chest radiology interactive teaching session
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Chest Radiology Interactive Teaching Session. Nevzat KARABULUT, M.D. Pamukkale University Hospital [email protected]. Case 1. 76-year-old female Bronkorhea Loss of apetite, weight loss (10 kg in 5 months). 76- year - old female. Which dx is the most unlikely? - PowerPoint PPT PresentationTRANSCRIPT
Chest RadiologyChest RadiologyInteractive Teaching SessionInteractive Teaching Session
Nevzat KARABULUT, M.D.
Pamukkale University Hospital
Case 1Case 1
• 76-year-old female
• Bronkorhea
• Loss of apetite, weight loss (10 kg in 5 months)
76-year-old female76-year-old female
Which dx is the most unlikely?a) Diffuse pneumoniab) Pulmonary alveolar
proteinosisc) Cryptogenic organizing
pneumoniad) Tumore) Hypersensitivity
pneumonitis
76-year-old female76-year-old female
Which of the following signs are present on CT?Which of the following signs are present on CT?
a) CT Angiogram
b) Crazy paving
c) Halo sign
d) 1+2
e) 1+2+3
Which of the following signs are present on CT?Which of the following signs are present on CT?
1. CT Angiogram
2. Crazy paving
3. Halo sign
4. 1+2
5. 1+2+3
What is your final diagnosis?a) Diffuse pneumoniab) Pulmonary alveolar proteinosisc) Cryptogenic organizing pneumonia
d) Bronchioloalveolar cell carcinoma
e) Diffuse alveolar damage
Mucinous Bronchioloalveolar Mucinous Bronchioloalveolar cell carcinomacell carcinoma
Bronchioloalveolar cell carcinomaBronchioloalveolar cell carcinoma
• Subgroup of adenocarcinoma • 5% of all bronchogenic carcinomas • Mucinous (20-30%) and Clara cell or
type II pneumocyte • Can be seen as
– Single or multiple nodules– single or multiple consolidation (more
common in mucinous tumors)
Consolidative BACConsolidative BAC
• CT findings that suggest BAC rather than pneumonia – non-resolving peripheral
consolidative pneumonia with associated nodules
– stretching, squeezing and widening of the branching angle of bronchus within consolidation
– Bulging of the interlobar fissure
– multiple cysts or bubble like radiolucencies
Jung JI. Br J Radiol 2001; 74:490-494
CTCT angiogramangiogram signsign
• Presence of >3 cm pulmonary vessel within a consolidation
• Initially described for lobar form of BAC– 92% specificity
• Pneumonia• Pulmonary edema• Obstructive pneumonitis • Lymphoma• Mets from GI carcinomas
Crazy paving patternCrazy paving pattern
• Interlobular septal thickening superimposed on ground glass opacity
• Initially described for PAP
• Bronchiloloalveolar cell carcinoma
• Exogeneous lipoid pneumonitis
• Infections
Alveolar proteinosis
Pneumocystis jiroveci pneumonitis
CASE 2CASE 2
• 49-year-old male
• Chest pain and cough
• CABG operation 5 years ago
49-year-old male
What is the most likely diagnosis?
a) Foreign body
b) Lung cancer
c) Hamartoma
d) Solitary fibrous tumor
GossypibomaGossypiboma
• Hx of surgery
• Low-density inhomogeneous mass with hyperdense capsule
• Whirling hyperdense lines
Topal U. Intrathoracic gossypiboma. AJR 2001 177:1485-1486.
IInnccompletomplete border sign e border sign
• Partial obscuration of border of extrapulmonary lesions where it is not surrounded by air
• Analogy with Sillhoutte sign
• Extrapleural fat
• Solitary fibrous tumor of pleura
• Rib lesions
64 y-male, RLLobectomy 3 months ago64 y-male, RLLobectomy 3 months ago
50 y-female, CABG
CASE 3CASE 3
45-year-old asymptomatic female with abnormal CXR
A) Central mass @ RLL
B) Atelectasis of RLL
C) Vascular abnormality
D) RML disease
E) Kartagener syndrome
a) AVM
b) Atelectasis of RLL
c) Abnormal pulmonary venous return
d) Swyer James Syndrome
e) Kartagener’s syndrome
Scimitar signScimitar sign
Scimitar signScimitar signHHyypogenetipogenetic Lungc Lung s syyndromndromee
• Small Right hemithorax
• Retrocardiac or paracardiac tubular density
• Abnormal vein:– IVC– PV, HV, Right atrium
• 25% associated with CHD– ASD, VSD, PDA
The recognition of signs and The recognition of signs and patterns on CXR and CT is helpful patterns on CXR and CT is helpful for accurate diagnosisfor accurate diagnosis
Case 4: Case 4: 25-year-old man, smoking (+)25-year-old man, smoking (+) Cough, bloody sputum, mild dispnea Cough, bloody sputum, mild dispnea
What is your presumptive diagnosis?What is your presumptive diagnosis?
a) Mass
b) Interstitial thickening
c) Cystic lung disease
d) 3+1
e) 4+1
a) Fungus ball in tuberculosis cavity
b) Fungus ball in Lymphangioleiomyomatosis
c) Fungus ball in Langerhans cell histiocytosis
d) Cystic and solid metastases
e) Invasive aspergillosis in cystic lung disease
What is your final diagnosis?
Fungus ball in Fungus ball in Langerhans cell Langerhans cell histiocytosishistiocytosis
Aspergilloma (mycetoma)Aspergilloma (mycetoma)
• Colonization of a preexisting lung cavity by
saprophytic fungi (Aspergillus spp)• Preexisting lung cavity
• TB• Sarcoidosis• Bronchiectasis
• Fungus ball: fungus, cellular debris, fibrin, and inflammatory cells
• Thick and vascular wall: hemoptysis
LCH LAMLCH LAM
Case 5: Case 5: 59-year-old female with dry mouth59-year-old female with dry mouth
59-year-old female with dry mouth59-year-old female with dry mouth
a) Lymphangioleiomyomatosis
b) Langerhans cell histiocytosis
c) Lymphoid interstitial pneumonia
d) Centrilobular emphysema
e) Birt Hogg Dubé syndrome
What is your diagnosis?
LIP (Sjögren syndrome)
25% of cases
Thank you for your attention and participation