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Transcript of Siddharth Pandya DO - Tallahassee, FL - Home · Siddharth Pandya DO Neuroradiologist Clinical...
Siddharth Pandya DO Neuroradiologist
Clinical Associate Professor NOVA Southeastern College of Osteopathic Medicine
X-ray Anatomy
There are three principal varieties of pulmonary edema: cardiac, overhydration and increased capillary permeability (ARDS)
Lungs
Lung abnormalities as areas of increased densities
Consolidation
Atelectasis
Nodule or mass - solitary or multiple
Interstitial
The main differential diagnosis of Kerley B lines is: 1.interstitial edema in heart failure 2.lymphangitis carcinomatosa
CHF
CHF
Bilateral perihilar consolidation with air bronchograms
Increased heart size
Subtle interstitial markings
Large vascular pedicle
Pattern of Pulmonary Fibrosis
Usual Interstitial Pneumonia – UIP
Scarring – fibrosis – involves the interstitial lung -as does edema in CHF.
Interstitial reticular pattern
If persists after treatment then consider CT - likely to show honeycombing
Lobar Pneumonia
Air bronchograms
If proper clinical settings -infection
Chronic – Neoplasm
Sarcoidosis
Eosinophilic
Alvelar proteinosis
This patient had fever and cough. Thought to be a diffuse broncho pneumonia
Unlike lobar pneumonia, which starts in the alveoli, bronchopneumonia starts in the airways as acute bronchitis -
Legionella
Solitary Pulmonary Nodule -- CT
• Size : nodule is less than 3 cms, if over 3cms – malignancy
• Stability: if stable over 2 years -benignity
• Shape: if relatively flat – benign sign
• Margin: • Corona radiata sign – highly associated with malignancy
• Lobulated margin – intermediate.
• Smooth margins – more likely benign –unless metastasis
• Air bronchogram sign – more likely malignant –most commonly seen in bronchoalvelar cell carcinoma and adenocarcinoma
1.Heart Failure (HF) (Congestive Heart Failure) in Merck manual 2.Radiographic analysis of vascular distribution: a review (PDF) by Carle Ravin Presented as part of a Conference on Chest Radiology 1982 3.Pulmonary artery-bronchus ratios in patients with normal lungs, pulmonary vascular plethora, and congestive heart failure. by J H Woodring April 1991 Radiology, 179, 115-122. 4.American College of Radiology ACR Appropriateness Criteria: Congestive Heart Failure 5.The Radiologic Distinction of Cardiogenic and Noncardiogenic Edema (PDF) by Eric Milne et al American Journal of Roentgenology, Vol 144, Issue 5, 879-894 6.The vascular pedicle of the heart and the vena azygos. Part II: Acquired heart disease. by M Pistolesi, E N Milne, M Miniati and C Giuntini July 1984 Radiology, 152, 9-17. 7.Radiology Assistant http://www.radiologyassistant.nl/en/p4c132f36513d4/chest-x-ray-heart-failure.html Simone Cremers, Jennifer Bradshaw, Herfkens Albert Schweitzer Hospital, Dordecht & Medical Center Alkmaar, The Netherlands.