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Back to Basics Radiology 2010 Back to Basics Radiology 2010 Rebecca Peterson Department of Radiology University of Ottawa.

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Presentation on theme: "Back to Basics Radiology 2010 Back to Basics Radiology 2010 Rebecca Peterson Department of Radiology University of Ottawa."— Presentation transcript:

1 Back to Basics Radiology 2010 Back to Basics Radiology 2010 Rebecca Peterson Department of Radiology University of Ottawa

2 Routine Technique: PA and Lateral

3 Normal Chest – PA and Lateral

4 PA Chest SVC Azygous Rt Hilum Rt Atrium Trachea Aortic arch Lt Pulm Artery Lt Mainstem bronchus Lt Ventricle Lt Diaphragm Rt Diaphragm

5 Lateral Chest Trachea Rt Pulm Artery Rt Ventricle Rt Diaphragm Aortic Arch Lt Pulm Artery Lt upper lobe bronchus Lt atrium Lt Ventricle Lt Diaphragm

6 Consolidation Without volume loss Without volume loss Pneumonia, Pulmonary edema, Hemorrhage Pneumonia, Pulmonary edema, Hemorrhage With volume loss With volume loss “Atelectasis” or “Collapse” “Atelectasis” or “Collapse”

7 Consolidation Without Volume Loss

8 Consolidation With Volume Loss

9 Consolidation Means “solid lung” Means “solid lung” Characteristics: Characteristics: Increased density Increased density Acinar shadow Acinar shadow Silhouette sign Silhouette sign Air bronchogram Air bronchogram

10 Consolidation and Air Bronchogram CT Scan

11 Consolidation, Air Bronchogram and Silouhette Sign PNEUMONIA

12 Consolidation Without Volume Loss Airspace Disease

13 LLL Pneumonia NORMAL LLL PNEUMONIA Loss of diaphragm Sharp interface Consolidation

14 LLL Pneumonia NORMALLLL PNEUMONIA Loss of lt diaphragm Sharp interface consolidation

15 Normal RML Consolidation Loss of heart border

16 Normal RML Consolidation Consolidation

17 RLL Pneumonia PA ViewLateral

18 Lingular Pneumonia PA View Lateral

19 Right Lower Lobe Pneumonia

20 LLL Pneumonia

21 Causes of Airspace Disease Pneumonia Pneumonia Hemorrhage Hemorrhage Pulmonary Edema Pulmonary Edema Neoplasm Neoplasm Other Other

22 Consolidation With Volume Loss Atelectasis or Collapse

23 Passive Atelectasis

24 Endobronchial Lesion

25 Signs of Volume Loss Direct Signs: Direct Signs: Movement of a fissure Indirect Signs: Indirect Signs: Elevated diaphragm Elevated diaphragm Tracheal shift Tracheal shift Mediastinal shift Mediastinal shift Elevated or lowered mainstem bronchus Elevated or lowered mainstem bronchus Movement of hilum Movement of hilum Fewer vessels in aerated lung Fewer vessels in aerated lung

26 Right upper lobe collapse Movement of the Fissures, a DIRECT sign of volume loss Elevation of diaphragm Tracheal shift Hilum displaced

27 RLL Collapse Fissure displaced Hilum pulled down Tracheal shift Collapsed lung

28 Atelectasis LLL Normal Portable Chest X-ray No diaphragm Diaphragm reappears

29 LLL Atelectasis

30 Complete collapse Tracheal shift Bronchus amputated Diaphragm

31 Pleural Effusion

32 Pleural Diseases Pneumothorax and Pleural Effusions

33 Pneumothorax

34 Tension Pneumothorax INSPIRATORY VIEWEXPIRATORY VIEW

35 Pneumothorax CT SCAN

36 Pleural Effusion Meniscus sign

37 Infrapulmonary Effusion EFFUSIONNORMAL Stomach

38 Pleural Effusion DECUBITUS VIEW

39 Large Right Pleural Effusion PA VIEW CT SCAN Chest X-ray

40 Pulmonary Edema Interstitial and Airspace Edema

41 Interstitial Pulmonary Edema

42 Vascular Indistinctness Normal Interstitial Edema

43 Vascular Indistinctness NormalAbnormal

44 Interstitial Pulmonary Edema Kerley “B” Lines Kerley “B” Lines Peribronchial cuffing Peribronchial cuffing Hila look larger Hila look larger Vessels are ill-defined Vessels are ill-defined Upper lobe vessels are larger Upper lobe vessels are larger Fluid in fissures Fluid in fissures Small pleural effusions Small pleural effusions

45 Interstitial Pulmonary Edema NORMALINTERSTITIAL EDEMA

46 Minimal Changes Lateral View NORMALINTERSTITIAL EDEMA

47 Interstitial Edema PA View Lateral

48 Pulmonary Edema

49 Interstitial Edema Kerley “B”s

50 Kerley “B” Lines CT SCAN

51 Airspace Edema

52 Airspace and Interstitial Edema Normal Pulm Edema

53 Airspace Edema Patient Supine

54 Airspace Edema

55 Consolidation is bilateral Consolidation is bilateral Consolidation is symmetrical Consolidation is symmetrical Consolidation is “gravity dependent” Consolidation is “gravity dependent” Consolidation changes day to day Consolidation changes day to day

56 Chronic Obstructive Lung Disease

57 Emphysema

58 Characteristics of Emphysema Increased Lung Volume Increased Lung Volume Flattened Diaphragms Flattened Diaphragms Increase in Retrosternal Airspace Increase in Retrosternal Airspace Barrel chest Barrel chest Small Vessels Small Vessels Small, narrow cardiac silouhette Small, narrow cardiac silouhette

59 Emphysema CT Scan

60 Emphysema - CT Black holes Bulla

61 Bronchiectasis

62 Bronchiectasis Signet Ring Sign

63 Pneumonia

64 Radiological Patterns of Pneumonia Lobar pneumonia Lobar pneumonia Bronchopneumonia Bronchopneumonia Interstitial pneumonia Interstitial pneumonia

65 Lobar Pneumonia Involves single area, usually a lobe Involves single area, usually a lobe Bloodborn pathogen Bloodborn pathogen Unilateral Unilateral Commonest pathogen:Strept Pneumonia Commonest pathogen:Strept Pneumonia RLL PNEUMONIA

66 LLL Pneumonia

67 Right Lower Lobe Pneumonia

68 Lobar Pneumonia

69 Bronchopneumonia Central bronchi involved Central bronchi involved Patchy bilateral disease Patchy bilateral disease Asymetrical Asymetrical Peribronchial Cuffing Peribronchial Cuffing Commonest pathogen: Staph aureus Commonest pathogen: Staph aureus

70 Bronchopneumonia

71 Bronchopneumonia CT SCAN

72 Interstitial Pneumonia Involves interstitial space, not airways Involves interstitial space, not airways “ground glass” appearance “ground glass” appearance Bilateral, symetrical Bilateral, symetrical If severe, involves airspace If severe, involves airspace Commonest pathogen: PCP, mycoplasma Commonest pathogen: PCP, mycoplasma

73 Interstitial Pneumonia NORMAL INTERSTITIAL PNEUMONIA

74 Interstitial Pneumonia NormalAbnormal

75 Interstitial Pneumonia

76 ABDOMEN Soft Tissue Findings

77 Normal Abdomen Psoas muscle Kidney LiverSpleen Outlined by fat

78 Hepatosplenomegally NORMAL ABNORMAL

79 Splenomegally

80 Pancreatitis NORMAL SUPINE ABNORMAL SUPINE Psoas muscle

81 Pancreatitis NORMAL PANCREATITIS CT Scan Psoas muscle

82 Properitoneal Fat Line Normal Abdomen Normal fat line Large bowel

83 Ascites Paracolic gutter Separation of bowel and fat line by fluid

84 Ascites CT SCAN UPPER ABDOMEN CT SCAN PELVIS Fluid

85 ABDOMEN Calcifications

86 Renal Calculi Renal Stones

87 Renal Calculus

88 Renal Calculus on Intervenous Pyelogram DELAYED EXCRETION OF CONTRAST ON IVP Normal

89 Renal Calculus on Intervenous Pyelogram (IVP) DILATED COLLECTING SYSTEM POST VOID Obstructed Ureter

90 Renal Calculus on CT Scan Dilated Renal Pelvis Renal Calculus Bladder

91 Stone Pelvis in Distal Ureter

92 Abdominal Aortic Aneurysm

93

94 Ruptured AAA Aorta Blood

95 Gallstones SupineUpright

96 Gallstone ULTRASOUND Stone Acoustic shadow

97 Acoustic Shadowing on Ultrasound CALCIFIED GALLSTONE SOFT TISSUE POLYP

98 Appendicolith SupineUpright

99 ABDOMEN Bowel Gas Distribution

100 Normal Small Bowel SMALL BOWEL FOLLOW-THROUGH

101 Normal Large Bowel BARIUM IN LARGE BOWEL

102 Large Bowel Constipation Fecal Impaction Rectum

103 Generalized Ileus Supine Decubitus Dilated large and small bowel No air/fluid levels

104 Localized Ileus Supine Upright

105 Small Bowel Obstruction SUPINE VIEW UPRIGHT VIEW Air-fluid levels

106 Small Bowel Obstruction NORMAL DILATED SMALL BOWEL

107 Small Bowel Obstruction SUPINE VIEWUPRIGHT VIEW

108 SUPINE VIEW

109 Free Air and SBO UPRIGHT VIEWDECUBITUS VIEW

110 Free air and fluid CT SCAN

111 Free Air Can see both sides of bowel wall (Rigler’s Sign) Normal

112 Free Air SupineDecubitus

113 Large Bowel Obstruction SUPINE VIEWUPRIGHT VIEW

114 Sigmoid Volvulus SUPINE VIEW – DISTENDED LOOP ARISING OUT OF PELVIS

115 Sigmoid Volvulus UPRIGHT VIEW DECUBITUS VIEW

116 Volvulus CECAL VOLVULUS Associated with SBO SIGMOID VOLVULUS Associated with LBO

117 Thumbprinting SUPINE VIEW BARIUM ENEMA

118 Causes of Thumbprinting Enteritis or colitis Enteritis or colitis Infarction Infarction Hemorrhage into bowel wall Hemorrhage into bowel wall SUPINE VIEW

119 Bowel Infarction SUPINE VIEW Air in Bowel Wall Air in Portal Vein

120 Bowel Infarction CT SCAN Air in Bowel Wall Air in Portal Vein

121 Thank You!


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