הגישה הקלינית להדמיית הריאה ד"ר צבי פרידלנדר מכון הריאה מרכז רפואי הדסה ע"כ

טכניקות להדמיית הריאה X-ray film Fluoroscopy ((שיקוף CT (HRCT, CT-Angio) PET & PET-CT MRI Lung scan (V/P) – מיפוי ריאות U/S

צלום החזה התקין שם המצולם נכון... מיקום (סימטרי / א-סימטרי). חשיפה (חדור / לא-חדור). נשימה (ב-INS או EXP). PA לעומת AP.

לבחור את שיטת הדימות המתאימה ! Screening – X-ray Diaphragmatic paralysis - Fluoroscopy Parenchyma – CT (HRCT) Mediastinum - CT (window), - MRI Chest wall – MRI

לבחור את שיטת הדימות המתאימה ! Pleura – CT, U/S Tumor staging – PET-CT Split Function – Quantitative perfusion scan Pulmonary embolism CT-Angio Lung scan (מיפוי)

Basic patterns in Lung Diseases Air bronchogram Silhouette sign Pulmonary opacity Increased transradiancy (translucency) of the lung

Air bronchogram Silhouette sign Pulmonary opacity Increased transradiancy (translucency) of the lung Basic patterns in Lung Diseases

הסננה / בצקת ברקמה סמוכה לברונכים הניגוד מדגיש את דרכי האוויר. מאפיין לרב תהליך זיהומי. Air bronchogram

אותו חולה – ב-CT

Air bronchogram Silhouette sign Pulmonary opacity Increased transradiancy (translucency) of the lung Basic patterns in Lung Diseases

Air bronchogram Silhouette sign Pulmonary opacity Increased transradiancy (translucency) of the lung

Atelectasis Pulmonary mass (nodule) Ring shadows and cysts Line shadows Air-space filling (alveolar pattern) Widespread nodular, reticulonodular and honeycomb shadowing (interstitial pattern) Pulmonary opacity

Atelectasis Pulmonary mass (nodule) Ring shadows and cysts Line shadows Air-space filling (alveolar pattern) Widespread nodular, reticulonodular and honeycomb shadowing (interstitial pattern) Pulmonary opacity

Atelectasis Pulmonary mass (nodule) Ring shadows and cysts Line shadows Air-space filling (alveolar pattern) Widespread nodular, reticulonodular and honeycomb shadowing (interstitial pattern) Pulmonary opacity

Pneumatocele

Lung abscess Cavitating tumor

Lung abscess

Cavitating tumor

Cystic bronchiectases

Atelectasis Pulmonary mass (nodule) Ring shadows and cysts Line shadows Air-space filling (alveolar pattern) Widespread nodular, reticulonodular and honeycomb shadowing (interstitial pattern) Pulmonary opacity

Kerley lines מזוהים בצל"ח. טיפוסיים למצב של בצקת ריאות. אלו עכירויות (opacities), אינטרסטיציאליות, לינאריות, שנגרמות ע"י נוזל או תאים ב-Interstitium.

Kerley lines Kerley B – Short Parallel Peripheral right angles and in-contact with the pleura. Mostly at the bases. Represent interlobular septa – CHF and ILD

Atelectasis Pulmonary mass (nodule) Ring shadows and cysts Line shadows Air-space filling (alveolar pattern) Widespread nodular, reticulonodular and honeycomb shadowing (interstitial pattern) Pulmonary opacity

Alveolar pattern - causes Water- Edema Pus- Pneumonia Blood- Trauma, Vasculitis Cells- Bronchioloalveolar Carcinoma Protein- Alveolar proteinosis Fat- Lipoid Pneumonia

Pulmonary edema

Pneumonia

Acinar shadows (TB)

Atelectasis Pulmonary mass (nodule) Ring shadows and cysts Line shadows Air-space filling (alveolar pattern) Widespread nodular, reticulonodular and honeycomb shadowing (interstitial pattern) Pulmonary opacity

Viral pneumonia

Lymphangitis carcinomatosa (Colon Ca)

Reticulo-nodular (Interstitial)

Ground glass

Honey-combing Lung

Basic patterns in Lung Diseases Air bronchogram Silhouette sign Pulmonary opacity Increased transradiancy (translucency) of the lung

Lt. Pneumonectomy

Pneumothorax

Emphysema

Emhysema- HRCT NormalEmphysema

Miscellaneous

Pulmonary embolism

Pleural effusion

Huge Mediastinal Mass

Thymoma

SUPERIOR SULCUS TUMOR (PANCOAST)

PET - CT