Podcast
Questions and Answers
Where is paraseptal emphysema predominantly located?
Where is paraseptal emphysema predominantly located?
What size of lucency is classified as subpleural blebs or bullae?
What size of lucency is classified as subpleural blebs or bullae?
Which component is NOT part of the spectrum of Chronic Obstructive Pulmonary Disease (COPD)?
Which component is NOT part of the spectrum of Chronic Obstructive Pulmonary Disease (COPD)?
Which finding is indicative of emphysema on a plain radiograph?
Which finding is indicative of emphysema on a plain radiograph?
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What is observed on a CT scan in chronic bronchitis?
What is observed on a CT scan in chronic bronchitis?
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What imaging modality is considered the most accurate for diagnosing bronchiectasis?
What imaging modality is considered the most accurate for diagnosing bronchiectasis?
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Which of the following describes the appearance of cylindrical bronchiectasis on imaging?
Which of the following describes the appearance of cylindrical bronchiectasis on imaging?
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What is a common etiology of bronchiectasis?
What is a common etiology of bronchiectasis?
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Which of the following CT findings indicates the presence of bronchiectasis?
Which of the following CT findings indicates the presence of bronchiectasis?
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What bronchial wall thickness measurement indicates possible bronchiectasis?
What bronchial wall thickness measurement indicates possible bronchiectasis?
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Which feature is NOT associated with cystic bronchiectasis?
Which feature is NOT associated with cystic bronchiectasis?
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What sign is associated with identifying cylindrical bronchiectasis on imaging?
What sign is associated with identifying cylindrical bronchiectasis on imaging?
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Which of the following is a characteristic of crazy paving appearance in CT findings?
Which of the following is a characteristic of crazy paving appearance in CT findings?
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What is a common radiographic finding in rib fractures on X-ray?
What is a common radiographic finding in rib fractures on X-ray?
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Which imaging technique is more sensitive for detecting rib fractures compared to X-ray?
Which imaging technique is more sensitive for detecting rib fractures compared to X-ray?
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What characteristic is associated with Pectus Excavatum on X-ray?
What characteristic is associated with Pectus Excavatum on X-ray?
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In the context of pleural effusion, what does a blunting of the costophrenic angle indicate?
In the context of pleural effusion, what does a blunting of the costophrenic angle indicate?
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Which statement about pneumothorax is correct?
Which statement about pneumothorax is correct?
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Which imaging modality is capable of detecting small amounts of pleural fluid, as little as 3-5 mL?
Which imaging modality is capable of detecting small amounts of pleural fluid, as little as 3-5 mL?
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What does the Haller index assess in patients with Pectus Excavatum?
What does the Haller index assess in patients with Pectus Excavatum?
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What finding is typically seen with pleural diseases on a plain radiograph for pneumothorax?
What finding is typically seen with pleural diseases on a plain radiograph for pneumothorax?
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What occurs with large volume pleural effusions in terms of mediastinal shift?
What occurs with large volume pleural effusions in terms of mediastinal shift?
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What is a characteristic feature of lobar pneumonia?
What is a characteristic feature of lobar pneumonia?
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Which of the following is NOT a characteristic sign of rib fractures as observed in imaging?
Which of the following is NOT a characteristic sign of rib fractures as observed in imaging?
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What is the definitive method to diagnose COVID-19?
What is the definitive method to diagnose COVID-19?
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Which of the following is a common presentation of lobar pneumonia on a CT scan?
Which of the following is a common presentation of lobar pneumonia on a CT scan?
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In which situation might CT chest be useful during a COVID-19 assessment?
In which situation might CT chest be useful during a COVID-19 assessment?
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Which statement is true regarding atelectasis in the context of lobar pneumonia?
Which statement is true regarding atelectasis in the context of lobar pneumonia?
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Which of the following is NOT a typical radiological finding in a tension pneumothorax?
Which of the following is NOT a typical radiological finding in a tension pneumothorax?
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What characterizes centrilobular emphysema in terms of its primary location?
What characterizes centrilobular emphysema in terms of its primary location?
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Which of the following features is NOT associated with hyperinflation in emphysema?
Which of the following features is NOT associated with hyperinflation in emphysema?
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What is the most common type of emphysema?
What is the most common type of emphysema?
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What imaging technique is best for evaluating emphysema?
What imaging technique is best for evaluating emphysema?
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Panlobular emphysema is primarily associated with which location in the lungs?
Panlobular emphysema is primarily associated with which location in the lungs?
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Paraseptal emphysema typically affects which areas of the lungs?
Paraseptal emphysema typically affects which areas of the lungs?
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What is a distinguishing feature of panlobular emphysema compared to centrilobular emphysema?
What is a distinguishing feature of panlobular emphysema compared to centrilobular emphysema?
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What is a common cardiovascular manifestation associated with emphysema?
What is a common cardiovascular manifestation associated with emphysema?
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Study Notes
Radiology of Selected Diseases (Part 1)
- The presentation covers radiology of various diseases affecting the chest, including chest wall, pleural, pulmonary, and airway diseases.
Table of Contents
- Chest Wall Diseases: Includes topics like rib fractures, and pectus excavatum.
- Pleural Diseases: Discusses pleural effusion and pneumothorax.
- Pulmonary Diseases: Covers lobar pneumonia (non-segmental pneumonia) and COVID-19.
- Airway Diseases: Focuses on bronchiectasis and emphysema.
Chest Wall Diseases
-
Rib Fractures:
- Trauma-induced, potentially life-threatening.
- X-rays may miss up to 50% of rib fractures, showing discontinuity of the rib cortex.
- CT is more sensitive for detecting rib fractures than plain radiography.
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Pectus Excavatum:
- Congenital chest wall deformity characterized by a concave depression of the sternum.
- X-rays show blurring of the right heart border, increased density of the inferomedial lung zone, horizontal posterior ribs, and vertical anterior ribs (heart-shaped).
- Displacement of the heart to the left and obliteration of the descending aortic interface occur.
- CT is useful in diagnosing this, often with significant mediastinal shift.
- The Haller index (HI) is used to assess the severity of the sternum's incursion into the mediastinum.
Pleural Diseases
-
Pleural Effusion:
- Abnormal fluid accumulation within the pleural space, often from processes exceeding the pleura's reabsorption capacity.
- Plain x-rays reveal blunting of the costophrenic and cardiophrenic angles, fluid in fissures, and mediastinal shift (away from the effusion if large).
- CT is good for detecting small amounts of fluid, and identifying underlying causes (e.g., malignancies).
- Ultrasound is effective in differentiating fluid from pleural thickening, and guiding procedures like thoracocentesis (even in small collections).
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Pneumothorax:
- Presence of air in the pleural space, causing mediastinal structures to compress.
- Plain x-rays show a sharp white visceral pleural line, lack of lung markings peripheral to it, and radiolucent adjacent lung.
- Lung collapse is possible. Mediastinal shift away from the pneumothorax may occur unless it's a tension pneumothorax.
- CT is effective in detecting it and identifying bullous diseases.
Pulmonary Diseases
-
Lobar Pneumonia:
- Homogeneous and fibrinosuppurative consolidation of one or more lung lobes, often from bacterial infection.
- Plain x-rays show homogeneous opacification, sharply defined at fissures, more commonly segmental consolidation, non-opacified bronchus, and air bronchograms. Consolidation isn't necessarily associated with volume loss but atelectasis can occur with small airways constriction.
- CT shows focal dense opacification of most of a lobe while sparing large airways. Possible ground glass opacity in the involved areas suggesting partial involvement or atelectasis.
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COVID-19:
- Infection caused by SARS-CoV-2.
- Definitive diagnosis via RT-PCR tests. CT scans aren't used for diagnosis but can assess complications.
- Initial phase x-rays may appear normal. More advanced cases show airspace opacities, which can be bilateral, peripheral, and lower zone predominant, which could also be ground-glass opacities (GGOs) or consolidation.
- CT findings can include ground-glass opacities (GGOs), often bilateral and subpleural; crazy-paving appearance; intra-lobular and inter-lobular thickening; air space consolidation; bronchovascular thickening; and traction bronchiectasis.
Airway Diseases
-
Bronchiectasis:
- Irreversible dilatation of the bronchial tree (chronic inflammation)
- CT is best diagnostic modality, potentially showing bronze visualization within 1 cm from the pleural surface. Especially true for the lung close to the costal pleura. The diameter of a bronchus should measure approximately 0.65-1.0 times that of the adjacent pulmonary artery branch (bronchoarterial ratio). A value greater than 1.5 suggests bronchiectasis.
- Findings on CT scans include tram-track signs, signet ring signs, string of pearls, and cluster of grapes signs.
- Plain x-rays may show abnormalities, but aren't conclusive. Possible tram-track opacities in cylindrical bronchiectasis and air-fluid levels with cystic bronchiectasis. Bronchovascular markings often increased, and end-on bronchi may appear as ring shadows.
-Emphysema: - Abnormal enlargement of airspaces distal to terminal bronchioles, with alveolar wall destruction and without fibrosis. A common component of COPD. - Subtypes include centrilobular, panlobular, and paraseptal emphysema. - The pattern of each subtype on a CT scan is used to diagnose the type of emphysema observed: - Centrilobular: primarily in upper lobes; patchy distribution. - Panlobular: uniform distribution, predominantly in lower lobes. - Paraseptal: located near the pleura; peripheral distribution. - Plain x-rays often don't clearly show emphysema except in advanced cases with bullae formation. Associated features that may be noted include flattened hemidiaphragms, increased and irregular lung radiolucency, increased retrostemal airspace, and wider spaced ribs.
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Chronic Obstructive Pulmonary Disease (COPD):
- Spectrum of obstructive airway diseases that includes chronic bronchitis-small airways disease, and emphysema.
- Phenotypes can be categorized based on which component is predominant e.g., emphysema predominant, airways predominant, small airways predominant, large airways predominant, mixed predominant.
- CT may show chronic bronchitis signs like abnormal wall thickening, repeated inflammation, fibrosis and other features related to emphysema in the case of mixed phenotypes.
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Description
This quiz focuses on radiology related to various diseases of the chest, examining chest wall, pleural, pulmonary, and airway diseases. It includes key topics like rib fractures, pleural effusion, and COVID-19. Test your knowledge on the diagnostic imaging techniques and conditions covered in this section.
