Basic Chest Radiology 2 Airspace shadowing Nodes, nodules and
masses Air where it should not be!
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The secondary pulmonary lobule The smallest unit we can see on
CT scans 3 cm long Best anatomical organisation in the lower lobe
Centrilobular Pulmonary arteries Pulmonary veins and
lymphatics
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Septal lines and a lamellar effusion
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Radiological signs of pulmonary oedema Between 20-25 mmHg. PIE
interstitial shadowing, peribronchial cuffing. septal lines(Kerley
Bs).overlaping Kerley As-reticular shadowing. The vessels become
indistinct Upper lobe blood diversion. Difficult to asses 3mm in
1st intercostal space. Blood vessel larger than accompanying
bronchus. Ground glass appearance/consolidation usually bilateral
unless there is dependence or unilateral disease. Airspace
shadowing can be pus,fluid, blood and rarely tumour
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Classic radiological consolidation
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Diagnosis depends on history 1.Oedema-cardiac or non cardiac
2.Pneumonia 3.Aspiration 4.Haemorrhage 5.Alveolitis for any
cause
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Lymph nodes The axial diameters of lymph nodes goes as one
descends in the chest. From 1 cm in the paratracheal regions to
1.5cm in the subcarinal region. Look at hilar and right
paratracheal regions. The right hilar drains right lung and at
least the lower of the left
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1.Sarcoid-bilateral symmetrical 2.TB-usuallY unilateral
3.Lymphoma-usually bilateral asymmetrical 4.Ca-usually unilateral
5.Metastatic-unilateral or asymmetrical 6.Fungal-unusual in UK
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If in doubt use the surgical sieve SPN 1.Primary
tumour-malignant or benign 2.Harmatoma 3.granuloma-TB 4.Solitary
metastases 5.Solitary AVM 6.Round pneumonia 7.Rond atelectasis
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Solitary pulmonary nodule By definition a nodule measures less
than 3 cm. Lobulated (worse) or spiculated is bad. Calcification is
good. Needs to be central, uniform or popcorn. Crossing fissures is
bad. Very unlikely to be malignant in a non smoker.
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If a disease pattern is diffuse in the lungs, it is most
apparent where there is most volume of lung-mid and lower zones and
more centrally. Applies to interstitial desease,airspace disease
and multiple nodules.
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MULTIPLE NODULES 1.METASTASES 90%+ 2.RHEUMATOID NODULES-very
rare in absence of clinical disease 3.AVMs-may see feeding vessels
4.Wegeners-isually cavitating 5.Septic emboli-usually staph or
strep 6.Multiple granuloma-usually small with calcification.
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Can be difficult to see,especially with underlying COPD. The
more dense the nodules the easier, it is to see them- hence
alveolar microlithiasis is easy to see. Multiple calcified small
nodules is almost always secondary to old varicella pneumonia.
Pulmonary venous back pressure can cause small calcific densities
in the bases. Miliary TB does not cause calcification Micronodular
disease
Pneumothorax 1.Look for a pleural line 2.2cm edge corresponds
to 50% of volume 3.Should always aim for an erect film 4.There is
no evidence that an expiratory film is more sensitive 5.Decubitus
or lateral may be helpful 6.Beware a tension pneumothorax,
mediastinal shift away and flattening of hemidiaphragm, increased
pressure causes decreased venous return and death/compromise. 7.In
the supine position look for a deep sulcus sign and very sharp
border.Air rises the highest part of the chest is abuts over the
lower mediastinum
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1.Air from bullae/pneumothorax 2.Ruptured airway 3.Ruptured
oesophagus-commonest cause iatrogenic from endoscopy 4.Air from
retroperitoneum
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1.Cavitating disease in right upper lobe and apical segment of
left lower lobe. This is reactivation/secondary TB. Other
cavitating organisms.. 2.Septic emboli-strep(pneumatocoelees) and
staph (true cavitation). Straight forward staph and strep also can.
3.Aspiration gram negatives 4.Haemophillus
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Large cavitating mass 1.TB 2.Cavitating tumour 3.Abscess-in
dependent areas 4.Aspergilloma in old TB or ankylosing spondylitis
scarring (upper lobes) 5.Hydatid rare
