CHEST RADIOLOGY

PULMONARY DISEASES
 PULMONARY DISEASES

 According to predominant involvement of

pulmonary tissues, altered density in
pulmonary area of chest x-ray could
represent:
 Alveolar processes
 Interstitial processes
 Mixed alveolar and interstitial processes
 ALVEOLAR PROCESSES

 Also sometimes called CONSOLIDATION

 These result in increased lung radio
density by filling the alveoli and in some
cases, the smaller bronchi with material
other than air, usually fluid.
 BRONCHOPULMONARY
SEGMENTS
 10 on right and 9 on left side
 ALVEOLI & PULMONARY
LOBULES

 Bronchi divide between 6-20 times before

becoming bronchioles
 Terminal bronchioles are 0.2mm in diameter
 Each terminal bronchiole receives 2-3
respiratory bronchioles, which connect between
2 and 11 alveolar ducts.
 Each alveolar duct in turn receives 2-6 alveolar
sacs, which are connected to Alveoli.
 ALVEOLI & PULMONARY
LOBULES
 ACINUS is the functioning lung unit arising from
terminal bronchiole. It casts 5-6 mm shadow
when filled with water.
 Pores of KOHN, 3-13 µ m, connect alveoli
 Canals of LAMBERT, 30 µ m, connect
bronchioles and alveoli.
 PRIMARY LOBULE arises from last respiratory
bronchiole
 SECONDARY LOBULE 1-2.5 cm in size
surrounded by connective tissue septa.
 ALVEOLAR PROCESSES
 Differential Diagnosis:
 Bacterial pneumonias
 Pulmonary edema
 Tuberculosis
 Lung contusion/bleeding
 Adult respiratory distress syndrome
 Viral and fungal pneumonias
 Aspiration
 Carcinomas
 Pulmonary embolism
 RADIOLOGY SIGNS OF
ALVEOLAR PROCESSES

 SPECIFIC SIGNS:
 Silhouettesign
 Air bronchogram
 Inhomogenous alveolar infiltrates
 Lung abscess
 Pneumetoceles
 RADIOLOGY SIGNS OF
ALVEOLAR PROCESSES

 NON-SPECIFIC SIGNS: -
 Fluffymargins
 Lobar distribution
 Segmental distribution
 Central fluffy pattern
 INTERSTITIAL PROCESSES

 These processes are those that add to the

radio density of structures in the
interstitium of lung.
 INTERSTITIAL PROCESSES

 Abnormal structures sought are:

 Thickened bronchial walls
 Thickened interlobular septa
 Engorged lymphatic channels
 Nodules
 Thick bands of fibrosis
 INTERSTITIAL PROCESSES

 RADIOLOGICALLY THEY APPEAR AS: -

 Lines
 Nodules and
 Ring shadows
THICKENED BRONCHIAL WALLS

 Common Differential Diagnosis are:

 Chronic bronchitis
 Asthma
 Bronchiectasis
 Cystic fibrosis
 Heart failure
 Tumor engorgement of lymphatic Channels
 LINEAR INTERSTITIAL
PATTERNS

 Common Differential Diagnosis include:

 Interstitial pulmonary edema
 Fibrosis
 Viral
pneumonia
 Granulomatous tissue disease
 Metastatic tumors
NODULAR (MILLIARY) PATTERN

 Granulomatous disease like

 Tuberculosis
 Sarcoidosis
 Histoplasmosis
 Metastasis
 HONEY COMBING

 Is seen commonly in
 Rheumatoid lung
 Sarcoidosis
 Pneumoconiosis
 Bronchiectasis
 Scleroderma