printable 2018 modified for TBcourse Radiology...•Teach a systematic but basic approach to...

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Chest Radiology

Declare The Past, Diagnose The Present And Foretell The Future - Hippocrates

Disclosures

None

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Objectives• Teach modalities that are commonly

employed in detecting lung / thoracic disease

• Teach a systematic but basic approach to interpret the chest radiograph

• Show examples of some common imaging patterns of chest diseases

Systematic ApproachChest Radiograph

Look at:

Soft tissues and bones

Abdomen

Heart and mediastinum

Pleura

Lungs

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Normal

Systematic Approach

Look for:

Opacity (whiter than normal)

Lucency (blacker than normal)

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Soft Tissues

Radiographs are not great for soft tissues,

but keep an eye out…

Chest wall sarcoma

• Notice the asymmetry

• Notice the large soft tissue opacity on the left (arrow)

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Chest wall sarcoma

Bones

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Normal

Multiple myeloma withrib destruction

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Breast cancer with (blown out ) bone metastasis to the left humerus

Upper Abdomen

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Pneumoperitoneum (from abdominal surgery)

A thin sliver of air below the diaphragm(arrows)

Heart and Mediastinum

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Normal

Cardiomegaly and vascular engorgement

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Mediastinal mass--Lymphoma

Test case

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Lymphangioma

Pleura

• Effusion

• Pneumothorax

• Thickening

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Recurrent left pleural effusion (unknown cause)

R decubitus L decubitus

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Rt Lateral DecubitusUpright

Leave the patient in this position for at least few minutes before shooting the radiograph

Large left pleural effusion (“whiteout”).Note: decubitus views don’t help!

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Lungs

• Vessels

• Hila

• Airway

• Parenchyma

Hila

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Enlarged central pulmonary arteriespulmonary arterial hypertension (PAH)

Normal

Lumpy hilar lymphadenopathy from sarcoidosis

Normal

PAH

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Trachea and Bronchi

Bronchiectasis

Bronchiectasis from cystic fibrosis

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Bronchiectasis

Bronchiectasisfrom cystic fibrosis

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Test Case

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Kartagener’s Syndrome

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Lung Parenchyma

Focal

Diffuse

Nodular

Focal Consolidation

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Right lower lobe (superior segment) pneumonia

Silhouette Sign

• The loss of a normal profilee.g., the right atrial border

• Helps identify lung disease

• Helps locate lung diseasee.g., RML vs RLL pneumonia

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RML vs RLL pneumonia: which is which?

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Test Case

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Normal

Diffuse Lung Disease

Opacity(whiter than

normal)

Ground glass opacity(GGO)—not white enough to obscure vessels

Denser opacity—obscures vessels

Lucency(blacker than

normal)

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Heart failure: cardiomegaly and interstitial edema. Note septal(Kerley B) lines and thick fissure.

Diffuse Lung DiseaseCauses

Edema

Diffuse alveolar damage (ARDS)

Hemorrhage

Pneumonia (often opportunistic)

Aspiration

Fibrosis

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• Air• Fluid• Blood• Pus

Diffuse Lung Disease

Destroyed tissue

(emphysema)

Decreased blood flow

(pulmonary embolism)

Less overlying soft-tissue

(mastectomy)Pneumothorax

Lucent Lung (causes)

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Emphysema

COPD, obstruction, hyperinflation, flat diaphragm

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Test Case

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Alpha 1 antitrypsin deficiency

Nodules

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Lung Nodule or Mass

• Malignancy is the primary concern

• Two findings suggest nodule is benign– Stability for 2 years or more

– Calcification

• Many nodules are indeterminate

Lung cancer (poorly differentiated adenocarcinoma)

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Lung Cancer

CT

PET

Lungs: Localization of Lesion

Know the expected location of lobes and fissures in the lung so that you can tell when they are not normal

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Metastases from unknown primarySome nodules have cavitated.

Multiple small nodules (miliary)

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Miliary Distribution DDx

• TB

• Fungal Infection

• Metastasis

• Sarcoidosis

• Others

Lets put our skill to test!

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TB

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Summary

• Chest radiograph is a great initial tool

• Radiologic features of TB mimic other diseases

• CT often helps in further characterization

• Understanding the spectrum of imaging features of TB aids in making early diagnosis

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