c
 



  c 
   
 
 


c
Standard examination : PA + lateral projection; tube-film distance
1,5m to minimize distorsion and magnification.

ical lordotic view To see disease in pulmonary apices, may be

obscured by clavicle & 1st rib; AP direction with patient leaning
backward on cassette holder.
Lateral decubitus Outline fluid levels in cavities or in pleural
space; x-ray beam directed in a horizontal plane and patient lying on
either right or left side.
Prone chest film In patients whom lung bases obscured by fluid.
Su ine radiogra hs intensive care units.
Com uted radiogra hy employs photostimulable phosphor plates;
the latent image stored on imaging plate,read out by a laser beam.
  tudy dynamics of cardiovascular system,
diafragmatic motion , air trapping. isadvantage: high
radiation dose.
  tudy of bronchial tree by introduction
of opaque material into desired bronchi. ce laced by CT.
irect methods such as fiberoptic bronchoscopy, brush biopsy,
percutaneous biopsy permit a tissue or bacteriologic diagnosis.
! Possible to examine a single layer of tissue
and to blur tissues above and below the level by motion ( the
tube and the film move in opposite direction).The method was
largely re laced by CT.
 !"#"! indications in lung:
- Evaluation and staging of primary pulmonary neoplasms
- etection of metastasis from non-pulmonary primary tumors.
- Characterization of solitary pulmonary nodules as benign or
malignant
- Characterization of focal and diffuse lung disease for
diagnosis.
Indications for the mediastinum:
- Causes of mediastinal widening
- taging of tumors that spread to mediastinum
- Characterization of mediastinal masses cysts, solid,
vascular, fat.
Other indications:
Pleura plaques, masses, loculated fluid, occult calcification,
chest wall masses.


  evaluation of interstitial lung disease,
bronchiectasis, emphysema, cystic lung disease.
 r"  fluid can be localized and
differentiated from solid pleural masses; mediastinal cysts in
contact with the chest wall and several conditions near the
diafragm.
 #" #  # !   indications:
Assesment of aortic vascular disease, subacute and chronic
dissection, vascular anomalies.
Cardiac evaluation of selected congenital and acquired
heart conditions and pericardial diseases.
Evaluation of brachial plexopathy.
Evaluation of the diafragm and peridiafragmatic processes.
Evaluation of intracardiac and paracardiac masses.
Assesment of chest-wall lesions.
Evaluation of breast implants and breast masses.
etermination of the extent posterior mediastinal masses,
especially those with intraspinal extension.
 3!    $    arterial or
venous anomalies; thromboembolic disease.

3#" # " " ### $%

 "%
 
  
  

- Bony thorax ribs, clavicles, scapulae, thoracic vertebrae

- oft tissues
- Mediastinum
- Lungs anatomy (lobar and segmental), hilum, vessels,
bronchi, apices
- Pleura
- iafragm

c# "# $#&"  !" $# #"# '"  (

"# &$#    (!" )))
  



"#!  (#" 

0. Lobar (alveolar, air-space) pneumonia the organism

reaches the periphery of the lung via the airways.Alveolar
transudation is followed by migration of leucocytes into the
alveolar fluid.
2. Bronchopneumonia (lobular neumonia) often observed
in staphyloccocal infection of the lung. The disease
originates in the airways and spreads to peribronchial
alveoli.
3. cute interstitial neumonia usually caused by a virus or
a mycoplasma.
4. Mixed neumonia is a combination of lobar,
bronchopneumonia and interstitial pneumonia.
3 #! #! 
- Caused by .pneumoniae.
- The onset is sudden, roentgen findings can be observed
within 6 to 12 hours after onset of symptoms.
- Rx: opacity, triangular, the tip towards the hilum, the base
towards the periphery of the lung. All of the elements in the
diseased lobe except the larger bronchi may be affected air
bronchogram.
- Resolution is fairly rapid if there are not complications the
opacity becomes more irregular and patchy, the intensity
decreases.
- Complications delayed resolution or nonresolution,
empyema, lung abscess, pleural effusion.
  #!  is an acute pulmonary infection,
bacterial in origin.
- It is most commonly found in the very young or very
old
- The inflammatory disease does not cross septal
boundaries, therefore the pattern of disease is
discontinous or patchy.
- Rx: nodular opacities, of varying size, poorly defined
with the center more opaque compared to the periphary.
- It is particularly difficult to define and diagnose when
it occurs as a complication in cardiac failure.
" #!  caused by .aureus may be
primary in the lungs or secondary to a primary staphyloccocal
infection elsewhere in the body.
- Usually occurs in debilitated adults or in the first year
of life.
- Consolidation rapidly spreads to involve a whole lobe
and bronchi are obscured by exudate so the air
brohogram is rarely seen.
- Abscess formation may occur and coalescense of
small abscesses is frequent.
- Pleural effusion, empyema and pneumothorax are
often noted.
- Pneumatocele a check-valve obstruction develops
between the lumen of a small bronchus and the adjacent
interstitium.
- The disease is usually bilateral

 


  
!3 #! 
Mycoplasma pneumoniae is responsible for a significant
percentage of primary atypical pneumonia in children and
young adults.
- Roentgen findings:
- Peribronchial or interstitial type streaky
densities extending outward from the hilum
following the vascular markings.
- Bronchopneumonic type.
- egmental or lobar types
- iffuse type
Mycoplasma vs.bacterial pneumonia: lack of pleural
involvement, delay in radiological appearance, the tendency to
clear in one area and to spread in another, bilaterality.
cute interstitial neumonia  (# *
cute interstitial neumonia
cute interstitial
neumonia
 3 


BRONHOPNEUMONIA

 
 
3
r 

 $#
- When an acute suppurative pulmonary infectious process
breaks down to form a cavity it is termed lung abscess.
- Primary / secondary.
- Rx: consolidation that produces an opacity confined to one
pulmonary segment,round, irregular borders. When
bronchial communication is established the fluid
contents of the cavity are replaced by air hydro-aeric
image with orizontal fluid level.
- Very useful CT to define the inner and outer walls and
for complications (rupture into a bronchus or into the
pleural space).
- ifferential diagnosis: early stage pneumonia; cavity
tbc, cancer, hydatid cyst, fungal infection
 rcr

- Transmitted by inhalation of infected droplets of

Mycobacterium tuberculosis
- Target population: patients of low economic scale,
alcoholics, elderly, AI

3! (#" c +#!#, 

0. Ghon focus pulmonary consolidation (1-7cm),

irregular borders, non-homogeneous, low intensity,
lower lobe " upper lobes
. Lym hadeno athy hilar and paratracheal, 95%
3. Lym hangitis linear opacity
&" 

- Healing
- Fibrosis
- Calcification
- Cavitation

!" 

- Miliary TB
- TB pneumonia
- TB bronchopneumonia
- Pleural effusion
#  (#" active disease in adults most
commonly represents reactivation of a primary focus.

"$" 
- Typically limited to apical and posterior segments of
upper lobes
- Rarely in anterior segments of upper lobes

c(#"#

axudative TB patchy or confluent airspace disease,

adenopathy is uncommon.
Fibrocalcific TB sharply circumscribed linear densities
radiating to hilum
Cavitation - 40%
!" 

1. Miliary TB
2. Bronchogenic spread to lung
3. Tuberculoma
4. Bronchial stenosis
5. Bronchiectasis
6. Pneumothorax
7. Pleural effusion often loculated
 

Xnown routes of HIV transmission:
- Blood and blood products
- exual activity
- In utero transmission
- uring delivery

Clinical:
- Lymphadenopathy
- Opportunistic infections
- Tumors: lymphoma, Xaposi sarcoma
- Other manifestations: lymphocytic interstitial
pneumonia, spontaneous pneumothorax, septic emboli
 pectrum of chest manifestations:

odules Xaposi sarcoma (usually associated with skin

lesions), septic infarcts, fungal (Cryptoccocus, Aspergillus)
Large o acity: consolidation, mass hemorrhage, NHL,
Pneumonia
Linear or interstitial o acities PCP, atypical
mycobacteria, Xaposi sarcoma
Lym hadeno athy Mycobacterial infections, Xaposi
sarcoma, lymphoma
Pleural effusion Xaposi sarcoma, fungal infection,
pyogenic empyema