Bony Thorax Pathology PDF

BONY THORAX PATHOLOGY 14.) Pleural Effusion/Hydrothorax 1.) Aspiration/Foreign Body  Collection of fluid in the pleural cavity  Inspiration of a foreign material into the 15.) Pneumoconiosis airway...

BONY THORAX PATHOLOGY 14.) Pleural Effusion/Hydrothorax 1.) Aspiration/Foreign Body  Collection of fluid in the pleural cavity  Inspiration of a foreign material into the 15.) Pneumoconiosis airway  Lung diseases resulting from inhalation of 2.) Atelectasis industrial substances  A collapse of all or part of the lung Anthracosis 3.) Bronchiectasis  Coal miner’s lung or black lung  Chronic dilatation of the bronchi &  Inflammation caused by inhalation of coal bronchioles dust (anthracite) 4.) Bronchitis Asbestosis  Inflammation of the bronchi  Inflammation caused by inhalation of 5.) Chronic Obstructive Pulmonary Disease asbestos  Chronic condition of persistent obstruction Silicosis of bronchial airflow  Inflammation caused by inhalation of silicon 6.) Cystic Fibrosis dioxide  Widespread dysfunction of the exocrine 16.) Pneumonia glands  Acute infection in the lung parenchyma  Abnormal secretion of sweat & saliva & Aspiration accumulation of thick mucus in the lungs  Pneumonia caused by inhalation of foreign 7.) Emphysema particles  Enlargement of alveolar wall caused by Interstitial/Viral/Pneumonitis alveolar wall destruction & loss of elasticity  Pneumonia caused by a virus & involving 8.) Epiglottitis alveolar walls & interstitial structures  Inflammation of the epiglottis Lobar/Bacterial 9.) Histoplasmosis  Pneumonia involving the alveoli of an entire  Infection caused by the yeastlike organism lobe without involving the bronchi Histoplasma capsulatum Lobular/Bronchopneumonia 10.) Sarcoidosis  Pneumonia involving the bronchi and  Condition of unknown origin often associate scattered throughout the lung with pulmonary fibrosis 17.) Pneumothorax 11.) Tubercolosis  Accumulation of air in the pleural cavity  Chronic infection of the lungs due to the resulting in collapse of the lung tubercle bacillus 18.) Pulmonary Edema 12.) Hyaline Membrane Disease/Respiratory  Replacement of air with fluid in the lung Distress Syndrome interstitium & alveoli  Underaeration of the lungs due to a lack of surfactant 13.) Metastases  Transfer of a cancerous lesion from one area to another  BONY THORAX A.) TRACHEA  Sharp outline of heart  Sharp outline of diaphragm (expiration) AP PROJECTION  Ten posterior ribs above diaphragm PP: Supine/upright; neck slightly extended; MSP ┴ Upright Position Rationale: to IR; exposure during slow inspiration  Diaphragm at its lowest position RP: Manubrium  Air-fluid levels are seen CR: ┴  Avoid engorgement of the pulmonary SS: Air-filled trachea vessels LATERAL PROJECTION AP PROJECTION PP: Seated/upright; hands clasped behind the body; PP: Supine/upright; back against IR; place hands on shoulder rotated posteriorly (prevents hips; elbow flexed; hand pronated superimposition of arms & superior mediastinum); RP: 3 in. inferior to jugular notch neck extended slightly; exposure during slow CR: ┴ inspiration SS: Somewhat similar to PA but magnified RP: Midway b/n jugular notch & midcoronal plane  Magnified heart & great vessels (for trachea); 4-5 in. lower (for superior  Lung fields appear shorter mediastinum)  Clavicle projected higher CR: ┴  Ribs assume horizontal position SS: Air-filled trachea & superior mediastinum Resnick Recommendation: ER: described by Eiselbeg & Sgalitzer  CR 30o caudad to midsternal region  Used to demonstrate restrosternal extensions  Rationale: to free basal portions of the lung of the thyroid gland fields from superimposition by anterior  Thymic enlargement in infants (recumbent diaphragmatic, abdominal & cardiac position) structures  Opacified larynx & upper esophagus  Outline of trachea & bronchi LINDBLOM METHOD For foreign body localization AP AXIAL PROJECTION PP: Upright; step 1 foot in front; lean backward in B.) CHEST extreme lordosis; elbow flexed; pronate hands beside the hips; shoulder against IR; PA PROJECTION RP: Midsternum PP: Upright/seated-upright (always); chin extended CR: ┴ or 15-20o cephalad (no leaning backward) upward; dorsal aspect of hands against the hips SS: Lung apices inferior to shadow of clavicles (rotates scapulae laterally; depress shoulder; pull  Demonstrate interlobar effusions breast upward & laterally (female); exposure after ER: Used in preference to PA axial projection in second full inspiration (general) or end of full hyperstenic patient & whose clavicles occupy a inspiration & expiration (for presence of high position pneumothorax & foreign body) RP: T7 CR: ┴ SS: Entire lung field  BONY THORAX PA AXIAL PROJECTION  RAO: PP: Upright; chin rested against the IR; elbow o Maximum area of left lung flexed; pronate hands on hips; depress shoulder & o Trachea rotated forward; exposure at end of full inspiration o Entire left branch of bronchial tree RP: T3 o Best image of left atrium, anterior CR: 10-15o cephalad portion of apex of left ventricle & SS: Lung apices superior to shadow of clavicles right retrocardiac space o Esophagus (if barium filled) LATERAL PROJECTION  Medial part of right middle lobe & lingula of PP: Upright/seated-upright; left side against the IR the left upper lobe free from hilum (CR 10- (for heart & left lung) or right side against the IR 20o) (for right lung); MSP // to IR; MCP ┴ to IR; arms extended directly upward; elbow flexed; forearm AP OBLIQUE PROJECTION resting on elbows PP: Upright/supine; LPO/RPO (affected side RP: T7 down); body rotated 45o toward affected side; CR: ┴ shoulder of affected side against IR SS: RP: 3 in. inferior to jugular notch  Heart, aorta & left-sided pulmonary lesions CR: ┴ (left lateral) SS:  Right-sided pulmonary lesions (right lateral)  LPO: maximum area of left lung; similar to ER: RAO  Employed to demonstrate the interlobar  RPO: maximum area of right lung; similar fissures to LAO  To differentiate the lobes ER:  To localize pulmonary lesions  Used when patient is too ill to be turned in prone position PA OBLIQUE PROJECTION  Supplementary position in investigation of PP: Upright/seated-upright; LAO/RAO (affected specific lesions side up); body rotated 45o toward unaffected side;  Used with recumbent patient in contrast 55-60o (for cardiac series; )10-20o (for study of studies of the heart & great vessels pulmonary diseases); shoulder of unaffected side against IR AP/PA PROJECTION RP: T7 R or L Lateral Decubitus CR: ┴ PP: Lateral decubitus; patient lie on affected side SS: (for pleural effusion) or unaffected side  LAO: (pneumothorax); body elevated 2-3 in.; arms well o Maximum area of right lung above the head; remain in position for 5 minutes o Trachea & carina before exposure o Entire right branch of bronchial tree RP: 3 in. inferior to jugular notch (AP) or T7 (PA) o Heart, descending aorta & aortic arch CR: Horizontal o Esophagus (if barium filled)  BONY THORAX ER:  Sternum projected over the heart  Used to demonstrate the change in fluid AP Oblique Projection: position (pleural effusion)  LPO position  Reveals any previously obscured pulmonary  For trauma patients in supine position areas  Demonstrate the presence of any free air MOORE METHOD (pneumothorax) PA OBLIQUE PROJECTION Ekimsky Recommendation: PP: Modified prone position; tube positioned over  Patient leaning laterally 45o the patient’s right side; patient stand at the side of  Rationale: for demonstration of small table; bend at the waist; arms above shoulders; pleural effusions palms down on table RP: level of T7 & 2 in. to the right of spine LATERAL PROJECTION CR: 25o toward MSP; large patient (less R or L Position angulation); small patient (more angulation) Ventral/Dorsal decubitus Position SS: Sternum free of superimposition from vertebral PP: Supine/prone; thorax elevated 2-3 in.; remain in column position 5 minutes before the exposure; extend arms ER: Perform on an ambulatory patient who is well above the head; affected side against the IR having acute pain to provide comfort & to produce RP: 3 in. inferior to jugular notch (ventral high-quality sternum image decubitus) or T7 (dorsal decubitus)  Sternum projected over the heart CR: Horizontal ER: LATERAL PROJECTION  Used to demonstrate the change in fluid R or L Position position PP: Lateral recumbent/upright or dorsal decubitus  Reveals pulmonary areas that obscured by (for patient with severe injury); patient in true fluid in standard projection lateral position; broad surface of sternum ┴ to IR; suspended deep inspiration C.) STERNUM RP: Lateral border of midsternum CR: ┴ PA OBLIQUE PROJECTION SS: Best demonstrate the entire length of sternum & PP: Prone or upright (trauma patient); RAO; body its surrounding tissue rotated 15-20o (prevents superimposition of sternum & vertebrae); long exposure time: slow, shallow D.) STERNOCLAVICULAR JOINTS breaths during exposure; short exposure time: suspend breathing at the end of expiration PA PROJECTION RP: T7 of elevated side of posterior thorax & 1 in. PP: Prone or upright (trauma patient); arms along lateral to MSP the sides; palms facing upward; head turned facing CR: ┴ the affected side for unilateral examination (rotates SS: Best projection to demonstrate sternum the spine slightly away from side of interest); head  Sternum free of superimposition from rested on chin for bilateral examination vertebral column RP: T3 CR: ┴  BONY THORAX SS: Sternoclavicular joints RP: T7 CR: ┴ or 10-15o caudad (to demonstrate 7th-9th KURZBAUER METHOD ribs) LATERAL PROJECTION SS: Anterior ribs (1st-9th) above the diaphragm PP: Lateral recumbent; affected side against IR; hips & knee flexed; arm of affected grasp the end of AP PROJECTION table (for support); arm of unaffected side grasp the PP: dorsal surface of hip (depressed shoulder); anterior  Upright: to image ribs above diaphragm; IR surface of manubrium ┴ to IR top board 1.5 in. above shoulder; shoulder RP: Lowermost sternoclavicular articulation rotated forward; suspend at full inspiration CR: 15o caudad (to depress diaphragm) SS: Unobstructed sternoclavicular joint  Supine: to image ribs below diaphragm; shoulder in the same transverse plane; PA OBLIQUE PROJECTION suspend at full expiration (to elevate Body Rotation Method diaphragm) PP: Prone or seated-upright (trauma patient); RP: T7 (upper ribs) or T10 (lower ribs) RAO/LAO; body rotated 10-15o toward affected CR: ┴ side (projects vertebrae well behind the SC joint) SS: Posterior ribs above the diaphragm (1st-10th) & RP: Level of T2-T3 (3 in. distal to vertebral below the diaphragm (8th-12th) prominens) & 1-2 in. lateral from MSP CR: ┴ AP OBLIQUE PROJECTION  Entrance: right side (left SC joint); left side PP: RPO/LPO; body rotated 45o (affected side (right SC joint) down); arm of affected side abducted; opposite SS: Sternoclavicular joints hand on hip  Upright: to image ribs above diaphragm; PA OBLIQUE PROJECTION hand rested on head; suspend at full Central Ray Angulation Method inspiration (to depress diaphragm) PP: Prone or seated-upright (trauma patient); chin  Supine: to image ribs below diaphragm; hip rested on table or rotated toward the side of interest elevated; suspend at full expiration (to RP: Level of T2-T3 (3 in. distal to vertebral elevate diaphragm) prominens) & 1-2 in. lateral from MSP RP: T7 (upper ribs) or T10 (lower ribs) CR: 15o toward MSP CR: ┴  Entrance: right side (left SC joint); left side SS: Axilliary ribs closest from IR (right SC joint) SS: Sternoclavicular joints PA OBLIQUE PROJECTION PP: RAO/LAO; body rotated 45o (affected side up) D.) RIBS  Upright: to image ribs above diaphragm; forearm of affected side rested on grid PA PROJECTION device; suspend at full inspiration (to PP: Upright/prone; hands rested against hips; palms depress diaphragm) turned outward; chin rested on chin; suspend at full inspiration (depresses diaphragm)  BONY THORAX  Supine: to image ribs below diaphragm; patient rested on forearm; knee of elevated side flexed; suspend at full expiration (to elevate diaphragm) RP: T7 (upper ribs) or T10 (lower ribs) CR: ┴ SS: Axilliary ribs away from IR AP AXIAL PROJECTION PP: Supine; head rested directly on table (to avoid accentuating the dorsal kyphosis); arms along sides of the body RP: 2 in. superior to xiphoid process CR: 20o cephalad  Increase 5-10o angle (patient w/ pronounced dorsal kyphosis) SS: Costal joints  Costovertebral & costotransverse joints  THE END  “BOARD EXAM is a matter of PREPARATION. If you FAIL to prepare, you PREPARE to fail” 04/09/14