SURGICAL RADIOLOGY (CHEST ) BY DR IBRAHIM GALAL PROFESSOR OF GENERAL SURGERY

PA VIEW

× NORMAL AP

× NORMAL AP √ NORMAL PA

STRUCTURES FORMING THE MEDIASTINAL MARGINS

CHEST EXAM = ABCDEF AIRWAY. BONE. CARDIOMEDIASTINAL SILHOUETTE. DIAPHRAGM. EXPANDED LUNGS/EVERYTHING ELSE. FOREIGN OBJECTS

FOCAL SHADOWS NEOPLASIA: -PRIMARY: -BRONCHOGENIC. -PLUERAL. -LYMPHOMA. -SECONDARY: BREAST,HYPERNEPHROMA,MELANOMA, THYROID, STOMACH, PROSTATE, OSTEOSARCOMA. CYST: -SIMPLE. -HYDATID. -ABSCESS. -EMPHYSEMATOUS. CONSOLIDATION: -COLLAPSE. -PNEUMONIA.

SINGLE FOCAL LESION RT.APICAL LT. MID ZONAL

RT. FOCAL LESION Q.BREAST METS

PERIPHERAL LESION

PERIPHERAL LESION

CENTRAL FOCAL LESION BLUE ARROW: FOCAL LESION (Q.BRONCHIAL CA) RED ARROWS: HILAR SHADOWS (Q.NODAL METS)

RT. MULTIPLE FOCAL SHADOWS + RT DIAPHRAGMATIC PARALYSIS

BILATERAL MULTIPLE FOCAL SHADOWS

MEDIASTINUM

SUPERIOR MEDIASTINAL SHADOW RETROSTERNAL GOITER

SUPERIOR MEDIASTINAL SHADOW AORTIC ANEURYSM

WIDE MEDIASTINUM Q.HEMATOMA(AORTIC INJURY)

ANT. MEDIASTINAL SHADOW THYMUS

POSTERIOR MEDIASTINAL SHADOW LYMPHADENOPATHY

LOWER POSTERIOR MEDIASTINALSHADOW (SLIPPED FUNDOPLIACTION)

PNUEMOTHORAX

PATHOGENESIS OF PNUEMOTHORAX PRESENCE OF AIR INSIDE THE PLEURA . AIR MAY ENTER THE PLEURA VIA A TEAR FROM EITHER: 1- OUTSIDE (PLEURO-CUTANEOUS COMMUNICATION). 2- INSIDE (PLEURAO-BRONCHIALCOMMUNICATION).

CAUSES OF PLEURAL TEAR 1- TRAUMA. 2- SPONTANEOUS (RUTURE PATHOLOGICAL LESION): -EMPHYS. BULLA,TB CVITY,CYST). 3- IATROGENIC: - BAROTRAUMA(VENTILATOR) . - CVP INSERTION.

TYPES 1- CLOSED (SIMPLE). 2- OPEN (SUCKING). 3- VALVULAR (TENSION).

RADIOLOGICAL PICTURE PNUEMOTHORAX : - PLEURA : CONTAINS JET BLACK AIR IN THE PERIPHERY. - LUNG : COLLAPSED MEDIALLY WITH VISIBLE EDGE. - MEDIASTINUM: - CENTRAL SIMPLE . - SHIFTED  FLUTTER  OPEN.  FIXED  TENSION.

CLINICAL PICTURE RESPIRATORY DISTRESS. HYPER-RESONANCE. DIMINISHED AIR ENTERY. IN ADDETION: 1- OPEN : SUCKING CHEST WOUND (HISSING SOUND). MEDIASTINAL FLUTTER. 2- TENSION : CONTRALATERAL FIXED MEDIASTINAL SHIFT. CONGESTED NECK VEINS.

TENSION PNEUMOTHORAX

TENSION PNEUMOTHORAX

PLEURAL EFFUSION PRESENCE OF FLUID INSIDE THE PLEURA .

RT. PLUERAL EFFUSION

HYDRO/PNEUMOTHORAX

RIGHT JET BLACK PLEURAL SPACE. COLLAPSED LUNG. AIR/FLUID LEVEL. OBLITERATED C/PH ANGLE. CENTRAL MEDIASTINUM

LEFT

LEFT

LEFT

BILATERAL

CARDIOMEGALY CARDIOTHORACIC RATIO SHOULD BE LESS THAN 55%. IN THIS CASE IT IS GREATER THAN 70%. AN ECHOCARDIOGRAM EXCLUDED A PERICARDIAL EFFUSION. THE CENTRAL PULMONARY VESSELS ARE DILATED (BLACK ARROWS). AN INFUSION PORT CATHETER IS NOTED OVERLYING THE RIGHT CHEST (YELLOW ARROW)

CYISTIC LESIONS SIMPLE. PARASITIC. INFLAMATORY. EMPHYSEMATOUS. BRONCHIECTASIS. NEOPLASTIC.

RT.SINGLE CYST

BRONCHOGRAPHY BRONCHIECTASIS

BRONCHIECTASIS

BRONCHIECTASIS

TB CAVITY

DIAPHRAGMATIC HERNIA

DIAPHRAGMATIC HERNIA

AIR UNDER DIAPHRAGM

CARDIAC AIR EMBOLISM

LUNG FIBROSIS

DIFFUSE LUNG INFILTRATES ESINOPHILIC PNEUMONIA

LYMPHANGITIS CARCINOMATOSIS

CVP

CVP COMPLICATION LEFT PNEUMOTHORAX (DOUBLE-HEADED YELLOW ARROW). LEFT LUNG MARGIN (BLACK ARROWS). THE DISTAL TIP OF THE CENTRAL VENOUS LINE IN THE SUPERIOR VENA CAVA (RED ARROW). TIP OF THE ENDOTRACHEAL TUBE (WHITE ARROW).

PACEMAKER THE WIRES CONNECTING THE PACEMAKER TO THE INTRACARDIAC ELECTRODES MUST BE INTACT. (YELLOW ARROW IN THE SVC & RED ARROW IN THE RT. VENTRICLE).

LT LOWER LOBE COLLAPSE WITH EFFUSION

LOBAR COLLAPSE RT UPPER LOBE

PNUEMONIA RT UPPER LOBE LT MIDDLE ZONE

SARCOIDOSIS

COPD

TRACHEAL SHIFT(GOITER)