Radiological Examination of the Chest PDF

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..