chest imaging - usmf · 2019. 3. 4. · radiological semiology of pulmonary pathology pulmonary...

Chest Imaging

Chest Imaging

Methods of investigation

Radiology

• Conventional radiography (Chest X-ray)

– PA

– LL

– OBLIC

• Fluoroscopy

• Conventional Tomography

• Computed Tomography (CT)

• Tomosynthesis (digital tomosynthesis)

Simple chest X-ray

Chest Imaging

Radiology

• Contrast examinations

– Bronhography

– Pulmonary angiography

– Air contrast studies (not used anymore)

• Diagnostic pneumothorax

• Diagnostic pneumomediastinum

Bronhography

Bronhography

General (bilateral) selective (unilatgeral)

Bronhography

Pulmonary angiography

Contrast studies

CHEST CT

Chest Imaging

Nuclear Medicine • Pulmonary ventilation scintigraphy

• Pulmonary perfusion scintigraphy

Thromembolism of pulmoany artery

Perfusion scintigraphy

Cold nodes

Chest Imaging

Ultrasonography

(pleural metastasis)

Chest Imaging

MRI

Chest Imaging

Radiological anatomy - chest wall

Bony structures

• Ribs

• Clavicles

• Vertebrae

• Sternum

• Scapulae

• Humerus

Soft tissue

structures

• Muscular

• Fat tissue

Chest Imaging Radiological anatomy – internal chest

structures

• Mediastinum

• Trachea

• Diaphragm

• Hilum

• Costo-phrenic

angles

• Cardio-phrenic

angles

• Lungs fields

Chest Imaging

Radiological anatomy • Lung fields

– Right

– Left

Chest Imaging Radiological anatomy Lungs. Lobs

• On right – SR

– MR

– IR

• On left – SL

– IL

Fissures

• Horizontal

• Oblique

Chest Imaging

Radiological anatomy

Right Lung

– Superior lobe:

• 1 - apical; 2 - posterior; 3 - anterior

– Middle lobe:

• 4 - lateral; 5 - medial

– Inferior lobe:

• 6 - superior (apical); 7 - medial basal;

8 - anterior basal; 9 - lateral basal;

10 - posterior basal

Chest Imaging


Left Lung

– Superior lobe:

• 1 - apical; 2 - posterior; 3 – anterior; 4, superior

lingular; 5, inferior lingular

– Inferior lobe:

• 6 - superior (apical); 8 - anterior basal;

9 - lateral basal; 10 - posterior basal

Chest Imaging


• Lungs

– Segments

Chest Imaging

Radiological

anatomy

• Lungs

– Segments a – right lung

b – left lung

1-10 – segments

ZONES OF THE CHEST RADIOGRAPH

UPPER

ZONE

MIDDLE

ZONE

LOWER

ZONE

Apex to a line drawn through the lower borders of the anterior ends of the 2nd costal cartilage.

From the 1st line to one drawn through the lower borders of the 4th costal cartilage & includes the Hila of the lungs

From the 2nd line to the bases of the lungs.

Pulmonary hilum

Normal pulmonary pattern (pulmonary

vasculature, pulmonary picture)

Is formed by pulmonary arteries and veins

Dichotomic division of vessels

The diameter of each vessel is 2 times less than the

diameter of the previuos

Pulmonary pattern is more evident in the inferior

regions

Pulmonary pattern is no more seen at the distance

of 1,5-2 cm from the chest wall

Radiological semiology of

pulmonary pathology

• Pulmonary opacity

• Pulmonary hyperlucency

• Changes of pulmonary picture

• Changes of pulmonary hilum

Radiological semiology of pulmonary pathology

Pulmonary opacity is a nonspecific term describing

an area of increased pulmonary attenuation caused

by an intraparenchymal process resulting in the

decreased ratio of gas to soft tissue (blood, lung

parenchyma and stroma) in the lung.

Radiological semiology of pulmonary pathology

Pulmonary opacity

• Number (single / multiple, disseminated)

• Dimensions (nodular / limited (to lobe, lobar segment) / large)

• Location (unilateral / by ribs / regions / lobes / segments)

• Shape (rounded / ring-shape / linear / triangle / irregular)

• Borders (well-defined, regular or irregular / ill-defined )

• Structure (homogeneous / heterogeneous)

• Intensity (subcostal / costal / supracostal)

• Relation to the mediastinum (without displacement / with

displacement (pushing / pulling))

Decreased lung density on images can be described as

pulmonary hyperlucency on conventional chest radiographs

and hypoattenuation (hypodensity) on CT scans.

Hyperlucency on images can result from an excess of air

in the pulmonary parenchyma or a decrease in mass of the

pulmonary parenchyma caused by a reduction in

vasculature or blood flow, reduction or obliteration of

airways, or a combination of these potential causes.

Pulmonary hyperlucency


pulmonary pathology


Classification

• Outside or Inside the lungs

• unilateral or bilateral

• focal or diffuse


Outside the lungs (pneumothorax)

Inside the lungs

• Pulmonary emphisema

• Pulmonary hypovolemia


pulmonary pathology

Changes of pulmonary picture

• Deformaton

• Enhanced

• Reduced

Total and subtotal opacity

Limited opacity

Rounded opacity

Ring-shaped

opacity

Ring-shaped opacity

Nodular opacity

Miliary opacities

Radiografia antero-posterioară şi de profil

Opacitate in lobul mediu şi segmentele bazale.

CT în fereastră parinchimatoasă. Opacitate

alveolară.

CT în fereastră mediastinală. Opacitate

alveolară. Absenţa măririi ganglionilor limfatici.

Meniscus sign (bilateral) – pleural effusion

Pulmonary hyperlucency - emphisema

Pulmonary hyperlucency - pneumothorax

Hydroaeric level – hydropneumothorax

The phases of bronchial obstruction

I. Partial obstruction (hypoventilation)

II. Valve-type obstruction (hyperinflation/obturative emphysema)

III. Complete obstruction (atelectasis)

I. II. III.

chest imaging - usmf · 2019. 3. 4. · radiological semiology of pulmonary pathology pulmonary...

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