Term
| What are the three major causes and one minor cause of an opacified hemithorax? |
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Definition
-atelectasis
-large effusion
-pneumonia
-pneumonectomy |
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Term
| What causes atelectasis of an entire lung? What is atelectasis? Are there mediastinal and cardiac shifts seen? Which direction? Do the visceral and parietal pleura separate? |
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Definition
-complete obstruction of main bronchus
-loss of volume
-mediastinal and cardiac shifts towards atelectasis
-the pleura never separate |
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Term
| If a pt's L lung is atelectatic, what might be seen of the R lung? |
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Definition
| herniation of the R lung causing hyper expansion of the R lung |
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Term
| What causes a large pleural effusion? What does this collection act like? Which direction do the heart and mediastinum shift? What happens to the view of the ipsilateral hemidiaphragm? |
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Definition
-blood, transudate, or exudate ("collection)
-collection acts like a mass
-pushes heart and mediastinum AWAY
-it disappears (silhouette sign) |
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Term
| What can be seen in pneumonia of the entire lung that has not been mentioned in the previous two pathologies? If the complete lung is involved in the pneumonia, which structures may be silhouetted? Is there any cardiac or mediastinal shift? |
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Definition
-air bronchograms secondary to alveolar opacification
-may silhouette heart and diaphragm
-little if ANY cardiac or mediastinal shift |
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Term
| In a large pleural effusion, what type of sign is seen in addition to a silhouette sign? |
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Definition
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Term
| in pneumonia of the entire lung which is sometimes seen: silhouette or meniscus sign? |
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Definition
silhouette sign
never meniscus sign |
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Term
| What are some identifying structures to differentiate pneumonectomy from atelectasis? |
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Definition
in pneumonectomy:
-surgical clips in the hilum
-5th or 6th rib resection
-a greater mediastinal shift toward the opacity |
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Term
| What can be seen on the film of a pt with a malignant effusion and an atelectasis caused by underlying obstructing bronchogenic carcinoma? |
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Definition
| the shift of the effusion and the shift of the atelectasis can balance each other out so that the lung is completely opaque, but there is not shift |
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Term
| in simple terms, what are three causes of atelectasis? |
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Definition
failure to expand
airway obstruction
passive |
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Term
| what are three signs of atelectasis |
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Definition
-increase in radio density of the affected lung
-trachea, fissures, heart, and hemidiaphragm show displacement towards the affected side
-hyperinflation of contralateral lung and unaffected ipsilateral segments |
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Term
| What are the three main types of atelectasis? explain each |
|
Definition
-subsegmental: splinting (esp post-op), pleural chest pain, only minimal volume loss
-compressive: passive external compression (poor inspiration, PTX, or effusion)
-obstructive: obstruction of bronchus from endoluminal lesion (plugging, malignancy) |
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Term
| What is a rounded atelectasis? What is the name for the bronchovascular markings emanating from the mass back tot the hilum? |
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Definition
a type of passive atelectasis in which the lung does not re-expand when a pleural effusion recedes, usually due to pre-existing pleural disease. Round atelectasis may produce a mass like lesion that can mimc a tumor on chest radiographs
-"comet tail" |
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Term
| What is the S sign of golden? |
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Definition
| if the right upper lobe atelectasis is produced by a large enough mass in the right hilum, the combination of the hilar mass and the upward shift of the minor fissures produces a characteristic appearance on the frontal radiograph: the S sign of golden |
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Term
| what happens if an endotracheal tube is accidentally inserted into the right lower lobe bronchus? |
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Definition
| only the right lower lobe tends to be aerated and remain expanded. atelectasis of the entire left lung and the right upper and middle lobes will develop. atelectasis clears usually quickly when the tube is withdrawn above the carina |
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Term
| an obstructive atelectasis produces a recognizable pattern, explain |
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Definition
-increased lung density
-displacement of fissures
-shift of heart and mediastinal structures toward atelectasis
-compensatory hyperinflation of unaffected ipsilateral and contralateral lung |
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Term
| describe what sub segmental atelectasis looks like? |
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Definition
| -linear densities of varying thickness usually parallel to the diaphragm most commonly at lung bases-- does not produce enough volume loss for shift in structures. |
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Term
| the more atelectatic a lobe or segment becomes (that is, the smaller the volume) the (more/less) visible it becomes on a chest radiograph |
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Definition
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Term
| What are the three main causes of pleural effusions? |
|
Definition
-excess formation of fluid
-decreased resorption of fluid
-transport from peritoneal cavity |
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|
Term
| what are 4 causes of excess formation of fluid? |
|
Definition
-CHF (increased hydrostatic pressure)
-hyponatremia (decreased colloid osmotic pressure)
-parapneumonic effusions (inflammation)
-hypersensitivity reactions (inflammation) |
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|
Term
| what are 3 causes of decreased resorption of fluid? |
|
Definition
-lymphangitic blockade (tumor)
-increased central venous pressure
-decreased intrapleural pressure (e.g. atelectasis) |
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Term
| what is the most common cause of transport from peritoneal cavity causing effusion? |
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Definition
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Term
| what determines if a pleural effusion is a transudate or exudate? |
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Definition
depends on the protein and LDH content
-transudate: low protein and LDH <200)
-exudate: high protein and LDH >200) |
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Term
| transudates tend to form in settings of _________ hydrostatic pressure OR ___________ osmotic pressure. some examples? |
|
Definition
increased
decreased
-chf, hypoalbuminemia, cirrhosis, nephrotic syndrome |
|
|
Term
| in what setting do exudates tend to form? |
|
Definition
setting of direct/indirect lung pathology
-malignancy, empyema, hemothorax, chylothorax |
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Term
| what are two diseases that usually cause bilateral pleural effusions? |
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Definition
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Term
| what are three instances when a unilateral pleural effusion forms with no preference of L or R |
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Definition
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Term
| What are three diseases that are left side effusion predominant? |
|
Definition
| -pancreatitis, distal thoracic duct obstruction, dressler syndrome |
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Term
| what are three diseases/states that are right side effusion predominant? |
|
Definition
-abd dz's related to liver and ovaries (e.g. ascites)
-RA
-proximal thoracic duct obstruction |
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Term
| all pleural collections start out collecting ____________, do they flow freely? |
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Definition
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|
Term
| blunting of the costophrenic angles happens at how much fluid posteriorly and laterally? |
|
Definition
posteriorly at 75 mL
laterally at 300 mL |
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|
Term
| what sign is nearly diagnostic of pleural collection? |
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Definition
| meniscus sign: when fluid rises higher along lateral margins |
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|
Term
| what can mimic the CP angle blunting? |
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Definition
| pleural thickening- usually irregular/sharper angle, will NOT change in appearance with patient positioning |
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Term
| what are three things that can be discovered by a decubitus view? |
|
Definition
confirm the presence of effusion
determine if it flows freely or is located
uncover a porting of the lung previously hidden by effusion |
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|
Term
| is a pseudotumor effusion loculated or free flowing? |
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Definition
| located and usually in the R minor fissure |
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Term
| what is a laminar pleural effusion? what is it usually due to? what does it look like? does it blunt the CP angles? |
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Definition
| uncommon, seen in CHF and lymphangetic spread of malignancy, thin band of fluid density aligned vertically along inner lateral chest wall, does NOT produce CP angle blunting |
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Term
| what is a tell tale sign of a collection + pneumothorax? |
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Definition
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Term
| what is the normal amount of fluid in the pleural space? what is the rate of fluid production? |
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Definition
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Term
| How many liters of fluid fills the thorax and produces a mass effect? |
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Definition
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Term
| if there is no meniscus with a collection, what does this signal? |
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Definition
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Term
| scarring sometimes produces a ______/______ appearance that does not move when pt changes a position. this is one way to tell scarring from an effusion |
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Definition
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