alveoli. This inflammation tends to produce small patches of consolidation.
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Radiographic appearance of bronchopneumonia
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Small patches of consolidation may be seen as opacifications that are scattered throughout the lungs and separated by air containing lung tissue.
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Lobular pneumonia
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Pneumonia that affects a large and continuous area of the lobe of a lung.
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Interstitial pneumonia
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This is most commonly produced by viral and mycoplasmal infections. The inflammatory process involves the walls and lining of the alveoli and the interstitial supporting structures of the lung.
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Radiographic Appearance of interstitial pna
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This type of pna appears as a linear or reticular pattern. Left untreated, it may cause "honeycomb lung" which is demonstrated in CT as cystlike spaces and dense fibrotic walls.
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Treatment for Interstitial pna
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Use antiviral medications and symptomatic meds, including anti inflammatories.
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Aspiration Pneumonia
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The aspiration of esophageal or gatric contents into the lung leading to the development of pna. Usually occurs in the right lung due to the vertical characteristics of the right bronchiole.
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Those at risk for aspiration pna
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Aspiration of esophageal material may occur in patients with esophageal obstruction, diverticula, or neuromuscular swallowing disturbances.
Aspiration of liquid gastric contents is related to general anesthetic, tracheostomy, coma or trauma. |
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Treatment for aspiration pna
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Early diagnosis is especially important for effective treatment. Corticosteroids and antibiotic therapy are essential. Fluids, rest and fever control are also useful.
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Diagnostic quality landmarks on PA chest
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-apices
-entire diaphragm -axillary borders -carina -angles -ribs (10 on the right side) |
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Diagnostic quality landmarks on a lateral chest
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-apices
-superimposed hemi-diaphragms -sternum -intervertebral foramina -cardiac silhouette -left bronchus |
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Lung Abscess
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This is a necrotic area of pulmonary parenchyma containing purulent (puslike) material. It is the collection of fluid in an abnormal space, the progression of a bacterial infection. Aspiration is the most common cause.
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Signs and symptoms of lung abscess
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Fever, cough, production of copious amounts of foul-smelling sputum. Infected material may be carried by the blood from the lung to the heart and on to the brain causing a brain abscess.
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Radiographic appearance of lung abscess
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A spherical density with a dense center and a hazy poorly defined periphery.
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Treatment of lung abscess
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Specific therapy is used to control and eradicate the underlying organism. Supplemental treatment is used to alleviate possible complications. Supportive treatment is also used.
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Tuberculosis
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Caused by Mycobacterium tuberculosis, rod-shaped bacteria that has a protective waxy coat allowing it to live outside the body for long periods of time. It is spread by droplets in the air that are produced by the coughing patient.
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Most common areas affected by TB
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Lungs (specifically the apices), GI tract, genitourinary (kidneys), and skeletal system (vertebrae).
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Radiographic appearance of TB
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1. Infiltrate may be seen as a lobular or segmental air-space consolidation that is homogeneous, dense and well defined.
2. Associated enlargement of hilar or mediastinal lymph nodes is common 3. Ghon lesion: combination of 1 and 2 4. Pleural effusion is common. |
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Air Bronchogram Sign: black markings inside whitened area of lungs. This is an indication of distal obstruction, an area of complete consolidation.
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1. Superior vena cava
2. right atrium 3. inferior vena cava 4. aortic arch 5. left pulmonary trunk 6. left pulmonary artery 7. left atrium 8. left ventricle 9. left cardiophrenic angle |
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Divisions of the mediastinum:
Anterior--thymus gland, fatty filled (lymph nodes), should look aerated Middle--esophagus, aorta, trachea, carina, sup/inf vena cava, vagus nerve/phrenic nerves, heart Posterior--descending aorta, spine, small vessels, azygus and hemiazygus veins |
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Diagnostic Quality Landmarks
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Apices
Entire diaphragm Axillary borders Carina Costophrenic and cardiophrenic angles Ribs |
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Lateral Quality Landmarks
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Apices
Superimposed hemidiaphragms Sternum Intervertebral foramina Cardiac Silhouette Left bronchus |
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Respiratory Divisions: Upper and Lower
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Respiratory Air Flow:
larynx, trachea, primary bronchi, secondary bronchi, tertiary bronchi, bronchioles, alvelar duct, alveoli |
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COPD
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Chronic Obstructive Pulmonary Disease: includes several conditions in which chronic obstruction of the airways leads to an ineffective exchange of respiratory gases making breathing difficult. Includes chronic bronchitis and emphysema which often coexist to cause the obstruction.
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Chronic Bronchitis
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Characterized by excessive tracheobronchial mucus production leading to the obstruction of small airways. May be caused by air pollution or smoking. The walls of the bronchi and bronchioles thicken and produce viscous mucus causing the glands to become hyperplastic over time.
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Radiographic appearance of bronchitis
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1/2 of patients demonstrate no change on a CXR. The most common appearance on a radiograph is a generalized increase in bronchovascular markings, "dirty chest," especially in the lower lungs.
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Treatment for chronic bronchitis
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Prophylactic antibiotic therapy reduce infections. Bronchial dilators reduce spasm and open the airways. Expectorants assist in keeping the lungs clear. Treatment is designed to improve symptoms and prevent progression of the disease.
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Emphysema
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The distension of distal air spaces as the result of the destruction of alveolar walls and the obstruction of small airways. This leads to a dramatic increase in the volume of air in the lungs. Often closely associated with heavy cigarette smoking. This type of pollutant destroys the cilia found within the airways creating difficulty in sweeping away foreign particles. The collection of foreign particles causes inflammation and secretion of excess mucus causing blockage. Air then gets trapped in the lungs causing a breakdown of the alveolar walls and a loss of elasticity.
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Radiographic appearance of emphysema
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The most common sign is a flattening of the domes of the diaphragm because the diaphragm is trying to compensate and remove the stale air in the lungs. Bullae (large air filled spaces that form when the walls of the alveoli are destroyed) may also be present.
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Treatment for emphysema
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There is no cure for emphysema. Treatment is designed to assist in relieving symptoms and preventing progression of the disease.
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Bronchiectasis
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Chronic dilation of the bronchi or bronchioles. This is a complication of a disease process. The fibrosing of air passages leads to the chronic dilation. Air passages cannot close leading to proliferation of bacteria and collection of mucus. Patient will typically have a productive cough.
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Radiographic appearance of bronchiectasis
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Coarseness and loss of definition of interstitial markings caused by fibrosing of the air passages. Oval or circular cystic spaces may appear in more advanced stages of the disease.
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Treatment for bronchiectasis
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Vaccines prevent many of the bacterial and viral infections that may lead to bronchiectasis. Treatment consists of an anitbiotic and therapy designed to decrease symptoms
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Asbestosis
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This disease may develop in workers engaged in manufacturing asbestos products, handling building materials, or working with insulation made of asbestos. The long thin asbestos particles produce major fibrosis in the lungs upon inhalation. The asbestos fibers deposit on the alveolar ducts. Mesothelioma is major complication of asbestos exposure.
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Radiographic appearance of asbestosis
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Pleural thickening appearing as linear plaques of opacification along the lower chest wall and diaphragm. These opacities may obscure the heart border producing the "shaggy heart."
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Coal Miner's Disease
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This occurs when coal miner's inhale high concentrations of coal dust. These particles then collect in the bronchioles causing weakening of the musculature and dilatation, obstructing the alveolar sacs.
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Radiographic Appearance of coal miner's disease
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Multiple, small irregular opacities and massive fibrosis can develop.
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Silicosis
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Caused by the inhalation of high concentrations of silicon dioxide, primarily affecting workers engaged in mining, sandblasting and foundry work. Inhalation of the quartz dust causes fibrosing in the lungs, cutting off air to the avleolar sacs.
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Radiographic appearance of silicosis
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Multiple nodular shadows scattered throughout the lungs. The nodules are usually well circumscribed and of uniform density and may become calicified.
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Pneumoconiosis
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Prolonged exposure to certain irritating particulates causing severe pulmonary disease. These particulates are retained permanently causing irreversible damage. Most common are silicosis, asbestosis, and coal miner's disease.
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Treatment for pneumoconiosis
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No effective treatment because particles are embedded in the lung tissue and cannot be removed. Avoid further exposure and breathing clean air may help to halt progression of the disease. May also treat with anti-inflammatories, steroids, bronchodilators, but these are only palliative treatments.
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Aspergillus
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Fungal infection of the lungs associated with pigeons and the fungus found in their feces. When breathed in, it easily spreads due to the warm, moist environment that the lungs provide. This fungal infection will eat away at the lung tissue creating nodules and cavernous lesions. Treat with antifungal medications to try to kill the fungus.
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Pleural Effusion
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Complication of a disease process where fluid accumulates in the pleural space. Common causes include CHF, pulmonary embolism, infection (TB), recent surgery, ascites, pancreatitis.
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Treatment of pleural effusion
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Try to eliminate the cause and determine the extent of the problem, how much space does it take up? Thoracentesis may be used to remove the fluid. If not resolved, the tissue will necrose due to the pressure placed on the vascular flow to the area.
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Bird Flu
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New strain of the influenza virus that caused an outbreak. H5N1 are the proteins of the virus. Carried by birds and other animals, the avian flu has a 3-5 day incubation period in which the patient does not reveal any signs/symptoms.
S/S: low grade fever, achiness, N/V, chills, cough, runny nose, difficulty breathing, congestion. |
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Anthrax
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Caused by the sporelike microbe known as Bacillus anthracis. A biologic threat that occurred in 2001. It is considered a highly volatile microbe due to its ease of transmission and high fatality rate. Ways to contract anthrax: 1) cutaneous, through an opening in the skin, 2) inhalation which is usually fatal, and 3) through the GI tract. Vaccines are highly effective.
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SARS
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Sudden acute respiratory syndrome, affected many individuals in China in 2003. Caused by a new strain of a virus that caused a hypersensitive response. It spread rapidly due to the 5-7 day incubation period. Treated with antiviral medications.
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