Lesson-1_2 (Radiological Examination of the Chest).pdf
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Eastern Mediterranean University
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RADIOLOGICAL EXAMINATION OF THE CHEST DR. ÇAGATAY ÇİMŞİT Learning Objectives Evaluate the quality of a CXR. Learn basic radiographic anatomy on a CXR. Be aware of the «hidden areas». Learn CXR imaging findings in common and emergency conditions. Which methods do we use? Chext X-ray Compu...
RADIOLOGICAL EXAMINATION OF THE CHEST DR. ÇAGATAY ÇİMŞİT Learning Objectives Evaluate the quality of a CXR. Learn basic radiographic anatomy on a CXR. Be aware of the «hidden areas». Learn CXR imaging findings in common and emergency conditions. Which methods do we use? Chext X-ray Computerised Tomography (CT) and sometimes MR or US very rarely Angiography Chest X-ray Two projections PA Lateral PA AP Lateral projection is taken with the left side on the film side. Magnification effect Heart is reduced. will look smaller Closer to the film (remember the candle ☺) Lateral decubitus position Detects pleural effusion Not so frequently used anymore Is it a good image? Full inspiration Penetration Dorsal vertebra barely seen through the heart, vessels are visible Rotation Clavicles Superposition 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 !! 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 Primary and Reactivation (Post-primary) Features overlap Differentiation not always possible. Primary Initial infection Mostly in children but rate increases in adults (25-35% of all adult cases) CXR normal in 15% Early cases Primary Tuberculosis - Parenchyma Dense consolidation in any lobe. Similar appearance to LAP, lack of response to antibiotics In 2/3 parenchymal focus resolves w/out sequela. May bacterial pneumonia take up to 2 years. In 1/3 there is scarring which may calcify in 15%. Primary Tuberculosis - Parenchyma Primary Tuberculosis - Lymphadenopathy Seen in 96% of children and 43% of adult cases Can be the only finding especially in children. Calcified LAP + Ghon focus = Ranke complex Primary Tuberculosis Miliary Disease 1-7% of all forms of TBC. Elderly, Evenly infants, immunecompromised patients. distributed 2-3 mm sized nodules Primary Tuberculosis Miliary TBC Postprimary Tuberculosis Primarily a disease of adolescence and adulthood. Re-infection or reactivation. Progressive (as opposed to primary which is usually self limiting). Cavitation Causes hematogenous spread Postprimary Endobronchial Tuberculosis Tree-in-bud pattern COPD Resistance to expiratory airflow CXR highly specific. Hyper-expanded lungs with flattening of both hemi-diaphragms ‘Barrel-shaped chest’ Foreign Body Aspiration Symptoms: Asymptomatic > Choking CXR: Foreign body Loss may or may not be seen. of volume segmental collapse Hyperinflation (Valve mechanism) If suspicion is high >> Expiration CXR CT or bronchoscopy. Foreign Body Aspiration Solitary Pulmonary Nodule A nodule unchanged for 2 years is most likely benign Complete or central calcification is likely benign Growth, change in appearance Biopsy, PET, surgery A few words on CT Gold standard in thoracic imaging Detailed anatomy Cross sectional images Higher dose !! Indications Further analysis of anomalies seen on Chest X-ray Pulmonary Embolism Nodule follow-up Oncology Treatment decisions Başarılar..
