cxr: multiple cavities
TRANSCRIPT
CHEST SKIAGRAM FOR CHEST SKIAGRAM FOR DISCUSSIONDISCUSSION
DR AMUDHANDR AMUDHAN
PROF Dr E. DHANDAPANI ‘S PROF Dr E. DHANDAPANI ‘S UNITUNIT
X-ray chest PA ViewX-ray chest PA View Properly positioned,good penetration with Properly positioned,good penetration with
full inspirationfull inspiration Trachea slightly to leftTrachea slightly to left Bony and Soft tissue shadow normalBony and Soft tissue shadow normal Costophrenic angle freeCostophrenic angle free Hyperinflation of lungHyperinflation of lung
Large cavity with surrounding Large cavity with surrounding emphysematous changes – upper & middle emphysematous changes – upper & middle zone with bronchiectatic changes –middle & zone with bronchiectatic changes –middle & lower zone of right hemithorax.lower zone of right hemithorax.
Multiple cavitatory lesions seen in upper Multiple cavitatory lesions seen in upper &middle zones with nonhomogenous opacity &middle zones with nonhomogenous opacity & bronchiectatic changes in lower zone of left & bronchiectatic changes in lower zone of left hemithorax. hemithorax.
Fibrosis of both upper lobesFibrosis of both upper lobes
Chest xray shows tracheal shift to leftChest xray shows tracheal shift to left Multiple cavitatory lesions bilaterallyMultiple cavitatory lesions bilaterally left hilum pulled upleft hilum pulled up Areas of consolidation left mid and Areas of consolidation left mid and
lowerzoneslowerzones Areas of bronchiectasisAreas of bronchiectasis Fibrosis both upper lobesFibrosis both upper lobes
CT THORAX CT THORAX Fibrotic changes B/L upper lobe with Fibrotic changes B/L upper lobe with
bronchiectatic changes in left lower lobebronchiectatic changes in left lower lobe Multiple cavitary lesion in both lungs. 11x3x5.4 Multiple cavitary lesion in both lungs. 11x3x5.4
cm sized thin walled cavity in right lung cm sized thin walled cavity in right lung 10 x 2 x4.2 cm cavity in left lung.10 x 2 x4.2 cm cavity in left lung. Patchy consolidation left lower lobe & B/L Patchy consolidation left lower lobe & B/L
Fibrosis with traction bronchieactasis in left Fibrosis with traction bronchieactasis in left upper lobe.upper lobe.
A cavity is defined as an air containing A cavity is defined as an air containing space within the lung surrounded by a space within the lung surrounded by a complete wall of 1mm or greater thicknesscomplete wall of 1mm or greater thickness
Thin walled cavity has a wall thickness of Thin walled cavity has a wall thickness of <1mm<1mm
Bulla is a type of thin walled cavityBulla is a type of thin walled cavity
FEATURES TO NOTED IN A FEATURES TO NOTED IN A CAVITYCAVITY
LocationLocation OutlineOutline Wall thicknessWall thickness Air fluid levelAir fluid level Contents of cavityContents of cavity Satellite lesionsSatellite lesions Surrounding lung parenchymaSurrounding lung parenchyma Intracavitary noduleIntracavitary nodule
LocationLocation
TB cavity usually upper zoneTB cavity usually upper zone Posterior segment of upper lobe &apical Posterior segment of upper lobe &apical
segment of lower lobesegment of lower lobe Site of lung abscesses following aspiration Site of lung abscesses following aspiration
depends on patients position at time of depends on patients position at time of aspiration usually lower zone and right sidedaspiration usually lower zone and right sided
Pulmonary infarcts are usually lowerzonePulmonary infarcts are usually lowerzone Pulmonary sequestration usually left side Pulmonary sequestration usually left side
lower zonelower zone
Thin walled cavityThin walled cavity
Bullae Bullae PneumatocelePneumatocele Inactive TB cavitiesInactive TB cavities Cystic bronchiectsisCystic bronchiectsis Hydatid cystsHydatid cysts Traumatic lung cystsTraumatic lung cysts
Thickwalled cavityThickwalled cavity
Acute abscessesAcute abscesses Squamous cell carcinomaSquamous cell carcinoma LymphomaLymphoma Most secondariesMost secondaries Wegener’s granulomatosisWegener’s granulomatosis Rheumatoid nodulesRheumatoid nodules
Satellite lesions are commonly seen in Satellite lesions are commonly seen in benign conditions like TBbenign conditions like TB
Fluid levels are seen in lung abscessFluid levels are seen in lung abscess
Fluid levels are uncommon in cavitating Fluid levels are uncommon in cavitating metastases & TB cavities metastases & TB cavities
Intracavitory nodulesIntracavitory nodules
AspergillomaAspergilloma Inspissated pusInspissated pus Blood clotsBlood clots Necrotic tumourNecrotic tumour CavernolithsCavernoliths Pulmonary gangrenePulmonary gangrene Ruptured hydatid cysts with daughter cysts Ruptured hydatid cysts with daughter cysts
floating within cavityfloating within cavity
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