radiology - imaging of the thorax
DESCRIPTION
RADIOLOGY - IMAGING OF THE THORAX. THE CHEST METHODS OF EXAMINATION. Radiography Standard examination : - PA + lateral projection; - tube-film distance – 1,5 m to minimize divergent distorsion and magnification; - full inspiration. Apical lordotic view – - PowerPoint PPT PresentationTRANSCRIPT
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RADIOLOGY - IMAGING OF THE THORAX
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THE CHEST METHODS OF EXAMINATION
RadiographyStandard examination :
- PA + lateral projection; - tube-film distance – 1,5 m to minimize divergent distorsion
and magnification; - full inspiration.
Apical lordotic view – - is used to see diseases in the pulmonary apices, which may
be obscured by the clavicle and the first rib; - AP wiew with the patient leaning backward on the cassette
holder.Supine radiographs – intensive care units.
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DIGITAL RADIOGRAPHYDIGITAL RADIOGRAPHYDIGITAL RADIOGRAPHYDIGITAL RADIOGRAPHY
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Fluoroscopy –dynamic study of the cardiovascular system, diafragmatic motion. Disadvantage: high radiation dose.Bronchography – the study of the bronchial tree by means of the introduction of opaque material into the bronchi. Replaced by CT, fiberoptic bronchoscopy, brush biopsy, percutaneous biopsy Tomography – it is possible to examine a single layer of tissue and to blur the tissues above and below the level by motion (the tube and the film move in opposite directions).- replaced by CT.
THE CHEST METHODS OF EXAMINATION
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THE CHEST METHODS OF EXAMINATION
Fluoroscopy
1933 2000
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THE CHEST METHODS OF EXAMINATION
Tomography
Tub Rx
Caseta/film
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THE CHEST METHODS OF EXAMINATION
• Computed tomography – indications for the lung:• - Evaluation and staging of primary pulmonary neoplasms• - Detection of metastasis from non-pulmonary primary
tumors.• Characterization of solitary pulmonary nodules as benign
or malignant• Characterization of focal and diffuse lung disease for • diagnosis.
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Computed tomographyIndications for the mediastinum:- Causes of mediastinal widening- Staging of tumors that spread to the mediastinum- Characterization of mediastinal masses – cysts, solid, vascular, fat.Other indications:Pleura plaques, masses, loculated fluid, occult calcification, chest wall masses.High-resolution CT – evaluation of interstitial lung disease, bronchiectasis, emphysema, cystic lung disease.
THE CHEST METHODS OF EXAMINATION
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THE CHEST METHODS OF EXAMINATION-
Computed tomografy
1975 1995
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THE CHEST METHODS OF EXAMINATION
Ultrasonography – fluid can be localized and differentiated
from solid pleural masses; - mediastinal lesions in contact with the chest
wall- lesions near the diafragm.
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Magnetic resonance imaging – indications:-dissection of the aorta, aneurysm -congenital and acquired heart conditions -intracardiac and paracardiac masses.-pericardial diseases.-brachial plexopathy.-diafragm and peridiafragmatic processes.-chest-wall lesions.-breast implants and breast masses.-Extention of the posterior mediastinal masses, especially
those with intraspinal extension.
THE CHEST METHODS OF EXAMINATION
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MRI
MAGNET
Coils
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Pulmonary and bronchial angiography – arterial or venous anomalies; thromboembolic disease.
Scintigraphy
Single Photon Emission Computed Tomography (SPECT )
- Tc 99m – iv injection - pulmonary perfusion- Xe gas is inhaled – pulmonary ventilation
THE CHEST METHODS OF EXAMINATION
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How to analyze the chest X-ray - Soft tissues- Bony thorax – ribs, clavicles, scapulae, thoracic vertebrae- Mediastinum - Lungs – hilum, vessels, apices- Pleura- Diafragm
Roentgen observations must be correlated with all the available clinical information
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Gr.IGr.I
Nodular opacitiesNodular opacities
MILIARY tuberculosis
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FFELSONELSON sign sign
Lesion in the mediastinumLesion in the mediastinum Lesion in the lungLesion in the lung
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Diffuse opacitiesDiffuse opacitiesATELECTAATELECTASISSIS
PNEUMONIPNEUMONIAA
PLEURPLEURAL FLUIDAL FLUID
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PLEURAL FLUIDPLEURAL FLUID ATELECTASISATELECTASIS
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LINLINEEARAR OPACITIES OPACITIES
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DIFFUSE HYPERLUCENCIESDIFFUSE HYPERLUCENCIES
PNEUMOTPNEUMOTHHORAXORAX EMEMPHYSPHYSEMEMAA
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CIRCUMSCRICIRCUMSCRIBED BED HYPELUCENCIESHYPELUCENCIES
1.1.BullaBulla2. Aeric cyst2. Aeric cyst3. Cavity- TB3. Cavity- TB4. Cvity - cancer4. Cvity - cancer
11
22 33 4
331
2233
Chist hidaticChist hidatic
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ABABSSCESCESSS RUPTURED RUPTURED
HYDATID CYSTHYDATID CYST
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CHEST INFECTIONSAcute pulmonary infections
1. Lobar pneumonia – the organism reaches the periphery of the lung via the airways.Alveolar transudation is followed by migration of leucocytes into the alveolar fluid.
2. Bronchopneumonia (lobular pneumonia) – often observed in staphyloccocal infection of the lung. The disease originates in the airways and spreads to peribronchial alveoli.
3. Interstitial pneumonia – usually caused by a virus or a mycoplasma.
4. Mixed pneumonia – is a combination of lobar, bronchopneumonia and interstitial pneumonia.
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Pneumococcal pneumonia- Caused by S.pneumoniae.- roentgen findings can be observed within 6 to 12 hours after onset of symptoms.- Chest x-ray:
- triangular opacity, the tip towards the hilum, the base towards the periphery of the lung. - all the elements in the diseased lobe may be affected except the large bronchi– “air bronchogram”.- Resolution is rapid if there are not complications – the opacity becomes more irregular and patchy, the intensity decreases.
- Complications – delayed resolution, lung abscess, pleural effusion.
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Bronchopneumonia – staphyloccocal infection of the lung - It is the most commonly found in the very young or very old- The inflammatory disease does not cross septal boundaries the pattern of disease is discontinous or patchy.-Chest x-ray:
-nodular opacities, 1-10mm, -poorly defined -with the center more opaque compared to the periphary.
- It is particularly difficult to define and diagnose when it occurs as a complication in case of cardiac failure.
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Staphylococcal pneumonia
– caused by Staphylococcus aureus - the infection may be primary in the lungs or secondary to a primary staphylococcal infection elsewhere in the body.- Usually occurs in debilitated adults or in the first year of life.- Consolidation rapidly spreads to involve a whole lobe and bronchi are obscured by exudate, so the air brohogram is rarely seen.- Abscess formation may occur; coalescense of small abscesses is frequent.- Pleural effusion, empyema and pneumothorax are frequent- Pneumatocele – a check-valve obstruction develops between the lumen of a small bronchus and the pulmonary parenchyma.- The disease is usually bilateral
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Interstitial pneumonia - usually caused by a virus or Mycoplasma pneumoniae (is
responsible for a significant percentage of primary atypical pneumonia in children and young adults).
- Roentgen findings:- Peribronchial or interstitial type – streaky densities
extending from the hilum following the vascular markings.- Bronchopneumonic type.- Segmental or lobar types- Diffuse type – bilateral reticulo-nodular pattern
DD - interstitial pneumonia bacterial pneumonia: - delay in radiological onset
- lack of pleural involvement, - the tendency to clear in one area and to spread in another, bilaterality.
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Acute interstitial pneumonia : influenza: influenzaAcute interstitial pneumonia : influenza: influenza
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Acute interstitial pneumonia
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Acute interstitial pneumonia
COMPLICATIONSCOMPLICATIONS
Acute interstitial pneumonia
COMPLICATIONSCOMPLICATIONS
BRONHOPNEUMONIA
SEGMENTALSEGMENTAL
PNEUMONIAPNEUMONIA
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Lung abscess- lung abscess = when an acute pulmonary infectious process
breaks down to form a cavity.- Primary / secondary.-Chest x-ray
- opacity confined to one segment, round, irregular borders. - When bronchial communication is established the fluid content of the cavity is replaced by air – hydro-aeric image with orizontal fluid level.
-CT – Very useful to define the inner and outer walls, for complications (rupture into the pleural space).-Differential diagnosis:
-early stage – pneumonia; -cavity – tbc, cancer, hydatid cyst, fungal infection
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TUBERCULOSIS - Transmitted by inhalation of infected droplets of
Mycobacterium tuberculosis- Target population: patients of low economic scale,
alcoholics, elderly, AIDS
Primary TB
Rancke (primary) complex :1.Ghon focus – nodular opacity (1-7cm), irregular
borders, non-homogeneous, low intensity, lower lobe2.Lymphadenopathy – hilar and paratracheal, 95%3.Lymphangitis – linear opacities
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Primary TB
Evolution:- Healing - Fibrosis- Calcification- Cavitation
Complications:- Miliary TB- TB pneumonia- TB bronchopneumonia- Pleural effusion
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Secondary TB
- active disease in adults most commonly represents reactivation of a primary focus; the disease tends to be progressive
-Typically limited to the upper lobes-No adenopathy
Radiographic features•Early infiltrate – low intensity, poorly defined opacities•Cavitation – 40%•Fibro-caseous TB
•Fibrotic TB – sharply circumscribed linear densities radiating to hilum; •Fibrothorax, tuberculoma
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Secondary TB
Complications: 1. Miliary TB2. Bronchogenic spread 3. Bronchial stenosis4. Bronchiectasis5. Pneumothorax6. Pleural effusion – often loculated
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ASPERGILOMA
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AIDSKnown routes of HIV transmission:
- Blood and blood products- Sexual activity- In utero transmission- During delivery
Clinical:- Lymphadenopathy- Incidental infections- Tumors: lymphoma, Kaposi sarcoma- Other manifestations: interstitial pneumonia,
spontaneous pneumothorax, septic emboli
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AIDSSpectrum of chest manifestations:
Nodules – Kaposi sarcoma (usually associated with skin lesions), septic infarcts, fungal infections (Cryptoccocus, Aspergillus)
Large opacity: consolidation, mass – hemorrhage, pneumonia
Linear or interstitial opacities – atypical pneumonia, Kaposi sarcoma
Lymphadenopathy – Mycobacterial infections, Kaposi sarcoma, lymphoma
Pleural effusion – Kaposi sarcoma, fungal infection, pyogenic empyema