p.19
Consolidation and Pneumonia
What does widespread consolidation in the lungs indicate?
It indicates bronchopneumonia.
p.48
Consolidation and Pneumonia
What does an asymmetrical distribution of shadowing on a chest X-ray indicate?
It may point to lung injury as a cause.
p.24
Pleural Effusion Diagnosis
What do the films show regarding pleural effusions?
They show varied appearances of pleural effusions.
What does a CT image show in cases of left upper lobe collapse?
The midpoint of the mediastinum shifted to the left.
p.24
Pleural Effusion Diagnosis
What does the first film depict?
A small left pleural effusion filling the costophrenic angle with a curved upper margin.
p.17
Volume Loss in Pulmonary Conditions
What can cause tracheal deviation?
It can be pushed by a mass lesion in the mediastinum, often an enlarged thyroid gland.
What is the primary cause of lung collapse?
A buildup of air or fluid in the pleural space.
p.51
Consolidation and Pneumonia
What can make diagnosing bronchiectasis difficult?
It can be difficult to diagnose on a plain chest X-ray.
p.50
Consolidation and Pneumonia
What caused the localized area of bronchiectasis in the right lower lobe?
An earlier pertussis infection.
What visual change occurs in the lung field when the left upper lobe collapses?
A haze appears over the whole of the left lung field.
p.52
Cavitating Lung Lesions
What should you compare when assessing bronchiectasis in the periphery of the lung?
The diameter of the airway to that of the neighbouring blood vessels.
What is the term for pulmonary fibrosis with no known predisposing cause?
Cryptogenic fibrosing alveolitis (CFA).
What is indicated by the whiteness immediately above the diaphragm in right lower lobe collapse?
It causes a loss of the diaphragm's outline.
p.36
Lung Nodules and Their Evaluation
What does the arrow in the CT scan indicate?
The location of the left oblique fissure.
What is the primary cause of lung collapse?
A buildup of air or fluid in the pleural space.
p.39
Cavitating Lung Lesions
What is a cavitating lung lesion?
A type of lung abnormality characterized by the presence of a cavity or hollow space within the lung tissue.
p.25
Pleural Effusion Diagnosis
How can pleural effusion be diagnosed?
Through physical examination, imaging studies like chest X-ray or ultrasound, and analysis of pleural fluid.
What is a common sign of right middle lobe collapse on an X-ray?
The right diaphragm may be slightly raised.
p.22
Pneumocystis Carinii Pneumonia
What symptoms did the patient present with?
A week-long history of a dry cough and increasing breathlessness.
What distinct appearance does lung collapse give on an X-ray?
A distinct appearance of the affected lobe.
p.18
Consolidation and Pneumonia
What does consolidation indicate in a medical context?
The appearance of lobar pneumonia.
What is the primary cause of lung collapse?
A buildup of air or fluid in the pleural space.
p.48
Consolidation and Pneumonia
What should you look for if the chest X-ray suggests a diagnosis of ARDS?
Clues as to the cause of ARDS.
What are common symptoms of a collapsed lung?
Sudden chest pain and shortness of breath.
How can a collapsed lung be treated?
Through observation, needle decompression, or chest tube insertion.
What happens during a left lower lobe collapse?
The left lower lobe collapses down behind the heart.
p.52
Cavitating Lung Lesions
What is a sign of more proximal airway dilatation in the middle third of the lung fields?
If the airway walls do not taper over 2 cm.
p.22
Pneumocystis Carinii Pneumonia
What is Pneumocystis carinii pneumonia (PCP)?
A type of pneumonia caused by the organism Pneumocystis carinii, particularly in immunocompromised individuals.
p.46
Acute respiratory distress syndrome
What was required for the man's treatment due to his acute shortness of breath?
Intubation and ventilation.
Where is the fine meshwork pattern worse in pulmonary fibrosis?
In the periphery of the lungs, especially at the lung bases.
What are the symptoms of a collapsed lung?
Sudden chest pain and shortness of breath.
p.59
Cavitating Lung Lesions
Which infections can lead to fibrosis?
Tuberculosis, psittacosis, and aspiration pneumonia.
p.39
Cavitating Lung Lesions
What symptoms might indicate the presence of a cavitating lung lesion?
Symptoms can include cough, chest pain, and difficulty breathing.
What happens to the heart border in right middle lobe collapse?
It is sometimes indistinct.
p.55
Consolidation and Pneumonia
How can old X-rays help in diagnosing fibrosis?
Fibrosis is a chronic process, so if present a while ago, it is more likely to be fibrosis than consolidation or edema.
p.59
Cavitating Lung Lesions
What is a potential iatrogenic cause of fibrosis?
Medications like amiodarone and busulfan, as well as radiotherapy.
p.27
Pleural Effusion Diagnosis
What are some causes of transudate pleural effusion?
Heart failure, liver failure, protein loss, reduced protein intake, and iatrogenic causes.
p.19
Consolidation and Pneumonia
In which areas of the lungs is consolidation especially noted?
In the mid to lower zones.
p.25
Pleural Effusion Diagnosis
What is pleural effusion?
The accumulation of fluid in the pleural space between the lungs and the chest wall.
What happens to the outline of the right heart border in right lower lobe collapse?
The outline of the right heart border is maintained.
p.43
Volume Loss in Pulmonary Conditions
What are common symptoms of left ventricular failure?
Shortness of breath, fatigue, and fluid retention.
p.25
Pleural Effusion Diagnosis
What are the symptoms of pleural effusion?
Shortness of breath, chest pain, and cough.
How does the horizontal fissure appear in right middle lobe collapse?
It may be lower than usual.
p.30
Mesothelioma Characteristics
What symptoms did the patient present with?
Right lateral chest wall pains.
p.51
Consolidation and Pneumonia
What is the most sensitive diagnostic test for bronchiectasis?
CT scanning, specifically high-resolution CT (HRCT) scan.
p.51
Consolidation and Pneumonia
What should be identified on an HRCT scan to diagnose bronchiectasis?
Areas in which the bronchi are dilated.
p.3
Volume Loss in Pulmonary Conditions
How does volume loss affect the vascularity of the lung?
It decreases vascularity, making the unaffected part look blacker.
p.51
Consolidation and Pneumonia
What does a normal chest X-ray not exclude?
The diagnosis of bronchiectasis.
p.31
Mesothelioma Characteristics
What characteristics does mesothelioma shadowing exhibit?
It has characteristics of pleural shadowing and some malignant shadows.
p.31
Mesothelioma Characteristics
What should you assess about the spread of whiteness to suspect mesothelioma?
Determine whether it follows lung boundaries; if not, it may be pleural in origin.
p.20
Consolidation and Pneumonia
What clinical signs increase the likelihood of consolidation?
The presence of a temperature and signs of infection.
p.63
Consolidation and Pneumonia
How can you distinguish between miliary shadowing and normal lung appearance?
By examining the distribution of shadowing, especially in the periphery, and the characteristics of the opacities.
What happens to the volume of the lung when collapse occurs?
There is a loss of volume in that part of the lung.
What is a common difficulty in identifying left upper lobe collapse?
It is difficult to spot because most of the left upper lobe lies in front of the left lower lobe.
What can fill the left upper lobe bronchus in cases of collapse?
A soft tissue density, such as a tumor.
p.24
Pleural Effusion Diagnosis
How does a large pleural effusion affect the mediastinum?
It may push the mediastinum away from the midline due to the large volume of fluid.
p.33
Asbestos Plaques and Related Conditions
What are pleural plaques?
Discrete structures that are partly soft tissue and partly calcified.
What are the treatment options for a collapsed lung?
Observation, needle aspiration, or surgery, depending on severity.
p.46
Acute respiratory distress syndrome
What complication did the man develop while in the hospital?
Acute respiratory distress syndrome (ARDS).
p.50
Consolidation and Pneumonia
What appearance do the typical ring shadows in bronchiectasis resemble?
A 'bunches of grapes' appearance.
p.36
Lung Nodules and Their Evaluation
What did the remainder of the CT scan reveal?
No evidence of metastatic disease and no hilar or mediastinal lymph nodes involved.
p.50
Consolidation and Pneumonia
What are tramline shadows?
Thick parallel lines seen side-on due to bronchial wall thickening.
p.37
Lung Nodules and Their Evaluation
What are some benign causes of solitary pulmonary nodules?
Benign tumors, e.g., hamartoma.
What appearance is produced in very severely affected areas of pulmonary fibrosis?
A ‘honeycomb’ appearance.
p.46
Acute respiratory distress syndrome
What did the X-ray show regarding signs of left ventricular failure?
No signs of left ventricular failure.
p.59
Cavitating Lung Lesions
What are some collagen vascular diseases that can cause fibrosis?
Rheumatoid arthritis and systemic lupus erythematosus (SLE).
What are potential treatments for a collapsed lung?
Observation, chest tube insertion, or surgery in severe cases.
p.14
Volume Loss in Pulmonary Conditions
What change is observed in the left-sided ribs?
They are crowded together compared to the right side.
p.18
Consolidation and Pneumonia
What characteristic of the inferior margin indicates right upper lobe pneumonia?
The inferior margin of the consolidation is quite straight.
p.24
Pleural Effusion Diagnosis
What is observed in the second film?
A much larger right pleural effusion encasing the lung with increased whiteness around the apex.
p.24
Pleural Effusion Diagnosis
How can a large pleural effusion be compared to a pneumonectomy?
The appearance of a large pleural effusion can be compared to the almost totally white lung seen after a pneumonectomy.
p.17
Volume Loss in Pulmonary Conditions
What are the lung volumes in the case described?
The lung volumes are normal.
p.52
Cavitating Lung Lesions
What indicates that an airway is dilated?
If the diameter of the airway is larger than that of the neighbouring blood vessel.
How is a collapsed lung diagnosed?
Through physical examination and imaging tests like chest X-rays or CT scans.
p.43
Volume Loss in Pulmonary Conditions
What is left ventricular failure (LVF)?
A condition where the left ventricle of the heart cannot pump blood effectively.
p.60
Cavitating Lung Lesions
What imaging finding is typical in a patient with chickenpox pneumonia?
Numerous bilateral calcified intrapulmonary nodules.
What is a tension pneumothorax?
A life-threatening condition where air enters the pleural space and cannot escape, leading to increased pressure.
p.46
Acute respiratory distress syndrome
What did the chest X-ray suggest about the man's condition?
He developed acute respiratory distress syndrome (ARDS).
p.49
Volume Loss in Pulmonary Conditions
What should be monitored on a chest X-ray for a patient with ARDS?
Signs of disease progression or resolution, and development of pneumothorax or lung cysts.
p.15
Volume Loss in Pulmonary Conditions
What is a pneumonectomy?
A surgical procedure to remove one lung.
What are the treatment options for a collapsed lung?
Observation, chest tube insertion, or surgery in severe cases.
p.15
Volume Loss in Pulmonary Conditions
What is a notable feature of the heart border on an X-ray after a pneumonectomy?
The heart border may be shifted so far that it is no longer visible.
p.16
Volume Loss in Pulmonary Conditions
What treatment did the patient receive after surgery?
Postoperative radiotherapy.
p.27
Pleural Effusion Diagnosis
What is the protein level that classifies a pleural effusion as an exudate?
Greater than 30 g/l of protein.
p.21
Consolidation and Pneumonia
What should be done for patients who fail to recover from pneumonia?
Further X-rays are necessary to look for complications like empyema or pulmonary abscess.
p.27
Pleural Effusion Diagnosis
What are some causes of exudate pleural effusion?
Infection, infarction, malignancy, collagen vascular disease, abdominal disease, and trauma/surgery.
p.21
Consolidation and Pneumonia
When should early follow-up X-rays be warranted for pneumonia patients?
For patients admitted to intensive care to ensure their condition is not progressing.
p.47
Consolidation and Pneumonia
What is Acute Respiratory Distress Syndrome (ARDS) defined as?
Respiratory failure associated with a chest X-ray showing confluent alveolar opacification resembling pulmonary edema.
p.35
Lung Nodules and Their Evaluation
What is the main concern regarding lung nodules?
They may represent a carcinoma.
p.26
Pleural Effusion Diagnosis
What does the absence of mediastinal shift suggest?
The presence of a pleural effusion.
How does left lung collapse affect diaphragm position?
It may distort the usual position of the right diaphragm, which is usually higher.
What are common symptoms of a collapsed lung?
Sudden chest pain and shortness of breath.
p.33
Pleural Effusion Diagnosis
What does the pleura appear like on a contrast-enhanced CT scan in the case of empyema?
It may 'enhance' and appear whiter than normal.
p.33
Pleural Effusion Diagnosis
What is a characteristic of simple pleural effusion?
It is a benign type of pleural effusion.
What is observed on the lateral film in right lower lobe collapse?
A white triangle at the lower posterior part of the lung field.
p.25
Pleural Effusion Diagnosis
What are common causes of pleural effusion?
Heart failure, pneumonia, malignancy, and pulmonary embolism.
What are common symptoms of a collapsed lung?
Sudden chest pain and shortness of breath.
p.30
Mesothelioma Characteristics
What history does the patient have that is relevant to his condition?
History of asbestos exposure.
p.59
Asbestos Plaques and Related Conditions
What is a common cause of fibrosis related to the environment?
External/occupational factors, such as extrinsic allergic alveolitis and asbestosis.
p.22
Pneumocystis Carinii Pneumonia
What did the imaging reveal in the patient with PCP?
Vague white shadowing around the hilum and enlargement of the right hilum from lymphadenopathy.
p.31
Mesothelioma Characteristics
What type of tumor is mesothelioma?
A malignant tumor of the pleura.
p.41
Cavitating Lung Lesions
What can cause cavitation around pneumonia?
Cavitation around a pneumonia.
p.61
Lung Nodules and Their Evaluation
What is the appearance of calcified nodules in chickenpox pneumonia?
They should be very white in appearance.
What mediastinal change may be confirmed by a scan in sarcoidosis?
Bilateral hilar lymphadenopathy.
p.61
Lung Nodules and Their Evaluation
What is the typical size of nodules associated with chickenpox pneumonia?
Usually less than 3 mm in diameter.
p.16
Volume Loss in Pulmonary Conditions
What anatomical change occurred to the trachea as a result of the volume loss?
The trachea has been pulled to the right.
p.20
Consolidation and Pneumonia
How can old X-rays help in diagnosing lung conditions?
They can indicate whether a condition is chronic (like fibrosis) or transient (like consolidation).
p.47
Consolidation and Pneumonia
What is a common cause of pulmonary edema that must be distinguished from ARDS?
Left ventricular failure.
p.35
Lung Nodules and Their Evaluation
What edge characteristics of a lung nodule suggest malignancy?
A spiculated, irregular, or lobulated edge.
p.27
Pleural Effusion Diagnosis
What is a common infectious cause of exudate pleural effusion?
Pneumonia or tuberculosis.
p.16
Volume Loss in Pulmonary Conditions
What does diaphragmatic tenting resemble?
It looks as though a tent pole has been put underneath to push it upwards.
p.29
Asbestos Plaques and Related Conditions
What do pleural plaques represent?
Areas of pleural thickening caused by exposure to asbestos fibers.
p.35
Lung Nodules and Their Evaluation
What does a cavitating lung nodule look like?
The center may be darker than the circumference.
p.53
Cavitating Lung Lesions
How does cystic fibrosis affect bronchiectasis?
It causes widespread bronchiectasis, often more marked in the upper zones.
What should the heart's position be in relation to the midline?
The heart should straddle the midline with one-third to the right and two-thirds to the left.
What are common symptoms of a collapsed lung?
Sudden chest pain and shortness of breath.
p.51
Consolidation and Pneumonia
What do ring shadows on a chest X-ray indicate?
They represent diseased bronchi seen end on and can appear as groups resembling 'bunches of grapes'.
p.52
Cavitating Lung Lesions
What are areas of mucus plugging in the airways?
Airways in which the lumen has been blocked by mucus.
p.51
Consolidation and Pneumonia
What distinguishes true tramline shadows from normal parallel lines?
True tramline shadows are thicker and not necessarily close to the hilum.
p.51
Consolidation and Pneumonia
What do tubular shadows represent on a chest X-ray?
Bronchi filled with secretions seen side on.
p.34
Lung Nodules and Their Evaluation
What procedure may be performed if bronchoscopy does not provide an answer?
The nodule could be biopsied percutaneously under CT guidance.
p.45
Consolidation and Pneumonia
What appearance does severe pulmonary edema give on imaging?
A 'bat's wing' appearance due to confluent alveolar shadowing spreading from the hilum.
What can be seen on the pleura in lymphangitis carcinomatosis?
Nodular deposits, though distribution differs from sarcoidosis.
p.42
Consolidation and Pneumonia
What characteristic shadows are seen in the film of a patient with pulmonary edema?
'Bat's wing' hilar shadows.
p.20
Consolidation and Pneumonia
What does a uniform whiteness with a well-demarcated border in lung imaging suggest?
It is more likely to indicate an area of collapse or a pleural effusion.
p.45
Consolidation and Pneumonia
How does the hilum appear in pulmonary edema?
It may appear distended, and vessels close to the hilum may be blurred.
p.30
Mesothelioma Characteristics
Where is further pleural thickening evident in the chest X-ray?
Next to the right side of the mediastinum.
p.59
Cavitating Lung Lesions
What is cryptogenic fibrosis?
Fibrosis with no known cause.
p.16
Volume Loss in Pulmonary Conditions
What effect did the lobectomy and radiotherapy have on the remaining lung?
They led to volume loss in the remaining right lung.
p.59
Cavitating Lung Lesions
What role does sarcoidosis play in fibrosis?
It is one of the causes of fibrosis.
p.44
Volume Loss in Pulmonary Conditions
What should the cardiothoracic ratio be for a normal heart size?
Less than half the maximum diameter of the thorax.
p.55
Consolidation and Pneumonia
What appearance does pulmonary fibrosis give on imaging?
It can appear as a fine meshwork giving a ground-glass appearance or a coarse honeycomb appearance.
p.31
Mesothelioma Characteristics
What indicates that a pleural effusion is unlikely?
If the upper edge is lobulated and no meniscus is visible.
p.63
Consolidation and Pneumonia
What are some likely causes of miliary shadowing?
Miliary TB, sarcoid, or malignant miliary metastasis.
p.32
CT Scan Findings in Pleural Disease
What should not be visible on a CT scan?
The pleura, as they are very thin.
p.44
Volume Loss in Pulmonary Conditions
What does upper lobe blood diversion indicate?
The first sign of heart failure.
p.32
CT Scan Findings in Pleural Disease
What indicates potential pleural disease on a CT scan?
An increased grey area on the inner surface of the chest wall.
p.17
Volume Loss in Pulmonary Conditions
What is the position of the ribs and diaphragms in this case?
They are in their normal positions.
p.52
Cavitating Lung Lesions
What appearance does a normal airway have on imaging?
A white ring (the airway wall) surrounding a black hole (the air within the airway).
p.49
Volume Loss in Pulmonary Conditions
What is the primary cause of Acute Respiratory Distress Syndrome (ARDS)?
Insult to either the alveolar or endothelial cells leading to fluid leakage into the alveoli.
What should be checked on a lateral film to assess for lung collapse?
The position of the oblique and horizontal fissures.
What are common causes of lung collapse?
Pneumothorax, pleural effusion, and atelectasis.
p.51
Consolidation and Pneumonia
What do glove finger shadows resemble?
They look like the fingers of a glove and represent a group of tubular shadows seen head on.
p.61
Lung Nodules and Their Evaluation
What can chickenpox pneumonia in adulthood lead to?
The development of numerous calcified nodules.
p.49
Volume Loss in Pulmonary Conditions
What complications can arise from positive pressure ventilation in ARDS treatment?
Pneumothorax or lung cysts due to barotrauma.
p.38
Cavitating Lung Lesions
What is observed in the first study of the films?
Bilateral thin-walled cavities, some with air–fluid levels.
p.14
Volume Loss in Pulmonary Conditions
What spinal condition has developed in the patient?
A slight curvature of the spine.
p.38
Cavitating Lung Lesions
What condition caused the cavitating lung lesions in the first study?
Wegener’s granulomatosis.
p.38
Cavitating Lung Lesions
What does the second film show?
A single cavitating mass lesion in the left mid zone.
p.26
Pleural Effusion Diagnosis
How does the upper border of a pleural effusion appear?
It has a concave shape due to the meniscus.
p.40
Cavitating Lung Lesions
What indicates cavitation when examining the center of a lesion?
If the center is darker than the periphery.
p.40
Cavitating Lung Lesions
What feature should you look for to suggest the presence of a cavity?
A fluid level with a horizontal line within the lesion.
p.20
Consolidation and Pneumonia
What is an 'air bronchogram'?
It is the appearance of small airways as black against a white background in an area of consolidation.
p.26
Pleural Effusion Diagnosis
Why is a lateral view helpful in diagnosing pleural effusion?
The meniscus is often more obvious and can extend into one of the fissures.
p.31
Mesothelioma Characteristics
What are some types of pleural tumors mentioned?
Mesothelioma, primary pleural adenocarcinoma, pleural sarcoma, pleural fibromas.
p.29
Asbestos Plaques and Related Conditions
What are the characteristics of pleural plaques?
They may be predominantly soft tissue with small amounts of calcium or be heavily calcified.
p.55
Consolidation and Pneumonia
Why should HRCT be ordered even if the chest X-ray is normal?
It is more sensitive and specific for demonstrating the distribution and character of fibrosis.
p.32
CT Scan Findings in Pleural Disease
What are the two layers of the pleura?
Visceral pleura (next to the lung) and parietal pleura (next to the chest wall).
p.57
Consolidation and Pneumonia
What does ground glass density indicate in the lung?
Abnormal increased whiteness while still allowing visibility of blood vessels.
p.29
Asbestos Plaques and Related Conditions
Where are asbestos plaques commonly found in relation to the ribs?
Running along the line of the anterior portion of the ribs.
p.1
Volume Loss in Pulmonary Conditions
What condition is discussed in section 4.11?
Left ventricular failure.
How does the left lung field appear in a left lower lobe collapse?
It appears much darker than normal.
What is the primary focus of the topic 'Collapse'?
Understanding the mechanisms and consequences of lung collapse.
p.49
Volume Loss in Pulmonary Conditions
What are some causes of ARDS?
Aspiration, lung trauma, pneumonia, radiation, sepsis, drugs, drowning, fat embolism, hypersensitivity reactions, and transfusion reactions.
p.43
Volume Loss in Pulmonary Conditions
How does left ventricular failure affect the lungs?
It can lead to pulmonary congestion and edema.
p.39
Cavitating Lung Lesions
How can cavitating lung lesions be diagnosed?
Through imaging techniques such as chest X-rays or CT scans.
p.37
Lung Nodules and Their Evaluation
What is an example of a malignant tumor that can cause solitary pulmonary nodules?
Bronchial carcinoma, single secondary.
What might be observed on a lateral film during a left lower lobe collapse?
A white triangle at the bottom posterior corner of the lung fields.
p.61
Lung Nodules and Their Evaluation
Where do nodules tend to be located in chickenpox pneumonia?
In the lower and mid zones of the lungs.
p.30
Mesothelioma Characteristics
What does the chest X-ray demonstrate?
Lobulated pleural thickening around the upper, mid, and basal right lung.
p.20
Consolidation and Pneumonia
What does non-uniform shadowing with poorly demarcated borders indicate?
It may suggest consolidation, fibrosis, or another infiltrative condition.
p.15
Volume Loss in Pulmonary Conditions
How does the contralateral lung field appear on an X-ray after a pneumonectomy?
It appears hyperinflated and darker than usual.
p.14
Volume Loss in Pulmonary Conditions
What happens to the right lung in this patient?
It becomes hyperinflated.
p.44
Volume Loss in Pulmonary Conditions
What is a strong indicator of heart failure when assessing heart size?
Left ventricular dilation.
p.14
Volume Loss in Pulmonary Conditions
What unusual lung positioning is noted in the right lung?
Some of the lung crosses over the midline.
p.15
Volume Loss in Pulmonary Conditions
What should be examined regarding the ribs in a patient who has had a pneumonectomy?
Look for rib deformity or absence, particularly of the 5th rib.
p.16
Volume Loss in Pulmonary Conditions
How does the remaining lung appear compared to the left lung?
It is of increased blackness due to hyperinflation.
p.15
Volume Loss in Pulmonary Conditions
What is a rare cause of a similar appearance to pneumonectomy on an X-ray?
Extensive hypoplasia or congenital absence of one lung.
p.47
Consolidation and Pneumonia
What should be observed in the chest X-ray to suspect ARDS?
Bilateral white shadows in both lungs.
p.35
Lung Nodules and Their Evaluation
What does the presence of calcification in a lung nodule indicate?
Calcification is rare in malignant lesions and suggests an alternative diagnosis.
p.53
Cavitating Lung Lesions
What condition is often associated with proximal bronchiectasis?
Allergic bronchopulmonary aspergillosis (ABPA).
p.26
Pleural Effusion Diagnosis
What is the recommended method to confirm the presence of pleural fluid?
Request an ultrasound of the chest.
p.53
Cavitating Lung Lesions
What are some structural causes of bronchiectasis?
Obstruction due to carcinoma or foreign body.
p.47
Consolidation and Pneumonia
What should be checked for the presence of pleural effusion in ARDS?
Look carefully at the edge of the diaphragm for loss of the normal costophrenic angle.
p.32
CT Scan Findings in Pleural Disease
How does a small pleural effusion appear on a CT scan?
It usually lies against the posterior chest wall when the patient is lying flat.
p.36
Lung Nodules and Their Evaluation
Where is the coin lesion located in relation to the oblique fissure?
It lies on the oblique fissure and in front of it.
What change occurs to the heart shadow in a left lower lobe collapse?
The heart shadow appears much whiter than normal.
p.25
Pleural Effusion Diagnosis
What is the treatment for pleural effusion?
Treatment may include diuretics, thoracentesis, or addressing the underlying cause.
How is a collapsed lung diagnosed?
Through physical examination and imaging tests like chest X-rays or CT scans.
p.45
Consolidation and Pneumonia
What may be present in cases of generalized shadowing due to severe pulmonary edema?
Upper lobe blood diversion and Kerley B lines.
p.27
Pleural Effusion Diagnosis
What is the protein level that classifies a pleural effusion as a transudate?
Less than 30 g/l of protein.
What changes are often seen in the pleura with asbestos lung diseases?
Pleural thickening and calcified pleural plaques.
p.63
Consolidation and Pneumonia
What is miliary shadowing in the lungs?
A condition where the lungs have a spotted appearance due to discrete opacities.
p.38
Cavitating Lung Lesions
How does the wall of the lesion in the second film compare to the first?
It has a much thicker wall.
p.63
Consolidation and Pneumonia
What characteristics of opacities indicate miliary shadowing?
The opacities should be discrete, of similar density and size.
What is crucial for the accuracy of HRCT scan interpretations?
The skill of the interpreter, requiring assessment by experienced radiologists.
p.40
Cavitating Lung Lesions
Why are lateral films useful in identifying cavities?
Cavities and fluid levels are often easier to see on lateral views, especially if they are posterior or inferior.
How do the airway walls in pulmonary fibrosis differ from those in bronchiectasis?
In pulmonary fibrosis, the walls do not appear thickened.
p.20
Consolidation and Pneumonia
How does the distribution of shadowing in consolidation change?
Consolidation gets denser as one moves down the lung, with a clearer demarcation at the lower border.
What does a pulled-up horizontal fissure in the right lung suggest?
Right upper lobe collapse.
p.44
Volume Loss in Pulmonary Conditions
What is a common mistake when interpreting upper lobe blood diversion on a supine film?
Assuming it indicates heart failure, when it is normal in that position.
p.29
Asbestos Plaques and Related Conditions
Where is pleural thickening easiest to identify?
At the periphery of the lungs, appearing as a thickened line around the edge.
p.29
Asbestos Plaques and Related Conditions
What anatomical feature should be compared to identify the origin of whiteness in lung imaging?
Intrapulmonary structures, such as lobes of the lung.
p.1
CT Scan Findings in Pleural Disease
What imaging technique is discussed in section 4.8?
CT scan findings in pleural disease.
What is the primary cause of lung collapse?
A buildup of air or fluid in the pleural space.
p.56
Cavitating Lung Lesions
What pattern is observed on CT images indicating fibrosis?
A honeycomb pattern with small black holes around the lung edges.
p.51
Consolidation and Pneumonia
Where are tramline shadows typically found on a chest X-ray?
Towards the periphery of the lung.
What pattern does the film demonstrate in pulmonary fibrosis?
A fine meshwork pattern over the lungs.
p.43
Volume Loss in Pulmonary Conditions
What can cause left ventricular failure?
Coronary artery disease, hypertension, and heart valve disorders.
p.39
Cavitating Lung Lesions
What are common causes of cavitating lung lesions?
Infections, such as tuberculosis or fungal infections, and certain types of lung cancer.
p.34
Lung Nodules and Their Evaluation
Why does the lung nodule need to be investigated?
It may represent a small tumour.
What is a characteristic appearance of interlobular septa in lymphangitis carcinomatosis?
Irregular thickening of the interlobular septa.
How is a lung collapse diagnosed?
Through physical examination and imaging tests like chest X-rays.
p.15
Volume Loss in Pulmonary Conditions
What happens to the trachea in a pneumonectomy?
It shifts to the side of the pneumonectomy.
p.39
Cavitating Lung Lesions
What is the significance of identifying a cavitating lung lesion?
It can indicate serious underlying conditions that require further investigation and treatment.
p.55
Consolidation and Pneumonia
What distribution of shadowing may indicate fibrosis?
Shadowing that is mid zone or apical.
p.3
Volume Loss in Pulmonary Conditions
What happens to the vessels in the over-inflated lobe due to volume loss?
The vessels become more spread out.
p.3
Volume Loss in Pulmonary Conditions
Why is detecting volume loss considered difficult?
It is a subtle sign that may not be easily noticeable.
p.40
Cavitating Lung Lesions
What should you compare to identify cavitation in a coin lesion?
The center of the lesion to the periphery.
p.45
Consolidation and Pneumonia
What is a characteristic feature of non-cardiogenic pulmonary edema regarding peripheral sparing?
There will not necessarily be sparing of the peripheries.
p.63
Consolidation and Pneumonia
What should you look for in the distribution of shadowing to determine if it is pathological?
If the shadowing is present in the periphery, it is more likely to be pathological.
p.53
Cavitating Lung Lesions
What is a characteristic appearance of mucus plugs in bronchiectasis on HRCT?
They may have a solid appearance and can be darker than the airway wall.
p.44
Volume Loss in Pulmonary Conditions
What are Kerley B lines indicative of?
Oedema of the interlobular septa.
p.21
Consolidation and Pneumonia
What should be arranged if a patient has persistent symptoms or is at risk of malignancy after 6 weeks?
A follow-up X-ray should be arranged to ensure complete resolution.
p.38
Cavitating Lung Lesions
Why is the thickness of the wall significant in the second film?
It makes a cavitating tumour a more likely diagnosis.
p.63
Consolidation and Pneumonia
In miliary TB, where are the opacities most profuse?
In the upper zone of the lungs.
p.40
Cavitating Lung Lesions
What is a characteristic feature of cavity walls in neoplasms?
Cavity walls are often thicker than 5 mm.
p.57
Lung Nodules and Their Evaluation
What is 'beading' in the context of sarcoidosis?
Nodules may coalesce to form masses and be seen along the fissures.
p.40
Cavitating Lung Lesions
What does the presence of a white ball inside a cavity suggest?
It is characteristic of an aspergilloma.
What does a blurred heart border indicate?
Collapse of the lung adjacent to the heart.
What should be the position of the trachea in a normal X-ray?
The trachea should be central.
p.29
Asbestos Plaques and Related Conditions
What is a key feature of pleural plaques along the diaphragm?
They are often calcified, with streaks of dense white material indicating their presence.
Where does sarcoidosis predominantly cause changes in the lungs?
In the mid zones and around the hila.
p.43
Volume Loss in Pulmonary Conditions
What is a common treatment for left ventricular failure?
Medications such as diuretics, ACE inhibitors, and beta-blockers.
p.37
Lung Nodules and Their Evaluation
What infections can lead to solitary pulmonary nodules?
Pneumonia, abscess, tuberculosis, hydatid cyst.
p.55
Consolidation and Pneumonia
What lung size change is associated with fibrosis?
Fibrosis may cause shrinkage of the lungs.
What is the shape of the area of whiteness seen in right middle lobe collapse?
A triangular area with its apex at the hilum.
Why is it important to identify lung collapse on an X-ray?
It indicates possible serious pathology.
Where does the base of the triangular area of whiteness run in right middle lobe collapse?
Between the sternum and the diaphragm.
p.27
Pleural Effusion Diagnosis
What condition is an example of a cause for transudate pleural effusion related to heart issues?
Congestive cardiac failure.
p.53
Consolidation and Pneumonia
What are the changes in lung parenchyma associated with bronchiectasis?
Atelectasis, 'tree in bud' appearance, and larger patches of consolidation.
What is a key indicator of right-sided lung collapse?
The right lung should be larger than the left; if not, suspect collapse.
p.55
Consolidation and Pneumonia
How do vascular markings change in areas of fibrosis?
They become less distinct due to the development of small areas of lung collapse.
p.40
Cavitating Lung Lesions
What can old films reveal about a lesion?
They may show the cavity developing if the lesion is longstanding.
p.47
Consolidation and Pneumonia
What feature may indicate consolidation in ARDS?
The presence of an air bronchogram.
p.32
CT Scan Findings in Pleural Disease
What does it mean if pleural density is the same as the chest wall?
It is more likely to be pleural thickening.
What characterizes idiopathic pulmonary fibrosis and asbestosis in terms of fibrotic distribution?
They are characterized by patchy distribution and subpleural, predominantly basal, fibrotic changes.
p.32
CT Scan Findings in Pleural Disease
What does lobulated margins of pleural density suggest?
It is more likely to be a malignancy.
p.45
Consolidation and Pneumonia
What is a key difference between severe heart failure and non-cardiogenic pulmonary edema?
In non-cardiogenic pulmonary edema, the heart size is likely to be normal.
p.55
Consolidation and Pneumonia
How does fibrosis affect the shape of the mediastinum?
It pulls the mediastinum and distorts the outline.
p.15
Volume Loss in Pulmonary Conditions
What should be noted about the diaphragm on the side of the pneumonectomy?
The upper border of the diaphragm should not be visible.
p.55
Consolidation and Pneumonia
What type of shadowing is characteristic of pulmonary fibrosis?
Reticular-nodular shadowing.
p.26
Pleural Effusion Diagnosis
How can you differentiate a pleural effusion from a raised hemidiaphragm?
The upper border of an effusion peaks more laterally than the diaphragm.
p.27
Pleural Effusion Diagnosis
Which malignancies can cause exudate pleural effusion?
Bronchial carcinoma, mesothelioma, and metastasis.
What is a characteristic feature of pulmonary fibrosis around the airways?
There is a lot of inflammation that can pull the airway walls apart, known as traction airway change.
p.31
Mesothelioma Characteristics
What volume change may increase suspicion of mesothelioma?
Loss of volume on the affected side.
p.57
Lung Nodules and Their Evaluation
What type of lung nodules can occur in pulmonary fibrosis?
Very small lung nodules that may be well defined or slightly hazy.
p.47
Consolidation and Pneumonia
How can heart size help distinguish ARDS from left ventricular failure?
In left ventricular failure, the heart is usually enlarged; in ARDS, it may be normal size.
p.47
Consolidation and Pneumonia
What is the distribution of shadowing in left ventricular failure compared to ARDS?
In left ventricular failure, it tends to be more central; in ARDS, it is more peripheral.
p.53
Cavitating Lung Lesions
What infections can lead to bronchiectasis?
Childhood pertussis, measles, tuberculosis, and pneumonia.
How can a radiologist determine the aetiology of pulmonary fibrosis?
By examining the distribution of fibrotic changes in HRCT images.
p.29
Asbestos Plaques and Related Conditions
How do pleural plaques differ from pleural effusions in appearance?
Pleural plaques are patchy in nature, while pleural effusions are more uniform.
What is a tension pneumothorax?
A life-threatening condition where air enters the pleural space and cannot escape, leading to increased pressure.
p.56
Cavitating Lung Lesions
What is one of the first changes observed on the pleura surface indicating fibrosis?
Development of small irregular lumps on the pulmonary surface of the pleura.
p.26
Pleural Effusion Diagnosis
What are the possible causes of an area of whiteness at the base of a lung?
Pleural effusion, raised hemidiaphragm, or area of consolidation/collapse.
p.42
Consolidation and Pneumonia
What do the horizontal septal lines in the magnified image indicate?
They are characteristic of pulmonary edema.
p.26
Pleural Effusion Diagnosis
What texture indicates consolidation on an X-ray?
More heterogeneous shadowing with the presence of an air bronchogram.
p.61
Lung Nodules and Their Evaluation
What are some causes of numerous calcified nodules?
Infection (e.g., TB, histoplasmosis, chickenpox), inhalation (e.g., silicosis), chronic renal failure, lymphoma following radiotherapy, chronic pulmonary venous hypertension in mitral stenosis.
p.35
Lung Nodules and Their Evaluation
What is a lung nodule?
A discrete area of whiteness situated within a lung field, less than 3 cm in diameter.
p.44
Volume Loss in Pulmonary Conditions
Where are Kerley B lines best seen?
At the periphery of the lung just above the costophrenic angle.
p.53
Cavitating Lung Lesions
What does localized bronchiectasis in one lobe suggest?
It could be due to an obstructive lesion requiring further investigation.
p.47
Consolidation and Pneumonia
How is the shadowing in ARDS typically described?
Fairly ill-defined, making it difficult to see a clear edge.
p.63
Consolidation and Pneumonia
What can mimic interstitial shadowing in normal lungs?
Normal vasculature, usually occurring towards the center of the lung fields.
p.35
Lung Nodules and Their Evaluation
What should be assessed peripheral to a lung nodule?
Look for problems distal to it, such as infection or collapse.
p.35
Lung Nodules and Their Evaluation
How can old films help in assessing a lung nodule?
Comparing size over time can indicate growth; if unchanged for two years, it is unlikely to be malignant.
p.47
Consolidation and Pneumonia
Why is reviewing old films important in diagnosing ARDS?
A large heart and pleural effusion may indicate left ventricular failure as a more likely diagnosis.
p.1
Volume Loss in Pulmonary Conditions
What syndrome is covered in section 4.12?
Acute respiratory distress syndrome.
p.56
Cavitating Lung Lesions
What happens to the airways in the presence of fibrosis?
The airways are pulled apart and the usual smooth curve of the fissure is lost.
What can HRCT scans accurately determine?
The aetiology of interstitial lung disease.
p.20
Consolidation and Pneumonia
What happens to alveolar spaces in consolidation?
They become filled with fluid, making them appear white.
p.16
Volume Loss in Pulmonary Conditions
What change occurred to the right diaphragm?
It has changed shape, known as diaphragmatic tenting.
p.21
Consolidation and Pneumonia
What should be done if there is persistent consolidation after 6 weeks?
Further investigations should be arranged to exclude malignancy.
p.55
Consolidation and Pneumonia
What is the established test for patients with pulmonary fibrosis?
HRCT (High-Resolution Computed Tomography).
p.35
Lung Nodules and Their Evaluation
What is an air bronchogram and what does it indicate?
It is a sign of consolidation and would be unusual if the lesion was a tumor.
p.29
Asbestos Plaques and Related Conditions
How can isolated pleural thickening affect lung imaging?
It can cause a localized area of white lung and can be difficult to separate from lung shadows.
p.35
Lung Nodules and Their Evaluation
What does the presence of multiple coin nodules suggest?
It strongly suggests metastatic disease.
p.35
Lung Nodules and Their Evaluation
What additional findings may be associated with malignant tumors on an X-ray?
Mediastinal lymphadenopathy or bone metastasis.
p.26
Pleural Effusion Diagnosis
What should you check on an X-ray if you diagnose a pleural effusion?
Size of the heart, hilum for enlargement, lung fields for masses, and bones for metastasis.
p.44
Volume Loss in Pulmonary Conditions
How should the upper lobe blood vessels compare to lower lobe vessels in a healthy individual?
Upper lobe vessels should be narrower than lower lobe vessels.
p.44
Volume Loss in Pulmonary Conditions
What causes upper lobe blood diversion?
Lower zone arteriolar vasoconstriction secondary to alveolar hypoxia.
p.29
Asbestos Plaques and Related Conditions
In which regions are pleural plaques most prevalent?
Mid zones and axillary region of the mid chest.
p.32
CT Scan Findings in Pleural Disease
What happens to the lung with a larger pleural effusion?
It surrounds the lung and compresses it, causing some outer regions to become solid.
p.31
Mesothelioma Characteristics
What is a characteristic feature of extensive pleural thickening?
It encases the lung and tracks into the fissures.
p.1
Pneumocystis Carinii Pneumonia
Which pneumonia is covered in section 4.4?
Pneumocystis carinii (jiroveci) pneumonia.
What appearance does the lung have in late-stage pulmonary fibrosis?
A 'honeycomb' appearance with areas of black air surrounded by a thicker white border.
p.57
Consolidation and Pneumonia
What can ground glass density represent?
Very fine fibrotic change or transient abnormalities such as infection or fluid.
p.32
CT Scan Findings in Pleural Disease
What does smooth margins of pleural density indicate?
It may be pleural fluid or pleural thickening.
p.29
Asbestos Plaques and Related Conditions
What should be noted about the edges of pleural plaques?
They should be well defined, unlike 'companion shadows' which have poorly defined margins.
How is a collapsed lung diagnosed?
Through physical examination and imaging tests like chest X-rays or CT scans.
p.23
Pneumocystis Carinii Pneumonia
In PCP, where does the whiteness typically not extend?
To the apices or affect the costophrenic angles.
p.53
Cavitating Lung Lesions
What should be considered when interpreting HRCT scans for bronchiectasis?
The extent of the disease and the clinical history of the patient.
p.47
Consolidation and Pneumonia
What are Kerley B lines and their significance in diagnosing ARDS?
They are more common in left ventricular failure but can occur in ARDS.
p.23
Pneumocystis Carinii Pneumonia
What does large areas of whiteness in lung fields indicate in PCP?
Large areas of consolidation as the disease progresses.
p.29
Asbestos Plaques and Related Conditions
Why is it important to look at old X-rays when diagnosing pleural plaques?
Pleural plaques are slow growing and are probably visible on previous X-rays.
What are potential treatments for a collapsed lung?
Observation, needle decompression, or chest tube insertion.
p.23
Pneumocystis Carinii Pneumonia
What symptoms should raise suspicion for PCP despite a normal chest X-ray?
Shortness of breath and hypoxia.
p.56
Cavitating Lung Lesions
What are septal lines and how are they related to fibrosis?
Thin white lines, 1–2 cm in length, that are perpendicular to the pleura, indicating fibrosis.
p.23
Pneumocystis Carinii Pneumonia
What is peribronchial cuffing and how does it appear in PCP?
Increased whiteness within the walls of the airways, giving a thickened or fuzzy appearance.
p.23
Pneumocystis Carinii Pneumonia
What lung volume change may indicate early PCP?
Reduced volume in both lungs.
p.23
Pneumocystis Carinii Pneumonia
How do blood vessels appear in the hilum area in PCP?
Less well defined than normal.
