imaging of chest diseases
TRANSCRIPT
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o Lungo Pleurao Diaphragmo Soft Tissue and Skeletalo Kardiovaskularo Mediastinum
CHEST DISEASES
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INCRESE !PCIT"o Pneumonia
o tele#tasiso Pulmonar$ Contusion %
La#eration
o Traumati# &et Lung
o Pulmonar$ Edemao Pulmonar$ Mass
o Pulmonar$ Metastasis
LUNG
INCRESE L'CENC"o Emph$sema
o (ullae % (le)o C$st
o Tu)er#ulous #avit$
o Pulmonar$ a)s#ess
o Malignant Cavit$o (ron#hie#tasis and
(ron#hitis
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PNEUMONIA
Inammation of teairspaces and!or interstitium
"tiology Infective
#acterial$ %irus$ Fungi$ Parasites
&utoimmune
'emical
meconiumaspiration
(eoplasm
Idiopatic
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PNEUMONIA
Preferred imaging modalityPosteroanterior cest + ray
,ateral cest + ray
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PNEUMONIA
'lassi-cation )ased onradiology appearance
,o)ar pneumonia,o)ularis pneumonia !
#roncopneumonia
Interstitial pneumoniaRound pneumonia
'avitary pneumonia
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Lobar Pneumonia
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Why do we still see the silhouette othe right diaphragm on the PA-flm
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Lobar Pneumonia
&ir )roncogram
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Lobar Pneumonia
RUL Pneumonia
Homogenousopaci-cation
&ir )roncogram
,imited )y teminor -ssure at
te inferiorSiloutte to te
upper mediastina
(o volume canges
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Lobar Pneumonia
RML Pneumonia
Homogenousopaci-cation
&ir )roncogram
,imited )y te minor-ssure at te
superiorSiloutte to te rigt
eart )order
(o volume canges
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Lobar Pneumonia
RLL Pneumonia
Homogenousopaci-cation
&ir )roncogram
Siloutte to te rigtdiapragm
(o volume canges
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Lobar Pneumonia
RLL Pneumonia
Homogenousopaci-cation
&ir )roncogram
,imited )y te major-ssure at te anterior
Siloutte to te rigtdiapragm 5only onediapragm tat isseen6
(o volume canges
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Lobar Pneumonia
LUL Pneumonia
Homogenousopaci-cation
&ir )roncogramSiloutte to te
mediastinum andleft eart )order/
4e left diapragmcan still )e seen/
(o volume canges
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Lobar Pneumonia
LUL Pneumonia
Homogenousopaci-cation
&ir )roncogram,imited )y te major
-ssure at teposterior
#ot of te diapragmscan still )e seen/
(o volume canges
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Lobar Pneumonia
Lingular Pneumonia
Homogenousopaci-cation
&ir )roncogramSiloutte to te left
eart )order/
(o volume canges
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Bronco!neumonia orLobular Pneumonia
&.ected te pulmonary lo)ules/ 'ommences in te terminal and
respiratory )roncioles "ndo)roncial spread/ In-ltrates or patcy consolidation (o air )roncogram
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Bronco!neumonia
Patcy
consolidation(o air)roncogram
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In"er#"i"ial Pneumonia
,ack of alveolar e+udate Inammatory centered *itin alveolar *all 8
interstitium Interstitium consists of a continuum of connective
tissue trougout te lung comprising 9su)division14e )roncovascular 5a+ial6 interstitium
Surrounding )ronci$ arteries$ 8 veins from ilum to
respiratory )ronciole4e parencymal 5acinar interstitium6
#et*een alveolar 8 capillary )asement mem)ranes
Su)pleura connective tissue contiguous *it te interlo)ular
septa
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In"er#"i"ial Pneumonia
"tiology 1 Usually viral 5late stage alveolar process6
Inuen:a virus types & and #
Respiratory syncytial virus
&denovirus
Mycoplasma pneumonia
,inear opaci-cation
Increased )roncovascular marking (o silouette sign or air )roncogram/
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In"er#"i"ial Pneumonia
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Roun$ Pneumonia
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Roun$ Pneumonia
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Ca%i"ar& Pneumonia
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Ca%i"ar& Pneumonia
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ATELECTASIS
Reduced ination of all opart of te lung
Synonim1 collapse Reduced lung volume
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ATELECTASIS
'lassi-ed )ased on etiology1 'ompressive!rela+ation!passive
"+pansion is ampered )y pneumotora+ or pleurale.usion
=)structive!a)sorption!resorption ,uminal occlusion *it air a)sorption at te distal part
"! mass$mucous plug$corpal$inammation$lymp node
&desif Surfactant de-ciency
'icatrical!contraction ,ung or pleural -)rosis tat ampered te lung e+pansio
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ATELECTASIS
9 direct sign 5major6 Displacement of
interlo)ar -ssures Increased opacity Increased
)roncovascular marking
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ATELECTASIS
> indirect signs 5minor6 Diapragm elevation
Mediastinal sift 4raceal deviation Hilar traction
'ompensated yperinatioof normal lung
Intercostal space narro*ing
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ATELECTASIS
=ter type of atelectasis Su)segmental 5discoid!plate2
like6 'ompressive *it
compensation nomediastinal sift/
Round atelectasis S golden sign RU,
atelectasis *it periilar mass/
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RUL A"elec"a#i#
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RUL A"elec"a#i#
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RML A"elec"a#i#
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RML A"elec"a#i#
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RML A"elec"a#i#
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RLL A"elec"a#i#
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RLL A"elec"a#i#
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LUL A"elec"a#i#
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LUL A"elec"a#i#
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LLL A"elec"a#i#
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LLL A"elec"a#i#
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'ompressive *it compensation
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Round &telectasis
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Round &telectasis
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?old S sign
PULMONAR* CONTUSION AND
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PULMONAR* CONTUSION ANDLACERATION
4e most common complicationof )lunt injury to te cest
Intra2alveolar and interstitial
aemorrage at te impactsite/
'linical istory play an
important role Resem)le pneumonia$
aspiration
PULMONAR* CONTUSION AND
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PULMONAR* CONTUSION ANDLACERATION
In-ltrates at te periperalarea 5ma+imum impact point6
Usually no air )roncogram > ours after trauma and
disappear after @< ours/
Persist ;@< ours
pulmonary laceration orpneumonia/
PULMONAR* CONTUSION AND
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PULMONAR* CONTUSION ANDLACERATION
Pulmonary laceration ard to )ediagnosed in -rst couple of dayscovered )y contusion
4e -ndings of pulmonarylaceration1
=void mass if it is -lled
completely )y )lood/&ir uid level if partially -ll
*it )lood and air/
'yst if -lled *it air/
PULMONAR* CONTUSION AND
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PULMONAR* CONTUSION ANDLACERATION
(eed *eeks or monts forte cest + ray to )e seenclearly again/
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PULMONAR* CONTUSION
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PULMONAR* CONTUSION
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PULMONAR* LACERATION
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TRAUMATIC +ET LUNG
'ontroversy Synonim *it pulmonary
contusion and laceration Di.erent1
4raumatic *et lung or Da (ang,ungpulmonary edema tat *as
not directly caused )y trauma atte cest
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PULMONAR* EDEMA
'lassi-ed into 'ardiogenic
(on2cardiogenic
'ardiogenic pulmonary edema eart failure Heart failure
,eft eart failure )ack*ard failure pulmonary
congestion
pulmonary edema Rigt eart failure)ack*ard failure systemic
congestiondoesnAt cause pulmonary edema
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PULMONAR* EDEMA
'est + ray screening tool ,eft eart failure1
Heart enlargement *it te ape+ do*n*ard to
te diapragm Depend on te severity
B/ 'raniali:ation ! cepali:ation 5P'CP B2BEmmHg6
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PULMONAR* EDEMA
'raniali:ation ! cepali:ation Pulmonary veins at te superior part of te lung ;92
E1B tan te pulmonary veins at te inferior part of
te lung/ %ascular marking at te superior part of te lung is
more cro*ded tan te inferior part of te lung/
Measure at e3uidistant from te ilar point/
Mecanism1 Decreased vascular compliance at te lung )ase/
Hypo+ic vasoconstriction penomenon
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PULMONAR* EDEMA
'raniali:ation ! 'epali:ation
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PULMONAR* EDEMA
Interstitial pulmonary edema Interlo)ular septa tickening
0erley # lung )ase 1 tickness Bmm$ lengt B2cm$ o)li3ue at te central part
0erley ' reticular at te lung )ase 5en face 0erley #6
Peri)roncial tickening at )ot ila Fluid in -ssures
Pleural e.usion 5#ilateral especially te rigt side6
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PULMONAR* EDEMA
0erley # lines
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PULMONAR* EDEMA
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PULMONAR* EDEMA
Peri)roncial tickening and uid in
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PULMONAR* EDEMA
Interstitial pulmonary edema
O
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PULMONAR* EDEMA
&lveolar pulmonary edema In-ltrates in te medial t*o tird of te lung/
#atAs *ing appearance
#uttery appearance Usually no air )roncogram
PULMONAR* EDEMA
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PULMONAR* EDEMA
&lveolar pulmonary edema
PULMONAR* EDEMA
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PULMONAR* EDEMA
&lveolar pulmonary edema
PULMONAR* EDEMA
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PULMONAR* EDEMA
(on cardiogenic pulmonary edema More periperally
(o craniali:ation!cepali:ation
"tiology1 %olume overload
&RDS
(S&ID
(eurogenic pulmonary edema 5intracranialpressure;;6
Dro*ned
PULMONAR* EDEMA
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PULMONAR* EDEMA
(on cardiogenic pulmonary edema
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PULMONAR* NEOPLASM
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PULMONAR* NEOPLASM
Su)types1Small cell carcinoma
S3uamous cell carcinoma,arge cell carcinoma
&denocarcinoma
#roncioloalveolar carcinoma
PULMONAR* NEOPLASM
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PULMONAR* NEOPLASM
'linical management depends on diseasee+tent 5staging6 role of imaging otertan detection/
'entral 1Small cell carcinoma
S3uamous cell carcinoma
Periperal,arge cell carcinoma
&denocarcinoma
PULMONAR* NEOPLASM
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PULMONAR* NEOPLASM
Mass ;9cm
(odule G9cm'onsolidation
In-ltrates
Smoot or irregular
'avitation
Satellite nodules
,ympadenopaty
Skeletal involvement
Imaging -nding spectrum
PULMONAR* NEOPLASM
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PULMONAR* NEOPLASM
PULMONAR* METASTASIS
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PULMONAR* METASTASIS
4ypes1Milliary 5G/Ecm6
'oin lesion ! coarse nodular pattern 5B2
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PULMONAR* METASTASIS
Milliary4yroid$ lung$ )reast$ )one sarcoma
'oin lesion=roparyn+$ gaster$ tyroid$ limfosarcoma$ coriocarcinoma$ ovarian$
uterine ?olf )all
Sarcoma$ carcinoma$ seminoma$ renal cell ca
,ympangitic spread#reast$ pancreas$ lung$ lympoma$ leukemia$ tyroid$ laryn+$ stomac$
pancreas$ cervi+ Pneumonic 8 peri)roncial pattern
"sopagus$ lung$ )reast
Pleural e.usion 5not truly pulmonary metastasis6#reast$ gaster$ adenocarcinoma
MILIAR* PULMONAR* METASTASIS
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MILIAR* PULMONAR* METASTASIS
COIN LESION PULMONAR* METASTASIS
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COIN LESION PULMONAR* METASTASIS
GOLF BALL PULMONAR*
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METASTASIS
L*MPHANGITIC SPREAD
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PULMONAR* METASTASIS
PNEUMONIC T*PE PULMONAR* METASTASIS
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PNEUMONIC T*PE PULMONAR* METASTASIS
PLEURAL EFFUSION METASTASIS
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PLEURAL EFFUSION METASTASIS
AT*PICAL PULMONAR*
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METASTASIS
Mass *it cavitationS3uamous cell ca of ead 8 neck$ adenocarcinoma of
te ?I tract$ )reast$ sarcoma
Mass *it calci-cation=steosarcoma$ condrosarcoma 5)one formation6
Papillary carcinoma of te tyroid$ ?'4$ synovialsarcoma 5dystropic calci-cation6
Mucinous adenocarcinoma of ?I tract or )reast5mucoid calci-cation6
Spontaneous pneumotora+=steosarcoma$ angiosarcoma
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Ma## ,i" Ca%i"a"ion
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Ma## ,i" Ca%i"a"ion
Ma## ,i" Calci-ca"ion
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Ma## ,i" Calci-ca"ion
Pneumo"ora.
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Pneumo"ora.
Groun$(gla## A""enua"ion
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Groun$(gla## A""enua"ion
Con#oli$a"ion
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Con#oli$a"ion
M i i P l A
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Ma## ,i"in Pulmonar& Ar"er&
+ " ) i
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+e#"ermar) #ign
H " / i
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Ham!"on/# um! #ign
En$obroncial Ma## ,i"
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En$obroncial Ma## ,i"A"elec"a"ion
Em!ema
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Em!ema
"mpysema is de-ned patologically aspermanent enlargement of te airspacesdistal to te terminal )roncioles$
accompanied )y destruction of teir *alls"tiology 1 Im)alance of elastase and antielastase
activity of elastase 5smokers6
JB2antiprotease
Proteolytic destruction of elastin alveolar *alldestruction
Em!ema
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Em!ema
Finding1Hyperaeration of te lung/
Decreased )rocovascular marking 5Increased ifaccompanied )y cronic )roncitis6
Cidened intercostal space 8 ori:ontal ri)sFlattening of te diapragm 8 )lunted costoprenic angle
#arrel cest 5&nteroposterior diameter ;;6/
; @tri) anteriorly or ;B tri) posteriorly/
4ear drop eart/Retrosternal space *idening in lateral cest + ray
Respiratory e+cursion G 9cm/
&typical appearance of pneumonia or pulmonary edema/
Em!ema
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Em!ema
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Bullae 0 Bleb
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Bullae 0 Bleb
C"
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C"
B K 9 mm *all &ir or uid -lled Call tat contains respirator epitelium$
cartilage$ smoot muscle and glands 'ontained *itin te lung 'ongenital or ac3uired Pneumatocele cyst associatied *it
pneumonia$ fre3uently transient
C"
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C"
Tuberculou# Ca%i"&
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Tuberculou# Ca%i"&
Result from process tatproduces necrosis of te central
portion of te lesionCall tickness 92E mm
'ontained *itin te lung
Tuberculou# Ca%i"&
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Tuberculou# Ca%i"&
Ab#ce##
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Ab#ce##
4ick *all ;Emm
Smoot inner margin
#ackground pneumonia 5@2Bdays6
Same lengt on )ot frontal andlateral vie* 5di.erent *itempyema6
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Malignan" Ca%i"&
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Malignan" Ca%i"&
4ick *all ;Emm
Irregular inner margin
Mural nodule
Malignan" Ca%i"&
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Malignan" Ca%i"&
Bronciec"a#i#
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Bronciec"a#i#
&)normal dilatation of te )roncialtree/
Irreversi)le locali:ed or di.use)roncial dilatation$ usually resultingfrom cronic infection pro+imal
air*ay o)struction$ or congenital/Irreversi)le e+cept some traction)ronciectasis/
Bronciec"a#i#
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Bronciec"a#i#
'auses1
Post Infective 5most common6
'ongenital
=)struction
,oss of surrounding lung volume5traction6
Bronciec"a#i#
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Bronciec"a#i#
Bronciec"a#i# %# Bronci"i#
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ronciectasis
Ring sado*
4ram2track or tram2line
Increased)roncovascularmarking
Honeycom) appearance
5old terminology6&ir2uid level infected
#roncitis Ring sado* 'uLng sign 5en
face6 4ram2track 5en
pro-le6 or tram2line
Increased)roncovascularmarking
Bronci"i#
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Bronciec"a#i#
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'ongenital cystic )ronciectasis
Bronciec"a#i#
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Bronciec"a#i#
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Bronciec"a#i#
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Bronciec"a#i#
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'4 Findings1
#roncial dilatation
Signet ring sign,ack of tapering of )ronci
Identi-cation of )ronci *itin Bcm of te pleural surface
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PLEURAL EFFUSION
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o Fluid collection in te pleural cavity
o Produced 1 parietal pleura capillaries
o &)sor)ed 1 visceral pleura andlympatic at te parietal pleural
PLEURAL EFFUSION
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'an )e caused )yo Increased production
o ydrostatic pressure 5left eart failure6o
oncotic pressure 5ypoproteinemia6o capillary permea)ility 5pneumonia$
ypersensitivity6o Decreased resorption
o lympatic a)sorption 5o)struction )ytumour6
o intrapleural cavity pressure 5atelectasis6
PLEURAL EFFUSION
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o 9 m, "rect cest + rayo @E m, ,ateral cest + ray
o BE2
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o Minimal pleural e.usiono Ultrasonograpy e+amination
o '4 scan
o &spiration guiding also *itultrasonograpy/
PLEURAL EFFUSION
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%arious appearanceo Su)pulmonal e.usion
o 'ostoprenic sinus )lunting
o Meniscus signo Homogenous opaci-cation
o ,ocali:ed e.usion
o
Pseudotumor ! vanising tumoro ,aminar e.usion
o Hydropneumotora+
PLEURAL EFFUSION
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Su)pulmonal
PLEURAL EFFUSION
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(ormal and )lunting
PLEURAL EFFUSION
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Meniscus sign
PLEURAL EFFUSION
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Homogenous opaci-cation *it
PLEURAL EFFUSION
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,ocali:ed pleural e.usion
PLEURAL EFFUSION
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Pseudotumor or vanising tumor 5lemon
PLEURAL EFFUSION
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,aminar e.usion
H*DROPNEUMOTHORA2
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Hydropneumotora+ 5ori:ontal air2uid
PLEURAL THIC3ENING
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o Mimicking pleural e.usion/o4e margin is not smoot
o Does not cange *it position
o Do not conform to te menicus sign
sky2slope
o If tere is traction sc*arte
o More opa3ue tan te soft tissue5su)jective6
PLEURAL THIC3ENING
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EMP*EMA
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o Distinction )et*een a sterile pleurale.usion and an infected collection5empyema6 is often impossi)le/
o
'lue 1 air uid level tat *as locali:ed/o Citout air uid level it is ard to )e
recogni:ed/
o ,enticular
o4e lengt of air uid level in &P!P& vie*is di.erent *it te air uid level in lateralvie*/
EMP*EMA
-
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149/184
-
7/25/2019 Imaging of Chest Diseases
150/184
Lung Ab#ce## Em!&ema
PNEUMOTHORA2
-
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151/184
o &ir in te pleural cavityo =ne of cest trauma complication
o4ension type 1 progressive accumulation
mediastinal sift
cardiovascularcompromise
o Pleural line can )e seen
o (o )roncovascular marking )eyond te
pleural lineo "+piration -lm
o Deep sulcus sign tension pneumotora+
PNEUMOTHORA2
-
7/25/2019 Imaging of Chest Diseases
152/184
PNEUMOTHORA2
-
7/25/2019 Imaging of Chest Diseases
153/184
-
7/25/2019 Imaging of Chest Diseases
154/184
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
155/184
o P!SITI!N
o C!NT!'Ro *ERNITI!N
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
156/184
Positiono Rigt diapragm is iger tan te left
diapragm/
o
(ormal 1
-
7/25/2019 Imaging of Chest Diseases
157/184
E"iolog& o4 rig" $ia!ram ele%a"ioo Hepatomegaly
o 'ilaiditi syndrome
o Paralysis n/prenicuso "ventratio
o Su)pulmonal e.usion
o &telectasis
o Fi)rosis
o Intraa)dominal tumor
o Su)prenic a)scess
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
158/184
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
159/184
E"iolog& o4 le4" $ia!ram ele%a"io Paralysis n/prenicus
o "ventratio
o
Su)pulmonal e.usiono &telectasis
o Fi)rosis
o Distended stomac or colon
o Intraa)dominal tumor
o Su)prenic a)scess
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
160/184
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
161/184
E"iolog& o4 bo" $ia!ramele%a"ion
o &scites
o Intraa)dominal tumour
o Pregnancy
o
=)esityo Pneumoperitoneum
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
162/184
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
163/184
Con"our o4 $ia!ragmo4enting
o (ormal variant
o Pulmonary ! pleural -)rosis
o &telectasis 5caused )y pulmonary ligamenttraction6
o Scalloping ! )ulging
o
(ormal varianto "ventratio
o Focal mass )elo* te diapragm or atdiapragmatic pleura/
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
164/184
Scalloping
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
165/184
4enting
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
166/184
Dia!ragma"ic ernia"iono 'ongenital
o Morgagni 5anterior6
o #ocdalek 5posterior6o &c3uired 54raumatic6
o Hiatal ernia
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
167/184
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
168/184
DIAPHRAGM
-
7/25/2019 Imaging of Chest Diseases
169/184
Diapragm rupture *it erniation
SOFT TISSUE 0 S3ELETAL
-
7/25/2019 Imaging of Chest Diseases
170/184
o RI( +RCT'RE
o CL,ICLE +RCT'RE
o SCP'L +RCT'RE
o S'(C'TIS
EMP*"SEM
o C!RP'S LIEN'M
RIB FRACTURE
-
7/25/2019 Imaging of Chest Diseases
171/184
CLA5ICLE FRACTURE
-
7/25/2019 Imaging of Chest Diseases
172/184
SCAPULAR FRACTURE
-
7/25/2019 Imaging of Chest Diseases
173/184
SUBCUTIS EMPH*SEMA
-
7/25/2019 Imaging of Chest Diseases
174/184
CORPUS ALIENUM
-
7/25/2019 Imaging of Chest Diseases
175/184
-
7/25/2019 Imaging of Chest Diseases
176/184
Tan) &ou
Hi$$en Area#
-
7/25/2019 Imaging of Chest Diseases
177/184
Hi$$en Area#
-
7/25/2019 Imaging of Chest Diseases
178/184
Hi$$en Area#
-
7/25/2019 Imaging of Chest Diseases
179/184
Hi$$en Area#
-
7/25/2019 Imaging of Chest Diseases
180/184
Hi$$en Area#
-
7/25/2019 Imaging of Chest Diseases
181/184
Hi$$en Area#
-
7/25/2019 Imaging of Chest Diseases
182/184
-
7/25/2019 Imaging of Chest Diseases
183/184
-
7/25/2019 Imaging of Chest Diseases
184/184