Lecture 3. Inflammatory Processes

Size: px

Start display at page:

Download "Lecture 3. Inflammatory Processes"

Maria Mae Greene
6 years ago
Views:

1 Lecture 3 Inflammatory Processes Process: Increased vascular permeability Water and cellular infiltrations Results: Abscess, ulceration, cavitation Penetration, perforation and fistula formation Scarring, strictures 1

2 Inflammatory Processes Lungs and pleura Gastrointestinal tract Soft tissues of extremities Brain Inflammatory Lung, Mediastinal and Pleural Diseases Bronchitis Acute Chronic Pneumonia Infective Chemical 2

3 Inflammatory Lung, Mediastinal and Pleural Diseases Pulmonary abscess Pleuritis Empyema Lymphadenopathy Pulmonary Air Space Pattern (Consolidation or Infiltration) Alveoli filled with pus, water, blood, cells, protein Appearance- fluffy, ill defined margins Single (segmental or lobar), multiple, or diffuse distribution Rapid development 3

4 Pulmonary Air Space Pattern (Consolidation or Infiltration) Air bronchograms fluid filled alveoli li surround air filled bronchi Butterfly shadow E.G. Pneumonia, alveolar pulmonary edema LUL Lingular Pneumonia Obliterated left cardiac border 4

5 LUL Lingular Pneumonia Lateral Consolidation anterior to the major fissure Compare to PA exam LUL Lingular Pneumonia 5

6 LLL Pneumonia Air space disease left lower lobe Density behind heart Obliteration of left diaphragm at edge of heart Left heart border preserved LLL Pneumonia Note obliteration of the posterior portion of the left diaphragm (arrows) Right diaphragm clearly seen 6

7 RLL Pneumonia Density at the right lateral diaphragm Obliteration of lateral diaphragm border RLL Pneumonia Density at the mid diaphragm Sharp margination at the major fissure (arrows) 7

8 Lung Abscess Thick walled irregular cavity RUL Fluid level representing partial evacuation of necrotic material via airway Lung Abscess Thick walled irregular cavity RUL Fluid level representing partial evacuation of necrotic material via airway 8

9 Pulmonary Interstitial Pattern Fluid or cells in the pulmonary interstitial space e.g. Peribronchial tissue and bronchial wall, perivascular space and vessels, lymphatic structure Alveoli aerated Pulmonary Interstitial Pattern Appearance: Linear, lattice-like, or multiple small nodules Examples: Cystic fibrosis, bronchiectasis, asbestosis, silicosis, and other pneumoconiosis i 9

10 Cystic Fibrosis Bronchial wall thickening Ring shadows and parallel bronchiole walls of bronchiectasis Ill-defined linear lesions Obstructive airway with low diaphragms Interstitial Edema CHF Bilateral central interstitial linear lattice pattern Small nodular lesions Ill-defined enlarged hila Septal lines (Kerley s) Multiple horizontal lines near costophrenic angles (Kerley B) 10

11 Interstitial Edema CHF Variation in another patient t Cardiomegaly Pulmonary vascular changes as on prior patient Classic Pulmonary Edema Batwing or butterfly appearance Smoke inhalation 11

Pleural Inflammatory Lesion Pleural effusion (hydrothorax due to

) Pleural thickening, adhesion, calcification resulting from prior

Right Pleural Effusion Fluid density right base Upward concave border

12 Pleural Inflammatory Lesion Pleural effusion (hydrothorax due to exudate, transudate, t blood, etc.) Pleural thickening, adhesion, calcification resulting from prior inflammatory process Usually associated with concurrent lung disease Right Pleural Effusion Fluid density right base Upward concave border extends along the right lateral chest wall Some lower lung obscured Incidentally noted implanted infusion device (arrow) 12

13 Pleural Effusion Blunting of both costophrenic angles (arrows) Loss of lower heart margins Calcified plaque along both lateral chest walls (arrows) Result of Asbestos exposure Some plaque along diaphragm Pleural Effusion - Plaque 13

exposure Esophageal Inflammatory Disease Esophagitis

14 Pleural Effusion - Plaque Calcified plaque along both posterior chest walls (arrows) Result of asbestos exposure Esophageal Inflammatory Disease Esophagitis commonly due to infection Bacteria Virus Fungus Gastroesophageal reflex 14

Esophageal Inflammatory Disease Chemical substance

esophagitis are similar No radiologic abnormalities when

esophagus Smooth indentation anterior wall upper third

15 Esophageal Inflammatory Disease Chemical substance corrosion Radiologic manifestations of different causes of esophagitis are similar No radiologic abnormalities when degree of inflammation is mild Normal Esophagus Barium in esophagus Smooth indentation anterior wall upper third from the aortic arch Focal ring distal esophagus at gastric junction 15

16 Esophageal Candidiasis Multiple oval filling defects along the esophageal mucousa Plaques of candida along the esophagus (filling defects in barium coating) Gastrointestinal Inflammatory Disease Mucosal changes Swelling: local or diffuse enlargement of mucosal folds Defect: ulceration Penetration, perforation and abscess formation (ULCER CRATER) Scarring: stricture Need to use contrast (barium) study to illustrate the lumen and inner wall of GI tract 16

Gastric and Duodenal Ulcers Benign ulcer: Ulcer projects beyond lumen Sharp margin, round barium dot viewed en face Edematous halo around ulcer in acute stage Mucosal folds radiate out like

17 Gastric and Duodenal Ulcers Benign ulcer: Ulcer projects beyond lumen Sharp margin, round barium dot viewed en face Edematous halo around ulcer in acute stage Mucosal folds radiate out like spokes of wheel in sub-acute or chronic stage Normal Gastrointestinal Study Gas in fundus of stomach Opacification of stomach, duodenum and jejunum Peristalsis in the distal duodenal bulb 17

18 Normal Barium Enema Single contrast exam Notice the normal haustrations Competent t ileocecal valve Normal Barium Enema Double (air) contrast t Supine image Coating of mucosa and distended with gas Appendix is filled with barium 18

19 Development And Its Anomolies Embryo Milestones Detected by Ultrasound Gestation sac Yolk sac Embryo Placenta weeks 5 weeks 5-6 weeks 8 weeks 19

Endovaginal scan, more detail, resolution Gestational

20 Early Gestation Longitudinal scan Anechoic structure Echogenic rim Gestational sac Cervix Sac Bladder Endovaginal scan, more detail, resolution Gestational sac, embryo (cursors), yolk sac Gestational age 8 weeks 4 days Embryo 20

21 Yolk Sac Yolk sac indicated by two white arrows Amniotic membrane visible as faint curvilinear echoes in sac 25 Embryonic Heart 25 21

22 12 Week Fetus Longitudinal scan Fetal head in profile Placenta located anterior Fetal Head 30 Weeks Normal head axial view level of ventricles Central echogenic line = third ventricle line Ventricles(hypechoic) and choroid plexus(echogenic) Gray echogenic area=parenchyma Outer echogenic rim=calvarium 22

23 Normal Fetal Chest Four chamber heart view Heart chambers labeled RV RA LV LA Fetal Chest and Abdomen Sagittal view Rib shadows Abdominal contents Ribs Bowel 23

Section through level of bladder Oval hypoechoic area represents

24 Normal Fetal Abdomen Axial at level of kidneys Echogenic dots above represent spine(arrow) Kidneys (arrowhead) Normal Fetal Pelvis Section through level of bladder Oval hypoechoic area represents bladder (arrow) Femurs parallel linear echogenic (A) Sacrum under arrow A 24

25 Normal Fetal Spine Sagittal view C,T, L spine Parallel row of dots represent ossification centers of pedicles and dbodies Note: images not true sagittal Normal Fetal Spine Axial view Level of cervical, thoracic and lumbar vertebrae Ossification centers triangular arrangement Body in center, pedicles lateral * At the center of each spinal canal * * * 25

26 Fetal Femur Fetal Cord Insertion Transverse abdomen Cord insertion midline White represents doppler evaluation of blood flow in cord Fetal Abdomen 26

27 3 Vessel Cord V A 27

10/17/2016. Nuts and Bolts of Thoracic Radiology. Objectives. Techniques

10/17/2016. Nuts and Bolts of Thoracic Radiology. Objectives. Techniques Nuts and Bolts of Thoracic Radiology October 20, 2016 Carleen Risaliti Objectives Understand the basics of chest radiograph Develop a system for interpreting chest radiographs Correctly identify thoracic