Imaging of Chest Diseases

7/25/2019 Imaging of Chest Diseases

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o Lungo Pleurao Diaphragmo Soft Tissue and Skeletalo Kardiovaskularo Mediastinum

CHEST DISEASES


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INCRESE !PCIT"o Pneumonia

o tele#tasiso Pulmonar$ Contusion %

La#eration

o Traumati# &et Lung

o Pulmonar$ Edemao Pulmonar$ Mass

o Pulmonar$ Metastasis

LUNG

INCRESE L'CENC"o Emph$sema

o (ullae % (le)o C$st

o Tu)er#ulous #avit$

o Pulmonar$ a)s#ess

o Malignant Cavit$o (ron#hie#tasis and

(ron#hitis


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PNEUMONIA

Inammation of teairspaces and!or interstitium

"tiology Infective

#acterial$ %irus$ Fungi$ Parasites

&utoimmune

'emical

meconiumaspiration

(eoplasm

Idiopatic


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PNEUMONIA

Preferred imaging modalityPosteroanterior cest + ray

,ateral cest + ray


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PNEUMONIA

'lassi-cation )ased onradiology appearance

,o)ar pneumonia,o)ularis pneumonia !

#roncopneumonia

Interstitial pneumoniaRound pneumonia

'avitary pneumonia


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Lobar Pneumonia


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Why do we still see the silhouette othe right diaphragm on the PA-flm


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Lobar Pneumonia

&ir )roncogram


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Lobar Pneumonia

RUL Pneumonia

Homogenousopaci-cation

&ir )roncogram

,imited )y teminor -ssure at

te inferiorSiloutte to te

upper mediastina

(o volume canges


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Lobar Pneumonia

RML Pneumonia


&ir )roncogram

,imited )y te minor-ssure at te

superiorSiloutte to te rigt

eart )order

(o volume canges


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Lobar Pneumonia

RLL Pneumonia


&ir )roncogram

Siloutte to te rigtdiapragm

(o volume canges


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Lobar Pneumonia

RLL Pneumonia


&ir )roncogram

,imited )y te major-ssure at te anterior

Siloutte to te rigtdiapragm 5only onediapragm tat isseen6

(o volume canges


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Lobar Pneumonia

LUL Pneumonia


&ir )roncogramSiloutte to te

mediastinum andleft eart )order/

4e left diapragmcan still )e seen/

(o volume canges


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Lobar Pneumonia

LUL Pneumonia


&ir )roncogram,imited )y te major

-ssure at teposterior

#ot of te diapragmscan still )e seen/

(o volume canges


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Lobar Pneumonia

Lingular Pneumonia


&ir )roncogramSiloutte to te left

eart )order/

(o volume canges


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Bronco!neumonia orLobular Pneumonia

&.ected te pulmonary lo)ules/ 'ommences in te terminal and

respiratory )roncioles "ndo)roncial spread/ In-ltrates or patcy consolidation (o air )roncogram


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Bronco!neumonia

Patcy

consolidation(o air)roncogram


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In"er#"i"ial Pneumonia

,ack of alveolar e+udate Inammatory centered *itin alveolar *all 8

interstitium Interstitium consists of a continuum of connective

tissue trougout te lung comprising 9su)division14e )roncovascular 5a+ial6 interstitium

Surrounding )ronci$ arteries$ 8 veins from ilum to

respiratory )ronciole4e parencymal 5acinar interstitium6

#et*een alveolar 8 capillary )asement mem)ranes

Su)pleura connective tissue contiguous *it te interlo)ular

septa


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"tiology 1 Usually viral 5late stage alveolar process6

Inuen:a virus types & and #

Respiratory syncytial virus

&denovirus

Mycoplasma pneumonia

,inear opaci-cation

Increased )roncovascular marking (o silouette sign or air )roncogram/


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Roun$ Pneumonia


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Roun$ Pneumonia


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Ca%i"ar& Pneumonia


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Ca%i"ar& Pneumonia


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ATELECTASIS

Reduced ination of all opart of te lung

Synonim1 collapse Reduced lung volume


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ATELECTASIS

'lassi-ed )ased on etiology1 'ompressive!rela+ation!passive

"+pansion is ampered )y pneumotora+ or pleurale.usion

=)structive!a)sorption!resorption ,uminal occlusion *it air a)sorption at te distal part

"! mass$mucous plug$corpal$inammation$lymp node

&desif Surfactant de-ciency

'icatrical!contraction ,ung or pleural -)rosis tat ampered te lung e+pansio


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ATELECTASIS

9 direct sign 5major6 Displacement of

interlo)ar -ssures Increased opacity Increased

)roncovascular marking


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ATELECTASIS

> indirect signs 5minor6 Diapragm elevation

Mediastinal sift 4raceal deviation Hilar traction

'ompensated yperinatioof normal lung

Intercostal space narro*ing


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ATELECTASIS

=ter type of atelectasis Su)segmental 5discoid!plate2

like6 'ompressive *it

compensation nomediastinal sift/

Round atelectasis S golden sign RU,

atelectasis *it periilar mass/


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RUL A"elec"a#i#


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RUL A"elec"a#i#


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RML A"elec"a#i#


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RML A"elec"a#i#


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RML A"elec"a#i#


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RLL A"elec"a#i#


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RLL A"elec"a#i#


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LUL A"elec"a#i#


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LUL A"elec"a#i#


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LLL A"elec"a#i#


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LLL A"elec"a#i#


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'ompressive *it compensation


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Round &telectasis


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Round &telectasis


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?old S sign

PULMONAR* CONTUSION AND


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PULMONAR* CONTUSION ANDLACERATION

4e most common complicationof )lunt injury to te cest

Intra2alveolar and interstitial

aemorrage at te impactsite/

'linical istory play an

important role Resem)le pneumonia$

aspiration



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In-ltrates at te periperalarea 5ma+imum impact point6

Usually no air )roncogram > ours after trauma and

disappear after @< ours/

Persist ;@< ours

pulmonary laceration orpneumonia/



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Pulmonary laceration ard to )ediagnosed in -rst couple of dayscovered )y contusion

4e -ndings of pulmonarylaceration1

=void mass if it is -lled

completely )y )lood/&ir uid level if partially -ll

*it )lood and air/

'yst if -lled *it air/



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(eed *eeks or monts forte cest + ray to )e seenclearly again/


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PULMONAR* CONTUSION


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PULMONAR* CONTUSION


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PULMONAR* LACERATION


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TRAUMATIC +ET LUNG

'ontroversy Synonim *it pulmonary

contusion and laceration Di.erent1

4raumatic *et lung or Da (ang,ungpulmonary edema tat *as

not directly caused )y trauma atte cest


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PULMONAR* EDEMA

'lassi-ed into 'ardiogenic

(on2cardiogenic

'ardiogenic pulmonary edema eart failure Heart failure

,eft eart failure )ack*ard failure pulmonary

congestion

pulmonary edema Rigt eart failure)ack*ard failure systemic

congestiondoesnAt cause pulmonary edema


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PULMONAR* EDEMA

'est + ray screening tool ,eft eart failure1

Heart enlargement *it te ape+ do*n*ard to

te diapragm Depend on te severity

B/ 'raniali:ation ! cepali:ation 5P'CP B2BEmmHg6


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PULMONAR* EDEMA

'raniali:ation ! cepali:ation Pulmonary veins at te superior part of te lung ;92

E1B tan te pulmonary veins at te inferior part of

te lung/ %ascular marking at te superior part of te lung is

more cro*ded tan te inferior part of te lung/

Measure at e3uidistant from te ilar point/

Mecanism1 Decreased vascular compliance at te lung )ase/

Hypo+ic vasoconstriction penomenon


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PULMONAR* EDEMA

'raniali:ation ! 'epali:ation


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PULMONAR* EDEMA

Interstitial pulmonary edema Interlo)ular septa tickening

0erley # lung )ase 1 tickness Bmm$ lengt B2cm$ o)li3ue at te central part

0erley ' reticular at te lung )ase 5en face 0erley #6

Peri)roncial tickening at )ot ila Fluid in -ssures

Pleural e.usion 5#ilateral especially te rigt side6


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PULMONAR* EDEMA

0erley # lines


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PULMONAR* EDEMA


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PULMONAR* EDEMA

Peri)roncial tickening and uid in


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PULMONAR* EDEMA

Interstitial pulmonary edema

O


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PULMONAR* EDEMA

&lveolar pulmonary edema In-ltrates in te medial t*o tird of te lung/

#atAs *ing appearance

#uttery appearance Usually no air )roncogram

PULMONAR* EDEMA


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PULMONAR* EDEMA

&lveolar pulmonary edema

PULMONAR* EDEMA


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PULMONAR* EDEMA

&lveolar pulmonary edema

PULMONAR* EDEMA


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PULMONAR* EDEMA

(on cardiogenic pulmonary edema More periperally

(o craniali:ation!cepali:ation

"tiology1 %olume overload

&RDS

(S&ID

(eurogenic pulmonary edema 5intracranialpressure;;6

Dro*ned

PULMONAR* EDEMA


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PULMONAR* EDEMA

(on cardiogenic pulmonary edema


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PULMONAR* NEOPLASM


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PULMONAR* NEOPLASM

Su)types1Small cell carcinoma

S3uamous cell carcinoma,arge cell carcinoma

&denocarcinoma

#roncioloalveolar carcinoma

PULMONAR* NEOPLASM


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PULMONAR* NEOPLASM

'linical management depends on diseasee+tent 5staging6 role of imaging otertan detection/

'entral 1Small cell carcinoma

S3uamous cell carcinoma

Periperal,arge cell carcinoma

&denocarcinoma

PULMONAR* NEOPLASM


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PULMONAR* NEOPLASM

Mass ;9cm

(odule G9cm'onsolidation

In-ltrates

Smoot or irregular

'avitation

Satellite nodules

,ympadenopaty

Skeletal involvement

Imaging -nding spectrum

PULMONAR* NEOPLASM


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PULMONAR* NEOPLASM

PULMONAR* METASTASIS


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4ypes1Milliary 5G/Ecm6

'oin lesion ! coarse nodular pattern 5B2


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Milliary4yroid$ lung$ )reast$ )one sarcoma

'oin lesion=roparyn+$ gaster$ tyroid$ limfosarcoma$ coriocarcinoma$ ovarian$

uterine ?olf )all

Sarcoma$ carcinoma$ seminoma$ renal cell ca

,ympangitic spread#reast$ pancreas$ lung$ lympoma$ leukemia$ tyroid$ laryn+$ stomac$

pancreas$ cervi+ Pneumonic 8 peri)roncial pattern

"sopagus$ lung$ )reast

Pleural e.usion 5not truly pulmonary metastasis6#reast$ gaster$ adenocarcinoma

MILIAR* PULMONAR* METASTASIS


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MILIAR* PULMONAR* METASTASIS

COIN LESION PULMONAR* METASTASIS


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COIN LESION PULMONAR* METASTASIS

GOLF BALL PULMONAR*


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METASTASIS

L*MPHANGITIC SPREAD


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PNEUMONIC T*PE PULMONAR* METASTASIS


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PNEUMONIC T*PE PULMONAR* METASTASIS

PLEURAL EFFUSION METASTASIS


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PLEURAL EFFUSION METASTASIS

AT*PICAL PULMONAR*


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METASTASIS

Mass *it cavitationS3uamous cell ca of ead 8 neck$ adenocarcinoma of

te ?I tract$ )reast$ sarcoma

Mass *it calci-cation=steosarcoma$ condrosarcoma 5)one formation6

Papillary carcinoma of te tyroid$ ?'4$ synovialsarcoma 5dystropic calci-cation6

Mucinous adenocarcinoma of ?I tract or )reast5mucoid calci-cation6

Spontaneous pneumotora+=steosarcoma$ angiosarcoma


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Ma## ,i" Ca%i"a"ion


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Ma## ,i" Ca%i"a"ion

Ma## ,i" Calci-ca"ion


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Ma## ,i" Calci-ca"ion

Pneumo"ora.


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Pneumo"ora.

Groun$(gla## A""enua"ion


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Groun$(gla## A""enua"ion

Con#oli$a"ion


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Con#oli$a"ion

M i i P l A


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Ma## ,i"in Pulmonar& Ar"er&

+ " ) i


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+e#"ermar) #ign

H " / i


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Ham!"on/# um! #ign

En$obroncial Ma## ,i"


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En$obroncial Ma## ,i"A"elec"a"ion

Em!ema


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Em!ema

"mpysema is de-ned patologically aspermanent enlargement of te airspacesdistal to te terminal )roncioles$

accompanied )y destruction of teir *alls"tiology 1 Im)alance of elastase and antielastase

activity of elastase 5smokers6

JB2antiprotease

Proteolytic destruction of elastin alveolar *alldestruction

Em!ema


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Em!ema

Finding1Hyperaeration of te lung/

Decreased )rocovascular marking 5Increased ifaccompanied )y cronic )roncitis6

Cidened intercostal space 8 ori:ontal ri)sFlattening of te diapragm 8 )lunted costoprenic angle

#arrel cest 5&nteroposterior diameter ;;6/

; @tri) anteriorly or ;B tri) posteriorly/

4ear drop eart/Retrosternal space *idening in lateral cest + ray

Respiratory e+cursion G 9cm/

&typical appearance of pneumonia or pulmonary edema/

Em!ema


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Em!ema


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Bullae 0 Bleb


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Bullae 0 Bleb

C"


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C"

B K 9 mm *all &ir or uid -lled Call tat contains respirator epitelium$

cartilage$ smoot muscle and glands 'ontained *itin te lung 'ongenital or ac3uired Pneumatocele cyst associatied *it

pneumonia$ fre3uently transient

C"


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C"

Tuberculou# Ca%i"&


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Tuberculou# Ca%i"&

Result from process tatproduces necrosis of te central

portion of te lesionCall tickness 92E mm

'ontained *itin te lung

Tuberculou# Ca%i"&


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Tuberculou# Ca%i"&

Ab#ce##


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Ab#ce##

4ick *all ;Emm

Smoot inner margin

#ackground pneumonia 5@2Bdays6

Same lengt on )ot frontal andlateral vie* 5di.erent *itempyema6


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Malignan" Ca%i"&


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Malignan" Ca%i"&

4ick *all ;Emm

Irregular inner margin

Mural nodule

Malignan" Ca%i"&


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Malignan" Ca%i"&

Bronciec"a#i#


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Bronciec"a#i#

&)normal dilatation of te )roncialtree/

Irreversi)le locali:ed or di.use)roncial dilatation$ usually resultingfrom cronic infection pro+imal

air*ay o)struction$ or congenital/Irreversi)le e+cept some traction)ronciectasis/

Bronciec"a#i#


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Bronciec"a#i#

'auses1

Post Infective 5most common6

'ongenital

=)struction

,oss of surrounding lung volume5traction6

Bronciec"a#i#


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Bronciec"a#i#

Bronciec"a#i# %# Bronci"i#


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ronciectasis

Ring sado*

4ram2track or tram2line

Increased)roncovascularmarking

Honeycom) appearance

5old terminology6&ir2uid level infected

#roncitis Ring sado* 'uLng sign 5en

face6 4ram2track 5en

pro-le6 or tram2line

Increased)roncovascularmarking

Bronci"i#


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Bronciec"a#i#


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'ongenital cystic )ronciectasis

Bronciec"a#i#


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Bronciec"a#i#


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Bronciec"a#i#


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Bronciec"a#i#


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'4 Findings1

#roncial dilatation

Signet ring sign,ack of tapering of )ronci

Identi-cation of )ronci *itin Bcm of te pleural surface


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PLEURAL EFFUSION


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o Fluid collection in te pleural cavity

o Produced 1 parietal pleura capillaries

o &)sor)ed 1 visceral pleura andlympatic at te parietal pleural

PLEURAL EFFUSION


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'an )e caused )yo Increased production

o ydrostatic pressure 5left eart failure6o

oncotic pressure 5ypoproteinemia6o capillary permea)ility 5pneumonia$

ypersensitivity6o Decreased resorption

o lympatic a)sorption 5o)struction )ytumour6

o intrapleural cavity pressure 5atelectasis6

PLEURAL EFFUSION


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o 9 m, "rect cest + rayo @E m, ,ateral cest + ray

o BE2


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o Minimal pleural e.usiono Ultrasonograpy e+amination

o '4 scan

o &spiration guiding also *itultrasonograpy/

PLEURAL EFFUSION


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%arious appearanceo Su)pulmonal e.usion

o 'ostoprenic sinus )lunting

o Meniscus signo Homogenous opaci-cation

o ,ocali:ed e.usion

o

Pseudotumor ! vanising tumoro ,aminar e.usion

o Hydropneumotora+

PLEURAL EFFUSION


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Su)pulmonal

PLEURAL EFFUSION


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(ormal and )lunting

PLEURAL EFFUSION


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Meniscus sign

PLEURAL EFFUSION


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Homogenous opaci-cation *it

PLEURAL EFFUSION


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,ocali:ed pleural e.usion

PLEURAL EFFUSION


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Pseudotumor or vanising tumor 5lemon

PLEURAL EFFUSION


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,aminar e.usion

H*DROPNEUMOTHORA2


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Hydropneumotora+ 5ori:ontal air2uid

PLEURAL THIC3ENING


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o Mimicking pleural e.usion/o4e margin is not smoot

o Does not cange *it position

o Do not conform to te menicus sign

sky2slope

o If tere is traction sc*arte

o More opa3ue tan te soft tissue5su)jective6

PLEURAL THIC3ENING


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EMP*EMA


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o Distinction )et*een a sterile pleurale.usion and an infected collection5empyema6 is often impossi)le/

o

'lue 1 air uid level tat *as locali:ed/o Citout air uid level it is ard to )e

recogni:ed/

o ,enticular

o4e lengt of air uid level in &P!P& vie*is di.erent *it te air uid level in lateralvie*/

EMP*EMA


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Lung Ab#ce## Em!&ema

PNEUMOTHORA2


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o &ir in te pleural cavityo =ne of cest trauma complication

o4ension type 1 progressive accumulation

mediastinal sift

cardiovascularcompromise

o Pleural line can )e seen

o (o )roncovascular marking )eyond te

pleural lineo "+piration -lm

o Deep sulcus sign tension pneumotora+

PNEUMOTHORA2


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PNEUMOTHORA2


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DIAPHRAGM


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o P!SITI!N

o C!NT!'Ro *ERNITI!N

DIAPHRAGM


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Positiono Rigt diapragm is iger tan te left

diapragm/

o

(ormal 1


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E"iolog& o4 rig" $ia!ram ele%a"ioo Hepatomegaly

o 'ilaiditi syndrome

o Paralysis n/prenicuso "ventratio

o Su)pulmonal e.usion

o &telectasis

o Fi)rosis

o Intraa)dominal tumor

o Su)prenic a)scess

DIAPHRAGM


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DIAPHRAGM


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E"iolog& o4 le4" $ia!ram ele%a"io Paralysis n/prenicus

o "ventratio

o

Su)pulmonal e.usiono &telectasis

o Fi)rosis

o Distended stomac or colon

o Intraa)dominal tumor

o Su)prenic a)scess

DIAPHRAGM


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DIAPHRAGM


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E"iolog& o4 bo" $ia!ramele%a"ion

o &scites

o Intraa)dominal tumour

o Pregnancy

o

=)esityo Pneumoperitoneum

DIAPHRAGM


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DIAPHRAGM


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Con"our o4 $ia!ragmo4enting

o (ormal variant

o Pulmonary ! pleural -)rosis

o &telectasis 5caused )y pulmonary ligamenttraction6

o Scalloping ! )ulging

o

(ormal varianto "ventratio

o Focal mass )elo* te diapragm or atdiapragmatic pleura/

DIAPHRAGM


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Scalloping

DIAPHRAGM


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4enting

DIAPHRAGM


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Dia!ragma"ic ernia"iono 'ongenital

o Morgagni 5anterior6

o #ocdalek 5posterior6o &c3uired 54raumatic6

o Hiatal ernia

DIAPHRAGM


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DIAPHRAGM


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DIAPHRAGM


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Diapragm rupture *it erniation

SOFT TISSUE 0 S3ELETAL


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o RI( +RCT'RE

o CL,ICLE +RCT'RE

o SCP'L +RCT'RE

o S'(C'TIS

EMP*"SEM

o C!RP'S LIEN'M

RIB FRACTURE


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CLA5ICLE FRACTURE


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SCAPULAR FRACTURE


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SUBCUTIS EMPH*SEMA


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CORPUS ALIENUM


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Tan) &ou

Hi$$en Area#


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Hi$$en Area#


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Hi$$en Area#


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Hi$$en Area#


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Hi$$en Area#


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Hi$$en Area#


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Documents

Imaging of Chest Diseases