Professional Documents
Culture Documents
RADIOLOGY
Back to the Basics:
- Densities in Radiographs
- Common Radiographic Views
- Normal Chest Radiographic Interpretation
- Anatomic and Physiologic Basis of
Pulmonary Diseases
Cases:
Radiographic presentation
Clinical Application
Densities in Radiographs
AIR-FILLED FATTY VARIOUS
STRUCTURES TISSUE FLUIDS
BLACK WHITE
( LUCENT ) ( DENSE )
SOLID BONE/ CONTRAST METALS
TISSUES/ BARIUM & IODINE LEAD
MASSES
CALC’N
GRAY TO
WHITE WHITE
( DENSE ) ( DENSE )
Lead blocks passage of x-rays
& used for shielding
DENSITIES
Air < Fat < Liver < Blood < Muscle < Bone < Barium < Lead
6 feet
Film
film
X-ray
tube
heart magnified
higher diaphragms
lung volume (+) crowding
film under
patient difficult to assess vascularity
AP view:
light / lesion/heart
X-ray far from film
lesion/
heart
Film
PA view:
lesion/heart
near film
tube elevated
& angled 45º
Aortic
knob L hilum/
60º; <90º Left PA
R hilum >100º LAE
1.5 cm Rt PA LA
RA A
CTR = A
RV
LV B
B
< 0.52
9th p.rib
Lt CPS
Rt CPS
Superior
Mediast.
sternal
T4
angle
Ant
Med. trachea
retrosternal
space
RV
LA
Middle
Mediast.
LV
Post. retrocardiac
Mediast space
major fissures
T3 - -- T10
Hilum to rib 6
right
major f
left
majo
r f.
Rt major Lt. major
fissure pleural outline
fissure
maybe thickened due to fluid, fat, air, tumor & reactive ’s
Anatomic and Physiologic Basis of
Air-Space & Interstitial Diseases
AIRSPACE SPACE DISEASES
“CONSOLIDATION”
Air in alveoli replaced by:
Fluid (Pulmonary Edema)
Blood (Hemorrhage)
Cells (Tumor)
Inflammatory exudates
( Infections -bacteria &
mycobacteria)
Lipoprotein (Alveolar
proteinosis)
X-ray:
coalescing homogenous
opacities
“patchy”
“segmental”
“lobar”
“ diffuse consolidations”
Air Space Air Aveologram
Nodules
lucencies/air
incompletely
alveoli
poor margination
4-10 mm
Air-Bronchogram Sign
Air-bronchogram
Sign
air-filled bronchus
look like radiolucent
"tubes"
airways OK but
surrounding lung
tissues airless
Air-way Opacities Distribution
Diffuse Segmental
‘butterfly”
medullary
distribut’n
Ascending RUL/Anterior
Aorta segment
LUL/Posterior
Aortic knob
segemnt
LLL/Superior &
Descending
medial
Aorta
segments
LLL/Basal
Left Diaphragm
segments
Consolidation of Lung Segments
RIGHT
LEFT
LEFT
RIGHT
RIGHTLOWER
LEFTUPPER
UPPER
MIDDLE
LOWER LOBE
LOBE
LINGULA
LOBE
Atelectasis
INTERSTITIAL DISEASE
visceral pl parietal pl Alveolar Walls:
“ perihilar haze”
perivasc. sheath
bronchus
Axial : connective tissue support
pulmo art& bronchi
“peribronchial thickening”
“nodular” “reticulo-
nodular”
SEPTAL
Peribroncial
INTERSTITIAL
Perhilar Cuffing
EDEMA
Haziness
Kerley B-lines
Reticular /
Honeycomb Nodular
thick
interlob
honey-comb septa
perihilar
haze
fibrinopurulent exudates
MYCOPLASMA PNEUMONIA
Community Acquired Pneumonia
Most common
pathogens
S. Pneumoniae
limited by
(48%) pleural sfc
peripheral
loc. develop
Viruses (19%)
pl.effusion
H. Influenzae
(20%)
C. Pneumoniae
(13%)
M. Pneumoniae
(3%)
Nosocomial
Pneumonia
* maybe bilateral ,
multicentric perihilar and
basal distribution
Lung Abscess
Lung Abscess
Fungus Ball
Tuberculosis
Cavitary Tuberculosis
Tuberculosis
Miliary nodules : 2- 3 mm
Post-primary hematogenous spread
of TB w/ granulomatous response
DDx: varicella pneumonia & metastasis
PLEURAL DISEASE
Pneumothorax
Collapsed
Lung
re-expansion
of lung
Tension
Pneumothorax
Pneumothorax
Pleural Effusion
Loculated Pleural Effusion
(Empyema thoracis)
Mesothelioma
AIRWAY DISEASES
Bronchiectasis
arteriole
“Signet Ring”sign
Thickening
& dilatation
of bronchi
bronchiole
Emphysema
Foreign Body
causing Atelectasis
Atelectasis
right lung
Upper lobe
A- intrapulmonary mets
B- main tumor
C- lymph nodes
D- aorta
E- right mainstem bronchus
Metastasis
Lymphoma
Lymphoma
Aortic Aneurysm
GOOD DAY!