Basics of Chest Imaging

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Presentation transcript:

Basics of Chest Imaging Rebecca Peterson, M. D. Associate Professor Department of Radiology University of Ottawa

Anatomy

Normal PA

Normal Lateral

The Chest X-ray in Disease

Basic Patterns of Disease Air-Space Disease VS Interstitial Disease

Pulmonary Acinus

Air space disease

Consolidation Means “solid lung” Implies that there is “air-space disease” May occur with or without volume loss

Consolidation without volume loss

Air Bronchogram

Air Bronchogram

Characteristics of Air Space Disease Acinar shadow Homogeneous density (consolidation) “Silouette”sign Loss of distinct margins next to consolidation Air bronchogram Non-segmental distribution

Consolidation RML abnormal normal

Consolidation RML normal abnormal

Causes of Airspace Disease Infection Hemorrhage Edema Neoplasm Idiopathic

Consolidation with volume loss “Atelectasis” or “collapse”

Collapse LLL Normal

Collapse LLL

Direct signs of volume loss Movement of a fissure

Indirect signs of volume loss Upward shift of the diaphragm Mediastinal shift to that side Movement of main-stem bronchus Hypovascularity of remaining lung due to hyperinflation Lung looks darker

Collapse RUL complete incomplete

Collapse RUL incomplete complete

Collapse LUL incomplete complete

Collapse LUL incomplete complete

Collapse LLL

Collapse LLL

Collapse RML

Collapse RML

TEST

Basic Patterns of Disease Air-Space Disease VS Interstitial Disease

Interstitial Lung Disease Perivascular VS Parenchymal

Pulmonary Acinus

Perivascular Interstitial Disease Pulmonary Edema

Interstitial Pulmonary Edema

Interstitial Pulmonary Edema normal abnormal

Interstitial Pulmonary Edema normal abnormal

Interstitial Edema

Interstitial Edema

Kerley “B” Lines

Kerley “B” Lines

Signs of Interstitial Edema Vessels look larger and indistinct Peribronchial cuffing Fluid in fissures Kerley”B” lines Pleural effusions

Acute Airspace Edema

Airspace Edema

Acute Airspace Edema Consolidation is bilateral Consolidation is symmetrical Consolidation is gravity dependent

Parenchymal Interstitial Disease Usual Interstitial Pneumonia Asbestosis Sarcoidosis

Parenchymal Interstitial Disease

Usual Interstitial Pneumonia

UIP NORMAL ABNORMAL

UIP

UIP

Asbestosis

Asbestosis

Sarcoidosis

Sarcoidosis

Patterns of Pneumonia Lobar Pneumonia Bronchopneumonia Interstitial Pneumonia

Lobar Pneumonia Hematogenous spread Begins at lung periphery Involves whole lobe of lung Unilateral Commonest pathogen Strept Pneumoniae

Lobar Pneumonia

Lobar Pneumonia

Lobar Pneumonia

Bronchopneumonia Central bronchial inflammation Patchy airspace consolidation distally Due to inflammation Due to mucous plugs Bilateral, asymetrical Commonest pathogen Staph Aureus

Bronchopneumonia

Bronchopneumonia

Bronchopneumonia

Bronchopneumonia

Bronchopneumonia

Interstitial Pneumonia Involves interstitial parenchymal space “ground glass” opacity both lungs Bilateral, symmetrical Leads to airspace consolidation Commonest pathogens mycoplasma and Pneumocystis Carinii Pattern seen in SARS

Interstitial Pneumonia

Interstitial Pneumonia

Ground Glass

End stage Interstitial Pneumonia

End stage Interstitial Pneumonia

TEST