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THORAX: LUNGS AND PLEURA Chris Chris Sistrom Sistrom , MD, MPH , MD, MPH Assistant Professor, Diagnostic Radiology Assistant Professor, Diagnostic Radiology University of Florida College of Medicine University of Florida College of Medicine
Transcript of THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX:...
THORAX:LUNGS AND
PLEURA
Chris Chris SistromSistrom, MD, MPH, MD, MPHAssistant Professor, Diagnostic RadiologyAssistant Professor, Diagnostic RadiologyUniversity of Florida College of MedicineUniversity of Florida College of Medicine
BREAST
MAMMOGRAM=BREAST XRAY• Use low energy X-RAYS• Very efficient film/screen>>low dose• Breast compression important for good
images• Two views of each breast
– Help to identify abnormalities– Help to localize abnormalities
MAMMOGRAMSMAMMOGRAMSMLO=MEDIO LATERAL OBLIQUEMLO=MEDIO LATERAL OBLIQUE
CASSETTE AND FILM
LOW ENERGY XRAYS
MAMMOGRAMSMAMMOGRAMSMLO=MEDIO LATERAL OBLIQUEMLO=MEDIO LATERAL OBLIQUE
MASS
PECTORALMUSCLES
LYMPHNODES
MAMMOGRAMSMAMMOGRAMSCC=CRANIO CAUDALCC=CRANIO CAUDAL
CASSETTE AND FILM
LOW ENERGY XRAYS
MAMMOGRAMSMAMMOGRAMSCC=CRANIO CAUDALCC=CRANIO CAUDAL
MASS
MAMMOGRAMMAMMOGRAMDENSE AND FATTY BREASTSDENSE AND FATTY BREASTS
MASS
PECTORALMUSCLES
MRI OF THE BREASTSMRI OF THE BREASTS
DIFFUSE EARLY CANCER ON THE RIGHT
BREAST ULTRASOUNDBREAST ULTRASOUND
BENIGNCYST
CANCER
CHEST XRAYCHEST XRAYPA=POSTERIORPA=POSTERIOR
ANTERIORANTERIOR
PA CHEST XRAY
CHEST XRAYCHEST XRAYPA CLOSE UPPA CLOSE UP
NOTE SHARPLY DEFINED
CLAVICLES (ALSO CLOSER
TOGETHER)
PA CHEST XRAYPA CHEST XRAY
CHEST XRAYCHEST XRAYLATERALLATERAL
CHEST XRAY LATERALCHEST XRAY LATERAL
PA vs AP CHEST XRAY
SAME PATIENT: NOTE DIFFERENCE IN HEART SIZE AND AORTIC ARCH
EXPIRATORY CHEST XRAY
INSPIRATORY CHEST XRAY
CHEST XRAY QUALITYGOOD BAD
• Dedicated chest unit• PA Posterior-Anterior• Inspiratory• Upright• Healthy patient
• Portable equipment• AP Anterior-Posterior• Expiratory• Supine• Sick patient
TYPICAL PORTABLE CHEST
PLEURA• Visceral-superficial lung surface• Parietal-inner chest wall surface• Slide against each other to allow breathing• Normally have a tiny amount of fluid in an
empty (potential) space• May fill with fluid in many disease processes
– Called PLEURAL EFFUSION
PLEURAL SPACE
LUNGVISCERALPARIETAL
PLEURAL SPACE (CAVITY)
PLEURA
PLEURAL ABNORMALITIES• Air
– Called PNEUMOTHORAX• Fluid
– Simple fluid called EFFUSION– Pus called PYOTHORAX
or EMPYEMA– Blood called HEMOTHORAX– Lymph called CYLOTHORAX
• Mass• Calcification
TENSION PNEUMOTHORAXPLEURAL AIR COLLAPSED LUNG
TENSION PNEUMOTHORAX
TINYPLEURALEFFUSION
ON MRI
PLEURAL FLUID (EFFUSION) ON CHEST XRAY
THIS ONE IS PRETTY SMALL ~200 cc
PLEURAL FLUID (EFFUSION) ON CHEST XRAY
THIS ONE IS PRETTY LARGE ~1000 cc
PLEURAL FLUID (EFFUSION)LATERAL DECUBITUS XRAY
FLUID HAS“LAYERED OUT”
PLEURAL FLUID (EFFUSION)LOCULATED INTO FISSURE
NOTE HOW THE TWO VIEWS OF THE CHESTHELP TO LOCALIZE THE FLUID
PLEURAL FLUIDON CHEST CT SCAN
TINY AMOUNTON THE RIGHT
PLEURAL MASSON CHEST CT SCAN
LUNGS• Bronchi (airway)
– Pathway for VENTILATION (air in and out)• Pulmonary Arteries (large)
– Blood into lungs for gas exchange• Pulmonary Veins (large)
– Blood out of lungs after gas exchange• Bronchial Arteries (small)
– Supply the bronchi• Lymphatic channels (tiny)
– Return lymph to the central circulation
TRIPLE BLOOD SUPPLY
BRONCHI (AIRWAYS)
LYMPHATIC DRAINAGE
AIRWAYS: BRONCHOGRAMSTHESE ARE NOT DONE
ANY MORE
AIR BRONCHOGRAMS
THIS IS WHAT FOLKS MEANBY BRONCHOGRAMS NOW
AIRWAYS CT CORONAL RECONSTRUCTION
TRACHEAR MAIN BRRUL BRBR INTRLL BR
L MAIN BRLUL BRLLL BR
SEGMENTS FRONTAL
SEGMENTS LATERAL
SEGMENTS RIGHT
SEGMENTS LEFT
RIGHT
RIGHT
RIGHTUPPER
BRONCHI
LOOKLIKE
A WHALE!
THIS IS THE MINORFISSURE AT THE TOPOF THE MIDDLE LOBE
RIGHT THIS IS THE BRONCHUS INTERMEDIUS
RIGHT
MIDDLE LOBE ANDSUPERIOR SEGMENT
OF LOWER LOBE BRONCHIAT ALMOST THE SAME LEVEL
RML
SS RLL
RIGHT
RIGHT BOTH RIGHT AND LEFTHAVE SAME BASILER SEGS
ANT, POST, MED, LAT
A
ML
P
A
M
L
P
LEFT
LEFT
LEFT
LEFT
LEFT
LEFT
LINGULAR ANDSUPERIOR SEGMENT
OF LOWER LOBE BRONCHIAT ALMOST THE SAME LEVEL
LING
SS LLL
LEFT
LEFT BOTH RIGHT AND LEFTHAVE SAME BASILER SEGS
ANT, POST, MED, LAT
A
M
L
P
A
ML
P
WAYS OF VIEWING CT SCANSLUNG SETTINGS
SOFT TISSUE SETTINGS
LEFT PULMONARY ARTERY
RIGHT PULMONARY ARTERY
RIGHT PULMONARY ARTERYEMBOLISM (BLOOD CLOT)
RIGHT PULMONARY ARTERYEMBOLISM (BLOOD CLOT)
PULMONARY VEINS
RIGHT PULMONARY ARTERIOGRAM
RIGHT PULMONARY VENOGRAM
LEFT PULMONARY ARTERIOGRAM
LEFT PULMONARY VENOGRAM
