Rab Lab 1: Introduction to Chest RadiologyRab Lab 1:! Introduction to Chest Radiology Peter Clarke...
Transcript of Rab Lab 1: Introduction to Chest RadiologyRab Lab 1:! Introduction to Chest Radiology Peter Clarke...
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Rab Lab 1: ���Introduction to Chest
RadiologyPeter Clarke MDDon Di Salvo, MD
Harvard Medical SchoolBrigham and Women’s HospitalDana Farber Cancer Institute
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The Normal Chest
Can you identify the chambers of the heart?...the carina?
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These four patients present with fever and cough, and have pneumonias in
different lobes of the lung• can you localize the pneumonia to the
particular lobe?
• can you identify fissures or fissural interfaces?
• what structures are silhouetted, or obscured by adjacent lung consolidation? How does this help in localization when seen in only one projection?
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case 1
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On just the PA film, how would we know that the pneumonia is in the front or rear of the chest?case 1
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How does this radiograph illustrate the “silhouette” sign?
case 2
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Which normal structure has been “silhouetted?”case 2
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case 3
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case 3Identify and explain the “spine sign.”
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case 4
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case 4
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An intensive case patient with increasing hypoxia.case 5
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follow-upcase 5
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case 5
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This elderly diabetic patient with high grade fever. It is mid winter.
case 6-A
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case 6-A
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case 6-A
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case 6-ACT at lung windows
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case 6-A
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This 46 yr old woman has chronic dyspnea
case 6-B
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Describe the pattern of abnormality: alveolar or interstitial?Is the distribution uniform?
This patient has had prior surgery in the right lung: canyou see the evidence for this?case 6-B
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Patient’s chest CT shows a ‘reticulonodular’ pattern.What comprises the lung interstitium?
Are the upper or lower lobes more involved?Case 6-B
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50 year old smoker with weight loss and cough
case 7
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case 7
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case 7CT at level of carina
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case 7
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case 7
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42 year old woman s/p colonic resection for malignancy
case 8a
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case 8
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case 8b
case 8
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ANOTHER APPROACH TO THIS PROBLEM
50 yr old man with dyspnea, dullness to percussion in right chest
Case 8b
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Real time ultrasound right posterior chest
Case 8b
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Real time ultrasound right posterior chestCase 8b
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hemidiaphragm
Atelectatic lung
Pleural fluid
Case 8b
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Look at this clip of right lower chest, upper abdomen (liver):What is the curvilinear echogenic structure above the liver?
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Compare these two clips:What is NOT moving in clip #2 ?
This illustrates another use of US in the chest!
Clip #1 Clip #2
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60 year old man with history of���lung cancer, with shortness of
breath
case 9
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patient with lung cancer and shortness of breath
case 9
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42 year old woman s/p colonic resection for
malignancy
60 year old man with history oflung cancer
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54 year old alcoholic with fever, weight loss, and hemoptysis
case 10
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case 10
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case 10