Lesson-1_2 (Radiological Examination of the Chest) 2.pdf

RADIOLOGICAL EXAMINATION OF THE CHEST DR. ÇAGATAY ÇİMŞİT Learning Objectives u Evaluate the quality of a CXR. u Learn basic radiographic anatomy on a CXR. u Be aware of the «hidden areas». u Learn CXR imaging findings in common and emergency conditions. Which methods do we use?...

RADIOLOGICAL EXAMINATION OF THE CHEST DR. ÇAGATAY ÇİMŞİT Learning Objectives u Evaluate the quality of a CXR. u Learn basic radiographic anatomy on a CXR. u Be aware of the «hidden areas». u Learn CXR imaging findings in common and emergency conditions. Which methods do we use? u Chext X-ray u Computerised Tomography (CT) u and sometimes MR or US u very rarely Angiography Chest X-ray u Two projections u PA u Lateral PA AP u Lateral projection is taken with the left side on the film side. u Magnification effect is reduced. u Heart will look smaller u Closer to the film (remember the candle ) Lateral decubitus position u Detects pleural effusion u Notso frequently used anymore  which of the below makes a good image ? Is it a good image? u Full inspiration u Penetration u Dorsal vertebra barely seen through the heart, vessels are visible u Rotation u Clavicles u Superposition a good x ray is taken on full expiration false u Scapulae Exposure  Any Rotation? 23 Anatomy Trachea / Bronchi Trachea to the right of the aortic arch. -Large airways are radiolucent (black) - Trachea at the midline The Hilum: - Main pulmonary bronchi - Main pulmonary arteries Lung Zones: Chest X Rays are interpreted in zones. Not lobes !!might be a true or false Pleura Only visible in pathologic conditions. Lung lobes / Fissures - Both lungs have oblique fissures - Right lung has a horizontal fissure Lung lobes / Fissures - Oblique fissure Accessory Fissures Azygos Fissure&Lobe Most common accessory fissure(%1-2) Costophrenic Angle & Recess Between the lateral chest wall and diaphragma. Costophrenic angles and recesses They should be sharp and clearly visible. Diaphragm -Right higher than left -Stomach air below left diaphgram 23  Heart 23  Heart Cardiothoracic Ratio Lower than > CT Pneumonia Air Bronchogram Tuberculosis u Primary and Reactivation (Post-primary) u Features overlap u Differentiation not always possible. u Primary u Initial infection u Mostly in children but rate increases in adults (25-35% of all adult cases) u CXR normal in 15% u Early cases Primary Tuberculosis - Parenchyma u Dense consolidation in any lobe. u Similar appearance to bacterial pneumonia u LAP, lack of response to antibiotics u In 2/3 parenchymal focus resolves w/out sequela. u May take up to 2 years. u In 1/3 there is scarring which may calcify in 15%. Primary Tuberculosis - Parenchyma Primary Tuberculosis - Lymphadenopathy u Seen in 96% of children and 43% of adult cases u Can be the only finding u especially in children. u Calcified LAP+ Ghon focus = Ranke complex Primary Tuberculosis u Miliary Disease u 1-7% of all forms of TBC. u Elderly, infants, immunecompromised patients. u Evenly distributed 2-3 mm sized nodules Primary Tuberculosis Miliary TBC Postprimary Tuberculosis u Primarily a disease of adolescence and adulthood. u Re-infection or reactivation. u Progressive u (as opposed to primary which is usually self limiting). u Cavitation u Causes hematogenous spread Postprimary Endobronchial Tuberculosis Tree-in-bud pattern  COPD u Resistance to expiratory airflow u CXR highly specific. u Hyper-expanded lungs with flattening of both hemi-diaphragms u ‘Barrel-shaped chest’ Foreign Body Aspiration u Symptoms: Asymptomatic > Choking u CXR: u Foreign body may or may not be seen. u Loss of volume u segmental collapse u Hyperinflation (Valve mechanism) u If suspicion is high >> Expiration CXR u CT or bronchoscopy. Foreign Body Aspiration Solitary Pulmonary Nodule u A nodule unchanged for 2 years is most likely benign u Complete or central calcification is likely benign u Growth, change in appearance u Biopsy, PET, surgery A few words on CT u Gold standard in thoracic imaging u Detailed anatomy u Cross sectional images u Higher dose !! u Indications u Further analysis of anomalies seen on Chest X-ray u Pulmonary Embolism u Nodule follow-up u Oncology u Treatment decisions Başarılar..