Introduction to Radiology for TB Nurses Juzar Ali, MD; FRCP(C); FCCP May 4, 2018 Essential Skills for the TB Nurse Case Manager Little Rock, AR May 3 4, 2017 Juzar Ali, MD; FRCP(C); FCCP has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1
CHEST IMAGING PULMONOLOGY 2015 FOR NURSING TEAM Juzar Ali, M.D., FRCP (C), FCCP. Klein M.D. LSU Alumni Professor of Medicine ( Section of Pulmonary /Critical Care LSU School of Medicine, LSUHSC CMO, LSU HEALTH /HEALTHCARE NETWORK NEW ORLEANS SOME OBJECTIVES & SOME CONCEPTUAL TRADE SECRETS INSPECTION PALPATION PERCUSSION AUSCULTATION CPR Before to grab this. And then appreciate the symphony of sounds 2
Basics of CXR Reading PA & lateral is ONE UNIT Normal vs. no active disease Ask for old x-rays Focus on other areas too It is a photograph Describe what you see and not what you feel It is a comparative study: two x-rays; two sides Apples to apple: technique, view, exposure, position, tilt Black/white/gray Study of contrasts Lung Space Unit Predominant pattern i.e. nodular, linear, reticular, honeycomb Lateral view When helpful? When is it a waste? When not needed? 3
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VIEWS: A true story Indications and where it may help DIFFERENCES AND LIMITATIONS WHAT IS WRONG HERE?? 5
LET US PLAY HANGMAN WHERE IS THIS GOING???? 6
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Summary : READING Identification Technical Scan Airways Bone Cardiac & mediastinum Diaphragm & pleura Extrapulmonary & extra thoracic Fields : VIA It s ABCDEF and a little bit more of areas around The Bs: Bronchitis (A&C, Bronchial Asthma, Bronchiectasis 8
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The lung field AIR SPACE ALVEOLAR INTERSTITUM / LYMPHATICS CONNECTIVE TISSUE SEPTA VASCULAR LOBAR.SEGMENTAL.LOBULAR.ACINAR Figure 1"> Webb, W. R. Radiology 2006;239:322-338 Copyright Radiological Society of North America, 2006 10
Compare and contrast The lines and the markings The Vessels & the Interstitium 11
Figure 9"> Webb, W. R. Radiology 2006;239:322-338 Copyright Radiological Society of North America, 2006 12
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Figure 5"> Webb, W. R. Radiology 2006;239:322-338 Copyright Radiological Society of North America, 2006 15
The lung field AIR SPACE ALVEOLAR INTERSTITUM / LYMPHATICS CONNECTIVE TISSUE SEPTA VASCULAR LOBAR.SEGMENTAL.LOBULAR.ACINAR Figure 1"> Webb, W. R. Radiology 2006;239:322-338 Copyright Radiological Society of North America, 2006 16
Features Of Airspace Processes Opacities ; increased markings Confluent shadows Focal or diffuse Air-bronchograms Air-alveolograms 17
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What fills up the air spaces? Inflammatory cells: Blood: Fluid: Protein like material: Malignant cells: 19
X-ray Differential Air bronchograms with diffuse air-space disease caused by: Pus: Fluid: Blood: Cells: Protein: Pneumonia Pulmonary Edema / ARDS Injury pattern / Alveolar Hemorrhage Carcinoma/lymphoma Inhalational/Antigenic foreign material 20
Focal air space disease Pneumonia lobar or segmental location loss of the.silhouette sign characteristics age : signs of loss of volume signs of breakdown? complicated features 21
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A Tale of 2 x-rays and One Isolation Room and one N95 By Charles (No) Budget 24
Item A 45-year old recent immigrant from India admitted with history of massive hemoptysis 25
C FUNGUS BALL B A 26
Item A 67-year old immigrant from Eastern Europe with a past history of BCG as a infant, now has a 16 mm positive TST. She is asymptomatic with a normal physical exam. What to do next? 27
Solitary Pulmonary Nodule ( SPN)/s Benign: Granuloma, Hamartoma Malignant : Primary, Metastatic 28
X-ray differential Miliary densities: TB/Fungal/Pneumoconiosis/ Certain malignancies such as melanomas/thyroid Larger / more confluent: Alveolar sarcoid Nodular / Cavitary: Wegener's Confluent Cotton ball : metastatic 29
Item A 38-year smoker, admitted with shortness of breath. He denies chest pain, fever or chills. Lung exam reveals decreased breath sounds with hyper resonance X-ray differential PNEUMOTHORAX: visceral pleural line EMPHYSEMA: signs of hyper-inflation. 30
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Item A 34-year woman with long- standing is admitted with progressive shortness of breath. Physical exam reveals stony dullness with absent breath sounds in the left lung field IGRA ( QTG) positive 32
Answer X-ray features of pleural effusion Opacity without air bronchograms Blunted costophrenic angle meniscus sign 33
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MEDIASTINAL LESIONS 35
Characteristics of a mediastinal lesions Understanding the lateral Compartments 36
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Hope you are not too confused!! Thank you for your kind attention. Juzar Ali 5_Levels_of_Lucky.wmv 39