An Introduction to Chest Imaging

An Introduction to Chest Imaging. Dr Maysaloon Shaman Saeed M.B.Ch.B . - F.I.B.M.S. ( Diag.Rad .) University of Duhok -College of Medicine.

Learning Objectives. Requesting Technique for obtaining chest x-ray (CXR) Anatomy relevant to interpretation Basic x-ray physics and technical aspects Common chest pathologies.

[Audio] www.sportsinjurymanager.co.uk/ tour7.html Explain IRMER. Radiographer needs a valid request otherwise they cannot, by law, carry out the investigation. This needs to be clearly stated on the card. A request for a CXR is a request for a clinical opinion for a radiologist, who will be reporting the examination. PMH is relevant as the radiologist does not know the clinical history and any ongoing disease will help with interpreting the film correctly and in patient context. It is important to not irradiate the patient if they are pregnant as the risk to the developing fetus is higher than for the adult, despite the relatively low dose..

[Audio] fmh.org/images/ Chest_X-ray. jpg Explain the physics of a CXR Bone is bright white, fluid white, fat grey, air black. Important for interpretation later. PA if patient well enough to stand. More often AP slumpogram in recumbent, unwell inpatient. Explain the sequence of events, in the context of the last slide. Request made, patient goes to department for X-Ray and comes back with it, for you to look at. The chest XRay is eventually reported by a radiologist, but you will have the first look at an inpatient film..

STRUCTURES TO BE IDENTIFIED Supenor vena cava Azygoesophaged recess Ri91t main pulrnonary arte descending pulrnonary artery Right atrium angle Liver Breast shadow Descendng aorta Aortic arch ortopulmon Descending ptimonry ventricle Gastric bubble Splenic nexure of colon.

BRONCHOVASCULAR MARKING(which are not present in pneumothorax).

. PA(standard) CHEST For well patient True heart size Scapula is projected away from the chest Both lung appear clear, normal Broncho vascular marking(upper Broncho vascular are more exaugurated than of lower lobes).

Lateral view Scapula Hilar Region Thcxac:iC vertebrae Angles wiki Lung Apicies Oesophagus Sternum Ribs Heart.

Q: CAN YOU NAME THE ANTERIOR , MIDDLE , POSTERIOR MEDIASTINAL STRUCTURES ?? A) no.

CARDIOTHORACIC RATIO.

RADIOPAQUE – too white ( opaque ) RADIOLUCENT – too black ( lucent).

Technical aspects both lungs of equal transradiancy , and nearly the size Divide the lungs into 3 zones (area within lung hilum (correspond) to it is considered as middle lung zone) Area superior to hilum is superior zone and the area inferior to zone is lower lung zone Trachea should be centrally located Identify the horizontal fissure ,It should run from the hilum to the sixth rib in the axillary line. Both hila Costophrenic , cardio phrenic angles.

Technical factors. If we see the marker (R) that mean its the right side and also we can determine the appext of heart which is in left side while in dextrocardia its diviated to right site If we see the marker, that mean the apex is in the appropriate site(left) The marker can be used to determine whether the heart is in apporopraiate site(left) or in right site due to (dextrocardia or situs inversus).

Over exposed Dark lung(hyper-lucent) Heart appear as small shadow Hilum is very prominent Appears like that in emphysema and asthma, COPD(big chest).

Non rotated. The trachea should be centrally We will check the relation of both medial site of clavicle to the spinal process and their distance to spinal process should be equal.

Inspiratory. Is the normal one Taken at full inspiration Both costophrenic angle are clear Both lung field are clear There is no misleading condition.

. Hyper inflated chest. We can count more rib anteriorly and posteriorly In COPD.

Air bronchogram sign when we see patent airway inside the consolidated alveoli.

Silhouette(border) sign(its presence is normal and its absence is abnormal) : is the loss of normally sharp interface of lung and soft tissues by a pathology that obscures the borders of the lung with these soft tissues (diaphragms, cardiac and aortic outlines , silhouette means border, loss of silhouette means pathology ..

Air bronchogram due to infection(pneumonia, T.B, fungal infection) loss of bronchogram in malignancy(consolidation and collapse).

[Audio] www.meddean.luc.edu/.../ pulmonar/cxr/airb.htm Fluid in the " airspaces" Explain a bit about pneumonia ( pathology) bacterial infection (usually) infect alveoli, attacked by immune cells leading to pus (dead cells, inflammatory exudate) in the alveoli). Lung contusion, pulmonary haemorrhage other causes of consolidation Air bronchogram, illustrates the concept of contrast once again, bronchi are filled with air and are against a backdrop of water in consolidation Lobar and bronchopneumonia.

Collapse consolidation. Replacement of left hemi-thorax by consolidation ( exudate ) Non-homogenous , opaque , with internal lucency Trachea is shifted to site of cosolidation Presence of air-bronchogram.

Answer : due to obliteration of a major or minor bronchi by the consolidation.

Answer : Because in the collapsed lung , the alveoli ARE no more containing air so the negative pressure in the pleural space will PULL the mediastinal structures towards it..

Collapse ( Atelectasis ). Loss of volume either completely ( hemi-thorax ) or partially ( lobar collapse ) Trachea is not completed to carina and bronchi or cut of one major bronchi.

Right UL collapse Left lower lobe collapse.

ANSWER : DUE TO COMPLETE OCCLUSION OF THE LEFT LOWER LOBE BRONCHUS , SO THE AIR IN THE LUNG DISTAL TO THIS OCCLUSION IS ABSORBED LEADING TO LUNG SHRINKAGE AND COLLAPSE ..

2-diffuse lung disease (interstitial) : is diffuse non- homogenous and includes various patterns such as linear, septal lines, miliary, reticulo-nodular, nodular, honeycomb shadowing, cystic , ground-glass pattern..

31001 miliary tb. Miliary Reticulonodular.

Honey comb. Diffuse Cystic.

Ground glass appearance. Nodular Septal thickening.

3-nodules / masses/cavities. > 3 cm – Mass < 3 cm – Nodule Cavity is air containing lesion surrounded by walls..

CH032A. Pulmonary mass: when lesion measure more than 3 cm. 1-brochogenic CA. 2-hydatid cysts. 3-lung metastases..

Nodule. TB focus Hamartoma AV malformation Cancer ( primary or secondary).

Pulmonary cavities: 1-cavitating tumours (squamous cell CA) . 2-cavitating pneumonia(staph. Coccus strepto . , klebseilla ) , TB cavity , fungus ball . 3-complicated hydatid cyst, abscess ( air fluid level ).

4-air ways related disorders: COAD (asthma , emphysema).

over inflation of the lungs causes excessive hyperlucency of the lungs , flattening of the diaphragms ,increased rib spaces ,small looking heart shadow , prominent hila ..

Bronchectasis : irreversible dilatation of terminal bronchioles associated with bronchial wall thickening, cystic dilation of the bronchioles sometimes containing air fluid levels ..

[Audio] www.cancerhelp.org.uk/ help/default. asp? page= 2992 Causes of pleural effusion..

pleural effusion. Fluid is white - Homogenous. Initially loss of costophrenic angle.

Air in the pleural cavity. Pneumothorax.

ptx2. Air in pleural space. Lung collapses down. Clear lung edge ..

5-vascular pattern : A-Pulmonary plethora: due to increased pulmonary vascular flow, seen in cases of left to right shunts (ASD, VSD & PDA). B-Pulmonary oligaemia: due to decreased pulmonary vascular flow , seen in pulmonary artery stenosis. A B.

Heart failure. Stage of Congestive Heart Failure Stage 1 Redistribution pcwp 13-18 mmHg stage 2 Interstitial edema PCWP 18-25 mmHg stage 3 Alveolar edema RWP > 2S mmHg Redistribution vessels Cardiomegaly Broad vascular pedicle (non •cute CHF) Kerley lines Peribronchial cuffing Hazy contour of vessels interlobar fissure Consolidation Air bronchogram Cottonwnl apRarance Pleural effusion.

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THANK YOU for your attention.