chest surgical pathology &x rays
TRANSCRIPT
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Surgical Pathology & X-rays Surgical Pathology & X-rays for Medical Studentsfor Medical Students
Chest SurgeryChest Surgery20082008
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© Vascular 20072
•Normal Chest X-ray
•Pneumothorax
•Pleural Effusion
•Hydro-pnemothorax
•Complete Lung Collapse
•Opacified Hemithorax
•Bronchogenic Carcinoma
•Cavitary Lung Lesions
•Lung Abscess
•Fibro-caseous TB
•Pulmonary Metastasis
•Aortic Arch Aneurysm
Index
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Normal Normal Chest Chest X rayX ray
Index
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SVCSVC
RARA
PAPA
PAPA
LVLV
AAAA
CoPhSCoPhSIndex
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PneumothoraxPneumothorax
Index
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Lt. side pneumothoraxLt. side pneumothorax
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Rt. side pneumothoraxRt. side pneumothorax
•Marked difference in X-ray transparency (density) between the left and right thoracic cavities. •Complete radio-translucency (manifest as greater film density or darker lung field on the image) of the Rt. thorax with absence of vascular markings
Normal for comparison
Index
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Lt. tension pneumothoraxLt. tension pneumothorax NoteNote:•The marked density difference between the left and right thoracic cavities. •The complete translucency on the left with absence of vascular markings•Shifting of the mediastinum
•What appears as a left hilar mass is in fact the collapsed left lung retracted into a small central density
NormalIndex
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Lt. Tension pneumothorax
Index
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Lt. side tension Lt. side tension pneumothoraxpneumothorax
Index
Basis of Diagnosis:
•Hyperresonance of affected hemithorax •Decreased or absence of breath sounds•Tracheal deviation to the other side of pneumothorax•Respiratory distress•Hypotension•Tachypnea•Hypoxia•Distended neck veins (unless the patient is hypovolemic)
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Rt. side tension Rt. side tension pneumothorax pneumothorax
in an infantin an infant
Index
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Tension PneumothoraxTension Pneumothorax
Index
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Emergency treatment of tension pneumothoraxEmergency treatment of tension pneumothorax
Needle decompression (thoracostomy) with large-bore needle in the second intercostal space in the midclavicular line to convert the tension pneumothorax into a simple pneumothorax, then prepare for intercostal tube insertionThis simple procedure can save the patient’s life
Index
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Severe Rt. tension Severe Rt. tension pneumothoraxpneumothorax
Mechanism: The air enters to the pleural space and cannot escapeThe intrapleural pressure increases and the lung becomes collapsed with secondary shift of the mediastinal contents to the opposite side.
After treatment Index
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Pleural EffusionPleural Effusion
Index
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Rt. pleural effusionRt. pleural effusionoFlat opacified line at the right hemidiaphragm with obliteration of the costo-phrenic angle
oThe right middle lobe fissure is more sharply visible which tends to occur when (there is fluid in that fissure)
Index
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Lt. pleural effusionLt. pleural effusionoThe left base is showing a curved density in place of the normally convex diaphragm. oThat curvature is characteristic of a pleural effusion
Index
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Lt. pleural effusionLt. pleural effusion
Index
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Lt. massive Lt. massive pleural effusionpleural effusion
Index
Massive effusions usually have an accompanying mediastinal shift to the
contralateral side
Normal
If a massive effusion does not shift the mediastinum, suspect malignant effusion
where the mediastinum is fixed.
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Massive Lt. pleural effusionMassive Lt. pleural effusion
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The right hemithorax is
opaqueThere is a shift of the heart and trachea away from the side of opacification
Massive Right Pleural EffusionMassive Right Pleural Effusion
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Rt. lung Rt. lung effusioneffusion
If an effusion (whatever the fluid is) fills the entire hemithorax It acts like a mass Pushing the heart and trachea away from the side of opacification
Index
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Hydro-Hydro-pneumothoraxpneumothorax
Index
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Rt. hydro-Rt. hydro-pneumothoraxpneumothorax
Hydropneumothorax in three different
views:
The PA, lateral, and right decubetus
reveal a horizontal air and fluid level.
PA Lateral
Rt. decubetus
Index
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Lt. Massive hydro-pneumothoraxLt. Massive hydro-pneumothorax
Index
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Lung CollapseLung Collapse
Index
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Left Plural Tap was Left Plural Tap was NEGATIVENEGATIVE
Complete Lt. Lung CollapseComplete Lt. Lung Collapse
For comparison
Normal
Massive pleural effusion
Index
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Complete Lt. Lung CollapseComplete Lt. Lung Collapseo40-year-old woman with tuberculous bronchial stricture oChest radiograph shows complete collapse of left lung and deviation (arrows) of trachea to left lung
Index
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There is a shift of heart and hemidiaphragm toward side of opacification(toward side of volume loss)
Lt. Lung Lt. Lung CollapseCollapse
IndexNormal
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30
Compare
Rt. lung Rt. lung effusioneffusion
Lt. lung Lt. lung collapsecollapse
Index
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Compare
Lt. tension Lt. tension pnemothoraxpnemothorax
Lt. lung Lt. lung collapsecollapse
Index
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Compare
Rt. pleural effusionRt. pleural effusion Lt. lung collapseLt. lung collapse
Index
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Massive Massive PneumoniaPneumonia
Index
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Lt. lung Lt. lung pneumoniapneumonia
The hemithorax is opaque and there is no shift of the heart
or trachea
Index
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The left hemithorax is opaque
There is no shift of the heart or trachea
Pneumonia of the Pneumonia of the Left upper lobeLeft upper lobe
The opacified hemithorax contains air bronchograms
Index
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Lt. lung collapse Rt. lung effusion
Lt. lung pneumonia Lt. neumonectomy
Causes of an
Opacified Hemithorax
Index
The arrow shows
mediastinal shift
No
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Which is this?
Atelectasis
Pneumonia
Effusion
Index
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Bronchogenic Bronchogenic CarcinomaCarcinoma
Index
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Bronchogenic Bronchogenic CarcinomaCarcinoma
Fungating, hard solid white mass arising from the bronchial lining invading into the left bronchus and surrounding tissues.This is the lung of a 74-year-old man who first presents with cough, chest pain, wheezing, hemoptysis and progressive dyspnea
Can you relate his symptoms to the pathology seen?
Index
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Cough: infection distal to airway blocked by tumor.Hemoptysis: ulceration of tumor in bronchus.Dyspnoea: local extension of tumor.Chest pain: involvement of pleura and chest wall.Wheeze: narrowing of airway.
Index
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72-year-old man with bronchogenic carcinoma : Bone scintigraphy study shows multiple sites of increased uptake in left tibia, fibula and foot (metastasis)
Index
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Lung Lung CarcinomaCarcinoma
Index
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oA large, well-defined mass in the right upper lobe
oExtensive emphysematous change
Lung CarcinomaLung Carcinoma
Index
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Squamous cell carcinomaA portion of the tumor demonstrates central cavitation, probably because the tumor outgrew its blood supply
Index
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Cavitary Lung LesionCavitary Lung LesionoThe air-fluid level indicates communication with the airway - hence sputum is likely to be helpful in diagnosis.oThe appearance of The appearance of the lesion could be a the lesion could be a carcinoma or an carcinoma or an abscess.abscess.o Sputum cytology was squamous cell bronchogenic carcinoma. oCavitation is a typical morphologic feature of this form of lung cancer.
Index
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Bronchogenic carcinoma
Cavitating staphylococcal pneumonia Note left lower lobe
consolidation with large cavity and air-fluid level
Cavitary Lung LesionsCavitary Lung Lesions
Fibro-caseous cavitary TB
Index
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Lung AbscessLung Abscess
Index
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Fibro-caseous Fibro-caseous Pulmonary TBPulmonary TB
Index
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Fibro-caseous TB of both superior Fibro-caseous TB of both superior lobes with cavitations on the Rt. sidelobes with cavitations on the Rt. side
Index
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Pulmonary Pulmonary MetastasisMetastasis
Index
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Multiple Multiple Pulmonary Pulmonary
secondariessecondaries
Index
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Renal adenocarcinoma with multiple pulmonary metastasis
Index
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Lung metastasis Lung metastasis from CA colonfrom CA colon
Index
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Can you identify the pulmonary metastasis?
Index
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Aortic Arch Aortic Arch AneurysmAneurysm
Index
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The mediastinal shadow is dominated by the dilation of the aorta.
Better definition of the aortic anatomy is achieved with the CT scan Index
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Thoracic aortic
aneurysm
Pulmonary T.B.
Index