T2 L9: Imaging the anatomy of the chest

• What are the key review areas in a chest X-Ray?

  Apices

  Costo-phrenic angle (acute angle)

  behind the heart

  Hila

  Peripheries
• How to check if patient is standing straight?

  align spinous process of thoracic vertebrae with medial ends of both clavicles

  distance should be equal

  
• What is the 'aortic knuckle'?

  distal aortic arch on an X-ray (M1)

  
• What chambers of the heart make up the silhouette borders on the chest X-ray?

  right atrium and left ventricle

  
• What vertebral level is the arch of aorta located on?

  T4
• What is the 'hilar point'?

  v shaped point where the lower lobe pulmonary arteries cross the upper lobe pulmonary veins

  should be symmetrical

  
• What could a raised hilum indicate?

  upper lobe collapse, fibrosis (pathology)

  
• What could an obstructed hilum indicate?

  tumour / mass / lymphadenopathy
• What are the structures shown in this image?

  1. Ascending aorta
  2. main pulmonary artery
  3. right pulmonary artery
  4. left pulmonary artery

  
• An inhaled foreign body tends to choke up on which main bronchus?

  right bronchus

  as more vertical
• What is normal lung expansion?

  inhaled lungs cross 6th ribs
• What is hyperexpansion?

  lungs inhaled greater than 6 anterior ribs

  
• When is lung hyperexpansion normal?

  young, asthma, COPD / emphysema
• What are the soft tissues to be mindful of in a chest X-Ray?

  axillary tail

  diaphragm

  breast shadow

  gastric fundus and bowel gas below diaphragm

  
• What does this X-ray show?

  pneumoperitoneum on abdominal X-ray

  gas between liver and diaphragm showing free air within abdomen

  emergency

  
• What does this X-ray show?

  gas between stomach wall and diaphragm

  
• What are the two types of pneumothorax?

  tension pneumothorax

  non-tension pneumothorax
• What is a tension pneumothorax?

  air gets stuck and can't escape

  causing a gradual increase in pressure

  and pushing mediastinum to the right

  main cause: trauma

  (inhale, air sucked in through wound due to pressure difference, when breathing out soft tissue act as valve so air can't escape, more air sucked in during inspiration)

  treat by: chest drain

  
• What is a non-tension pneumothorax?

  collapsed lung where air can go in and out freely

  can happen spontaneously; no respiratory compromise

  most cases lung will re-expand itself; take another X-ray 24 hrs later

  COPD need to be treated more urgently (drain)

  
• What is cardiomegaly?

  heart enlargement

  heart border more than half of bottom border of chest

  causes: left ventricular heart failure, pericardial effusion, dilated cardiomyopathy

  
• What does this image show?

  left oblique fissure

  
• What does this image show?

  right oblique and right horizontal fissure

  
• Which lobe is this mass in?

  left upper lobe

  upper lobe is anterior

  
• What does 'centre' mean in relation to CT scan greyscale?

  the grey tone in the middle of the greyscale
• What does 'width' mean in relation to CT scan greyscale?

  Tissue density, tone either side of the 'centre'
• What are the structures labelled?

  A: Right ventricle

  B: Left ventricle

  C: Right atrium

  D: Left Atrium

  X: Right AV valve

  Y: Left AV (mitral) valve

  V: pulmonary artery

  
• What chamber is the most posterior?

  left atrium
• What is shown in this image?

  SPECT

  left side MI

  dark blue = no perfusion (necrosis - scarred MI tissue)

  
• What is shown in this image?

  coronary arteries

  left pic - stenosis

  right pic - no stenosis

  
• Where does interventricular septum receive majority of blood supply from?

  circumflex branch (branch of left coronary artery)

  
• What does this image show?

  red cell scan

  heart, liver, kidneys

  
• What does this image show?

  white cell scan

  accumulation in spleen, bone marrow, RE system