UERMMMC Department of Radiology. Basic Chest Radiology

Transcription

1 UERMMMC Department of Radiology Basic Chest Radiology

2 PHYSICS DENSITIES BONE SOFT TISSUES WATER FAT AIR

3 TELEROENTGENOGRAM Criteria for an Ideal Chest Radiograph 1. Upright 2. Posteroanterior View 3. Full / Midinspiration 4. Six Feet Target Film Distance

4 NORMAL CHEST ANATOMY AIRWAYS Trachea Bronchi

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6 NORMAL CHEST ANATOMY LUNGS FISSURES LOBES SEGMENTS PULMONARY VASCULAR MARKINGS

7 MINOR FISSURE MAJOR FISSURE

8 MINOR MAJOR FISSURE

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10 RUL LUL RML RUL RLL RML LLL RLL

11 apical ant post S lat med M A L M L P 1O SEGMENTS

12 AP SL ant SL S IL AM IL L P 8 SEGMENTS AP & AM FUSED SEGMENTS

13 RIGHT = 10 SEGMENTS REMEMBER THIS APA (upper lobe) Apical, Posterior, Anterior ML (middle lobe) Medial Lateral SAMPLe BASAL Superior segment (no last name basal ) Anterior basal, Medial basal, Posterior basal, Lateral basal

14 REMEMBER THIS LEFT = 8 SEGMENTS SAMPLe BASAL Superior segment (no last name basal ) Antero-Medial basal, Posterior basal, Lateral basal LINGULA Superior, Inferior AP, A (upper lobe) ApicoPosterior, Anterior You have an AP in AM!

15 NORMAL CHEST ANATOMY MEDIASTINUM/HILA AORTA/MAIN PULMONARY ARTERY HEART CHAMBERS THE BUMPS

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18 RA LV RV LA

19 SVC AA MPA AA MPA SVC RA LV RA LV THE BUMPS

20 PROMINENT MEDIALLY TAPERS PERIPHERALLY PULMONARY VASCULAR MARKINGS

21 MORE PROMINENT INFERIORLY PULMONARY VASCULAR MARKINGS

22 NORMAL CHEST ANATOMY PLEURA PARIETAL VISCERAL

23 NORMAL CHEST ANATOMY OTHERS DIAPHRAGM RIBS GASTRIC BUBBLE LIVER SHADOW THYMUS

24 Visceral Pleura Parietal Pleura Pleural Space Pleural Fluid Normal 15-20cc LUNG

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26 L HEMIDIAPHRAGM L HEMIDIAPHRAGM R HEMIDIAPHRAGM LIVER SHADOW GASTRIC BUBBLE GASTRIC R HEMIDIAPHRAGM BUBBLE

27 IMPORTANT SIGNS IN CHEST RADIOLOGY AIR BRONCHOGRAM SIGN SILHOUETTE SIGN HELPFUL RULES BY SWISCHUCK

28 HELPFUL RULES RULE 1 IF THE VASCULARITY IS DECREASED, THE LUNG IS ABNORMAL

29 VISIBLE VISCERAL PLEURA ABSENT LUNG MARKINGS

30 ABSENT LUNG MARKINGS

31 RULE 2 IF THE PULMONARY VASCULARITY IS NORMAL OR INCREASED, THE LUNG PROBABLY IS NORMAL

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33 NORMAL VASCULAR MARKINGS

34 HELPFUL RULES RULE 3 COMPLETELY OPAQUE HEMITHORAX IS THE ABNORMAL HEMITHORAX

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37 AIR BRONCHOGRAM AIR BRONCHOGRAM SIGN BRANCHING LUCENCIES WITHIN THE OPACIFIED LUNG DENOTES AIR SPACE DISEASE PNEUMONIA PULMONARY EDEMA PULMONARY HEMORRHAGE

38 AIR BRONCHOGRAM AIR SPACE DISEASE PARENCHYMAL INVOLVEMENT ABSENT IN MASS LESIONS AND PLEURAL DISEASE (e.g., PLEURAL EFFUSION)

39 AIR-BRONCHOGRAM SIGN

40 AIR BRONCHOGRAM

41 AIR BRONCHOGRAM

42 AIR BRONCHOGRAM

43 AIR SPACE DISEASE H HEMORRHAGE E A EDEMA ALVEOLAR PROTEINOSIS P PNEUMONIA

44 BILATERAL AIR-SPACE OPACITES PULMONARY EDEMA

45 AIR-SPACE DISEASE Pulmonary contusion Peripheral location HX of trauma Pulmonary edema Usually bilateral Usually central HX of cardiac, Pneumonia (air-space) Usually unilateral Peripheral in location

46 SILHOUETTE SIGN ANY INTRATHORACIC LESION OBSCURING THE CARDIAC BORDER, AORTA, OR DIAPHRAGM IS ANATOMICALLY CONTIGUOUS WITH THAT STRUCTURE

47 SILHOUETTE SIGN LOCALIZING INTRAPARENCHYMAL LESIONS HEART IS ANTERIOR IN LOCATION OBLITERATION OF RIGHT CARDIAC SHADOW = LESION IS ANTERIOR = RIGHT MIDDLE LOBE OBLITERATION OF LEFT CARDIAC BORDER = LESION IS ANTERIOR = LINGULA

48 SILHOUETTE SIGN IF LESION IS IN THE RIGHT PARACARDIAC REGION BUT NOT OBLITERATING THE CARDIAC SHADOW = LESION IS POSTERIOR = RIGHT LOWER LOBE IF LESION IS IN THE LEFT PARACARDIAC REGION BUT NOT OBLITERATING THE CARDIAC SHADOW = LESION IS POSTERIOR = LEFT LOWER LOBE

49 N ABSENT BORDERS LESION ADJACENT STRUCTURES SHADOWS MERGE

50 DISTINCT MARGIN NON-CONTIGUOUS STRUCTURES TWO SHADOWS

51 RUL LUL RML RUL RLL RML LLL RLL

52 SILHOUETTE SIGN OBSCURED RIGHT CARDIAC BORDER RIGHT MIDDLE LOBE PNEUMONIA

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54 SILHOUETTE SIGN OBSCURED LEFT CARDIAC BORDER LINGULAR LOBE PNEUMONIA

55 ABSENT SILHOUETTE SIGN LOWER LOBE PNEUMONIA

56 COMMON CHEST PATHOLOGIES

57 PNEUMONIA AIR-SPACE PNEUMONIA INTERSTITIAL PNEUMONIA

58 AIRWAY AIR BRONCHOGRAM AIR SPACE

59 RIGHT UPPER LOBE PNEUMONIA

60 PNEUMONIA RUL, RML AND LLL

61 PNEUMONIA LLL

62 KLEBSIELLA PNEUMONIA

63 ATELECTASIS DIRECT SIGNS 1) DEVIATION OF THE FISSURE 2) CROWDING OF LUNG MARKINGS

64 ATELECTASIS INDIRECT SIGNS 1) INCREASED OPACIFICATION 2) SHIFTING OF MEDIASTINAL STRUCTURES 3) ELEVATION OF THE DIAPHRAGM 4) NARROWING OF RIB INTERSPACES 5) COMPENSATORY HYPERINFLATION OF THE UNAFFECTED LUNG

65 ATELECTASIS = LOSS OF VOLUME

66 Pulmonary vascular markings Air spaces Collapsed Crowded vascular markings air spaces Shifting Increased Fissures towards opacification the side of collapse Normal Lung Mediastinal Structures Atelectatic Lung

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68 UPWARD DISPLACEMENT OF THE MINOR FISSURE LOSS OF VOLUME RUL ATELECTASIS

69 Minor fissure

70 RUL ATELECTASIS

71 MASSIVE ATELECTASIS

72 HYDROTHORAX PLEURAL EFFUSION/HEMOTHORAX TRANSUDATE/EXUDATE DECUBITUS VIEW WHEN NOT TO REQUEST FOR A DECUBITUS VIEW LOCULATED FLUID ACCUMULATION

73 BLUNTING OF CPS PLEURAL EFFUSION

74 Meniscus = pleural effusion

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77 MASSIVE PLEURAL EFFUSION

78 MASSIVE PLEURAL EFFUSION

79 Pre-drainage Film Post Thoracostomy Tube Placement MASSIVE PLEURAL EFFUSION

80 UNILATERAL EFFUSION I INFECTIONS T TUMORS C CHYLOUS EFFUSION H HEMORRHAGE

81 BILATERAL EFFUSION VITAL ORGANS CARDIAC HEPATIC RENAL

82 CONSOLIDATED PNEUMONIA MASSIVE ATELECTASIS MASSIVE PLEURAL EFFUSION

83 CONSOLIDATED PNEUMONIA MASSIVE ATELECTASIS MASSIVE PLEURAL EFFUSION

84 PNEUMOTHORAX/ PNEUMOMEDIASTINUM

85 pneumothorax Absent lung markings Collapsed lung

86 The last words he uttered before he was stabbed by his wife Absence of lung markings Displacement of the mediastinal structures

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88 AIR- FLUID LEVEL = PNEUMOHYDROTHORAX

89 ENLARGED THYMUS SAIL SIGN

90 pneumomediastinum

91 ANGEL WINGS PNEUMOTHORAX/ PNEUMEDIASTINUM

92 PTB PRIMARY INFECTION 1)GHON FOCUS 2)ADENOPATHIES 3)LYMPHANGITIS 4)PLEURAL EFFUSION REACTIVATION TB

93 Primary Complex (Hilar nodularities)

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95 CALCIFIED GHON LESION

96 HILAR CALCIFICATIONS

97 TB LUL

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104 NEOPLASM

105 ROUND LESIONS < 3 = nodule > 3 = MASS

106 MASS/ NODULE = NO AIR BRONCHOGRAM

107 SOLITARY PULMONARY NODULE

108 CANNON BALLS (metastasis)

109 RIGHT HILAR MASS

110 Absent bowel loops Diaphragmatic hernia