PULMONARY RADIOLOGY

Pulmonary Radiology
Methods of Examination
Conventional Chest Radiography PA and lateral chest radiograph Portable radiography Special techniques lateral decubitus, expiratory, apicolordotic, chest fluoroscopy

Pulmonary Radiology
Methods of Examination
CT and HRCT MR PET - usingFDG US Ventilation/Perfusion Lung Scan

Normal Lung Anatomy

Trachea
hollow cylinder series of C-shaped cartilaginous rings posteriorly flat band of muscle and connective tissue called posterior tracheal membrane 12 cms long; diameter of 21-25 mm

Normal Lung Anatomy

Normal Lung Anatomy

Lobar and Segmental Anatomy
Lungs are divided by interlobar fissures
Minor fissure Right major fissure Left major fissure

Normal Lung Anatomy

Normal Lung Anatomy

Normal Lung Anatomy

Normal Lung Anatomy

Respiratory portion of the lung
Respiratory bronchioles alveolar ducts alveolar sacs Pulmonary alveolus lined by two types of pneumocytes:
Type 1 pneumocytes flattened squamous; 95% of alveolar surface area; incapable of mitosis or repair Type 2 pneumocytes cuboidal; capable of mitosis; source of new Type 1 pneumocytes; source of alveolar surfactant

Normal Lung Anatomy

Pulmonary Arteries
Pulmonary artery arises from the right ventricle; rotates around the aorta Left pulmonary artery direct continuation of the main pulmonary artery Right pulmonary artery branches just below the carina

Normal Lung Anatomy

Normal Lung Anatomy

Bronchial arteries nutrient vessels of the lung; supply blood to bronchial walls; arise from proximal descending aorta Pulmonary veins arise within the interlobular septa from the alveolar and visceral pleural capillaries; drain into the LA Pulmonary lymphatics clear fluid and particulate matter from interstitium

Normal Lung Anatomy

Pulmonary interstitium scaffolding of the lung; provides support for airways and pulmonary vessels; from the hilum extending peripherally to the visceral pleura

Normal Lung Anatomy

Chest Radiograph

Chest Radiograph
Soft tissues
Skin, subcutaneous fat, muscles Sternocleidomastoid muscles Companion shadows of clavicle Pectoralis major Breast

Chest Radiograph
Bones
Thoracic spine Ribs Costal cartilages Clavicles Scapulae

Chest Radiograph
Lung-lung interfaces relates to three regions:
Retrosternal space Retrotracheal triangle Retrocardiac space

Chest Radiograph
Retrosternal space
Anterior junction line overlies thoracic spine; corresponding to upper lobe reflection off the innominate veins

Chest Radiograph

Chest Radiograph
Right paraesophageal interface (solid arrows) Azygos arch (open arrows) Azygoesophageal recess (solid triangles) Preaortic recess (open triangles)

Chest Radiograph
Right lung-mediastinal interfaces
Right paraesophageal SVC/right paratracheal stripe Anterior arch of azygos vein Right paraspinal interphase Azygoesophageal recess Lateral margin of RA Confluence of right pulmonary veins IVC

Chest Radiograph
Left lung-mediastinal interfaces
Left subclavian artery Aortic knob Aortopulmonary window Main pulmonary artery Left atrial appendage Left ventricle Epicardial fat pad Left paraspinal interface

Chest Radiograph
Lungs Diaphragm Upper abdomen