Basics of Chest Imaging

Rebecca Peterson, M. D. Associate Professor Department of Radiology University of Ottawa

Anatomy

Normal PA

Normal Lateral

The Chest X-ray in Disease

Basic Patterns of Disease

Air-Space Disease

VS

Interstitial Disease

Pulmonary Acinus

Air space disease

Consolidation

Means “solid lung”

Implies that there is “air-space disease”

May occur with or without volume loss

Consolidation without

volume loss

Air Bronchogram

Air Bronchogram

Characteristics of Air Space Disease

Acinar shadow

Homogeneous density (consolidation)

“Silouette”sign Loss of distinct margins next to

consolidation

Air bronchogram

Non-segmental distribution

Consolidation RML

normal abnormal

Consolidation RML

normal abnormal

Causes of Airspace Disease

Infection

Hemorrhage

Edema

Neoplasm

Idiopathic

Consolidation withvolume loss

“Atelectasis” or “collapse”

Collapse LLL Normal

Collapse LLL

Direct signs of volume loss

Movement of a fissure

Indirect signs of volume loss

Upward shift of the diaphragm

Mediastinal shift to that side

Movement of main-stem bronchus

Hypovascularity of remaining lung due to hyperinflationLung looks darker

Collapse RUL

incomplete complete

Collapse RUL

incomplete complete

Collapse LUL

incomplete complete

Collapse LUL

incomplete complete

Collapse LLL

Collapse LLL

Collapse RML

Collapse RML

TEST

Basic Patterns of Disease

Air-Space Disease

VS

Interstitial Disease

Interstitial Lung Disease

Perivascular

VS

Parenchymal

Pulmonary Acinus

Perivascular Interstitial Disease

Pulmonary Edema

Interstitial Pulmonary Edema

normal abnormal

Interstitial Pulmonary Edema

Interstitial Pulmonary Edema

normal abnormal

Interstitial Edema

Interstitial Edema

Kerley “B” Lines

Kerley “B” Lines

Signs of Interstitial Edema

Vessels look larger and indistinct

Peribronchial cuffing

Fluid in fissures

Kerley”B” lines

Pleural effusions

Acute Airspace Edema

Airspace Edema

Acute Airspace Edema

Consolidation is bilateral

Consolidation is symmetrical

Consolidation is gravity dependent

Parenchymal Interstitial Disease

Usual Interstitial Pneumonia

Asbestosis

Sarcoidosis

Parenchymal Interstitial Disease

Usual Interstitial Pneumonia

UIP

NORMAL ABNORMAL

UIP

UIP

Asbestosis

Asbestosis

Sarcoidosis

Sarcoidosis

Patterns of Pneumonia

Lobar Pneumonia

Bronchopneumonia

Interstitial Pneumonia

Lobar Pneumonia

Hematogenous spread

Begins at lung periphery

Involves whole lobe of lung

Unilateral

Commonest pathogen Strept Pneumoniae

Lobar Pneumonia

Lobar Pneumonia

Lobar Pneumonia

Bronchopneumonia

Central bronchial inflammation

Patchy airspace consolidation distallyDue to inflammationDue to mucous plugs

Bilateral, asymetrical

Commonest pathogen Staph Aureus

Bronchopneumonia

Bronchopneumonia

Bronchopneumonia

Bronchopneumonia

Bronchopneumonia

Interstitial Pneumonia

Involves interstitial parenchymal space

“ground glass” opacity both lungs

Bilateral, symmetrical

Leads to airspace consolidation

Commonest pathogens mycoplasma and Pneumocystis Carinii

Pattern seen in SARS

Interstitial Pneumonia

Interstitial Pneumonia

Ground Glass

End stage Interstitial Pneumonia

End stage Interstitial Pneumonia

TEST