Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor...
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Transcript of Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor...
![Page 1: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/1.jpg)
Chest RadiologyPlain Film and CT- Beyond the Basics
John W. Renner, M.S., M.D.Clinical Professor of Radiology
UCSD Medical Center
Brendan Kidder, M.S. IVUCSD School of Medicine
![Page 2: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/2.jpg)
Chest RadiologyGoals
• Review the basics of Chest Imaging
• Examine the modalities of the Chest “Plain Film” and Computed Tomography
• Review basic disease entities and their imaging evaluation
• Allow Hospitalists to better understand “How to talk to a radiologist in a hospital setting if you must!”
![Page 3: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/3.jpg)
Chest RadiologyNormal Radiographic Anatomy
• Normal frontal and lateral views
• Cross-sectional anatomy
• Symmetry and asymmetry
• Interfaces, lines and junction stripes
• Chest compartments
• Densities
![Page 4: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/4.jpg)
Normal Chest
![Page 5: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/5.jpg)
Pre-Vascular Space
![Page 6: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/6.jpg)
Anterior Junction Line
![Page 7: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/7.jpg)
Right Paratracheal Stripe
![Page 8: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/8.jpg)
Carina
![Page 9: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/9.jpg)
Basal Segmental Anatomy
![Page 10: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/10.jpg)
Main Pulmonary Artery
![Page 11: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/11.jpg)
Aortic Valve
![Page 12: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/12.jpg)
Inferior Pulmonary Veins
![Page 13: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/13.jpg)
Left Coronary Artery
![Page 14: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/14.jpg)
Right Coronary Artery
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Secondary pulmonary lobule
Webb, R : Radiology 2006
![Page 16: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/16.jpg)
Chest RadiologyPatterns of Disease
• Honeycombing
• Cystic lesions
• Nodules
• Ground-glass opacities
• Mosaic pattern
• Tree-in-bud
• Interlobular septal thickening
![Page 17: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/17.jpg)
Honeycombing
Chest X-Ray .com
![Page 18: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/18.jpg)
Centrilobular Emphysema
Webb, R. Radiology 2006
![Page 19: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/19.jpg)
Centrilobular Emphysema
![Page 20: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/20.jpg)
Centrilobular Emphysema
Webb, R. Radiology 2006
![Page 21: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/21.jpg)
Centrilobular Nodules
Webb, R. Radiology 2006
![Page 22: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/22.jpg)
Sarcoidosis
Chest X-Ray. com
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Sarcoidosis
Webb, R. Radiology 2006
![Page 24: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/24.jpg)
Hypersensitivity Pneumonitis
Webb, R. : Radiology 2006
![Page 25: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/25.jpg)
Ground-Glass Opacities
Chest X-Ray. com
![Page 26: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/26.jpg)
Pulmonary Edema
![Page 27: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/27.jpg)
Bronchopneumonia
![Page 28: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/28.jpg)
Mosaic Perfusion
Chest X-Ray. com
![Page 29: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/29.jpg)
Mosaic Perfusion
![Page 30: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/30.jpg)
Mosaic Perfusion
![Page 31: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/31.jpg)
Transplant Lung
![Page 32: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/32.jpg)
Transplant Lung
![Page 33: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/33.jpg)
Tree-in-Bud
![Page 34: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/34.jpg)
Tree-in-Bud
Webb, R. : Radiology 2006
![Page 35: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/35.jpg)
Interlobular Septal Thickening
Webb, R. Radiology 2006
![Page 36: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/36.jpg)
Interlobular Septal Thickening
Webb, R. Radiology 2006
![Page 37: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/37.jpg)
Lymphangitic Carcinomatosis
Webb, R. Radiology 2006
![Page 38: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/38.jpg)
Lymphangitic Carcinomatosis
![Page 39: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/39.jpg)
Bronchiectasis
Chest X-Ray. com
![Page 40: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/40.jpg)
Air Trapping
Chest X-Ray. com
![Page 41: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/41.jpg)
Head Cheese Sign
Webb, R. : Radiology 2006
![Page 42: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/42.jpg)
Crazy Paving Pattern
![Page 43: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/43.jpg)
Idiopathic Pulmonary Hemosiderosis
![Page 44: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/44.jpg)
Idiopathic Pulmonary Hemosiderosis
![Page 45: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/45.jpg)
Idiopathic Pulmonary Hemosiderosis
![Page 46: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/46.jpg)
Aspergilomas
![Page 47: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/47.jpg)
Bronchogenic Cyst
![Page 48: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/48.jpg)
Interstitial Pulmonary Fibrosis
![Page 49: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/49.jpg)
Interstitial Pulmonary Fibrosis
![Page 50: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/50.jpg)
Interstitial Pulmonary Fibrosis
![Page 51: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/51.jpg)
Neurofibromatosis
![Page 52: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/52.jpg)
Neurofibromatosis
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Neurofibromatosis
![Page 54: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/54.jpg)
Chest Radiography
• Congenital Pulmonary Abnormalities– Tracheal bronchus– Pulmonary arteriovenous malformation– Partial anomalous pulmonary venous return– Bronchopulmonary sequestration– Congenital lobar emphysema and cysts
![Page 55: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/55.jpg)
Right Upper Lobe Bronchus
![Page 56: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/56.jpg)
Tracheal Bronchus
![Page 57: Chest Radiology Plain Film and CT- Beyond the Basics John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S.](https://reader036.fdocuments.net/reader036/viewer/2022062305/56649d095503460f949db1a5/html5/thumbnails/57.jpg)
Hypogenetic Lung
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Pulmonary Sequestration
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Pulmonary Sequestration
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Thrombosed Aneurysm
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Pulmonary Sequestration
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Pulmonary Artery Sling
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Pulmonary Artery Sling
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Hilar Lymphadenopathy
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Pneumocystis Pneumonia
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Pneumocystis Pneumonia
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Pneumocystis Pneumonia
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Pulmonary Tuberculosis
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Chest RadiologyCritical Care Radiography
• Pulmonary Embolism– Chest radiograph
• Normal vs. abnormal– Westermark’s sign– Enlargement of the central pulmonary arteries– Hampton’s hump-pulmonary infarction– Atelectasis, consolidation and elevation of the ispilateral
hemidiaphragm– Pleural effusion
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Chest RadiographyCritical Care Radiography
• Pulmonary Thromboembolism-Catheter Angiogram– Pulmonary angiography-former “gold standard”– Invasive with known morbidity-mortality– High specificity—approaching 100%– Right heart catheterization-useful data– Negative exam excludes the diagnosis– Allows for treatment—
• Thrombolytics• IVC filter placement
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Chest RadiologyCritical Care Radiography
• Pulmonary Thromboembolism-CTA– High sensitivity (>90%), specificity (>95%)– CTA limited in sub-segmental arteries– Evaluation of upstream findings-right heart
strain– CT findings
• Intra-luminal filling defect or• Vessel cutoff• Mosaic perfusion
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Chest RadiologyCritical Care Radiography
• Pulmonary Thromboembolism-CTA– CT Pulmonary Angiogram
• Requires MDCT, helical scan• Requires iodinated contrast—high concentration of
iodine, non-ionic or iso-osmolar contrast agents• Requires apnea during scan• Requires normal renal function• Relatively high radiation dose!
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Massive Thromboembolism
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Massive Thromboembolism
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Massive Thromboembolism
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Pulmonary Thromboembolism
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Chest Radiology
• Chronic Thromboembolism– Organizing thromboemboli– Adherent clots to vessel wall– Lack of recanalization of a vessel– Webs, bands– Abrupt caliber change– Pulmonary arterial hypertension– Mosaic perfusion
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Type A Aortic Dissection
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Primary Pulmonary Hypertension
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Chest Radiology
• Pulmonary Arterial Hypertension– Dilation of central pulmonary arteries– Rapid tapering of peripheral pulmonary
arteries– Dilation of right interlobar pulmonary artery to
> 18 mm on PA chest view– Dilation of left pulmonary artery to > 18 mm
on lateral chest view– Dilation of RA, RV
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Primary Pulmonary Arterial Hypertension
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Primary Pulmonary Artery Hypertension
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Tricuspid Regurgitation
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Chest RadiologyIdiopathic Interstitial Pneumonias
• Idiopathic Pulmonary Fibrosis-IPF• Non-specific Interstitial Pneumonia-NSIP• Cryptogenic Organizing Pneumonia-COP• Respiratory Bronchiolitis-associated
Interstitial Lung Disease-RB-ILD• Desquamative Interstitial Pneumonia• Lymphoid Interstitial Pneumonia-LIP• Acute Interstitial Pneumonia-AIP
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Idiopathic Pulmonary Fibrosis
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Idiopathic Pulmonary Fibrosis
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Non-specific Interstitial Pneumonia
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IPF vs. NSIP
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Cryptogenic Organizing Pneumonia
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Respiratory Bronchiolitis-ILD
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Desquamative Interstitial Pneumonia
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Lymphoid Interstitial Pneumonia
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Organizing Pneumonia
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ILS plus GGO
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Chest RadiologyCritical Care Radiography
• CXR may be done on a daily basis• Evaluate “life-support” lines, tubes catheters,
devices, monitoring equipment• Evaluate changes in cardiopulmonary status• Determine why a patient has undergone “clinical
deterioration”—– Hypoxia– Hypotension– Sepsis
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Chest RadiologyCritical Care Radiography
• Pulmonary Edema– Hydrostatic– Increased capillary permeability– Diffuse alveolar damage –(DAD)– Differential diagnosis
• Atelectasis• Pneumonia• Aspiration • Pulmonary embolism and hemorrhage
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Chest RadiologyCritical Care Radiography
• Hydrostatic Pulmonary Edema– Pulmonary venous hypertension and vascular
redistribution– Interstitial pulmonary edema– Alveolar pulmonary edema– Cardiomegaly– Pleural effusion– Vascular pedicle
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Chest RadiologyCritical Care Radiography
• Pulmonary Edema– Interstitial pulmonary edema– Kerley A, B and C lines
• Interlobular septal thickening• Subpleural edema along fissures,pleura• Peribronchial cuffing• Perihilar haze• Interstitial veiling• Ground-glass opacities
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Interstitial Pulmonary Edema
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Chest RadiologyCritical Care Radiography
• Alveolar Edema– Air-space consolidation– Acinar or air-space ill-defined nodules– Peri-hilar or “batwing” distribution– Peripheral sparing– Rapid clearance with theraphy– Occasionally a clinical lag in onset and
clearance
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Chest RadiologyCritical Care Radiography
• Increased Permeability Edema or ARDS and DAD– Alveolar-capillary leak, normal left atrial pressure
• Multiple etiologies• Occurs in stages
– Latent period
– Air-space consolidation
– Homogeneous confluence and air bronchogram
– Decreased lung volumes and pulmonary compliance compliance
– Slow clearance
– Organizing chronic changes--fibrosis
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Chest RadiologyCritical Care Radiography
• Barotrauma– Mechanical ventilation and increased airway
resistance, high ventilatory pressures, CPAP and others
– Extra-alveolar air• Pulmonary interstitial emphysema• Pneumomediastinum• Pneumothorax• Subcutaneous emphysema
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Chest RadiologyCardiac
• Cardiac CT– Calcium scoring– Coronary artery angiography-CTA– Congenital Heart Disease– Anatomical applications– Triple rule-out
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LAD Stenosis
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CT Coronary Angiography
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LAD Stenosis
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Calcium LAD
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3D Workstation
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CTA Coronary Artery
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Right Coronary Artery
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LAD-Soft Plaque
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Multiplanar Reconstruction
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Anomalous Left Coronary Artery
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Consensus
• A negative test may be consistent with a low risk of a cardiovascular event in the next two to five years
• A high calcium score may be consistent with a moderate to high risk of a cardiovascular event within the next two to five years
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Chest Radiology
• Airways Disease– Trachea– Bronchiectasis-cylindrical, varicose, cystic– Cystic Fibrosis– ABPA and asthma– Chronic bronchitis– Bronchiolitis
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Chest Radiology
• Emphysema– Centrilobular emphysema– Panlobular emphysema– Paraseptal emphysema– Bullous emphysema– Saber-sheath trachea
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Chest RadiologyPneumonia
• Lobar pneumonia– Peripheral opacity to homogenous
consolidation
• Bronchopneumonia– Airway mucosa to alveoli
• Interstitial pneumonia– Reticular opacities to confluent infection
• Lung abscess– Cavitation
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Chest RadiologyTuberculosis
• Primary tuberculosis
• Post-primary tuberculosis
• HIV-associated tuberculosis
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Chest RadiologyLung Cancer
• Early Detection– National Lung Cancer Screening Trial
• Chest x-ray vs. low-dose CT
– International Early Lung Cancer Action Project—I-ELCAP
• Low-dose screening CT• 92% survival rate, stage I• NEJM 355:1763-1771, Oct. 26, 2006
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Chest RadiographyCardiac
• Cardiac MRI– Myocardial function– Myocardial viability– Valvular heart disease– Systolic heart failure– Diastolic heart failure– Myocarditis– Pericardial diseases
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Chest Radiology
• Thank you
John W. Renner, M.S., M.D.
Clinical Professor of Radiology
Department of Radiology
UCSD Medical Center
San Diego, California