Radiology of Chest Diseases Part 1

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Questions and Answers

What does pneumothorax refer to?

Fluid accumulation in the pleural space

Complete lung collapse

Presence of gas in the pleural space (correct)

Presence of blood in the pleural cavity

Which imaging technique is best for easily identifying pneumothorax?

Plain radiography

MRI

Ultrasound

CT scan (correct)

What is the primary limitation of X-ray in detecting rib fractures?

It is too expensive.

It requires advanced technology.

It can miss up to 50% of rib fractures. (correct)

It creates too much radiation exposure.

What characteristic on a plain radiograph indicates a presence of pneumothorax?

Thin white line along the pleural edge Signup and view all the answers

Which imaging technique provides the best sensitivity for detecting rib fractures?

CT Signup and view all the answers

What characteristic feature is seen in a patient with pectus excavatum on X-ray?

Displacement of heart towards the left Signup and view all the answers

In lobar pneumonia, what is generally observed on a plain radiograph?

Homogeneous opacification in a lobar pattern Signup and view all the answers

What does the Haller index assess in patients with pectus excavatum?

Degree of sternal deformity Signup and view all the answers

What indicates moderate disease onset in COVID-19 on a plain radiograph?

Airspace opacities often described as consolidation Signup and view all the answers

What is a common radiographic sign of pleural effusion seen on plain X-ray?

Blunting of the costophrenic angle Signup and view all the answers

What appears in lobar pneumonia on CT imaging?

Focal dense opacification with airway sparing Signup and view all the answers

What advantage does ultrasound have over X-ray in the assessment of pleural fluid?

Identification of small amounts of fluid Signup and view all the answers

What is the definitive diagnostic test for COVID-19?

RT-PCR test Signup and view all the answers

What is a common complication that may accompany pneumothorax?

Subcutaneous emphysema Signup and view all the answers

Which of the following imaging techniques can best identify underlying intrathoracic conditions associated with pleural effusion?

CT scan Signup and view all the answers

How much fluid must accumulate before X-ray can reliably detect pleural effusion?

50 mL Signup and view all the answers

Which type of emphysema is most commonly associated with smoking?

Centrilobular emphysema Signup and view all the answers

What feature is typically found on a plain radiograph of emphysema?

Lung hyperinflation Signup and view all the answers

What characterizes paraseptal emphysema in terms of its location?

It is located adjacent to the pleura and septal lines. Signup and view all the answers

Which type of emphysema is characterized by damage across the entire secondary pulmonary lobule?

Panlobular emphysema Signup and view all the answers

Which radiographic finding is indicative of emphysema on a plain radiograph?

Lung hyperinflation with flattened hemidiaphragms. Signup and view all the answers

In which lung zones does centrilobular emphysema predominantly occur?

Upper zones Signup and view all the answers

Which of the following descriptions is true regarding the size of lucencies in paraseptal emphysema?

Lucencies up to 10 mm are present, with larger ones termed subpleural blebs/bullae. Signup and view all the answers

What CT feature is used to identify centrilobular emphysema?

Focal lucencies located centrally within lobules Signup and view all the answers

Which of the following signs indicates hyperinflation in emphysema on a chest radiograph?

Flattened hemidiaphragm Signup and view all the answers

What is a distinguishing feature of chronic bronchitis observable on CT imaging?

Bronchial wall thickening and irregularity. Signup and view all the answers

Which clinical phenotype is NOT a component of Chronic Obstructive Pulmonary Disease (COPD)?

Asthma predominant. Signup and view all the answers

What condition may develop from paraseptal emphysema?

Spontaneous pneumothorax Signup and view all the answers

What change in pulmonary vasculature is commonly seen in emphysema patients?

Paucity of blood vessels Signup and view all the answers

What is the characteristic appearance of cylindrical bronchiectasis on imaging?

Uniform caliber bronchi with parallel walls Signup and view all the answers

Which CT feature indicates potential bronchiectasis when visualizing the bronchus?

Bronchus visualized within 1 cm of pleural surface Signup and view all the answers

What is a common underlying cause of bronchiectasis?

Chronic inflammation Signup and view all the answers

Which of the following accurately describes varicose bronchiectasis?

Beaded appearance with interspersed sites of narrowing Signup and view all the answers

What is a common CT sign associated with cylindrical bronchiectasis?

Tram-track sign Signup and view all the answers

Which statement regarding plain radiographs and bronchiectasis is true?

They show tram-track opacities indicating bronchiectasis. Signup and view all the answers

What defines the increased bronchoarterial ratio indicative of bronchiectasis?

Bronchus diameter of approximately 0.65 to 1.0 times that of the artery Signup and view all the answers

Which term is NOT associated with the morphologic classification of bronchiectasis?

Focal bronchiectasis Signup and view all the answers

Study Notes

Radiology of Selected Diseases (Part 1)

This presentation covers the radiology of various diseases affecting the chest, including chest wall, pleural, pulmonary, and airway diseases.
The presenter is Dr. Hajer Mohamed Sabri Abdullatif, an Assistant Professor of Physical Therapy at Aqaba University of Technology, Jordan
A table of contents is provided, listing the topics: Chest Wall Diseases, Pleural Diseases, Pulmonary Diseases, and Airway Diseases.

Chest Wall Diseases

Rib Fractures: Caused by trauma and can lead to life-threatening complications.
- X-rays can sometimes miss up to 50% of rib fractures, showing discontinuity of the rib cortex.
- CT scans are more sensitive for detecting rib fractures than plain X-rays.
Pectus Excavatum (Funnel Chest): A congenital chest wall deformity characterized by a concave depression of the sternum.
- X-rays show blurring of the right heart border, increased density in the inferomedial lung zone, and altered rib (horizontal and vertical) formation, along with possible heart displacement.
- CT scan is used to determine the severity of the condition with the Haller Index that measures the maximal transverse diameter divided by the narrowest AP length of the chest and assessing the sternum's incursion into the mediastinum.

Pleural Diseases

Pleural Effusion: Abnormal fluid accumulation in the pleural space, often arising from various pathological processes that exceed the pleura's reabsorption capacity.
- Plain X-rays show blunting of the costophrenic and cardiophrenic angles, fluid within the fissures, and, in substantial effusions, mediastinal shift away from the effusion. Shift occurs towards the effusion if the collapse is dominant.
- CT scans are helpful for detecting small amounts of fluid and identifying the underlying causes, including malignant pleural deposits, primary lung neoplasms, and subdiaphragmatic diseases.
- Ultrasound aids in distinguishing fluid from thickened pleura and is helpful in guiding thoracocentesis, even for small fluid collections.
Pneumothorax: Presence of air in the pleural space, with potential to compress mediastinal structures and be life-threatening.
- Plain X-rays exhibit a thin, sharp white line representing the visceral pleural edge, lack of lung markings outside the border of this line, and possible lung collapse.
- Mediastinal shift may or may not occur depending on whether a tension pneumothorax is present.
- CT scans help identify pneumothorax with ease, particularly in identifying loculated pneumothoraces if bullous disease is present.

Pulmonary Diseases

Lobar Pneumonia: Homogenous and fibrinosuppurative consolidation of one or more lung lobes, arising from bacterial pneumonia.
- Plain X-rays show homogeneous opacification in a lobar pattern, potentially defined sharply at the fissures.
- This consolidation often involves segmental areas, resulting in air bronchograms on X-rays.
- CT scans show focal dense opacification of the lobe, with less opacity around the major airways.
COVID-19: Caused by the SARS-CoV-2 virus.
- Definitive diagnosis requires a positive RT-PCR test; CT scans are not commonly used for diagnosis but are useful to detect complications.
- Radiographic findings in early/mild disease may be normal; however, typical symptoms manifest as airspace opacities, usually bilateral, peripheral, and lower-zone predominant, either as consolidation or ground-glass opacity (GGO) that show as ground glass or crazy-paving appearance. Associated findings on CT may be subpleural, crazy-paving, and airspace consolidations, bronchovascular thickening in the lesion, and traction bronchiectasis.
- CO-RADS is a scoring system used to assess the level of suspicion for COVID-19 based on CT findings.

Airway Diseases

Bronchiectasis: Irreversible abnormal dilation of the bronchial tree, arising from inflammation with varying underlying causes.
- High-resolution CT is the most accurate modality to diagnose bronchiectasis.
- X-rays are often abnormal, showing tram-track opacities in cylindrical patterns, air-fluid levels in cystic bronchiectasis, increasing bronchovascular markings, and bronchi seen end-on, shaped like rings.
- Using high-resolution CT, bronchus, visualized within 1 cm of the pleural surface, especially adjacent to the costal pleura, most helpful for early change. Further assessing lack of tapering and measuring bronchoarterial ratios (>1.5 indicates bronchiectasis) is helpful for diagnosis. Ancillary findings may include abnormal bronchial wall thickening, mucoid impaction, air trapping, mosaic perfusion, and tram-track, signet ring, string of pearls, and cluster of grapes signs.
Emphysema: Abnormal permanent enlargement of airspaces distal to terminal bronchioles, without obvious fibrosis, usually an entity in chronic obstructive pulmonary disease (COPD).
- Plain X-rays are non-specific but show hyperinflation (flattened hemidiaphragms, increased radiolucency, increased retrostemal airspace, widely spaced ribs, stermal bowing and tenting of the diaphragm), and vascular changes (paucity, distortion, pulmonary hypertension, pruning of peripheral vessels, and right ventricular enlargement).
- CT scans are helpful to distinguish between centrilobular, panlobular, and paraseptal emphysema. Centrilobular has a patchy distribution within the upper lung lobes, and has lucencies (spaces). Panlobular has a uniform distribution primarily within the lower lobes. Paraseptal involves the peripheral portion of the secondary lobules and has lucencies next to the pleural surfaces and mediastinum.

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Description

This quiz focuses on the radiology associated with various chest diseases, including chest wall, pleural, pulmonary, and airway conditions. It covers key topics such as rib fractures and the congenital deformity of pectus excavatum, providing insights into diagnostic imaging techniques like X-rays and CT scans. Perfect for students and professionals in the field of radiology and physical therapy.