Beruflich Dokumente
Kultur Dokumente
IMAGING OF CHEST
DISEASES
CHEST DISEASES
o Lung
o Pleura
o Diaphragm
o Soft Tissue and Skeletal
o Kardiovaskular
o Mediastinum
LUNG
Mediastinal shift.
Fissure traction.
Hilar traction.
widening.
The film should be symmetrical to
Air bronchogram
Lobar Pneumonia
Air bronchogram
Lobar Pneumonia
RUL Pneumonia
Homogenous
opacification
Air bronchogram
Limited by the
minor fissure at
the inferior
Silhoutte to the
upper mediastinal
No volume changes
Lobar Pneumonia
RML Pneumonia
Homogenous
opacification
Air bronchogram
Limited by the minor
fissure at the
superior
Silhoutte to the right
heart border
No volume changes
Lobar Pneumonia
RML Pneumonia
Homogenous
opacification
Air bronchogram
Limited by the minor
fissure at the
superior
Limited by the major
fissure at the
posterior
No volume changes
Lobar Pneumonia
RLL Pneumonia
Homogenous
opacification
Air bronchogram
Silhoutte to the right
diaphragm
No volume changes
Lobar Pneumonia
RLL Pneumonia
Homogenous
opacification
Air bronchogram
Limited by the major
fissure at the anterior
Silhoutte to the right
diaphragm (only one
diaphragm that is
seen)
No volume changes
Lobar Pneumonia
LUL Pneumonia
Homogenous
opacification
Air bronchogram
Silhoutte to the
mediastinum and
left heart border.
The left diaphragm
can still be seen.
No volume changes
Lobar Pneumonia
LUL Pneumonia
Homogenous
opacification
Air bronchogram
Limited by the major
fissure at the
posterior
Both of the diaphragms
can still be seen.
No volume changes
Lobar Pneumonia
Lingular Pneumonia
Homogenous
opacification
Air bronchogram
Silhoutte to the left
heart border.
No volume changes
Bronchopneumonia or
Lobular Pneumonia
Patchy
consolidation
No air
bronchogram
Interstitial Pneumonia
Lack of alveolar exudate
Inflammatory centered within alveolar wall &
interstitium
Interstitium consists of a continuum of connective
tissue throughout the lung comprising 3
subdivision:
The bronchovascular (axial) interstitium
Surrounding bronchi, arteries, & veins from hilum to
respiratory bronchiole
The parenchymal (acinar interstitium)
Between alveolar & capillary basement membranes
Subpleura connective tissue contiguous with the interlobular
septa
Interstitial Pneumonia
Etiology :
Usually viral (late stage alveolar process)
Influenza virus types A and B
Respiratory syncytial virus
Adenovirus
Mycoplasma pneumonia
Linear opacification
Increased bronchovascular marking
No silhouette sign or air bronchogram.
Interstitial Pneumonia
Round Pneumonia
Etiology:
Haemophilus influenzae
Streptococcus
Pneumococcus
Children are affected much more than adults.
Location usually lower lobe, most often posterior
May have slightly irregular border & air
bronchogram.
Differential diagnosis of mass.
Mechanism: immature development of the pores
of Kohn
Round Pneumonia
Round Pneumonia
Cavitary Pneumonia
Complication from severe necrotising
pneumonia (Staphylococcus aureus)
Can also result from pulmonary tuberculosis.
Show subtle area of radiolucency
superimposed on a region of consolidation
Should be differentiate with abscess which
have thick wall > 2cm. CT scan examination
with contrast media will give enhancement of
its wall.
Cavitary Pneumonia
Cavitary Pneumonia
Cavitary Pneumonia vs Lung
Abscess
ATELECTASIS
Reduced inflation of all or
part of the lung
Synonim: collapse
Reduced lung volume
ATELECTASIS
Classified based on etiology:
Compressive/relaxation/passive
Expansion is hampered by pneumothorax or pleural
effusion
Obstructive/absorption/resorption
Luminal occlusion with air absorption at the distal part
E/ mass,mucous plug,corpal,inflammation,lymph node
Adhesif
Surfactant deficiency
Cicatrical/contraction
Lung or pleural fibrosis that hampered the lung expansion
ATELECTASIS
interlobar fissures
Increased opacity
Increased
bronchovascular marking
ATELECTASIS
6 indirect signs (minor)
Diaphragm elevation
Mediastinal shift
Tracheal deviation
Hilar traction
Compensated hyperinflation
of normal lung
Intercostal space narrowing
ATELECTASIS
Other type of atelectasis
Subsegmental (discoid/plate-
like)
Compressive with
compensation no
mediastinal shift.
Round atelectasis
Controversy
Synonim with pulmonary
Classified into
Cardiogenic
Non-cardiogenic
Cardiogenic pulmonary edema heart failure
Heart failure
Left heart failure backward failure pulmonary
congestion pulmonary edema
Right heart failure backward failure systemic
congestion doesnt cause pulmonary edema
PULMONARY EDEMA
Chest x ray screening tool
Left heart failure:
Heart enlargement with the apex downward to
the diaphragm
Depend on the severity
1. Cranialization / cephalization (PCWP 10-15
mmHg)
2. Interstitial pulmonary edema (PCWP 20-25
mmHg)
3. Alveolar pulmonary edema (PCWP >25 mmHg)
PULMONARY EDEMA
Cranialization / cephalization
Pulmonary veins at the superior part of the lung >3-
5:1 than the pulmonary veins at the inferior part of
the lung.
Vascular marking at the superior part of the lung is
more crowded than the inferior part of the lung.
Measure at equidistant from the hilar point.
Mechanism:
Decreased vascular compliance at the lung base.
Hypoxic vasoconstriction phenomenon
PULMONARY EDEMA
Cranialization / Cephalization
PULMONARY EDEMA
Kerley B lines
PULMONARY EDEMA
PULMONARY EDEMA
Subtypes:
Small cell carcinoma
Squamous cell carcinoma
Large cell carcinoma
Adenocarcinoma
Bronchioloalveolar carcinoma
PULMONARY NEOPLASM
Mass >3cm
Nodule <3cm
Consolidation
Infiltrates
Smooth or irregular
Cavitation
Satellite nodules
Lymphadenopathy
Skeletal involvement
PULMONARY NEOPLASM
PULMONARY METASTASIS
Types:
Milliary(<0.5cm)
Coin lesion / coarse nodular pattern (1-
2cm)
Golf ball / cannon ball patter (>2cm)
Lymphangitic spread
Pneumonic and peribronchial pattern
Pleural effusion
PULMONARY METASTASIS
Milliary
Thyroid, lung, breast, bone sarcoma
Coin lesion
Oropharynx, gaster, thyroid, limfosarcoma, choriocarcinoma, ovarian,
uterine
Golf ball
Sarcoma, carcinoma, seminoma, renal cell ca
Lymphangitic spread
Breast,
pancreas, lung, lymphoma, leukemia, thyroid, larynx, stomach,
pancreas, cervix
Pneumonic & peribronchial pattern
Esophagus, lung, breast
Pleural effusion (not truly pulmonary metastasis)
Breast, gaster, adenocarcinoma
MILIARY PULMONARY METASTASIS
COIN LESION PULMONARY METASTASIS
GOLF BALL PULMONARY
METASTASIS
LYMPHANGITIC SPREAD
PULMONARY METASTASIS
PNEUMONIC TYPE PULMONARY METASTASIS
PLEURAL EFFUSION METASTASIS
ATYPICAL PULMONARY
METASTASIS
Mass with cavitation
Squamous cell ca of head & neck, adenocarcinoma of
the GI tract, breast, sarcoma
Mass with calcification
Osteosarcoma, chondrosarcoma (bone formation)
Papillary carcinoma of the thyroid, GCT, synovial
sarcoma (dystrophic calcification)
Mucinous adenocarcinoma of GI tract or breast
(mucoid calcification)
Spontaneous pneumothorax
Osteosarcoma, angiosarcoma
ATYPICAL PULMONARY
METASTASIS
Ground-glass attenuation
Choriocarcinoma, angiosarcoma, adenoca of GI tract
Consolidation with or without ground-glass opacity
Adenoca of GI tract
Hepatoma, breast, renal, gastric, prostatic,
choriocarcinoma
Mass within pulmonary artery
Hepatoma, breast and renal carcinoma, gastric and
prostatic cancers, and choriocarcinoma
Atelectasis, endobronchial mass
Renal cell carcinoma, breast cancer, colorectal cancer
Mass with Cavitation
Mass with Calcification
Pneumothorax
Ground-glass Attenuation
Consolidation
Mass within Pulmonary Artery
Westermark sign
Hamptons hump sign
Endobronchial Mass with
Atelectation
Emphysema
Thin-walled-less than 1 mm
Air-filled space
Contained within the lung
Bleb diameter < 1cm,
subpleura
Giant bulla > 1/3 hemithorax
vanishing lung syndrome
Bullae & Bleb
Cyst
1 3 mm wall
Air or fluid filled
Wall that contains respirator epithelium,
cartilage, smooth muscle and glands
Contained within the lung
Congenital or acquired
Pneumatocele cyst associatied with
pneumonia, frequently transient
Cyst
Tuberculous Cavity
Causes:
Post Infective (most common)
Congenital
Obstruction
(traction)
Bronchiectasis
Bronchiectasis vs Bronchitis
Bronchiectasis Bronchitis
Ring shadow
Ring shadow
Tram-track or tram-line
Cuffing sign (en
Increased
bronchovascular
face)
marking Tram-track (en
CT Findings:
Bronchial dilatation
o Pleural Effusion
o Pleural
Thickening
o Hydropneumotho
rax
o Empyema
o Pneumothorax
PLEURAL EFFUSION
Subpulmonal
PLEURAL EFFUSION
Meniscus sign
PLEURAL EFFUSION
Laminar effusion
HYDROPNEUMOTHORAX
o POSITION
o CONTOUR
o HERNIATION
DIAPHRAGM
Position
o Right diaphragm is higher than the left
diaphragm.
o Normal : 2.5 cm
o > 3 cm: abnormal
DIAPHRAGM
Scalloping
DIAPHRAGM
Tenting
DIAPHRAGM
Diaphragmatic herniation
o Congenital
o Morgagni (anterior)
o Bochdalek (posterior)
o Acquired (Traumatic)
o Hiatal hernia
DIAPHRAGM
DIAPHRAGM
DIAPHRAGM
o RIBFRACTURE
o CLAVICLE FRACTURE
o SCAPULA FRACTURE
o SUBCUTIS
EMPHYSEMA
o CORPUS ALIENUM
RIB FRACTURE
CLAVICLE FRACTURE
SCAPULAR FRACTURE
SUBCUTIS EMPHYSEMA
CORPUS ALIENUM
Thank you
Hidden Areas
Hidden Areas
Hidden Areas
Hidden Areas
Hidden Areas
Hidden Areas