RT 304 Lesson 1-3 (Prefinal) PDF

Trauma / Fracture Spiral Fracture of the Humerus Spiral Fracture of the Distal Tibia Fracture is a discontinuity of bone caused by mechanical forces either applied to the bone...

Trauma / Fracture Spiral Fracture of the Humerus Spiral Fracture of the Distal Tibia Fracture is a discontinuity of bone caused by mechanical forces either applied to the bone or transmitted directly along the line of a bone. Trauma may injure a bone, resulting in Fractures. Fracture The choice of Treatment usually depends on the Classification and Severity of the fracture. Closed and Nondisplaced Fractures: most common treatment is splinting, casting, / both. Closed Reduction: requires that a Local or General Anesthetic be given to the patient for pain management. A Splint or Cast is then applied. Open Reduction: is required when Orthopedic Hardware is needed to maintain Fracture Oblique and Spiral Fractures Reduction or when an open fracture needs to be Irrigated. Generally, this is referred to as Open Reduction Internal Fixation (ORIF). Oblique Fracture: the break has a Slanted or Sloped Pattern. Spiral Fracture: one part of the bone has been twisted at the break point. Open / Compound Fracture Occurs when the bone actually manages to pierce the skin. This fracture almost always require the surgical insertion of Internal Fixation Devices. This Patient fell and broke her Humerus at the Distal Portion of her Prosthesis. Transverse Fracture Characterized by a Horizontal Fracture in relation to the long axis of the bone. Patient fell directly on their knee and that trauma resulted in a Transverse Fracture of their Patella. To reduce this, an Internal Fixation Device will have to be surgically inserted. Spiral Fracture Occurs when the bone has been twisted apart. It will have a similar appearance to a Spiral Staircase. This fracture is sometimes referred to as a Torsion Fracture. Spiral fractures in babies and children can be a warning Sign of Abuse. Spiral Fractures run around the axis of long bones much like a Spiral Staircase. Comminuted Fracture Occurs when there are multiple bone fragments. Occurs as the result of some type of crushing injury or as the result of gunshot wound. Comminuted Fracture occurs when there are 2 or more bone fragments. This often occurs as the result of some type of crushing injury, or in this case, from the impact of a bullet. Callus Formation of a Transverse Fracture of the Femur. Torus Fracture Torus comes from the Latin word Tori which refers to a swelling or protuberance. The impact from a fall on an outstretched hand is usually the cause of this fracture. It commonly occurs in the distal forearm of young children and it is sometimes referred to as a “Buckle” Fracture. Characterized by small buckle or protuberance on one side of the bone but not on the other. Treatment consists of a short cast for 3 weeks in order to prevent any further injury. Comminuted Open Distal Tibial Fracture secondary to GSW. A type of Incomplete Fracture where one side of the bone will buckle but not affect the other side. Comminuted Fracture of the Calcaneous occurred as a result of falling feet first into an empty pool A forearm radiograph of a 14-year-old girl who fell on her hand, resulting in a torus fracture of with no shoes on. the distal radius. Greenstick Fracture Avulsion Fracture A type of partial fracture that is commonly associated with Children. Occurs when there is trauma in a location to where a ligament or tendon Analogy is in the pliable nature of their bones and inability to cleanly break a green twig. attaches to a bone. These fractures are easily repaired and most often corrected with a Closed Reduction. This occurs when the tear causes a piece of bone to be pulled off. Greenstick Fractures are sometimes associated with Rickets. Avulsion Fracture can be seen anywhere in the body but a common site is at the base of the 5th metatarsal. This radiograph of the wrist demonstrated a greenstick fracture of the distal radius and ulna. This Most Avulsion Fractures are treated as a Soft Tissue Injury and don’t type of partial fracture is common in children. require surgical repair. The most common fracture of the 5th metatarsal is called an Avulsion Fracture. This is sometimes It can most often be treated with a Closed Reduction and a Cast. called a “Pseudo-Jones” Fracture and it occurs when the Peroneus Brevis Tendon tears off a Some severe fractures may require the surgical insertion of an Internal Fixation Device. piece of the base of the 5th metatarsal. It is usually not badly displaced and is often treated with a Walking Cast or Boot. Colles’ Fracture occurs in the wrist and is most often the result of falling backwards on an outstretched hand. It is characterized by a posterior fracture of the distal radius and may require Jones Fracture surgery if badly displaced. Occurs on the shaft of the 5th metatarsal. Most often a Jones Fracture occurs without significant injury or impact. It is more difficult to heal than an avulsion fracture but usually only requires the wearing of a Walking Boot or Cast for 4 - 8 weeks. However, in some instances, it may require the surgical insertion of a Screw or Bone Graft in order to stimulate a healing response. Boxer’s Fracture Occurs at the head of the 4th or 5th metacarpal of the hand. Almost always occurs as the result of striking a firm object with closed fist. Compression Fracture Most boxer’s fractures can heal with a cast but some severe cases may Occurs when a vertebral body is crushed and collapses down upon itself. require surgical repair. It can be the result of Trauma, Cancer, or Osteoporosis. Boxer’s Fracture occurred at the head of the 5th metacarpal and it is almost always the result of the patient striking another person or a wall. Surgery may be Treatment depends on the severity of the fracture and its potential impact on the spinal cord: indicated to reduce this fracture in severe cases. Back Brace: stabilize the fracture while it heals. Surgical insertion of internal fixation devices. Blow-Out Fracture Vertebroplasty: may be performed. This requires the injection of bone cement (Polymethylmethacrylate) to the vertebral body Blow-Out Fracture of the eye socket may involve the Orbital Floor, Wall, or Roof. by an Interventional Radiologist to prevent further collapse of the vertebral body. Most common type of blow-out fracture involves the Floor of the Orbit and Maxillary Bone. Following blunt trauma to the eye, the contents of the orbit A Lateral Lumbar Radiograph demonstrating Compression Fractures of the 2nd and compress and push down into the Maxillary Sinus. 4th Lumbar Vertebral Bodies with no fracture of the posterior elements of the spine. Surgery may be indicated in some instances in order to relieve the symptoms of Double Vision and / or Muscle Entrapment. This Compression Fracture of L4 is the result of a motor vehicle accident. This type This patient has a fracture of the portion of the maxillary bone that of fracture occurs when the normal height of vertebral body has been compromised. makes up the floor of the orbit as indicated by the arrow on this tomogram. Colles’ Fracture Most often caused when an individual falls backwards onto a hard surface and braces themselves with an open hand. It consists of a fracture of the Distal Radius with Posterior and Lateral Displacement of the Distal Fragment. The surgical insertion of a Cage and Rods were required to stabilize the Compression Fracture depicted on the previous slide. Hip Fractures Vertebroplasty was performed on these Compression Fractures. Cement was inserted into the Occurs on the Proximal End of the Femur and is usually the result of a fall from an elderly vertebral body by an Interventional Radiologist to prevent further collapse of the vertebral bodies. patient with Osteoporosis. There are 4 Classifications of Hip Fractures: Femoral Head Fracture This is often the result of a high energy impact and is often combined with a Dislocation. Femoral Neck or Transcervical Fracture The blood supply to the Femoral Head is almost always disrupted with this type of fracture. As a result, many are treated with a Total Hip Replacement. Elbow Fracture: Fat Pad Sign Intertrochanteric Fracture A subtle fracture to the elbow in the area of the distal humerus can be very difficult to These fractures usually do not damage the blood supply to the hip and can often be reduced visualize radiographically. with the surgical insertion of a Metal Plate and Screws. The best position to view is the Lateral. Subtrochanteric Fracture On the Anterior Surface of the Elbow, there is a Fat Pad that is normally visualized as a Small Radiolucency. This fracture occurs just below the level of the Intertrochanteric Crest. There is also a Fat Pad located on the Posterior Surface of the Distal Humerus however, it It is actually physically located on the shaft of the Femur and may extend down the femur. is normally not demonstrated. If there is trauma to the elbow with an underlying fracture to the distal humerus, this The Femoral Neck on this patient has been fractured and this is sometimes referred to as a Posterior Fat Pad will be displaced and it will be visualized as a Radiolucent Density. Transcervical Fracture. The blood supply to the femoral head is almost always disrupted with this type of fracture and as a result, there is always a risk that this fracture may not heal. Therefore, many This is a normal Lateral elbow that has no injury to the distal humerus. The arrow points to the area are treated with a Total Hip Replacement. that would exhibit a Fat Pad Sign if there was an injury. This Lateral elbow did experience trauma to the distal humerus. The arrow is pointing to a Radiolucent Area that is indicative of a Positive Fat Pad Sign. This hip fracture occurred through the Intertrochanteric Crest (arrows). These fractures do not Galeazzi Fracture damage the blood supply to the hip and can be reduced with a Metal Plate and Screws. Occurs at the Radial Shaft with dislocation of the Distal Radioulnar Joint (DRUJ). This patient suffered a Subtrochanteric Hip Fracture. This type of fracture occurs just below the Intertrochanteric Crest. They often travel down the shaft of the femur as this example. Reduction of this Intertrochanteric Hip Fracture required surgical insertion of an AMBI hip pin, plate, and screws. Surgery is referred to as Open Reduction with Internal Fixation (ORIF). Salter-Harris Fractures Salter-Fractures involve fractures of the Growth Plate in children. There are 5 Categories of this Fracture: Type I The Epiphysis is completely dislocated from the Metaphysis (shaft) of the bone. This type usually only requires a Cast for treatment. Monteggia Fracture Type II Monteggia fracture is usually the result of a fall on an outstretched arm. This is the Most Common Type of Growth Plate Fracture. It involves a fracture of the Proximal 3rd of the Ulna combined with a dislocation of the It involves a partial dislocation of the Epiphysis and a fracture of the Metaphysis. Radial Head within the elbow joint. The Metaphysis has also been cracked. These are very unstable injuries that usually require surgical repair. Reduction of this fracture often does not require manipulation by the Physician. The Ulna will require an Internal Fixation Device and once this will usually reduce the Radial Head Dislocation. Type III Salter-Harris Type IIl Fracture is a relatively rare type of Growth Plate Fracture. It usually occurs at the distal portion of the Tibia and it is characterized by a fractured Epiphysis combined with a partial dislocation between the Epiphysis and the Metaphysis. Surgery is often recommended to reduce this fracture and it has a good Prognosis. Type IV This type is the result of a fracture of both the Epiphysis and the Metaphysis. Type V This one involves the impaction of the Epiphysis into the Metaphysis. These Diagrams illustrate the 5 types of Salter-Harris Fractures. This classification system has been Traumatic Diseases the standard for describing Growth Plate Fractures since the 1960s. Fractures Discontinuity of bone caused by mechanical forces either applied to the bone or transmitted directly along the line of a bone. Break in a Bone. Signs and Symptoms of Fracture: Pain Trouble using or moving the injured area or nearby joints. Unable to bear weight. Tripod Fracture Swelling. Malar or Zygomatic Bone articulates with Frontal, Temporal, and Maxillary Bone. Obvious deformity. Trauma directly to the Malar Bone may cause a fracture at each of these articulations. Treatment of this type of fracture usually requires a surgical reduction of the fracture sites. Cracking sound. Open Reduction and Internal Fixation (ORIF): Tripod Fracture occurs when the three articulations of the zygomatic or malar bone are fractured. (a) is pointing to a fracture of the articulation with the Frontal Bone. Is a type of surgery used to stabilize and heal a broken bone. (b) is pointing to a fracture of the articulation with the Temporal Bone. Classification of Fractures (c) is pointing to a fracture of the articulation with the Maxillary Bone. Trauma to Zygoma. (d) is pointing to blood in the Maxillary Sinus. Open or Compound fracture A Computed Tomography Image demonstrating a Tripod Fracture of the Right Zygomatic Bone. One in which the bone has penetrate the skin. Closed Fracture One in which the skin is not penetrated, thus reducing the chance of infection. Complete Fracture Those in which the bone has separated into 2 fragments. Incomplete Fracture Those in which only part of the bony structure gives way, little or no displacement. Comminuted Fracture The bone is separated into two or more and often numerous fragments. Types of Fractures Common Fractures Transverse Bennett's Fracture Complete Fractures that are at right angles to the long axis of the bone. A fracture of the base of the 1st metacarpal involving the 1st carpometacarpal joint. Fissure Colle’s Fracture (Dinner Fork) Incomplete Fracture that extends from surface into but not all the way to a long bone. A fracture through the distal 1 inch of the Radius. Oblique Smith’s Fracture The axis of the fracture is neither parallel nor perpendicular to the bone. Reverse Colle’s Fracture with displacement toward the palmar aspect of the hand. The length and angle of the fracture depend on the rotational stress. Supracondylar Facture Spiral Common Pediatric Fracture in which there is an alteration in the alignment of the Bone appears to be twisted apart. Common in the Humerus, and the Tibia of Skiers. Condyles, may come to lie directly under the shaft of the Humerus. Longitudinal Carpal-Navicular Fracture A lengthwise break in a bone. Usually caused by falling on one’s hand. Impacted Pott’s Fracture One bone fragment is driven into another. Involves both Malleoli, with dislocation of the ankle joint. Torus Hip Fractures Type of Impacted Fracture that is especially common in the Distal Radius of children. Exact location and severity of a hip fracture depends on direction of forces involved. Double The most common types of hip fractures: Subcapital, Transcervical, Intertrochanteric. Fracture of a bone in 2 district places. Bimalleolar Fracture Avulsion A fracture of the Lateral and Medial Malleolus. Occur when a fragment of bone is pulled away from the shaft. Trimalleolar Fracture Stress Has 3 components: the Medial and Lateral Malleolus and the Posterior Distal Tibia. Usually occur as a result of an abnormal degree of repetitive trauma. Fracture of the Base of the Fifth Metatarsal Fatigue Common Transverse Fracture. Occur as foot is suddenly twisted when ankle pronate. Occur at sites of maximal strain on a bone, in connection with unaccustomed activity. Stellate Fracture Pathologic Occurs when a person falls directly on the Patella, shattering it. Transverse fracture occurring in abnormal bone that is weakened by various disease. Butterfly Fracture Basilar Skull Fractures Comminuted Fracture in which there are one or more butterfly wing or wedge- A break in bone at the base of the skull. shaped fragments split off from the main fragments. Very difficult to demonstrate radiographically. Greenstick Fracture Air fluid levels in the sphenoid sinus and/or clouding of the mastoid air cells are often the only radiographic finding suggesting a fracture. Cortex breaks on one side without separation or breaking of the opposing cortex. Important to include Erect or Cross Table Lateral Skull Radiography. Almost exclusive in infants and children because of the softness of cancellous bone. Chip Fracture CT and MRI are often used to better identify Basilar Area Fractures and associated soft tissue damage within the skull. Avulsion Fracture of a small fragment or chip of bone from the corner of a Phalanx or Ecchymosis other long bone. Penetrating Fracture Discoloration of skin resulting from bleeding underneath, typically caused by bruising. Hemotympanum Type of incomplete fracture resulting from penetration by a sharp object such as a bullet or a knife. Presence of blood in your middle ear. Boxer’s Fracture Visceral Cranial Fracture Occurs when the 5th metacarpal fractures as a result of a blow to or with the hand. Zygomatic Arch Fracture Monteggia Fracture May be difficult to recognize initially because of the edema. One of the proximal 3rd of the Ulna Shaft, with anterior dislocation of Radial Head. May be indicated by clinical signs, which include black eyes, flattening of the cheek, Cerebral Cranial Fractures and/or a restriction of the movement of the mandible. Best demonstrated on underexposed films taken in the basal (submentovertical) Linear Skull Fracture projection (“jug handle” view). Appears on a plain radiograph as a sharp lucent line that is often irregular or jagged Mandibular Fractures and occasionally branches. Detected by patient’s inability to open the mouth & pain when moving the mandible. Depressed Skull Fracture This fracture also causes a misalignment of the patient’s teeth. Often Stellate (star-shaped) with multiple fracture lines radiating outward from a Fractures of the Maxilla central point. Serious because of the adjacent Nasal Cavity, Paranasal Sinuses, Orbit and close Tangential Views are required to determine the amount of depression. proximity of the Brain. The Maxilla also Transmits Cranial Nerves and Major Blood Vessels. Maxillary Fractures 3 Major Classifications: Joint Dislocation or Luxation LeFort I (Horizontal Fracture) Results when a bone is out of its joint and not in contact with its normal articulation. Common sites for are the Shoulders, Hip, and Acromioclavicular Joints. Refers to a separation of the body of the Maxilla from the base of the Skull above Sublaxation the Palate and below the Zygomatic Process. Results in a Freely Movable Jaw. A partial dislocation, often occurring with fracture. LeFort II (Pyramidal Fracture) The Ankle and the Vertebral Column are the common sites of subluxations. Battered Child Syndrome Involves vertical fractures through the Maxilla at the Malar and Nasal Bones, forming a Triangular Separation of the Maxilla. Also referred to as Nonaccidental Trauma (NAT). Lefort III (Transverse Fracture) A term associated with a physical form of child abuse. Most extensive and serious type of maxillary fracture; it extends across the orbits. Physical child abuse often co exists with both emotional and sexual abuse. Blow-Out Fracture Physical signs of battered child syndrome include bruises, burns, abrasions, and fractures in various stages of healing. Results from a direct blow to the front of the orbit, thus transferring the force to the Radiographic signs of child abuse include hematomas, single or multiple fractures of orbital walls and floor. varying ages, especially in areas where it is difficult for the child to self -inflict the injury. Occurs in the thinnest, weakest portion of the orbit, i.e., the Orbital Floor just above A Skeletal Radiographic Series is performed in such instances and includes an AP the Maxillary Sinuses. view of each extremity and the pelvis. AP and Lateral projections of the chest and Modified Parietoacanthial Projection (Modified Waters Method) is preferred. skull are also required. CT is the best modality for imaging the orbits. Legg-Calve-Perthes Disease Tripod Fracture A common form of Avascular Necrosis affecting the Femoral Head. Consists of fractures of the Zygomatic Arch and the Orbital Floor or Rim combined The cause of this disorder is unknown. with separation of the Zygomaticofrontal Suture. Tends to occur in males between the ages of 4 - 10 years and often follows injury or trauma Occurs when the Zygomatic or Malar Bone is fractured at all three sutures: Frontal, to the affected hip. Temporal, and Maxillary. Clinically these patients present with a limp that is accompanied by little or no pain. Nasal Bone Fracture Radiographically the bone in the center of the epiphysis is fragmented and the head of the The most frequently fractured Facial Bone. femur is flattened. Usually Transverse and Depresses the distal portion of the Nasal Bones. Vertebral Column Injuries May be accompanied by a fracture of the ascending process of the Maxillae (Anterior The causes of vertebral column injuries include direct trauma, hyperextension flexion Nasal Spine) or of the Nasal Septum. injuries (whiplash), osteoporosis or metastatic destruction. Compression Fractures Respiratory System The most frequent type of injury involving a vertebral body. Generally, occurs in the Thoracic and Lumbar Vertebrae. Also associated with Osteoporosis. Jefferson Fracture “Burst Fracture” of the 1st Cervical Vertebra (Atlas). Occurs as a result of a Severe Axial Force that causes compression, as a diving accident. The vertebral arch literally bursts. Internal Devices Hangman’s Fracture Endotracheal Tube or ETT Fracture of the arch of the 2nd cervical vertebrae and is usually accompanied by anterior Flexible Tube that is placed in the Trachea (Windpipe) through the mouth or nose. subluxation of the 2nd cervical vertebrae or the 3rd cervical vertebrae. It can be used to assist with breathing during surgery or to support breathing in people with Lung Disease, Chest Trauma, or Airway Obstruction. Clay Shoveler Fracture After Placement: ensure proper positioning of the tube because clinical evaluation (Bilateral Breath An avulsion fracture of a spinous process in the lower cervical or upper thoracic spine. Sounds, Symmetric Thoracic Expansion, and Palpation of the Tube in the Sternal Notch) does not Spondylolysis allow detection of the majority of malpositioned tubes. Daily: ensure that the tube has not been inadvertently displaced by the weight of the Respiratory Exists when there is a cleft or breaking down of the body of a vertebra between the Apparatus, the Patient’s Coughing, or other unforeseen events. superior and inferior articular processes (Pars Interarticularis). Occurs in the arch of the 5th lumbar vertebrae and appears radiographically as a “collar” or broken neck” on the Scottie Dog Appearance and is demonstrated on an Oblique Projection of the Lumbar Spine. Spondylolisthesis Forward slippage of the vertebral column of a vertebra that occurs because of spondylolysis On the Chest Radiograph, position of an ETT is determined by the location of its tip in relation to the Carina. Position of tip of ETT should be 5 - 7 cm above the Carina in the neutral position of neck. Patient with this condition may present symptoms identical to those of a herniated disk. Central Venous Catheter Swan-Ganz Catheterization Is a device inserted into a large, central vein (most commonly the Internal Jugular, Also called Right Heart Catheterization or Pulmonary Artery Catheterization passing of a thin Subclavian, or Femoral) and advanced until the terminal lumen resides within the Inferior tube (catheter) into the Right Side of the Heart and the Arteries leading to the Lungs. Vena Cava, Superior Vena Cava, or Right Atrium. To Monitor the Heart's Function and Blood Flow and Pressures in and around the Heart. Transvenous Endocardiac Pacing Method to maintain Cardiac Rhythm in patients with Heart Block or Brady Arrhythmias. A person may need a CVC for the following reasons: Radiographic evaluation plays an important role in the initial placement of a Pacemaker and To administer medications, such as Antibiotics, Chemotherapy, and Pain Medications. in the detection of any subsequent complications. To provide nutrition. There are 2 Major Types of Cardiac Conduction Devices: Pacemakers and Automatic To conduct certain medical tests. Implantable Cardioverter-Defibrillators (AICD / ICD), and these may be co-implanted as an ICD-pacemaker combination. CVP catheter. Located in the Right Internal Jugular Vein. CVP catheter with its tip in the Pleural Space. A Right Subclavian Catheter, which was introduced for Total Parenteral Nutrition, Perforated the Superior Vena Cava and Eroded to the Right Pleural Space. Note the tip of the catheter projecting beyond the right border of the Mediastinum. The direct infusion of Parenteral Fluid into the Pleural Space has led to a Large Right Hydrothorax. Ideally, the tip of the pacemaker should be positioned at the Apex of the Right Ventricle. Cardiac Pacemaker. Fracture of a pacemaker wire (arrow). Consolidation or Solidification Congenital / Hereditary Disorders Cystic Fibrosis Mucoviscidosis is a Hereditary Disease; secretion of excessively Viscous Mucus by all the Exocrine Glands; it is caused by a Defective Gene in the Middle of Chromosome 7. Thick Mucus secreted by Mucosa in the Trachea and Bronchi blocks the Air Passages. Thick Mucus is the result of imbalance of Sodium & Chloride Production & Reabsorption. These mucous plugs lead to focal areas of Lung Collapse. Lung Abnormal Appearance Recurrent Pulmonary Infections are common because bacteria that are normally carried away by mucosal secretions adhere to the sticky mucus produced in this condition. Reticular Densities Multiple small cysts superimposed on diffuse, coarse, reticular patten. Hazy Densities Hyaline Membrane Disease Inflammatory Disorders of Respiratory System Idiopathic Respiratory Distress Syndrome (IRDS). Croup One of the most common causes of Respiratory Distress in the Newborn. Primarily a viral infection of young children that produces inflammatory obstructive swelling It occurs primarily in Premature Infants, especially those who have Diabetic mothers or who localized to the Subglottic Portion of the Trachea. have been delivered by Cesarean Section. The edema causes Inspiratory Stridor or a Barking Cough, depending on the degree of Hypoxia and Increasing Respiratory Distress may not be immediately evident at birth but Laryngeal Obstruction. almost always appear within 6 hours of delivery. Cause: lack of Surfactant and Immature Lungs. Imaging Appearance: Surfactant: consists of a mixture of Lipids, Proteins, and Carbohydrates that creates a high surface tension, requiring less force to inflate and maintain the Alveoli. Frontal radiographs of the lower neck show a characteristic smooth, fusiform, tapered narrowing (hourglass shape) of the subglottic airway caused by the edema, which is unlike Alveolar Cell Walls: produce Lipoprotein, which maintains surface tension in the Alveoli. the broad shouldering normally seen. This tension permits the Alveoli to remain inflated so that Atelectasis does not occur. Disease process results from Surfactant Deficiency by Cell Immaturity or Birth Trauma. In addition to pronounced Underaeration, the radiographic hallmark of hyaline membrane disease is a finely granular appearance of the pulmonary parenchyma. A peripherally extending Air Bronchogram develops because the small airways dilate and stand out clearly against the Atelectasis in the surrounding lung. Epiglottitis Acute infections of the epiglottis, most commonly caused by Haemophilus Influenzae in children, cause thickening of epiglottic tissue and the surrounding pharyngeal structures. The incidence of epiglottitis has decreased dramatically since the inception of the Haemophilus Influenzae type B (HiB) vaccine as a routine childhood immunization. Imaging Appearance: On lateral projections of the neck using soft tissue techniques, a rounded thickening of epiglottic shadow gives the configuration and approximate size of an adult’s thumb, in contrast to the normal, narrow epiglottic shadow resembling an adult’s little finger. Thumb Sign. Pneumonia Pneumonia is an infection in one or both lungs. Pneumonia causes inflammation in the Alveoli. The Alveoli are filled with fluid or pus, making it difficult to breathe. How does Pneumonia Develop? Bronchopneumonia Most of the time, the body filters organisms. Typified by Staphylococcal Infection, is primarily an inflammation that originates in the This keeps the lungs from becoming infected. Bronchi or the Bronchiolar Mucosa and spreads to adjacent Alveoli. But organisms sometimes enter the lungs and cause infections. Because alveolar spread of infection in the peripheral air spaces is minimal, the inflammation tends to produce small patches of consolidation. This is more likely to occur when: Bronchial inflammation causing airway obstruction leads to Atelectasis & loss of lung volume. Immune System is weak. Imaging Appearance: Organism is very strong. Body fails to filter the organisms. Small patches of consolidation may be seen radiographically as opacifications that are scattered throughout the lungs but Alveolar Pneumonia separated by an abundance of air-containing lung tissue; air Alveolar or Air-Space Pneumonia, exemplified by Pneumococcal Pneumonia, is produced by bronchogram is absent. If consolidation causes obstructed an organism that causes an Inflammatory Exudate that replaces air in the Alveoli so that the airways, Atelectasis is evident. affected part of lung is no longer air containing but appears solid, or radiopaque. Ill-defined consolidation at right base. The inflammation spreads from one alveolus to the next by way of communicating channels, Interstitial Pneumonia and it may involve pulmonary segments or an entire lobe (Lobar Pneumonia). Most commonly produced by Viral and Mycoplasmal Infections. In this type of pneumonia, the Imaging Appearance: inflammatory process predominantly involves the walls and lining of the Alveoli and the Consolidation or Solidification of the Lung Parenchyma with little or no involvement of the interstitial supporting structures of the lung, the Alveoli Septa. airways produces the characteristic Air Bronchogram Sign. The sharp contrast between air Imaging Appearance: within the bronchial tree and the surrounding airless lung parenchyma permits the normally invisible bronchial air column to be seen radiographically. The interstitial dispersal of the infection produces a Linear or Reticular Pattern. The appearance of an air bronchogram requires the presence of air within the bronchial tree, When seen on end, the thickened interstitium may appear as multiple small nodular densities. which suggests that the bronchus is not completely occluded at its origin. Left untreated, interstitial pneumonia may cause “Honeycomb Lung,” which is demonstrated Air bronchogram excludes the diagnosis of a Pleural or Mediastinal Lesion because there are on CT as cyst-like spaces and dense fibrotic walls. no bronchi in these regions. Because air in the alveoli is replaced by an equal or almost equal quantity of inflammatory exudate and because the airways leading to the affected portions of lungs remain open, there’s no evidence of volume loss in Alveolar Pneumonia. Air Bronchogram in Pneumonia: air-filled bronchi (dark) being made visible by the opacification of surrounding Alveoli (grey/white). Aspiration Pneumonia Aspiration of esophageal or gastric content to lungs can lead to development of Pneumonia. Aspiration of esophageal material occur in patients with Esophageal Obstruction (tumor, stricture, & achalasia), Diverticula (Zenker’s), or Neuromuscular Swallowing Disturbance. Imaging Appearance: A lung abscess may be a complication of Bacterial Pneumonia, Bronchial Obstruction, Aspiration, Foreign Body, or the Hematogenous Spread of organisms to the lungs either in a Both types of Aspiration cause multiple alveolar densities, which may be patient with Diffuse Bacteremia or as a result of Septic Emboli. distributed widely and diffusely throughout both lungs. Because the Aspiration, the most common cause of Lung Abscess, frequently occurs in the Right Lung anatomic distribution of pulmonary changes is affected by gravity, the because the Right Main Bronchus is more vertical and larger in diameter than the left. Posterior Segments of the Upper and Lower Lobes are most commonly affected, especially in debilitated or bedridden patients. Imaging Appearance: Bilateral inhomogeneous patchy airspace opacities mainly in the lower zones. The earliest radiographic finding in lung abscess is a spherical density that characteristically Effacement of the costophrenic recesses consistent with aspiration. has a dense center with a hazy, poorly defined periphery. If there is communication with the bronchial tree, the fluid contents of the cavity are partly Anthrax replaced by air, producing a typical air-fluid level within the abscess. Serious Infectious Disease by gram-positive, rod-shaped bacteria called Bacillus Anthracis. Cavitary Lung Abscess usually has a thickened wall with a shaggy, irregular inner margin. Occurs naturally in soil and commonly affects domestic and wild animals around the world. CT assists in diagnostic process to demonstrate ill-defined outer wall & rule out Empyema. People can get sick with anthrax if they come in contact with infected animals or contaminated animal products. Imaging Appearance: Inhalation anthrax causes mediastinal widening and often pleural effusion without infiltrates on a chest image. Rarely, infiltrates may develop. Gastrointestinal involvement manifests as Mesenteric Adenopathy on CT. Although high-dose antibiotics in the early stages attack the bacteria, the anthrax toxins are still produced and sometimes cause death. Vaccines are highly effective and available for limited use. They are not employed routinely in the United States because the last known reported incidence was 1976 (until the previously mentioned 2001 attacks). Lung Abscess A Necrotic Area of Pulmonary Parenchyma containing Purulent (puslike) material. Tuberculosis Miliary Tuberculosis Caused by Mycobacterium Tuberculosis, a rod-shaped bacterium with a protective waxy coat Refers to dissemination of the disease by way of the Bloodstream. Radiographically, this that permits it to live outside the body for a long time. development produces innumerable fine discrete nodules (Granulomas) distributed uniformly Tuberculosis spreads mainly by droplets in the air, which are produced by the coughing of an throughout both lungs. infected patient. Respiratory Precautions must be followed by radiographers. Fine discrete nodules uniformly throughout both lungs. Organisms may be inhaled from sputum that has dried and turned into dust. They are rapidly killed by direct sunlight but survives in a long time in the dark. It is also acquired by drinking the milk of infected cows. Routine Pasteurization of Milk eliminated this route of infection. Primary Tuberculosis – Self-Limited Disease. Considered a disease of children and young adults. However, with the dramatic decrease in the prevalence of tuberculosis, primary pulmonary disease can develop at any age. The current decline is the result of wider screening and prevention programs. Combination of Focal Parenchymal Lesion & Enlarged Hilar or Mediastinal Lymph Nodes Tuberculous Pneumonia produces the classic primary complex (Ghon Lesion), suggestive of Primary Tuberculosis. May resolve completely and leave a Normal Lung. Imaging Appearance: However, if Necrosis and Caseation develop, some Fibrous Scarring occurs. The infiltrate may be seen as a lobar or segmental air-space consolidation that is usually Calcification may develop within both the Parenchymal and the Nodal Lesions, and it may be homogeneous, dense, and well-defined. the only residue of Primary Tuberculous Infection on subsequent images. Apical Lordotic Projection demonstrates apices without superimposition of bony structures. If disease responds poorly to therapy & continues to progress (patient with immunodeficiency Associated enlargement of hilar or mediastinal lymph nodes is very common. or diabetes and in those receiving steroid therapy), the Pneumonia may break down into Pleural Effusion is common, especially in adults. Most primary tuberculous pleural effusions multiple necrotic cavities or a single large abscess filled with caseous material. are unilateral and clear rapidly with treatment. Multiple large cavities with air-fluid levels in both upper lobes. Note Chronic Fibrotic Changes and Upward Retraction of Hila. Consolidation of Right Upper Lobe. Enlargement of Right Hilar Lymph Nodes without Discrete Parenchymal Infiltrate. “Ghon Lesion” or Focus is a Granuloma in the Lung from a previous Tuberculous Infection. It is an Abnormality of Primary Tuberculosis. Unilateral Right Tuberculous Pleural Effusion without Parenchymal or Lymph Node Involvement. Secondary (Reactivation) Tuberculosis Reactivation of organisms from previously dormant tubercles is termed a Secondary Lesion or Reinfection Tuberculosis. Tuberculosis Bacillus may remain inactive for many years before a Secondary Lesion develops, because of a decrease in the body’s immune defense. Imaging Appearance: Imaging Appearance: Secondary Tuberculosis most commonly affects the upper lobes, Pulmonary Histoplasmosis manifests as a solitary, sharply circumscribed, granulomatous especially the apical and posterior segments. It is initially seen as a nodule (Histoplasmoma), less than 3 cm in diameter and found in lower lobe. nonspecific, hazy, poorly marginated alveolar infiltrate that often Central, rounded calcification within the mass (the target lesion) is virtually pathognomonic radiates outward from the hilum. (characteristic) of the disease. Multiple soft tissue nodules scattered throughout both lungs Secondary Tuberculosis. Bilateral Fibrocalcific Changes at Apices. may simulate Miliary Tuberculosis. These shadows may clear completely or may fibrose and persist, appearing on chest radiographs as widespread punctate calcifications. Tuberculoma Coccidioidomycosis is caused by a Fungus, Coccidioides Immitis, which is found in the desert soil Sharply circumscribed Parenchymal Nodule, often containing viable of the Southwestern United States. Tuberculosis Bacilli, that develop in Primary or Secondary Disease. Although the residual localized caseation may remain unchanged for a Imaging Appearance: long period or permanently, it is potentially dangerous because it may Coccidioidomycosis typically produces small pulmonary consolidations in the periphery of the break down at any time and lead to dissemination of the disease. parenchyma that resemble those in Extensive Pneumonia. Imaging Appearance: Histoplasmosis. Diffuse calcifications in lungs produce snowball pattern. Tuberculomas appear as single or multiple pulmonary nodules, 1 - 3 cm in diameter. Coccidioidomycosis. Posteroanterior and Lateral Views demonstrate consolidation caused by They occur in any part of the lung but most common in the Periphery and in Upper Lobes. fungus in the left lung. Central Nidus of Calcification (detectable only in Tomograms) is strongly suggestive of the lesion representing a tuberculoma However, the lack of calcification is of no diagnostic value. Calcified Tuberculoma. Large soft tissue mass in left lung contains dense central calcification. Pulmonary Mycosis Means Fungal Infection of the Lung. Histoplasmosis, caused by the fungus Histoplasma Capsulatum, is a common disease that often produces a radiographic appearance simulating that of Tuberculosis. The primary form of Histoplasmosis is usually relatively Benign and often passes unnoticed. Chronic Obstructive Pulmonary Disease Asthma Bronchitis Occurs when the Bronchioles go into Spasm, causing Decreased Airflow and sometimes Emphysema Obstruction of the Airway. Asthma Early in the course of the disease, chest radiographs obtained between acute episodes Bronchiectasis demonstrate no abnormalities. During an acute asthmatic attack, bronchial narrowing and Advanced bronchiectasis difficulty in expiration lead to an increased volume of the hyperlucent lungs with flattening of the hemidiaphragms and increase in the retrosternal air space. Chronic Bronchitis Asthma, unlike in emphysema, Pulmonary Vascular Markings Excessive Tracheobronchial Mucus Production, leading to Obstruction of Small Airways. remain normal. In patients with Chronic Asthma, especially those with a history of repeated episodes of superinfection, thickening Imaging Appearance: of bronchial walls can produce prominence of interstitial markings and the “dirty chest” appearance. Approximately half of patients with chronic bronchial disease demonstrate no changes on Recurrent pulmonary infections led to development of Diffuse chest radiographs. The most common radiographic abnormality in chronic bronchitis is a Pulmonary Fibrosis & prominent interstitial markings in lungs. generalized increase in bronchovascular markings (dirty chest), especially in lower lung. Thickening of bronchial walls and peribronchial inflammation cause parallel or slightly tapered Bronchiectasis tubular line shadows (Tram Lines) or appear as thickening of bronchial shadows. Refers to Permanent Abnormal Dilation of one or more large bronchi as a result of destruction Emphysema of the Elastic and Muscular Components of the Bronchial Wall. Distention of Distal Air Spaces as a result of the Destruction of Alveolar Walls and the Imaging Appearance: obstruction of Small Airways. Plain Chest Radiographs may show coarseness and loss of definition of interstitial markings Imaging Appearance: caused by Peribronchial Fibrosis and Retained Secretions. In more advanced disease, Oval or Circular Cystic Spaces develop. These cystic dilations The major radiographic signs of emphysema are related to Pulmonary Overinflation, can be up to 2 cm in diameter and often contain air-fluid levels. In very severe cases, coarse alterations in the Pulmonary Vasculature, and Bullae Formation. interstitial fibrosis surrounding local areas of dilation can produce a Honeycomb Pattern. The hallmark of pulmonary overinflation is flattening of the Domes of the Diaphragm. Another important sign seen on Lateral Chest Radiographs is an increase in the size and Chronic Bronchiectasis. Severe coarsening of interstitial markings involve bases & right upper lobe. lucency of the Retrosternal Air Space, the distance between the posterior side of the sternum Oval and circular cystic spaces, produce a honeycomb-like pattern, best seen in the right upper lobe. and the anterior wall of the ascending aorta. Giant Emphysematous Bulla. Air-containing mass fills most of the Left Hemithorax. Silicosis Comparison of chest X-ray obtained 12 years prior and on admission. Chest X-ray imaging revealed pleural thickening 12 years prior (A). Current chest X-ray showed a few nodular opacities with lung The most common and best-known work-related lung disease. nodules and pleural thickening (B). The red arrows indicate lung nodules. The inhalation of high concentrations of Silicon Dioxide (Crystalline Silica) primarily affects workers engaged in mining, foundry work, and sandblasting. Quartz Dust, the most frequent cause of inhalation silicosis, is the second most common element in the earth’s crust. The lung reacts to the silica by producing a fibroblast-stimulating factor that results in extensive Fibrosis. Imaging Appearance: Classic radiographic pattern in Silicosis consists of multiple nodular shadows scattered throughout the lungs. These nodules, fairly well circumscribed and of uniform density, may become calcified. Solitary Pulmonary Nodule Silicosis. Calcification in miliary nodules is scattered throughout both lungs. Asymptomatic Solitary Pulmonary Nodule seen as an incidental finding on a screening chest radiograph poses a diagnostic dilemma because it could represent a Benign Granuloma or Neoplastic Process, a Primary Bronchogenic Carcinoma, or a Solitary Metastasis. In persons younger than 30 years, a small, round, sharply defined solitary pulmonary nodule is associated with a minimal risk of cancer. Imaging Appearance: The presence of central dense or popcorn calcification is diagnostic of a Benign Process, and a low-kVp technique may be required to Asbestosis demonstrate the calcification to best advantage. Benign Solitary Pulmonary Nodule (Tuberculoma). Note central May develop in improperly protected workers engaged in manufacturing asbestos products, calcification characteristic of this benign lesion (smooth surface). in handling building materials, or in working with insulation composed of asbestos. In the 1980s, many public buildings with fireproof plasterboard and ceiling panels containing Bronchial Adenoma asbestos, such as schools, were reconstructed, and the asbestos was removed to prevent Low-Grade Malignancy Neoplasm constitute 1% of Bronchial Neoplasms excessive public exposure to this particulate. Asbestos Particles occur as long, thin fibers that They are common in men and women. Bronchial Adenomas appear in a cause little dust but produce major fibrosis in the lung. younger age group than Bronchogenic Carcinoma. Hemoptysis and Imaging Appearance: Recurring Pneumonia are the most common symptoms. They arise in the Glandular Structures in Bronchi in which Malignant Neoplasms develop. Radiographic hallmark of Asbestosis is involvement of Pleura. Initially, pleural thickening 80% of Bronchial Adenomas occur centrally in Major or Segmental appears as linear plaques of opacification, which are most often along the lower chest wall Bronchi and cause Obstruction. Most common radiographic findings are Peripheral and diaphragm. Calcification of the pleural plaques is virtually pathognomonic of asbestosis, Atelectasis and Pneumonitis due to Bronchial Obstruction. This obstruction characteristically especially when the calcified plaques appear in the form of thin, curvilinear densities produces a homogeneous increase in density corresponding exactly to a lobe or one or more conforming to the upper surfaces of the diaphragm bilaterally. segments, usually with a substantial loss of volume. In the lungs, round or irregular opacities produce a combined linear and nodular pattern that may obscure the heart border, producing the so-called Shaggy Heart.  If large enough, a Central Bronchial Adenoma causing Peripheral Atelectasis and Pneumonia may be identifiable as a discrete, lobulated, soft tissue mass. A tumor too small to obstruct the lumen may not be detectable on the chest radiograph. Peripheral Bronchial Adenoma. Nonspecific Solitary Pulmonary Nodule at the Left Base. Brochogenic Carcinoma Closely linked to Smoking and to the inhalation of cancer-causing agents (Carcinogens), such as Air Pollution, Exhaust Gases, and Industrial Fumes. Major Form: Solitary Pulmonary Nodule within the Lung Parenchyma. Squamous Carcinoma: most common type of lung cancer which typically arises in the Major Central Bronchi and causes Gradual Narrowing of the Bronchial Lumen. Adenocarcinomas: arise in the Periphery of the Lung rather than in larger central bronchi. Bronchiolar (Alveolar Cell) Carcinoma: least common type of lung tumor. Non-small cell lung cancers (3 types of lung cancer listed) make up 80% of all lung cancers. Small Cell (Oat Cell) Carcinomas: cause bulky enlargement of Hilar Lymph Nodes, often bilaterally, and are responsible for the remaining 20% of Primary Pulmonary Malignancies. Pulmonary Metastases Hematogenous Metastases. Multiple, well-circumscribed nodules scattered diffusely throughout.