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Back to Basics Radiology 2010
Rebecca Peterson Department of Radiology University of Ottawa
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Routine Technique: PA and Lateral
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Normal Chest – PA and Lateral
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PA Chest Trachea SVC Aortic arch Azygous Lt Pulm Artery Rt Hilum
Lt Mainstem bronchus Lt Ventricle Rt Atrium Rt Diaphragm Lt Diaphragm
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Lateral Chest Aortic Arch Trachea Lt Pulm Artery Rt Pulm Artery
Lt upper lobe bronchus Rt Ventricle Lt atrium Rt Diaphragm Lt Ventricle Lt Diaphragm
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Consolidation Without volume loss With volume loss
Pneumonia, Pulmonary edema, Hemorrhage With volume loss “Atelectasis” or “Collapse”
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Consolidation Without Volume Loss
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Consolidation With Volume Loss
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Consolidation Means “solid lung” Characteristics: Increased density
Acinar shadow Silhouette sign Air bronchogram
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Consolidation and Air Bronchogram
CT Scan
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Consolidation, Air Bronchogram and Silouhette Sign
PNEUMONIA
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Consolidation Without Volume Loss
Airspace Disease
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LLL Pneumonia Consolidation Sharp interface Loss of diaphragm
NORMAL
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LLL Pneumonia consolidation Sharp interface Loss of lt diaphragm
NORMAL LLL PNEUMONIA
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Normal RML Consolidation Loss of heart border
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Normal RML Consolidation Consolidation
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RLL Pneumonia PA View Lateral
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Lingular Pneumonia Lateral PA View
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Right Lower Lobe Pneumonia
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LLL Pneumonia
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Causes of Airspace Disease
Pneumonia Hemorrhage Pulmonary Edema Neoplasm Other
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Consolidation With Volume Loss
Atelectasis or Collapse
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Passive Atelectasis
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Endobronchial Lesion
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Signs of Volume Loss Direct Signs: Movement of a fissure
Indirect Signs: Elevated diaphragm Tracheal shift Mediastinal shift Elevated or lowered mainstem bronchus Movement of hilum Fewer vessels in aerated lung
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Right upper lobe collapse
Tracheal shift Hilum displaced Elevation of diaphragm Movement of the Fissures, a DIRECT sign of volume loss
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RLL Collapse Tracheal shift Fissure displaced Collapsed lung
Hilum pulled down
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Normal Atelectasis LLL
No diaphragm Diaphragm reappears Portable Chest X-ray
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LLL Atelectasis
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Complete collapse Tracheal shift Bronchus amputated Diaphragm
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Pleural Effusion
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Pneumothorax and Pleural Effusions
Pleural Diseases Pneumothorax and Pleural Effusions
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Pneumothorax
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Tension Pneumothorax INSPIRATORY VIEW EXPIRATORY VIEW
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Pneumothorax CT SCAN
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Pleural Effusion Meniscus sign
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Infrapulmonary Effusion
Stomach NORMAL EFFUSION Stomach
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Pleural Effusion DECUBITUS VIEW
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Large Right Pleural Effusion
PA VIEW Chest X-ray CT SCAN
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Interstitial and Airspace Edema
Pulmonary Edema Interstitial and Airspace Edema
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Interstitial Pulmonary Edema
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Vascular Indistinctness
Normal Interstitial Edema
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Vascular Indistinctness
Normal Abnormal
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Interstitial Pulmonary Edema
Kerley “B” Lines Peribronchial cuffing Hila look larger Vessels are ill-defined Upper lobe vessels are larger Fluid in fissures Small pleural effusions
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Interstitial Pulmonary Edema
NORMAL INTERSTITIAL EDEMA
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Minimal Changes Lateral View
NORMAL INTERSTITIAL EDEMA
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Interstitial Edema PA View Lateral
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Pulmonary Edema
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Interstitial Edema Kerley “B”s
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Kerley “B” Lines CT SCAN
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Airspace Edema
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Airspace and Interstitial Edema
Pulm Edema Normal
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Airspace Edema Patient Supine
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Airspace Edema
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Airspace Edema Consolidation is bilateral Consolidation is symmetrical
Consolidation is “gravity dependent” Consolidation changes day to day
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Chronic Obstructive Lung Disease
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Emphysema
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Characteristics of Emphysema
Increased Lung Volume Flattened Diaphragms Increase in Retrosternal Airspace Barrel chest Small Vessels Small, narrow cardiac silouhette
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Emphysema CT Scan
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Emphysema - CT Bulla Black holes
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Bronchiectasis
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Bronchiectasis Signet Ring Sign
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Pneumonia
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Radiological Patterns of Pneumonia
Lobar pneumonia Bronchopneumonia Interstitial pneumonia
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Lobar Pneumonia Involves single area, usually a lobe
Bloodborn pathogen Unilateral Commonest pathogen:Strept Pneumonia RLL PNEUMONIA
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LLL Pneumonia
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Right Lower Lobe Pneumonia
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Lobar Pneumonia
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Bronchopneumonia Central bronchi involved Patchy bilateral disease
Asymetrical Peribronchial Cuffing Commonest pathogen: Staph aureus
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Bronchopneumonia
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Bronchopneumonia CT SCAN
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Interstitial Pneumonia
Involves interstitial space, not airways “ground glass” appearance Bilateral, symetrical If severe, involves airspace Commonest pathogen: PCP, mycoplasma
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Interstitial Pneumonia
NORMAL
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Interstitial Pneumonia
Normal Abnormal
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Interstitial Pneumonia
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ABDOMEN Soft Tissue Findings
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Normal Abdomen Liver Spleen Psoas muscle Kidney Outlined by fat
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Hepatosplenomegally ABNORMAL NORMAL
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Splenomegally
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Pancreatitis Psoas muscle ABNORMAL SUPINE NORMAL SUPINE
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Pancreatitis Psoas muscle CT Scan PANCREATITIS NORMAL
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Properitoneal Fat Line
Large bowel Normal fat line Normal Abdomen
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Separation of bowel and fat line by fluid
Ascites Separation of bowel and fat line by fluid Paracolic gutter
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Ascites Fluid Fluid CT SCAN PELVIS CT SCAN UPPER ABDOMEN
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ABDOMEN Calcifications
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Renal Calculi Renal Stones
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Renal Calculus
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Renal Calculus on Intervenous Pyelogram
Normal DELAYED EXCRETION OF CONTRAST ON IVP
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Renal Calculus on Intervenous Pyelogram (IVP)
Obstructed Ureter POST VOID DILATED COLLECTING SYSTEM
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Renal Calculus on CT Scan
Dilated Renal Pelvis Bladder Renal Calculus Renal Calculus
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Stone Pelvis in Distal Ureter
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Abdominal Aortic Aneurysm
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Abdominal Aortic Aneurysm
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Ruptured AAA Blood Aorta Aorta
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Gallstones Supine Upright
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Gallstone Stone Acoustic shadow ULTRASOUND
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Acoustic Shadowing on Ultrasound
SOFT TISSUE POLYP CALCIFIED GALLSTONE
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Appendicolith Supine Upright
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Bowel Gas Distribution
ABDOMEN Bowel Gas Distribution
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SMALL BOWEL FOLLOW-THROUGH
Normal Small Bowel SMALL BOWEL FOLLOW-THROUGH
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Normal Large Bowel BARIUM IN LARGE BOWEL
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Large Bowel Rectum Fecal Impaction Constipation
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Dilated large and small bowel
Generalized Ileus Supine Dilated large and small bowel No air/fluid levels Decubitus
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Localized Ileus Supine Upright
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Small Bowel Obstruction
Air-fluid levels UPRIGHT VIEW SUPINE VIEW
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Small Bowel Obstruction
NORMAL DILATED SMALL BOWEL
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Small Bowel Obstruction
SUPINE VIEW UPRIGHT VIEW
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SUPINE VIEW
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Free Air and SBO UPRIGHT VIEW DECUBITUS VIEW
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Free air and fluid CT SCAN
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Can see both sides of bowel wall
Free Air Normal Can see both sides of bowel wall (Rigler’s Sign)
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Free Air Supine Decubitus
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Large Bowel Obstruction
SUPINE VIEW UPRIGHT VIEW
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SUPINE VIEW – DISTENDED LOOP ARISING OUT OF PELVIS
Sigmoid Volvulus SUPINE VIEW – DISTENDED LOOP ARISING OUT OF PELVIS
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Sigmoid Volvulus DECUBITUS VIEW UPRIGHT VIEW
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Volvulus CECAL VOLVULUS Associated with SBO SIGMOID VOLVULUS
Associated with LBO
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Thumbprinting BARIUM ENEMA SUPINE VIEW
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Causes of Thumbprinting
Enteritis or colitis Infarction Hemorrhage into bowel wall SUPINE VIEW
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Bowel Infarction Air in Portal Vein Air in Bowel Wall SUPINE VIEW
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Bowel Infarction Air in Portal Vein Air in Bowel Wall CT SCAN CT SCAN
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Thank You!
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