4. cxr (2010 c1)

7/30/2019 4. CXR (2010 C1)

1/103

2

Abnormal Cases

Bone

Cardiovascular

Airspace Disease including Silhouette Sign

Interstitial Disease and Pulmonary Edema Atelectasis

Pulmonary Nodule

Pleura and Diaphragm

Mediastinal Mass

7/30/2019 4. CXR (2010 C1)

2/103

3

Bone and Soft Tissues

7/30/2019 4. CXR (2010 C1)

3/103

Fractures

4

7/30/2019 4. CXR (2010 C1)

4/103

5

Presenting CXR

7/30/2019 4. CXR (2010 C1)

5/103

6

7/30/2019 4. CXR (2010 C1)

6/103

7

MRI

Computed Tomography

Pancoast Tumour

7/30/2019 4. CXR (2010 C1)

7/103

8

Cardiovascular

7/30/2019 4. CXR (2010 C1)

8/103

9154 slides

Increased Cardiac Size: Can be

Cardiac or PericardialPericardial EffusionDilated Cardiomyopathy

What imaging would you use to differentiate between the two ?9

7/30/2019 4. CXR (2010 C1)

9/103

10154 slides

Left Ventricular Enlargement

Enlargement of Left Ventricle

Left

Ventricle

IVC

10

7/30/2019 4. CXR (2010 C1)

10/103

7/30/2019 4. CXR (2010 C1)

11/103

Pulmonary embolism

7/30/2019 4. CXR (2010 C1)

12/103

Pulmonary embolism

7/30/2019 4. CXR (2010 C1)

13/103

Airspace Disease and Silhouette

Sign

14

7/30/2019 4. CXR (2010 C1)

14/103

15

Normallung

Individual alveoli are

too small to resolve,

but together they

appear radiolucent.

7/30/2019 4. CXR (2010 C1)

15/103

16

Air-space Disease

Filling of alveoli by: water, blood,

pus, proteinaceous fluid, or cells

-opacities

-consolidation

7/30/2019 4. CXR (2010 C1)

16/103

Air-space pattern of lung disease 17

7/30/2019 4. CXR (2010 C1)

17/103

18

Airspace Disease

Filling in of acini (air space)

Air space (acinar) nodules

Coalesce to consolidation

Air bronchograms

Silhouette Sign

7/30/2019 4. CXR (2010 C1)

18/103

19

Air Space Disease: Etiology

Water-Pulmonary Edema

Pus-Infections, Non-infectious

inflammatory process

Blood-Pulmonary Hemmorhage Protein-Alveolar Proteinosis

Tumour-BAC, Lymphoma

7/30/2019 4. CXR (2010 C1)

19/103

22

Air Bronchogram

Airways are not normally seen in a normalchest radiograph because they are an air

structure within an aerated lung

When the aerated lung opacify, the bronchiibecome visualized because of the

surrounding contrast effect.

7/30/2019 4. CXR (2010 C1)

20/103

23154 slides

airbronch

23

7/30/2019 4. CXR (2010 C1)

21/103

24

7/30/2019 4. CXR (2010 C1)

22/103

25CT Consolidation: Air Bronchograms

7/30/2019 4. CXR (2010 C1)

23/103

26

Silhouette Sign Definition: The effacement of a normal structure

Example: Airspace disease may silhouette: right heart margin with right middle lobe pneumonia

diaphragm with lower lobe pneumonia

7/30/2019 4. CXR (2010 C1)

24/103

27

Silhouette sign

sign describes the observation that an

intrathoracic lesion will obliterate borders

of shadows of similar radiodense structuresthat it contacts

example: right middle lobe pneumonia will

obliterate apex of the right heart border

7/30/2019 4. CXR (2010 C1)

25/103

Silhouette sign

Normal

Pneumonia

(-) silhouette sign(visible heart silhouette)

Pneumonia

(+) silhouette sign

(no heart silhouette)28

7/30/2019 4. CXR (2010 C1)

26/103

Pulmonary edema+ silhouette sign

29

7/30/2019 4. CXR (2010 C1)

27/103

30

Pulmonary edema+ silhouette sign

Where is the Pneumonia?

7/30/2019 4. CXR (2010 C1)

28/103

31154 slides

Where is the Pneumonia?

31

7/30/2019 4. CXR (2010 C1)

29/103

32

7/30/2019 4. CXR (2010 C1)

30/103

33154 slides

Right Lower Lobe Pneumonia

Left

Right:

Partially seen 33

7/30/2019 4. CXR (2010 C1)

31/103

34154 slides

Left Lower Lobe Pneumonia

34

7/30/2019 4. CXR (2010 C1)

32/103

35154 slides

Where is the pneumonia?

35

7/30/2019 4. CXR (2010 C1)

33/103

36

7/30/2019 4. CXR (2010 C1)

34/103

37154 slides

Oblique(major)

fissure

Horizontal (minor fissure)

37

7/30/2019 4. CXR (2010 C1)

35/103

38154 slides

Right Middle Lobe Pneumonia

38

7/30/2019 4. CXR (2010 C1)

36/103

39

Interstitial Disease with Emphasis

on Pulmonary Edema

7/30/2019 4. CXR (2010 C1)

37/103

40

In a normal chest

radiograph, the visibleinterstitium is the

branching pulmonary

vessels

The branching

disappears peripherally

because they are beyond

resolution of the xray

7/30/2019 4. CXR (2010 C1)

38/103

41

Interstitial Disease

7/30/2019 4. CXR (2010 C1)

39/103

42

Hazy or ill defined interstitial lung disease

usually indicates acute disease

Sharp, well defined and distorted interstitiallung disease usually indicates chronic

disease

Interstital dz appears as linear, nodular, orreticular (net-like)


Interstitial pattern of

7/30/2019 4. CXR (2010 C1)

40/103

43

Interstitial pattern of

lung disease

7/30/2019 4. CXR (2010 C1)

41/103

44154 slidesInterstitial Disease: Pulmonary Fibrosis 44

7/30/2019 4. CXR (2010 C1)

42/103

45


Reticular=net-like

Nodular

Reticulonodular: Combination of the two

patterns

7/30/2019 4. CXR (2010 C1)

43/103

46154 slides

Reticular Pattern

46

Honeycombing in patient with single

7/30/2019 4. CXR (2010 C1)

44/103

47154 slides

Honeycombing in patient with single

lung transplant for pulmonary fibrosis

Normal Transplanted LungHoneycomb Native Lung 47

7/30/2019 4. CXR (2010 C1)

45/103

48154 slides

Miliary

Nodular Pattern: Miliary 48

7/30/2019 4. CXR (2010 C1)

46/103

55154 slides

cuffing

55

7/30/2019 4. CXR (2010 C1)

47/103

56Normal

7/30/2019 4. CXR (2010 C1)

48/103

57

Kerley linesare a sign seen on CXRwith interstitial pulmonary edema.

They are thin linear pulmonary opacities

caused by fluid or cellular infiltration

into the interstitium of the lungs

7/30/2019 4. CXR (2010 C1)

49/103

58

7/30/2019 4. CXR (2010 C1)

50/103

59154 slidesKerly B Lines 59

7/30/2019 4. CXR (2010 C1)

51/103

60154 slides

Edema kerly A

Pulmonary Edema

Minor fissure

60

Ed k l A

7/30/2019 4. CXR (2010 C1)

52/103

61154 slides

Edema kerly A

Septal Lines 61

7/30/2019 4. CXR (2010 C1)

53/103

7/30/2019 4. CXR (2010 C1)

54/103

63Kerley A

7/30/2019 4. CXR (2010 C1)

55/103

Other Lung Diseases

64

7/30/2019 4. CXR (2010 C1)

56/103

65

Emphysema (imaging findings)

bilaterally flat, depressed hemidiaphragm lung overinflation

increased pulmonary radiolucency

increased retrosternal space (>4.5cm)

accentuated kyphosis

increased intercostal spaces

prominent hilar vasculature, decreased

peripheral

bullae

7/30/2019 4. CXR (2010 C1)

57/103

66

emphysema

normal

Emphysema

7/30/2019 4. CXR (2010 C1)

58/103

67

Emphysema

7/30/2019 4. CXR (2010 C1)

59/103

68

7/30/2019 4. CXR (2010 C1)

60/103

69

Normal vs.

emphysematous

lung tissue

7/30/2019 4. CXR (2010 C1)

61/103

71

Bullous emphysema

7/30/2019 4. CXR (2010 C1)

62/103

72

Bullous emphysema

Bullous Emphysema

7/30/2019 4. CXR (2010 C1)

63/103

73154 slides

EnlargedRetrosternal

Air Space

Flattened Diaphragms

Bullous Emphysema

73

7/30/2019 4. CXR (2010 C1)

64/103

74

Atelectasis

7/30/2019 4. CXR (2010 C1)

65/103

75154 slides 75

Left lower lobe collapse

7/30/2019 4. CXR (2010 C1)

66/103

76154 slides

Left lower lobe collapse

Further investigations?

76

7/30/2019 4. CXR (2010 C1)

67/103

77154 slides 77

7/30/2019 4. CXR (2010 C1)

68/103

78154 slides 78

Diagnosis: LLL Collapse

7/30/2019 4. CXR (2010 C1)

69/103

79154 slides

Diagnosis: LLL Collapse

Collapse secondary to central obstructing

tumour

79

7/30/2019 4. CXR (2010 C1)

70/103

80

Pulmonary Nodule

7/30/2019 4. CXR (2010 C1)

71/103

81154 slides

Solitary Pulmonary Nodule: What Would You Do Next?

1) Compare with Any Available Previous

2) Computed Tomography

81

7/30/2019 4. CXR (2010 C1)

72/103

82154 slides

Solitary Pulmonary Nodule can be:

Benign: Densely calcified noduleMalignant: Adenocarcinoma

82

7/30/2019 4. CXR (2010 C1)

73/103

83154 slidesMultiple Nodules: Diagnosis? Metastases 83

7/30/2019 4. CXR (2010 C1)

74/103

Pleura

84

Pl d Di h

7/30/2019 4. CXR (2010 C1)

75/103

85

Pleura and Diaphragm

Pleural EffusionLateral decubitus>Lateral>PA in sensitivity

Pneumothorax

Upright

Deep sulcus sign in supine

Small Pleural Effusion

7/30/2019 4. CXR (2010 C1)

76/103

86154 slides 86

Small Pleural Effusion

7/30/2019 4. CXR (2010 C1)

77/103

87154 slides

Normal:Sharp Angles

Blunted posterior costophrenic sulcus 87

Large Pleural Effusion

7/30/2019 4. CXR (2010 C1)

78/103

88154 slides

Large Pleural Effusion

88

Lateral Decubitus

7/30/2019 4. CXR (2010 C1)

79/103

89154 slides

Lateral Decubitus

89

Pleural Effusion in Supine Patient

7/30/2019 4. CXR (2010 C1)

80/103

91154 slides

Pleural Effusion in Supine Patient

Pleural effusion

layers posteriorly

in a supineposition

Cause diffuse

increased density

91

7/30/2019 4. CXR (2010 C1)

81/103

93

7/30/2019 4. CXR (2010 C1)

82/103

95154 slides

Inspiration Expiration

95

7/30/2019 4. CXR (2010 C1)

83/103

96154 slides

Collapsed Right Lung

Tension Pneumothorax: Requires chest tube

Tracheal Deviation

What would you do with this patient?

96

7/30/2019 4. CXR (2010 C1)

84/103

Supine chest radiograph of a neonate illustrates the deep sulcus sign with abnormal

deepening and lucency of the left lateral costophrenic angle ().97

7/30/2019 4. CXR (2010 C1)

85/103

Supine Patient

7/30/2019 4. CXR (2010 C1)

86/103

99154 slidesDeep Sulcus 99

7/30/2019 4. CXR (2010 C1)

87/103

100

Non Dependent Portion of Lung at Base in Supine Patient

Deep Sulcus:

What can you do to confirm?

7/30/2019 4. CXR (2010 C1)

88/103

101154 slidesLeft lateral decubitus 101

7/30/2019 4. CXR (2010 C1)

89/103

102

Mediastinum: Overview

Classification of Mediastinum

Examples of mediastinal masses


7/30/2019 4. CXR (2010 C1)

90/103

103


Anatomic

Superior: above sternal angle

Anterior

Middle: heart and pericardium

Posterior

There are radiographic classification e.g.

Felsons


7/30/2019 4. CXR (2010 C1)

91/103

104

ANATOMIC CLASSIFICATION

The mediastinum is divided into 4 parts

Superior mediastinumApex of thorax to a planepassing through the manubrio-sternal junction and fourthdorsal vertebral body

Anterior mediastinumIs anterior to heart & great

vessels

Middle mediastinumContains heart & greatvessels, lymph nodes

Posteriormediastinum

Contains descending thoracicaorta, azygous/hemiazygousveins,esophagus, thoracic duct,nerves & lymph nodes

7/30/2019 4. CXR (2010 C1)

92/103

105

Anterior Mediastinal Mass

The 4 Ts

Thyroid

Thymus (Thymoma)Teratoma

Terrible Lymphoma (Tumour)

Thyroid Goiter

7/30/2019 4. CXR (2010 C1)

93/103

106154 slides

Thyroid Goiter

Most common

superior

mediastinal mass

extending tothoracic inlet

Note Tracheal Deviation106

Benign thymoma

7/30/2019 4. CXR (2010 C1)

94/103

107154 slides

Benign thymoma

Normal 107

Lateral CXR shows: mass is anterior

7/30/2019 4. CXR (2010 C1)

95/103

108154 slides

Lateral CXR shows: mass is anterior

NORMAL 108

Computed Tomography

7/30/2019 4. CXR (2010 C1)

96/103

109154 slides

p g p y

Thymoma

Do you know any

associated

clinical syndrome?

109

i h i

7/30/2019 4. CXR (2010 C1)

97/103

110154 slides

Hiatus hernia

110

7/30/2019 4. CXR (2010 C1)

98/103

111

Lymphadenopathy

7/30/2019 4. CXR (2010 C1)

99/103

112

Lymphadenopathy

LungCancer

7/30/2019 4. CXR (2010 C1)

100/103

113

Small cell CA

7/30/2019 4. CXR (2010 C1)

101/103

114154 slides Normal

Hilar and Mediastinal Lymphadenopathy

Diagnosis?114

Hilar Lymphadenopathy on lateral

7/30/2019 4. CXR (2010 C1)

102/103

115154 slides

Normal115

Sarcoidosis

7/30/2019 4. CXR (2010 C1)

103/103

4. cxr (2010 c1)

Documents