Term
| what factors should be considered when deciding appropriate imaging studies? |
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Definition
| acute/chronic, age, sex, past hx (sx?), prior imaging studies |
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Term
| what are the ABCs to consider when deciding appropriate imaging studies? what else should be r/o? |
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Definition
| Airway (patent vs obstructed. collapse, edema -> trauma? ). Breathing (spontaneous, labored, absent respiration). Circulation (bleeding externally or internally? shock?). also - is the pt conscious? r/o head injury, spinal cord injury |
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Term
| what are the appropriate steps if any of the ABCs demands immediate intervention? what is the basic goal of these steps? |
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Definition
| Airway: may need to be cleared, pt may need to be intubated, or have an emergency trach. Breathing - may require chest tube placement for tension pneumothorax. Circulation - bleeding may need to be controlled. essentially, steps should be taken to stabilize the pt. |
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Term
| what is triage? when is it used? |
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Definition
| triage is the sorting out and classification of symptoms to determine the priority of need and proper place of tx. it is used in natural/manmade disasters, accidents, the ER, outpatient clinics, and physician's waiting rooms - *in acute situations* |
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Term
| what are some chronic cardio, pulm, GI, and endocrine conditions that need to be taken into consideration when deciding appropriate imaging studies? |
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Definition
| cardio: arrythmia, valvular disease, dilated cardiomyopathy, atherosclerosis valve disease, HTN. pulm: COPD/emphysema/bullae, idiopathic pulm fibrosis, sarcoid, industrial inhalant exposure. GI: IBS, cirrhosis, hepatitis. endocrine: diabetes, metabolic syndrome, thyroid disease |
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Term
| what are different considerations for pts at newborn, adult and elderly stages? |
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Definition
| newborn: is it congenital? related to the birth process? transmitted from the mother, or due to an immature immune system? adult: trauma? early stages of chronic disease? exposure to disease in the general pop? travel? elderly: related to aging?, degenerative diseases - bones, joints, chronic diseases such as diabetes, HTN, and CA? |
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Term
| what are factors to consider when deciding on appropriate imaging studies in terms of sex? |
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Definition
| females: consider sarcoid, arthritis, pregnancy, osteoporosis/heart disease protection postmenopause, breast/cervical CA. males: consider aortic aneurysms, industrial exposure, colon/prostate CA, |
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Term
| what are factors to consider when deciding on appropriate imaging studies in terms of past medical/sx hx? |
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Definition
| medical: smoking, occupational, travel, CA, cardiovascular disease, HTN, diabetes, meds (OTC vs rx, allergies?), hx as it relates to the current complaint. family hx: consider hereditary disease, screening procedures. sx hx: consider pre-existing situations, altered anatomy, r/o certain entities, recurrence? |
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Term
| what are factors to consider when deciding on appropriate imaging studies in terms of prior imaging studies? |
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Definition
| what studies were done? contrast used (oral or IV)? for what purpose? when/where they were performed (any results/reports available)? difficulties w/studies (allergies/claustrophobia?) |
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Term
| what are the x-ray studies used to evaluate thoracic disease? |
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Definition
| plain films (readily available most places), CT, MRI, angiography (conventional, CT, MR), nuclear medicine: ventilation/perfusion (used for pulm embolus) or a thallium scan (used for cardiac perfusion) |
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Term
| what is the most common thoracic plain film view? what are the other CXR views? |
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Definition
| PA view: X-ray chest PA view gives a good assessment of the cardiac size. it is taken with the film in front of the chest and the X-ray tube behind, from a distance of 6 feet. the other views include AP, lateral, oblique, and decubital. |
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Term
| what can be evaluated with a CXR in the lung? |
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Definition
| the lung parenchyma can be evaluated for pneumonia, nodular discharge, and fibrotic change |
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Term
| what can be evaluated with a CXR in the mediastinum/vascular structures? |
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Definition
| whether there is a widening or shift in the mediastinum, if there is an aortic aneurysm |
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Term
| what can be evaluated with a CXR in terms of the heart/cardiac silhouette? |
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Definition
| cardiac enlargement, aneurysm, pericardial effusion |
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Term
| what can be evaluated with a CXR in terms of soft tissue? |
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Definition
| if there is inflammation, asbestos exposure, etc |
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Term
| what can be evaluated with a CXR in terms of osseous structures? |
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Definition
| fractures, osteoblastic activity |
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Term
| what can be evaluated with a CXR in terms of tube/lines? |
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Definition
| pacemakers, chemotherapy ports, pick lines, etc |
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Term
| what are acute diseases that you would look for with radiography? |
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Definition
| pneumonia, pneumothorax (usually young males, can be due to trauma), abcesses, and effusions |
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Term
| what are chronic diseases that you would look for with radiography? |
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Definition
| pleural thickening, bullae (smoking), granuloma (calcified lesions), or ASVD (atherosclerotic vascular disease) |
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Term
| what are indications for a thoracic CT? |
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Definition
| evaluation of parenchymal lung disease (mediastinal widening), chest x-ray abnormality, lung CA staging (soft tissue), pulm metastases assessment (multitude of nodules), assessing parenchymal vs pleural-based processes (a mass's location), evaluation of pulm embolus, aortic aneurysm/dissection, determination of bx approach/performance of bx, evaluation of heart/chamber size |
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Term
| what are indications for a thoracic MRI? |
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Definition
| (do not have to worry about radiation exposure) evaluation of congential/aquired cardiac anomalies or vascular disorders, dx of tumor invasion into chest wall or mediastinum (good soft tissue views, especially for staging), staging of lung cancer with contraindication to iodine contrast, and assessment of posterior mediastinal masses (close proximity to point of origin) |
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Term
| what are indications for angiography (either conventional, CT, MRI)? |
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Definition
| pulm emboli, aortic aneurysm/dissection, AVM (arteriovenous malformation), and tumor vascularity (can be dx as well as therapeutic) |
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Term
| what are indications for nuclear medicine evaluation? |
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Definition
| pulm embolisms can be diagnosed via mismatches in ventilation/perfusion (V/Q) scans. thalluim scans such as myocardial perfusion can be performed after cardiac events to determin whether damage is reversible |
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|
Term
| what are the three common chest complaints? |
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Definition
| chest pain, shortness of breath, and chest trauma |
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Term
| how is chest pain characterized? |
|
Definition
| sharp vs dull, localized vs generalized, radiating? R/L side, affected by respiration? affected by particular activity? point tenderness? what exacerbates/relieves it? how long/how often? ever sought medical treatment in past? |
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|
Term
| what are some causes of acute chest pain? |
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Definition
| unstable angina, MI, pneumothorax, pulm emboli, aortic dissection, esophageal rupture |
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Term
| what imaging techniques are commonly used in diganosing unstable angina? |
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Definition
| CXR, coronary arteriogram |
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|
Term
| what imaging techniques are commonly used in diganosing MIs? |
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Definition
| CXR, radionuclide thallium scan (to see if permanent damage) |
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|
Term
| what imaging techniques are commonly used in diganosing pneumothorax? |
|
Definition
|
|
Term
| what imaging techniques are commonly used in diganosing pulm emboli? |
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Definition
| CXR, lung V/Q, CT pulm angiography, conventional pulm, angiography |
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Term
| what imaging techniques are commonly used in diganosing aortic dissection? |
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Definition
| CXR, contrast enhanced CT, MRA, ultrasound |
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|
Term
| what imaging techniques are commonly used in diganosing esophageal rupture? |
|
Definition
| CXR, water soluble contrast, CT thorax |
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|
Term
| what are other common causes of acute chest pain? |
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Definition
| GERD, rib fractures, costochondritis, pericarditis, and pleurisy |
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|
Term
| what are other uncommon causes of acute chest pain? |
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Definition
| varicella zoster, ankylosing spondylitis, tabes dorsalis, and gallbladder/pancreatic disease |
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|
Term
| what are causes of acute shortness of breath? |
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Definition
| asthma, pulm edema, pneumonia, acute exacerbation chronic obstructive pulm disease (could be due to smoking), pulm embolism, pneumothorax, cardiac tamponade, tracheobronchial obstruction, and laryngeal obstruction (foreign object?) |
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Term
| what is the imaging technique used initially for asthma, pulm edema, pneumonia, and chronic obstructive pulm disease? |
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Definition
| CXR. echocardiography can also be used for pulm edema |
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|
Term
| what are common causes in terms of chest trauma? |
|
Definition
| iatrogenic, MVA (car accident; direct trauma such as fracture/tear, deceleration - aortic tear, femoral fracture -> fat embolus -> pulm embolism), foreign body (gunshot - bleeding, pneumothorax, infection), blunt trauma (rib/sternal fracture, contusion, and pneumothorax), and sharp trauma (stab wound - bleeding, pneumothorax, infection) |
|
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Term
| what imaging techniques can be used for iatrogenic, MVA, foreign body, blunt trauma, and sharp trauma chest damage? |
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Definition
| CT, CXR. (inspiratory/expiratory films for forein body) |
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Term
| which would you see the gastric bubble in; upright or supine view? |
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Definition
|
|
Term
| what is the R border of the cardiac silhouette composed of? the L border? where is the gastric bubble? the aortic knob? |
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Definition
| the R border is composed of the R atrium, the L is composed of the L ventricle. the gastric bubble is under the L ventricle. the aortic knob is right above the L atrium |
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|
Term
| which is more anterior, the trachea or esophagus? |
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Definition
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|
Term
| how would right middle lobe pneumonia appear on an x-ray? |
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Definition
| there would be an area of increased opacity in the R lower lung field (may also be seen to a lesser degree in other parts of the lung) |
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Term
| which is a better position to assess air fluid levels in the lungs, like that which may be seen associated with a cavitary process? |
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Definition
|
|
Term
| how would R pleural effusion appear? |
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Definition
| as a *curvilinear, *opaque line obscuring part of the R lung, causing the pair to appear asymmetrical (need frontal to determine which lung the fluid is in) |
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|
Term
| what is a good position for determining slight pleural effusions? |
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Definition
| lateral decubitus position - also good for determining if the fluid is free-flowing |
|
|
Term
| how does pulmonary edema appear? |
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Definition
| central, around the heart and extending from the hilum through the pulmonary vasculature |
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|
Term
| how does pneumothorax appear on a CXR? |
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Definition
| radiolucency (darker), absence of lung markings |
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|
Term
| on a CT scan how does pneumothorax show up? |
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Definition
| as an area of decreased attenuation (darkness) |
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|
Term
| what would you see on an esophageal rupture CXR? |
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Definition
| air density around the esophagus |
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|
Term
| how does a pulm embolus CXR appear? V/Q scan? |
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Definition
| CXR: as an opaque wedge shape w/the apex facing the hilum. V/Q: ventilation (V) is clear, perfusion (P) has a divot (V/Q needs a CXR along with it for dx) |
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Term
| how might a pulm embolus appear on a CT w/contrast? |
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Definition
| as the area in the vasculature w/no contrast |
|
|
Term
| how would an aortic aneurysm appear on a CXR? |
|
Definition
| significant mediastinal widening toward the apex of the L side of midline |
|
|
Term
| how would an dissecting aortic aneurysm appear on a CT w/contrast? |
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Definition
| part of the aorta will show contrast, but not all of it (yin-yang sign) |
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|
Term
| how would a pt w/asthma appear on a CXR? |
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Definition
| more radiolucence, due to hyperinflation |
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|
Term
| how would a pt w/COPD appear on a CXR? |
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Definition
| lungs are radiolucent, diaphragm is flattened, expansion of the sterum and retrosternal space out, and the interrib spaces are widened |
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|
Term
| how would a pulm mass appear on a CXR? |
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Definition
| focal area of increased opacification, well marginated border |
|
|
Term
| where is the descending aorta usually found on a CT looking cranially? |
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Definition
|
|
Term
| how would a foreign object, such as a peanut, lodged in a bronchus cause the lungs to appear on a CXR? |
|
Definition
| inspiration films could be normal, but if air is blocked from leaving the lungs on expiration, it can cause air-trapping, creating opacity as well as the mediastinum moving to that side with the object (which itself is not visible) |
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|
Term
| how would a L ventricular aneurysm appear on a CXR? |
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Definition
| the L side of the heart would be very enlarged |
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|
Term
| how would pericardial effusion appear on a CXR? |
|
Definition
| the cardiac silhouette will be much larger |
|
|
Term
| what should we be concerned about with increased mediastinal widening? |
|
Definition
|
|
Term
| how would a pulm contusion CXR appear? does it resolve quickly? |
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Definition
| as an opacity which should resolve in about 3 days |
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