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dc:title Thoracic radiology
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Thoracic radiology
slideShow slide slide-master-content
slide-content Chest radiology
Department of Radiology
University Hospital
Hradec Kralove
slide slide-master-content
slide-content Outline
Imaging methods
Normal chest X – ray
Abnormal imaging patterns : CXR, other methods
slide slide-master-content
slide-content Imaging methods - chest
CXR
posteroanterior upright anteroposterior supine
lateral films
conventional tomography, fluoroscopy
CT: computed tomography
conventional and spiral CT
non-contrast and contrast-enhanced study
CT angiography – pulmonary embolism
HRCT – high resolution CT
Ultrasonography
MR
Angiography
Scintigraphy, PET
slide slide-master-content
slide-content CXR – PA and lateral view
slide slide-master-content
slide-content
technical points
quality of exposure visibility of vascular pattern and spinal column
symmetry spinous processes, medial ends of clavicles
inspiration level of diaphragm (ant. 6r, post. 9r)
bones, chest wall (breasts, nipples)
free diaphragmatic angles
size and contours of mediastinum
C-T ratio < 0.5
hila
A-B index < 1.2
narrower upper vessels
symmetry of lung transparency, regularly branching vascular pattern, missing in peripheral 15 mm bands
PA view – normal pattern
slide slide-master-content
slide-content
technical points
quality of exposure visibility of vascular pattern and spinal column
symmetry spinous processes, medial ends of clavicles
inspiration level of diaphragm (ant. 6r, post. 9r)
bones, chest wall (breasts, nipples)
free diaphragmatic angles
contours and size of the mediastinum
C-T ratio < 0.5
hila
A-B index < 1.2
narrower upper vessels
symmetry of lung transparency, regularly branching vascular pattern, missing in peripheral 15 mm bands
PA view – normal pattern
slide slide-master-content
slide-content Normal heart, PA projection
slide slide-master-content
slide-content Normal CXR, lateral projection
slide slide-master-content
slide-content
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slide-content Mediastinum - compartments
slide slide-master-content
slide-content
technical points
quality of exposure visibility of vascular pattern and spinal column
symmetry spinous processes, medial ends of clavicles
inspiration level of diaphragm (ant. 6r, post. 9r)
bones, chest wall (breasts, nipples)
free diaphragmatic angles
contours and size of the mediastinum
C-T ratio < 0.5
hila
A-B index < 1.2
narrower upper vessels
symmetry of lung transparency, regularly branching vascular pattern, missing in peripheral 15 mm bands
PA view – normal pattern
slide slide-master-content
slide-content
technical points
quality of exposure visibility of vascular pattern and spinal column
symmetry spinous processes, medial ends of clavicles
inspiration level of diaphragm (ant. 6r, post. 9r)
bones, chest wall (breasts, nipples)
free diaphragmatic angles
contours and size of the mediastinum
C-T ratio < 0.5
hila
A-B ratio < 1.2
symmetry of lung transparency, regularly branching vascular pattern, missing in peripheral 15 mm bands
PA view – normal pattern
slide slide-master-content
slide-content Arterio-bronchial ratio
B
P
slide slide-master-content
slide-content Arterio-bronchial ratio conventional tomography
slide slide-master-content
slide-content
technical points
quality of exposure visibility of vascular pattern and spinal column
symmetry spinous processes, medial ends of clavicles
inspiration level of diaphragm (ant. 6r, post. 9r)
bones, chest wall (breasts, nipples)
free diaphragmatic angles
contours and size of the mediastinum
C-T ratio < 0.5
hila
A-B index < 1.2
narrower upper vessels
reflects distribution of blood flow
valid only on erect films
symmetry of lung transparency, regularly branching vascular pattern, missing in peripheral 15 mm bands
PA view – normal pattern
slide slide-master-content
slide-content 1/3
2/3
U
M
L
9
6
PA VIEW – lung fields
slide slide-master-content
slide-content Interlobar fissures
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slide-content
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slide-content Right lung
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slide-content Left lung
slide slide-master-content
slide-content U
M
L
PA VIEW – lung fields
slide slide-master-content
slide-content ICU films
-AP projection
- sitting
- supine position
limited diagnostic value
lung aeration, PNO, gross abnormalities
monitoring devices, lines
widened mediastinal shadow
C-T ratio < 0.6
equal size of upper and lower hilar vessels
slide slide-master-content
slide-content Supine x upright films
S
U
slide slide-master-content
slide-content Vertical versus horizontal beam direction
slide slide-master-content
slide-content Ultrasonography
cannot pass through the aerated lung
quickest and the most efficient method for depiction of pleural fluid
guidance of interventional procedures
slide slide-master-content
slide-content Chest CT
method of choice for further work-up of patient with chest disease
morfological diagnosis
mediastinum, lung parenchyma, vessels
guidance for interventional procedures (lung biopsies, drainages)
slide slide-master-content
slide-content Conventional x spiral CT
incremental scanning
spiral (helical) scanning
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slide-content
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slide-content
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slide-content High resolution CT (HRCT)
sequentional CT scanning
thin scan collimation
high spatial frequency algorithm
the most valuable method for:
interstitial parenchymal processes
details of masses
bronchi
slide slide-master-content
slide-content Pulmonary CT Angiography
spiral CT technique
contrast enhancement
dg. pulmonary embolism
the method of choice for diagnosis of PE in patients with chronic cardiopulmonary disease
slide slide-master-content
slide-content
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slide-content Pulmonary angiography
gold standard for diagnosis of pumonary embolism
currently rarely used
replaced by
ventilation/perfusion scintigraphy
spiral CT angiography
slide slide-master-content
slide-content Imaging methods - heart
CXR
PA upright, AP supine, lateral films
conventional tomography, fluoroscopy
Ultrasonography
transparietal, transoesophageal
CT: computed tomography
CT angiography – pulmonary embolism, aorta, pericardium, tumors
multislice CT – coronary arteries
MR – morphology, functional studies, myocardial viability
Coronarography, cardioangiography
Scintigraphy, PET
slide slide-master-content
slide-content Pulmonary vessels – MR angiography
slide slide-master-content
slide-content Cardiac MR - cine mode
slide slide-master-content
slide-content Fetal echocardiography
method of choice for fetal heart evaluation
no other possibility in fetus
high accuracy in experienced hands
slide slide-master-content
slide-content Fetal echocardiography
slide slide-master-content
slide-content Angiocardiography
slide slide-master-content
slide-content Coronarography
slide slide-master-content
slide-content Multislice CTA
coronary arteries
slide slide-master-content
slide-content Abnormal patterns - heart
slide slide-master-content
slide-content Mitral heart shape - triangle
triangular shape
left atrial enlargement
„Kernschatten“
double right contoure
dorsal extension
postcapillary hypertension
redistribution to upper LF
interstitial edema
alveolar oedema
natural history: precapillary hypertension
slide slide-master-content
slide-content Mitral stenosis
Normal heart
slide slide-master-content
slide-content Mitral valve disease - stenosis
slide slide-master-content
slide-content Aortal heart shape – „duck“
left ventricular enlargement
extension to the left
sinking of the apex towards the diaphragm
natural history:
left heart failure
left atrial enlargement
„Kernschatten“
double right contoure
dorsal extension
postcapillary hypertension
redistribution to upper LF
interstitial edema
alveolar oedema
slide slide-master-content
slide-content Aortic valve lesions
slide slide-master-content
slide-content I.- pulmonary venous hypertension: mitral stenosis, left ventricular failure
slide slide-master-content
slide-content Interstitial edema
after treatment
slide slide-master-content
slide-content Alveolar edema
slide slide-master-content
slide-content Right ventricular enlargement
retrosternal space filling
prominence of pulmonary arch
heart apex above the diaphragm
slide slide-master-content
slide-content Generalised heart enlargement
ischemic heart disease
myocardiopathy
myocarditis
pericardial fluid
slide slide-master-content
slide-content II. pulmonary arterial (precapillary) hypertension
normal: A-B ratio < 1.2
pulmonary embolism
„cor pulmonale“
Eisenmenger sy
high altitude
idiopathic
slide slide-master-content
slide-content III. pulmonary hyperemia – left to right shunting
ASD, VSD, PDA
arterial and venous dilatation
slide slide-master-content
slide-content VI. pulmonary oligemia – tetralogy of Fallot
narrowing of both arteries and veins
pulmonary stenosis, TOF, hypocirculatory status
slide slide-master-content
slide-content Pericarditis exudativa
slide slide-master-content
slide-content Pericarditis calcarea
slide slide-master-content
slide-content Abnormal patterns - lungs
slide slide-master-content
slide-content SHADOWS (compartments):
ALVEOLAR PATTERN:
CONSOLIDATION, EDEMA, COLLAPSE (ATELECTASIS)
INTERSTITIAL PATTERN
LUNG NODULE (S), MASSES
PLEURAL EFFUSION, MASSES, CHEST WALL
MEDIASINAL MASSES
LUCENCIES:
EMPHYSEMA
CAVITY
PNEUMOTHORAX
POST MASTECTOMY
slide slide-master-content
slide-content Lung parenchyma
pulmonary acinus (primary lobule)
apr. 7 mm, cca 400 alveoli, supplied by terminal bronchiole and arteriole
secondary lobule
last structure surrounded with connective tissue (septae)
15 – 20 mm, 3-5 acini, supplied with secondary bronchiole and arteriole
slide slide-master-content
slide-content Alveolar pattern - consolidation
shadowing and air-bronchogram
complete filling of lung segments, lobes etc ...
slide slide-master-content
slide-content Mediastinal lesions – dif. dg.
anterior mediastinum
thymoma, thyroid, teratoma,lymphadenopathy, vessels, inflamation, hematoma, hernias
middle mediastinum
tumorous spread (lung Ca), lymphadenopathy, hiatal hernias, esophageal lesions, cysts, vascular lesions,
posterior mediastinum
Ao lesions, neurogenic Tu, lymphadenopathy, vertebrogenic lesions
slide slide-master-content
slide-content Mediastinal lesions – imaging
CXR, CT
Thymoma
slide slide-master-content
slide-content Mediastinal and hilar lymphadenopathy
middle mediastinum
slide slide-master-content
slide-content Non-Hodgkin lymphoma
slide slide-master-content
slide-content Lucencies
emphysema
centrilobular
panlobular
paraseptal
slide slide-master-content
slide-content Pneumothorax
traumatic, spontaneous
internal, external
partial, complete
tension
fluidopneumothorax
slide slide-master-content
slide-content Cystic and cavitary lesions
slide slide-master-content
slide-content Cystic and cavitary lesions
necrotic Ca, meta, lymphoma
TBC, septic emboli, fungi
Wegener granulomatosis
lung abscesses
congenital cysts, pneumatocoeles, sequestrations
bronchiectasis
slide slide-master-content
slide-content Cystic and cavitary lesions
TBC
Bronchiectasis
Abscess
Abscess
slide slide-master-content
slide-content Opakování
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slide-content Silhouette sign - practise
lingular consolidation - pneumonia
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slide-content Left lower lobe consolidation (with some collapse)
elevation of left hemidiaphragm
silhouette sign
preservation of left heart border
loss of diaphragmatic contour
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slide-content
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slide-content ...
LF UK Hr. Králové | discipline: Cardiology, Angiology | ...: Array | published on: 8. 6. 2009