Respiratory System RT 91 Chapter 3

Normal Two View CXR

Mediastinum Anatomy – Heart, Hilar region, Thyroid &Thymus glands, Nervous & Lymphatic tissues. Anatomy – Heart, Hilar region, Thyroid &Thymus glands, Nervous & Lymphatic tissues.

Inspiration vs. Expiration

Elevated diaphram

What do you think? Dexatracardia

True or False? Mr. Parkers CXR?

Breast Implants

Radiography Correct exposure factors selection is critical Correct exposure factors selection is critical Radiologists rely heavily on consistent exposure factors for serial portable radiographs Radiologists rely heavily on consistent exposure factors for serial portable radiographs Recording technique selection Recording technique selection

Radiography For CXR maintaining kVp and changing the mAs is the general rule For CXR maintaining kVp and changing the mAs is the general rule AEC AEC A complete patient hx is very important A complete patient hx is very important CR/DR CR/DR High kVp High kVp

Technique Considerations Pathology Pathology Overlapping Structures Overlapping Structures Prior Examinations Prior Examinations Lungs/Bony Structures/Line Placement Lungs/Bony Structures/Line Placement

CR

Chest Positioning PA/Lt Lat PA/Lt Lat AP AP 72 inches 72 inches Upright or Supine Upright or Supine AP or PA Decubitus AP or PA Decubitus Oblique Projections Oblique Projections Lordotic Projections Lordotic Projections

Incorrect line placement

Correct Line Placement

Reversed image (line placement)

Congenital Disorders

Cystic Fibrosis An accumulation of excessively thick mucous and abnormal secretion of sweat and saliva An accumulation of excessively thick mucous and abnormal secretion of sweat and saliva

Cystic Fibrosis

Cystic Fibrosis neonate

Hyaline Membrane Disease RDS – Respiratory distress syndrome RDS – Respiratory distress syndrome Leading cause of infant death Leading cause of infant death Premature birth before 26 weeks Premature birth before 26 weeks “ground glass” look on the radiograph “ground glass” look on the radiograph

RDS

Hyaline Membrane Disease

Sail Sign Enlarged thymus in an infant Sail-like appearance

Sail Sign

Congenital hiatal hernia

Hiatal Hernia Any structure through the hiatus of the diaphram

Cervical rib

Depressed sternum

ACUTE DISORDERS

Croup Soft tissue neck Soft tissue neck Croup is a syndrome that is produced by an acute infection of the lower air passages and is usually seen in children below age of 3 Croup is a syndrome that is produced by an acute infection of the lower air passages and is usually seen in children below age of 3 Bark like cough Bark like cough Thumb sign Thumb sign

Croup

CHF Enlarged heart Enlarged heart PA chest – Distance? PA chest – Distance?

CHF

Atelectasis Collapse of all or part of the lung due to obstruction of bronchus Collapse of all or part of the lung due to obstruction of bronchus Lung compression/consolidation Lung compression/consolidation Air, fluid, tumors, enlarged lymph nodes, ET tube below carina Air, fluid, tumors, enlarged lymph nodes, ET tube below carina

atelectasis caused by the obstructive effects of carcinoma of the bronchus supplying the upper lobe of the right lung.

atelectasis

Plate-like atelectasis

Pleural Effusion Fluid within pleural space Fluid within pleural space Response to inflammation Response to inflammation Infection, Trauma Infection, Trauma

bilateral pleural effusions

pleural effusions

pleural fluid layering

Lung Collapse

Pneumonia Acute infection of lung parenchyma Acute infection of lung parenchyma Impairs air exchange Impairs air exchange

pneumonia infiltrates

streptococcal pneumonia

aspiration pneumonia

Aspiration of Ba What else do we see?

Interlobular pneumonia

Pneumonia vs. Effusion

Pneumonia & Effusion

Pneumothorax Collapse of lung, air in the chest cavity Collapse of lung, air in the chest cavity Change in interthoracic pressure Change in interthoracic pressure Radiographical importance Radiographical importance Order: 2V CXR Diag: Post BX/Pneumo Order: 2V CXR Diag: Post BX/Pneumo

Pneumothorax

Free air in the abdomen

Hemopneumothorax

Lobectomy

Thorocotomy for TB

Clavicle & Rib FX

Subcutaneous emphysema

Pulmonary Embolism/Infarction Acute onset of chest pain Acute onset of chest pain

Lung Abscess/Empyema Pus formed in a cavity Pus formed in a cavity Disintegration of tissue Disintegration of tissue

Empyema

CHRONIC DISORDERS

COPD A group of disorders that cause chronic airway obstruction. A group of disorders that cause chronic airway obstruction. Chronic, inflammation process involving the lungs Chronic, inflammation process involving the lungs Ex: Chronic bronchitis, emphysema, asthma & bronchiectasis. Ex: Chronic bronchitis, emphysema, asthma & bronchiectasis.

Asthma

pulmonary emphysema Blunting of the costophrenic angles. Barrel chest Trapped air

emphysema

bronchiectasis

Tuberculosis

TB

Cavitatory Pulmonary TB

Lordotic projection for TB

Asbestosis Plaques

PNEUMOCONIOSIS

Lung Cancer Bronchogenic Carcinoma is the most common fatal primary malignancy in the United States. Bronchogenic Carcinoma is the most common fatal primary malignancy in the United States. Pulmonary metastases are much more common than primary lung neoplasm. Pulmonary metastases are much more common than primary lung neoplasm.

Mediastinum Lymphoma Lymphoma Anatomy – Heart, Hilar region, Thyroid &Thymus glands, Nervous & Lymphatic tissues. Anatomy – Heart, Hilar region, Thyroid &Thymus glands, Nervous & Lymphatic tissues.

Bronchogenic carcinoma right hilar mass

Mediastinum Adenopathy

Adenopathy

primary

Pulmonary metastases uterine cancer “cotton ball” appearance

Mets

calcified nodes

Calcified Lymph nodes

Calcified hilar nodes

Lung cancer

Hiatal Hernia

Chest hernia

Coin in Esophagus

Marbles in Esoph.