Chest Imaging - USMF · 2019. 3. 4. · Radiological semiology of pulmonary pathology Pulmonary...
Transcript of Chest Imaging - USMF · 2019. 3. 4. · Radiological semiology of pulmonary pathology Pulmonary...
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Chest Imaging
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Chest Imaging
Methods of investigation
Radiology
• Conventional radiography (Chest X-ray)
– PA
– LL
– OBLIC
• Fluoroscopy
• Conventional Tomography
• Computed Tomography (CT)
• Tomosynthesis (digital tomosynthesis)
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Simple chest X-ray
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Chest Imaging
Radiology
• Contrast examinations
– Bronhography
– Pulmonary angiography
– Air contrast studies (not used anymore)
• Diagnostic pneumothorax
• Diagnostic pneumomediastinum
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Bronhography
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Bronhography
General (bilateral) selective (unilatgeral)
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Bronhography
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Pulmonary angiography
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Contrast studies
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CHEST CT
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CHEST CT
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Chest Imaging
Nuclear Medicine • Pulmonary ventilation scintigraphy
• Pulmonary perfusion scintigraphy
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Thromembolism of pulmoany artery
Perfusion scintigraphy
Cold nodes
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Chest Imaging
Ultrasonography
(pleural metastasis)
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Chest Imaging
MRI
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Chest Imaging
MRI
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Chest Imaging
Radiological anatomy - chest wall
Bony structures
• Ribs
• Clavicles
• Vertebrae
• Sternum
• Scapulae
• Humerus
Soft tissue
structures
• Muscular
• Fat tissue
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Chest Imaging Radiological anatomy – internal chest
structures
• Mediastinum
• Trachea
• Diaphragm
• Hilum
• Costo-phrenic
angles
• Cardio-phrenic
angles
• Lungs fields
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Chest Imaging
Radiological anatomy • Lung fields
– Right
– Left
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Chest Imaging Radiological anatomy Lungs. Lobs
• On right – SR
– MR
– IR
• On left – SL
– IL
Fissures
• Horizontal
• Oblique
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Chest Imaging
Radiological anatomy
Right Lung
– Superior lobe:
• 1 - apical; 2 - posterior; 3 - anterior
– Middle lobe:
• 4 - lateral; 5 - medial
– Inferior lobe:
• 6 - superior (apical); 7 - medial basal;
8 - anterior basal; 9 - lateral basal;
10 - posterior basal
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Chest Imaging
Radiological anatomy
Left Lung
– Superior lobe:
• 1 - apical; 2 - posterior; 3 – anterior; 4, superior
lingular; 5, inferior lingular
– Inferior lobe:
• 6 - superior (apical); 8 - anterior basal;
9 - lateral basal; 10 - posterior basal
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Chest Imaging
Radiological anatomy
• Lungs
– Segments
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Chest Imaging
Radiological
anatomy
• Lungs
– Segments a – right lung
b – left lung
1-10 – segments
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ZONES OF THE CHEST RADIOGRAPH
UPPER
ZONE
MIDDLE
ZONE
LOWER
ZONE
Apex to a line drawn through the lower borders of the anterior ends of the 2nd costal cartilage.
From the 1st line to one drawn through the lower borders of the 4th costal cartilage & includes the Hila of the lungs
From the 2nd line to the bases of the lungs.
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Pulmonary hilum
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Normal pulmonary pattern (pulmonary
vasculature, pulmonary picture)
Is formed by pulmonary arteries and veins
Dichotomic division of vessels
The diameter of each vessel is 2 times less than the
diameter of the previuos
Pulmonary pattern is more evident in the inferior
regions
Pulmonary pattern is no more seen at the distance
of 1,5-2 cm from the chest wall
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Radiological semiology of
pulmonary pathology
• Pulmonary opacity
• Pulmonary hyperlucency
• Changes of pulmonary picture
• Changes of pulmonary hilum
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Radiological semiology of pulmonary pathology
Pulmonary opacity is a nonspecific term describing
an area of increased pulmonary attenuation caused
by an intraparenchymal process resulting in the
decreased ratio of gas to soft tissue (blood, lung
parenchyma and stroma) in the lung.
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Radiological semiology of pulmonary pathology
Pulmonary opacity
• Number (single / multiple, disseminated)
• Dimensions (nodular / limited (to lobe, lobar segment) / large)
• Location (unilateral / by ribs / regions / lobes / segments)
• Shape (rounded / ring-shape / linear / triangle / irregular)
• Borders (well-defined, regular or irregular / ill-defined )
• Structure (homogeneous / heterogeneous)
• Intensity (subcostal / costal / supracostal)
• Relation to the mediastinum (without displacement / with
displacement (pushing / pulling))
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Decreased lung density on images can be described as
pulmonary hyperlucency on conventional chest radiographs
and hypoattenuation (hypodensity) on CT scans.
Hyperlucency on images can result from an excess of air
in the pulmonary parenchyma or a decrease in mass of the
pulmonary parenchyma caused by a reduction in
vasculature or blood flow, reduction or obliteration of
airways, or a combination of these potential causes.
Pulmonary hyperlucency
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Radiological semiology of
pulmonary pathology
Pulmonary hyperlucency
Classification
• Outside or Inside the lungs
• unilateral or bilateral
• focal or diffuse
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Pulmonary hyperlucency
Outside the lungs (pneumothorax)
Inside the lungs
• Pulmonary emphisema
• Pulmonary hypovolemia
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Radiological semiology of
pulmonary pathology
Changes of pulmonary picture
• Deformaton
• Enhanced
• Reduced
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Total and subtotal opacity
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Total and subtotal opacity
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Total and subtotal opacity
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Limited opacity
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Rounded opacity
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Rounded opacity
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Ring-shaped
opacity
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Ring-shaped opacity
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Nodular opacity
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Nodular opacity
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Miliary opacities
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Radiografia antero-posterioară şi de profil
Opacitate in lobul mediu şi segmentele bazale.
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CT în fereastră parinchimatoasă. Opacitate
alveolară.
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CT în fereastră mediastinală. Opacitate
alveolară. Absenţa măririi ganglionilor limfatici.
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Meniscus sign (bilateral) – pleural effusion
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Pulmonary hyperlucency - emphisema
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Pulmonary hyperlucency - pneumothorax
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Pulmonary hyperlucency - pneumothorax
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Pulmonary hyperlucency - pneumothorax
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Hydroaeric level – hydropneumothorax
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The phases of bronchial obstruction
I. Partial obstruction (hypoventilation)
II. Valve-type obstruction (hyperinflation/obturative emphysema)
III. Complete obstruction (atelectasis)
I. II. III.