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Cardiorespiratory

By Richard Snyder,2014-05-15 14:29
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Cardiorespiratory

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    Diagnostic Radiology 7-14-03

    Sherry’s notes

Diploic space = spongy area between the inner and outer tables of the skull.

The middle meningeal artery makes the deepest impression in the skull.

Sella turcica is part of the sphenoid bone.

Basion marks the anterior area of the foramen magnum.

In a normal x-ray, you should be able to fall off the clivus onto the dens.

Temporal bone parts mastoid process with bubbly sinus; tympanic; zygomatic; squamal part

    (where it articulates with the parietal bone)

The fossas are named more descriptive of the anatomy they hold.

Petrous bone is one of the very dense bones of the body and gives the “bone hardening” effect.

    Prevents a proper reading on CT.

Apsthian = forms the posterior edge of the foramen magnum (may not be spelled right)

Skull - 4 view lateral right and left, Caldwell P-A and gives frontal structures (forehead and nose

    are flat, 15 degrees caudal), Towne A-P and gives posterior anatomy (37 degrees caudal)

Diastasis spreading fracture

In an acute setting, a hemorrhage will show up faster on CT; so if there is trauma, order a CT.

    Also good for stroke/infarctions; affected areas will show up as low intensity.

MRI will be used for everything else.

Effacement = sulci and gyri are flattened out; occur in space occupying lesion and

    stroke/hemorrhage

On CT gray matter, looks white and white matter looks gray.

The choroid plexus regularly undergoes physiological calcification; the pineal gland also regularly

    undergoes physiological calcification.

Centrum Semi oval (?????)

MR T1 vs T2

     T1 cortex and gray matter = dark; white matter = white

     T2 cortex and gray matter = white; white matter = dark

     Views are axial, coronal and sagittal views/slices are available

    “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a Imaging methods supplement to help you study. Plain films fractures and foreign bodies

     CT trauma

     MR do not use on a gunshot wound

Risk for intracranial injury -

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     Low Risk category asymptomatic, headaches, hematoma or contusion, scalp laceration

    High risk category altered or loss of consciousness, focal neurological signs and symptoms, palpable depressed fracture, CSF leakage, worsening headaches

Types of skull fractures

    1. Linear most common

    2. Depressed a comminuted fractured that dents into the brain

    3. Diastatic separation of sutures

A fracture line will be more radiolucent than the vessel and fractures don’t cross sutures while

    vessels do.

Epidural hematoma = increased attenuation, convex in (pushing onto the brain); skull fractures

    generally associated with EH (epidural hematoma); trauma with fractures; signs and symptoms

    develop within hours after trauma.

Subdural hematoma = increased attenuation which layers out in a crescent shape; in patients

    with elderly and atrophied brain with slight trauma which severs the vessels bridging from the

    brain to the dura; signs and symptoms may take weeks to develop.

The more chronic the problem the lower the attenuation

Osteolytic lesions

    1. Mets from primary breast cancer lesions are variable in size

    2. Multiple myeloma lesions are of same size and usually small in diameter; multiple

    angular fracutres at the T/L junction will also be present

    3. Paget’s disease in the skull – presents as osteoporosis circumscripta

    4. Histiocytosis Langerhan’s Cell histiocytosis – three types immune problem

    presents in young patients

    a. Eosinophilic granumloma (older than others with beveled edge)

    b. Hans-Schueller

    c. ????

    5. Hemangioma benign bone tumor periosteal reaction that gives a sunburst

    appearance.

    6. Osteomylitis

Variants that look like lytic lesions

    1. Parietal thinning in the most posterior aspect of the bone where there is only one

    table instead of two.

    2. Arachnoid granulation by the sagittal suture along midline and they will be well

    circumscribed

    3. Venous lakes they are usually within the diploic space with vessels

    4. Digital or convolution markings found in pediatrics multiple lesions bilateral

    correspond to the gyri due to CSF pulsation this is bad in the older population, but

    OK in kids.

    5. Leptomeningeal cysts area where there was a fracture and a piece of dura got

    hung up

Osteoblastic lesions

    1. Ostemoa benign

    “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a 2. Mets supplement to help you study. 3. Paget’s – cotton-wool appearance many ill-defined blastic lesions with no clear

    inner/outer table

Variants that look like blastic lesions

    1. Calcification of the falx cerebri

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    2. Hyperostosis frontalis interna

    3. Calcification of the pineal gland and choroid plexus seen on CT

Diagnostic Imaging

    7-21-03

Evaluation of Chest

     Chest series cost effective or it wouldn’t be used as often as it is.

     Why use it? It serves cardio, respiratory, GI, musculoskeletal. It’s easy to perform.

    Technical difficulty is low. Need the appropriate film and a radiographic system. It isn’t designed

    to evaluate the spine. We use the PA, AP and lateral to evaluate the thoracic spine. Radiation

    cost is inexpensive also.

Clinical indications unexplained weight loss, hypertension workup (at least a PA), chest pain,

    cardiac symptoms (shortness of breath, etc.), hemoptosis, chronic cough. Chest pain can come

    from many sources (musculoskeletal, GI, cardiac, pulmonary, etc.)

The chest film may suggest other tests be done.

     Pulmonary indications then do CT with intravenous contrast

     Cardiac indications then echocardiography is next

     Anything else is chest CT with contrast (wide mediastinum, etc.)

Workup is CT with contrast or echocardiography for anything beyond the chest film.

MRI maybe a one-stop shop for cardiac examination in the next 5 years.

    Apical lordotic projection BOARDS QUESTION tube tilt of 30 degrees or so the clavicle comes off the lung - gives an unimpeded view of the lung apex. A followup radiographic view.

    Lateral decubitus (right side down is right lateral decubitus) allows for accumulation of fluid in the pleural space. Nothing good causes this pneumonia, lupus, etc.

Anatomy heart is very present, look at it last. FIVE STEPS

    FIRST Outside the chest first soft tissues (soft tissue phase) paraspinal soft tissues of the neck, the axillary, costphrenic and cardiophrenic and the diaphragm soft tissues are all

    included then up the other side.

     Paraspinal masses, calcifications (vessels and nodes)

     Axillary female look for breast; consciously count the breast shadow in the female the

    absence raises the question of masectomy it will alter the density of the chest film. In the aging

    male, the pecs may be visible.

     SECOND - bones posterior ribs, anterior ribs (points toward the heart), typically fracture

    at the flank, displaced fractures will be visible, but the others usually won’t be. Rib fractures can’t

    strest (breathing) so malunion is common. Won’t unite evenly. Fracture at 1 rib can cause ththproblems, 11 and 12 can puncture a kidney, or a pneumothorax can all be problems. Paget’s

    disease, metastatic disease of the spine.

     THIRD is the central shadow the trachea and the mediastinum trachea should be “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a midline, looking for the size of the mediastinum the widest part of the heart divided by (one side supplement to help you study. at a time to the midline and then add them together), the widest part of the thorax (should be no

    more than 55%) inside of the rib margin to inside of the rib margin CT ratio bigger than that is cardiomegaly. The size and the shape of the heart are the two components of this phase of the

    search pattern.

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     Left ventricular hypertrophy = broadening on the left side. Generally the result of

    hypertension a preventable disorder.

     FOURTH hilum a region, a space that consists of pulmonary arteries that eminate

    from the main vessels. The pulmonary circulation blue blood venous blood picks up oxygen from the lungs and comes back through the pulmonary vei. Can see HTN in these vessels it

    always occurs with chronic pulmonary diseases (ie. Emphysema) secondary pulmonary arterial hypertension. Cor pulmonale heart disease that comes from lung disease. Right heart

    undergoes the strain in response to chronic lung disease chronic asthma, cystic fibrosis, emphysema, broncheactesesis (??), chronic bronchitis. The majority come from smoking

    disorders. Cancer then follows can be in other parts of the body.

The inducer and the promoter (smoking is the inducer, alcohol is the promoter) for lung cancer.

    The hilum is where lung cancer occurs bronchogenic carcinoma usually only has branching vasculature so any density is considered cancer. While the tumor is small it looks like vessels.

    Pulmonary HTN in the hilum will cause large vessels happens due to increase in pressure in the pulmonary system. “The problem hilum” is what this area is called – a CT with contrast will determine whether it is a vessel or a tumor problem. Sensitivity is low in the hilum in regards to

    tumor.

    Pancose tumor under the apex pancose syndrome tumor develops in the apex.

    FIFTH lung and pleura a lucent structure because it is filled with air. The parenchyma

    is like a sponge and also filled with air however the pulmonary arteries aren’t lucent and appear thon the film. The horizontal fissure in the 4 ICS is the only other visible structure in the lungs.

    A calcified granuloma an old healed infection histoplasmosis endemic to the Mississippi Valley (or the eastern seaboard). This can also be visible on the area of the hilum or the lung.

LATERAL FILM search pattern

     FIRST skin and spinal column (and all the parts of the vertebra) notice that the column is opaque and then gets lucent toward the bottom.

     SECOND opaque and lucency opaque is the heart and the pulmonary vasculature

    (aorta and pulmonary vessels). Lucent the retrosternal space, the trachea, and the retrocardiac

    space.

     THIRD skin and the sternum down the anatomy and over the diaphragm to the

    costophrenic angle posteriorly and then the abdomen. (The diaphragm gutter goes to L1).

    (Gutter isn’t seen on the AP film) The collection in the posterior angle – 20-30 ml can be detected. Anterior gutter needs 600 ml to fill the costophrenic angle. These are both for pleural effusions.

    The lateral film is more sensitive to pleural effusion.

    Look along the search pattern for things that’s what the experienced readers do.

    Back to the search pattern mediastinum on the lateral starts in the retrosternal psace, the heart and the space behind the heart (which includes the column).

Masses inside the cavity DDX mediastinal masses the anterior mediastinal space = behind “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a the sternum up to the pericardium and the aorta. Five classical masses: supplement to help you study. Teratoma calcified teeth, etc., in the anterior mediastinum. Usually in the ovary but

    also appears in the retrosternal space

     Thyroid can develop here or move down to there a goiterous thyroid would be a substernal thyroid

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     Thymoma thymus is in the chest but starts to shrivel at about 19 y/o, produces anti-

    aging hormones, can enlarge here and become a thymoma associated with myesthenia gravis a neuromuscular junction disorder (??).

     Lymphoma terrible lymphoma Hodgkins specifically proliferation of WBCs.

     Aneurysm terrible aneurysm comes off the ascending aorta but the ascending aorta isn’t in the anterior mediastinum but the structure affected is in the anterior mediastinum - Marfans or HTN

PA it will appear as a bump on the contour of the mediastinum. The lateral should reveal this.

Middle mediastinum pericardium all the way back the just the anterior 1/3 of the vertebral body -

    DDX

     Lymphoma

     Bronchogenic carcinoma

Posterior mediastinum 2/3 of the vertebral body all the way back - DDX

     Neurogenic tumor most common neurofibroma can be quite sizable.

     Thoracic aneurysm

     Paraspinal masses fractures in the spine a hematoma will form will be visible on the

    film.

    Diagnostic Radiology

    7-23-03

Search pattern soft tissue outside the thoracic cage; bone (cervical spine, rib cage, etc.), the

    look at the central shadow (mediastinum and hilum), in the mediastinum look at the anterior,

    posterior and middle. Then look at the lungs apex, symmetry (look for pancose tumor and tuberculosis)

Tube tilt to get the top of the apex of the lungs tilt will be cephalad.

Lateral decubitis view is also another view will show a pneumothorax, hemothorax, the fluid in the

    posterior gutter will move from it’s position in the standing PA view – this view is also taken PA or AP but the patient is lying down.

Rib trauma expiratory PA view shows up a pneumothorax.

Regular thoracic series is on inspiration.

    Dr. Patel says there are 4 segments of the superior lobe I have no clue what he is referring to.

For Lobar pneumonia ONLY

R Upper lobe 3 segments, Apical, Posterior and Anterior

    R Middle lobe R side only Lateral and medial

    R lower Lobe 4 segments Superior Medial Basal, Anterior Basal and Lateral Basal;

    Posterior Basal

L Upper Lobe

     Apical Posterior, Anterior missed all of these!!!! Sorry!!!!

    “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a supplement to help you study. Normal anatomy in the CT of the chest bone window and soft tissue window normally in the

    chest it is called the mediastinum window (same as bone window) and the lung window (same as

    soft tissue window).

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    CT He went through to help orient us to the images. Trachea in the middle with the thyroid

    glands on either side, then the esophagus, internal jugular vein, common carotid artery,

    subclavian artery, contrast in the right subclavian vein, lung apex and costal.

Diagnostic Radiology

    7-28-03

Search pattern for the chest foundation for the evaluation of the chest lab this week. Problems

    of the mediastinum, hilum and lung. Soft tissue is the starting focus the neck, breasts, axilla, cardiophrenic angle (plueral effusion will blunt this, infection, neoplasm, congestive failure).

    Blunting of the anterior angle is after the posterior angle gutter fills.

Skeletal structures paget’s disease, fibrous dysplagia, any category can be present on the

    chest film. Run each rib, the vertebral column, then the central shadow. Trachea in midline,

    bump is the R atrium, 3 on the L (I missed this).

Mediastinum cavity retrosternal (anterior), middle, and posterior 2/3 of vertebral body is the

    posterior medistinum (NOT THE LUNG) CT scan identifies masses near the midline as to

    whether they are lung or mediastinum.

The 5 T’s – see the notes from the disk.

Neurogenic tumors posterior mediastinum soft tissue density.

Anuerysms in anterior or middle medistinum.

Fourth phase is the hilum- vessels are normal, can be big from pulmonary HTN (secondary

    would be from lung disease cor pulmonale) or the other source of hilar density would be lymphadenopathy bronchogenic carcinoma until otherwise confirmed.

Fifth phase - Lung and the pleura respiratory system we just want to see lucency the

    opacities are branches of pulmonary arteries. Hiding in there can be small densities of carcinoma

     will hide until big enough to be a nodule. Calcified nodule sign of old infection

    histoplasmosis. Can kill diabetics or HIV (any immunocompromised patient) otherwise it is

    clinically silent.

Lung division opaque on one side and abnormal lucency on the other.

Opaque nodules, masses, consolidation, atelectasis, interstitial disease

Abnormal lucency hyperinflation (COPD, emphysema) and pneumothorax.

Things which are opaque are sclerotic on a bone film; lucent on skeletal film = lytic.

Search pattern for the lateral film soft tissue and underlying bones on the posterior portion of

    the thorax. Check the skin, ribs, pedicles, vertebral bodies. The second sweep/phase breaks

    down the thoracic cage into 2 densities opaque heart, pulmonary arteries and aorta (aortic arch); lucencies retrosternal lucency, retrocardiac lucency; trachea and bronchi.

    “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a supplement to help you study. Third sweep/phase the anterior chest wall, skin and sternum, diaphragm and belly.

    MAMMOGRAPHY included in musculoskeletal radiology an exam for the detection of breast cancer Gold Standard. 1 of 9 women will get breast cancer. False negatives and false

    positives (pushing 20% - benign lesion). Get a biopsy if you aren’t sure. Breast MRI – a

    54820167.doc Page 7 of 13 competitor doesn’t require ionizing radiation – more expensive, can be done repeatedly (within

    the next month or so). Low Kvp, mAs is high (500-600) can be done without prescription.

The 4view compression of the breast medial and lateral, both breasts. Homogeneous tissue,

    hard to see densities. A cancer developing in the under-40 patient tends to be very aggressive

    but less common. Over 50 they are less aggressive and more common.

Older equipment can’t be used – higher frequency equipment is necessary.

Will detect a lesion 2 years before clinical detection. Counterpart in the male is the testicular self-

    screening test most common cancer in males and it is asymptomatic.

Bronchogram no longer performed patient inhaled an iodine contrast, could identify tracheal

    and bronchial diseases. Right-sided obstruction is more common than left due to the right going

    down straight left curves.

Right side of the heart right border is the R atrium, R ventricle on the left side of the sternum.

Arteriolegram left pulmonary artery and branches, R side behind the aorta, lobar artery Gold

    standard for the evaluation of pulmonary embolism. Kills about 100,000 per year. Few clinical

    signs that are helpful history is more helpful immobilization, chronic dehydration, contraception (oral), smoking, deep vein thrombosis in the lower extremity. When those risk

    factors conspire and produce a clot, it causes a pulmonary infarction. Usually very sutble (pleura)

     hurts when they take a deep breath they are short of breath respiratory rate over 20 is tachypnea, emophopsis and ??? a triad pulmonary embolism workup.

CT of the chest spiral is fast overtaking the arteriolegram.

Arterial side left ventricle through the ascending aorta to the arch. First vessel R side

    brachiocephalic, L subclavian to arm, Left carotid to brain. The descending aorta supplies the

    rest of the body.

Carotid 80%, Vertebral artery 20% - it comes from the subclavian arteries. Can produce an

    interesting problem if the subclavian is occluded proximal carotid will steal blood from the Circle of Willis, and go down the basilar artery, then the vertebral artery then to the arm. If you steal

    enough blood from the brain, you can have a stroke.

Angiogram of the coronary artery system Gold standard for evaluation before bypass surgery is

    done. Patients after 30 y/o think of coronary artery disease. Main arteries are left anterior descending (widow maker, captain of death), right coronary artery and circumflex artery. Beats

    about 2 million (billion??) in a lifetime requires a constant supply of blood.

Article Can Lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Used

    to be thought of as an irreversible fatal disease. D. Ornish 1990 Sept 8 Lancet. This was the first study done to show that this was a reversible disease it was a one year study.

ANOMALIES

Diaphragm left side abnormal elevated hemidiaphragm. Bones OK, Central Shadow

    deviated trachea to the left. Mediastinal position the heart is deviated to the left (nothing on the

    “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a right side should be). Hilum opacity pulmonary artery (OK), left hilum obscured by the heart supplement to help you study. shadow; Lung left pulmonary apex (replacement of air consolidation) homogeneously opaque. Not a mass because it is pulling the trachea to the left, not pushing it away; pulmonary

    infiltration; lung/rib interface on the left is obscured pleural scarring/thickening; calcified nodule

    in the left base of the lung.

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    Pulmonary nodule, uncalcified, less than 3 cm neoplasm bronchogeneic carcinoma vs. metastatic carcinoma. Category infection histoplasmosis, granuloma.

Granuloma under 70, probably not carcinoma. If there is no calcification, it is considered a

    bronchogeneic carcinoma until proven otherwise.

All these findings indicate atelectasis losts lung volume. This is chronic but not from a

    malignancy. Long history of cough secondary to tuberculosis. The infiltrates are tuberculosis

    scars in the lungs. They pull the tissue away from midline.

Tumor in a bronchus is the most common presentation of atelectasis, over 40 in the smoking

    population.

    Atelectasis air can’t get into lung because air is blocked by a tumor, the air already in there gets re-absorbed when there is no gas in the alveolar space they shrink and this pulls the tissue

    toward it. No air in the alveolar space.

Secondary signs trachea deviates toward the lesion site, mediastinum deviates towards the

    lesion site, diaphragm up; if the lesion is high it will pull tissues up, if it is lower it will pull is down.

    Primary atelectasis Golden S sign causes the fissures to move.

Atelectasis has consolidation associated with it.

KNOW THE DIRECT AND INDIRECT SIGNS OF ATELECTASIS!!!!!

NEXT

    Soft tissues right diaphragm elevated. Bones are fine. Mediastinum left is OK, right is obscured (silhouette sign). Hilum OK. Lung right side is smaller.

Air is injected into the abdomen raises the under-surface of the diaphragm. Soft tissue density

    above the diaphragm greater than 3 cm neoplasm = bronchogenic carcinoma; infection =

    pulmonary abscess. Today it would go to CT instead.

NEXt

Soft tissues normal. Bones normal. Hilum normal. Mediastinum normal. Lung solitary

    pulmonary nodule = granuloma, or bronchogenic carcinoma and/or ????

    NOTES FOR SUMMER 2000 Xray Test #2 looks better than what I’m getting here. Diagnostic Radiology

    7-30-03

Dr. Patel normal chest pitfalls

     It’s normal but it looks abnormal.

Pneumothorax not present, it was the axillary fold.

Mass in the L lung apex malignant or benign? Need a rib series or a T/S series to check out

    bone destruction before making a decision. Bone destruction = malignant lesion.

    “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a supplement to help you study. Heart shadow has shifted to the left. There is calcification under the diaphragm also missed

    what it was??? Prominence of the Aorta is also present.

    54820167.doc Page 9 of 13 Left hemidiaphragm higher can be caused by phrenic nerve damage, organomegaly, left lung

    base inflammation (will pull diaphragm toward it). Also scoliosis diaphragm on the convex side will be higher.

Due to the scoliosis this one pulled the right side even higher than normal.

Next slide Apex problem calcification in the lung apexes bilaterally, can be caused by

    tuberculosis, or some other scarring from infection. Aortic knob with some calcification in it.

    Next slide calcified lymph node in the left hilar region. Ghon complex this plus something else causes the complex didn’t get that.

Lucency in the Right lung apex sometimes in the chest, trace the border of the lesion borders

    if they are to normal structures then the problem is just a shadow.

Prominence in the right mediastinum aortic knob is usually on the left side, not the right this

    could be rotation check the borders again to see where they lead if it is to normal structures then it’s not a problem.

Superimposition of normal structures again it makes it look like there is a cavity when there isn’t.

Next the cavity is perfectly round with a fluid level in it.

Cervical ribs the cervical TPs point downward, the thoracic TPs point up.

Descending aorta a stripe next to the vertebra that is traced to the aortic knob. Can be on the

    right side if they have a right sided aorta. It will still be traced to the aortic knob.

Hyperdensity at the apex of the heart caused by ??????

Interlobar fissure between the superior and middle lob it’s supposed to be there – it’s ot

    calcification.

Next one not an interlobar fissure it’s too thick – linear atelectasis, margin is fuzzy and more

    sclerotic than the interlobar fissure.

Old tuberculosis infection increases the ??? marking in the lower lobes of both lungs. Can also

    be caused by pneumonia.

Mediastinum widening on the right side goiter, tracheal deviation, thyroid gland, goiter will

    absorb iodine (another test). Has to do with determination of thyroid problem from atelectasis.

    It’s called “subsequent goiter”?????

Trachea deviated to the right, contrast in the aorta.

    I missed a bunch at the end sorry He’s talking about the terrible T’s – I can’t understand him. Need a lateral view to determine where it actually is in the anterior mediastinum.

Diagnostic Radiology

    “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a 8-4-03 supplement to help you study.

    Lab this Thursday will focus on cardio-vascular and pulmonary artery disease.

Search pattern we should know this by now.

    54820167.doc Page 10 of 13 Atelectasis heart shadow is displaced, diaphragm displaced it distorts the anatomy of the chest indirect signs bronchogenic carcinoma is the prime suspect.

Right hemidiaphragm silhouette borders disappear they don’t have to be touching. It was

    actually a mass in the lung gas was induced to raise the diaphragm to find it. It was a

    pulmonary mass neoplasm (bronchogenic carcinoma) and infection (only other possibility);

    metastasis from GI tract, lung, reproductive organs, etc.

    Solitary pulmonary nodule smaller than a mass (less than 3 cm) non-calcified soft tissue density raises the same differential neoplasm (bronchogenic carcinoma or metastatic disease)

    or infection (histoplasmosis, tuberculosis, granuloma)

Calcified old infection.

Cartilage on the ends of the ribs can calcify this is normal. Rotation has to been excluded

    before making a diagnosis of asymmetry.

Calcified nodule on the rib (no clinical significance)

Diffuse opacity soft tissue density soft tissue mass (bigger than 3 cm), located in the right hilar

    mass. Bronchogenic carcinoma likes two locations the hilum (central) and the lung periphery

    (anywhere in the lung).

Soft tissues cardiophrenic gutter is elevated this is usually an anomaly. No evidence of

    atelectasis (anatomy is where it is supposed to be.) Known as congenital eventration (elevation

    of the diaphragm). Lateral will show this even better there are fewer diaphragm muscle fibers

    than needed to keep it in place. Apneac episodes can become fatal in obese patients.

    Skeletal system bony structures the finding is abnormal conformation of the ribs fractures that have healed (aka “remote” fractures) Ribs don’t stop moving so the healing process isn’t a

    short time period and isn’t a clean healing. (malunion). Don’t ever tape ribs in anyone over 50 or

    if they have ANY respiratory disease.

    Also on the right side the aortic arch ascending is tortuosity post-35 as more people become hypertensive shouldn’t have a curve on the right side of the vertebral column.

    Clavicle is off the apex the apical lordosis view tube tilt distorts the clavicle so it isn’t on the apices of the lungs

    Mediastinal widening at the top not in the lung part of the central shadow it is the brachiocephalic artery. Ectasia vessel is too big (spelling may not be right) Acasia????

    59 y/o female fatigue is chief complaint chest film is good for this fatigue after 6 months is usually stress induced. Under 6 months it is usually a viral syndrome of some type (or anemia,

    etc.).

On left side lung has been replaced by something other than air. This is called consolidation.

    Left upper lung lies over a rib or it wouldn’t be seen. Solitary pulmonary nodule could be a

    different diagnosis but it hasn’t gotten that big. Neoplasm or infection are the differential

    diagnosis need a CT with contrast. No infection evidenced. It’s a tumor.

    “Linda’s Notes” by Linda Hite – These notes are not guaranteed to be complete or without errors they are meant to be a supplement to help you study. Same history fatigue and cough in a 35 y/o with drenching night sweats (changing the sheets

    2X in the night). Lesion is both left an right tuberculosis loves the pulmonary apex oxygen density is the highest. This is reactivation TB it comes back.

Metastatic disease prefers the lower part of the lung.

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