basics of chest imaging rebecca peterson, m. d. associate professor department of radiology...
TRANSCRIPT
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Basics of Chest Imaging
Rebecca Peterson, M. D. Associate Professor Department of Radiology University of Ottawa
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Anatomy
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Normal PA
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Normal Lateral
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The Chest X-ray in Disease
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Basic Patterns of Disease
Air-Space Disease
VS
Interstitial Disease
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Pulmonary Acinus
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Air space disease
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Consolidation
Means “solid lung”
Implies that there is “air-space disease”
May occur with or without volume loss
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Consolidation without
volume loss
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Air Bronchogram
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Air Bronchogram
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Characteristics of Air Space Disease
Acinar shadow
Homogeneous density (consolidation)
“Silouette”sign Loss of distinct margins next to
consolidation
Air bronchogram
Non-segmental distribution
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Consolidation RML
normal abnormal
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Consolidation RML
normal abnormal
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Causes of Airspace Disease
Infection
Hemorrhage
Edema
Neoplasm
Idiopathic
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Consolidation withvolume loss
“Atelectasis” or “collapse”
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Collapse LLL Normal
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Collapse LLL
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Direct signs of volume loss
Movement of a fissure
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Indirect signs of volume loss
Upward shift of the diaphragm
Mediastinal shift to that side
Movement of main-stem bronchus
Hypovascularity of remaining lung due to hyperinflationLung looks darker
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Collapse RUL
incomplete complete
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Collapse RUL
incomplete complete
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Collapse LUL
incomplete complete
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Collapse LUL
incomplete complete
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Collapse LLL
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Collapse LLL
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Collapse RML
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Collapse RML
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TEST
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Basic Patterns of Disease
Air-Space Disease
VS
Interstitial Disease
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Interstitial Lung Disease
Perivascular
VS
Parenchymal
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Pulmonary Acinus
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Perivascular Interstitial Disease
Pulmonary Edema
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Interstitial Pulmonary Edema
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normal abnormal
Interstitial Pulmonary Edema
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Interstitial Pulmonary Edema
normal abnormal
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Interstitial Edema
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Interstitial Edema
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Kerley “B” Lines
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Kerley “B” Lines
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Signs of Interstitial Edema
Vessels look larger and indistinct
Peribronchial cuffing
Fluid in fissures
Kerley”B” lines
Pleural effusions
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Acute Airspace Edema
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Airspace Edema
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Acute Airspace Edema
Consolidation is bilateral
Consolidation is symmetrical
Consolidation is gravity dependent
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Parenchymal Interstitial Disease
Usual Interstitial Pneumonia
Asbestosis
Sarcoidosis
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Parenchymal Interstitial Disease
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Usual Interstitial Pneumonia
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UIP
NORMAL ABNORMAL
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UIP
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UIP
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Asbestosis
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Asbestosis
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Sarcoidosis
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Sarcoidosis
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Patterns of Pneumonia
Lobar Pneumonia
Bronchopneumonia
Interstitial Pneumonia
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Lobar Pneumonia
Hematogenous spread
Begins at lung periphery
Involves whole lobe of lung
Unilateral
Commonest pathogen Strept Pneumoniae
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Lobar Pneumonia
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Lobar Pneumonia
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Lobar Pneumonia
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Bronchopneumonia
Central bronchial inflammation
Patchy airspace consolidation distallyDue to inflammationDue to mucous plugs
Bilateral, asymetrical
Commonest pathogen Staph Aureus
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Bronchopneumonia
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Bronchopneumonia
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Bronchopneumonia
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Bronchopneumonia
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Bronchopneumonia
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Interstitial Pneumonia
Involves interstitial parenchymal space
“ground glass” opacity both lungs
Bilateral, symmetrical
Leads to airspace consolidation
Commonest pathogens mycoplasma and Pneumocystis Carinii
Pattern seen in SARS
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Interstitial Pneumonia
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Interstitial Pneumonia
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Ground Glass
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End stage Interstitial Pneumonia
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End stage Interstitial Pneumonia
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TEST
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