Download presentation
Presentation is loading. Please wait.
1
Chest Radiology Plain Film and CT- Beyond the Basics
John W. Renner, M.S., M.D. Clinical Professor of Radiology UCSD Medical Center Brendan Kidder, M.S. IV UCSD School of Medicine
2
Chest Radiology Goals Review the basics of Chest Imaging
Examine the modalities of the Chest “Plain Film” and Computed Tomography Review basic disease entities and their imaging evaluation Allow Hospitalists to better understand “How to talk to a radiologist in a hospital setting if you must!”
3
Chest Radiology Normal Radiographic Anatomy
Normal frontal and lateral views Cross-sectional anatomy Symmetry and asymmetry Interfaces, lines and junction stripes Chest compartments Densities
4
Normal Chest
5
Pre-Vascular Space
6
Anterior Junction Line
7
Right Paratracheal Stripe
8
Carina
9
Basal Segmental Anatomy
10
Main Pulmonary Artery
11
Aortic Valve
12
Inferior Pulmonary Veins
13
Left Coronary Artery
14
Right Coronary Artery
15
Secondary pulmonary lobule
Webb, R : Radiology 2006
16
Chest Radiology Patterns of Disease
Honeycombing Cystic lesions Nodules Ground-glass opacities Mosaic pattern Tree-in-bud Interlobular septal thickening
17
Honeycombing Chest X-Ray .com
18
Centrilobular Emphysema
Webb, R. Radiology 2006
19
Centrilobular Emphysema
20
Centrilobular Emphysema
Webb, R. Radiology 2006
21
Centrilobular Nodules
Webb, R. Radiology 2006
22
Sarcoidosis Chest X-Ray. com
23
Sarcoidosis Webb, R. Radiology 2006
24
Hypersensitivity Pneumonitis
Webb, R. : Radiology 2006
25
Ground-Glass Opacities
Chest X-Ray. com
26
Pulmonary Edema
27
Bronchopneumonia
28
Mosaic Perfusion Chest X-Ray. com
29
Mosaic Perfusion
30
Mosaic Perfusion
31
Transplant Lung
32
Transplant Lung
33
Tree-in-Bud
34
Tree-in-Bud Webb, R. : Radiology 2006
35
Interlobular Septal Thickening
Webb, R. Radiology 2006
36
Interlobular Septal Thickening
Webb, R. Radiology 2006
37
Lymphangitic Carcinomatosis
Webb, R. Radiology 2006
38
Lymphangitic Carcinomatosis
39
Bronchiectasis Chest X-Ray. com
40
Air Trapping Chest X-Ray. com
41
Head Cheese Sign Webb, R. : Radiology 2006
42
Crazy Paving Pattern
43
Idiopathic Pulmonary Hemosiderosis
44
Idiopathic Pulmonary Hemosiderosis
45
Idiopathic Pulmonary Hemosiderosis
46
Aspergilomas
47
Bronchogenic Cyst
48
Interstitial Pulmonary Fibrosis
49
Interstitial Pulmonary Fibrosis
50
Interstitial Pulmonary Fibrosis
51
Neurofibromatosis
52
Neurofibromatosis
53
Neurofibromatosis
54
Chest Radiography Congenital Pulmonary Abnormalities Tracheal bronchus
Pulmonary arteriovenous malformation Partial anomalous pulmonary venous return Bronchopulmonary sequestration Congenital lobar emphysema and cysts
55
Right Upper Lobe Bronchus
56
Tracheal Bronchus
57
Hypogenetic Lung
58
Pulmonary Sequestration
59
Pulmonary Sequestration
60
Thrombosed Aneurysm
61
Pulmonary Sequestration
62
Pulmonary Artery Sling
63
Pulmonary Artery Sling
64
Hilar Lymphadenopathy
65
Pneumocystis Pneumonia
66
Pneumocystis Pneumonia
67
Pneumocystis Pneumonia
68
Pulmonary Tuberculosis
69
Chest Radiology Critical Care Radiography
Pulmonary Embolism Chest radiograph Normal vs. abnormal Westermark’s sign Enlargement of the central pulmonary arteries Hampton’s hump-pulmonary infarction Atelectasis, consolidation and elevation of the ispilateral hemidiaphragm Pleural effusion
70
Chest Radiography Critical Care Radiography
Pulmonary Thromboembolism-Catheter Angiogram Pulmonary angiography-former “gold standard” Invasive with known morbidity-mortality High specificity—approaching 100% Right heart catheterization-useful data Negative exam excludes the diagnosis Allows for treatment— Thrombolytics IVC filter placement
71
Chest Radiology Critical Care Radiography
Pulmonary Thromboembolism-CTA High sensitivity (>90%), specificity (>95%) CTA limited in sub-segmental arteries Evaluation of upstream findings-right heart strain CT findings Intra-luminal filling defect or Vessel cutoff Mosaic perfusion
72
Chest Radiology Critical Care Radiography
Pulmonary Thromboembolism-CTA CT Pulmonary Angiogram Requires MDCT, helical scan Requires iodinated contrast—high concentration of iodine, non-ionic or iso-osmolar contrast agents Requires apnea during scan Requires normal renal function Relatively high radiation dose!
73
Massive Thromboembolism
74
Massive Thromboembolism
75
Massive Thromboembolism
76
Pulmonary Thromboembolism
77
Chest Radiology Chronic Thromboembolism Organizing thromboemboli
Adherent clots to vessel wall Lack of recanalization of a vessel Webs, bands Abrupt caliber change Pulmonary arterial hypertension Mosaic perfusion
78
Type A Aortic Dissection
79
Primary Pulmonary Hypertension
80
Chest Radiology Pulmonary Arterial Hypertension
Dilation of central pulmonary arteries Rapid tapering of peripheral pulmonary arteries Dilation of right interlobar pulmonary artery to > 18 mm on PA chest view Dilation of left pulmonary artery to > 18 mm on lateral chest view Dilation of RA, RV
81
Primary Pulmonary Arterial Hypertension
82
Primary Pulmonary Artery Hypertension
83
Tricuspid Regurgitation
84
Chest Radiology Idiopathic Interstitial Pneumonias
Idiopathic Pulmonary Fibrosis-IPF Non-specific Interstitial Pneumonia-NSIP Cryptogenic Organizing Pneumonia-COP Respiratory Bronchiolitis-associated Interstitial Lung Disease-RB-ILD Desquamative Interstitial Pneumonia Lymphoid Interstitial Pneumonia-LIP Acute Interstitial Pneumonia-AIP
85
Idiopathic Pulmonary Fibrosis
86
Idiopathic Pulmonary Fibrosis
87
Non-specific Interstitial Pneumonia
88
IPF vs. NSIP
89
Cryptogenic Organizing Pneumonia
90
Respiratory Bronchiolitis-ILD
91
Desquamative Interstitial Pneumonia
92
Lymphoid Interstitial Pneumonia
93
Organizing Pneumonia
94
ILS plus GGO
95
Chest Radiology Critical Care Radiography
CXR may be done on a daily basis Evaluate “life-support” lines, tubes catheters, devices, monitoring equipment Evaluate changes in cardiopulmonary status Determine why a patient has undergone “clinical deterioration”— Hypoxia Hypotension Sepsis
96
Chest Radiology Critical Care Radiography
Pulmonary Edema Hydrostatic Increased capillary permeability Diffuse alveolar damage –(DAD) Differential diagnosis Atelectasis Pneumonia Aspiration Pulmonary embolism and hemorrhage
97
Chest Radiology Critical Care Radiography
Hydrostatic Pulmonary Edema Pulmonary venous hypertension and vascular redistribution Interstitial pulmonary edema Alveolar pulmonary edema Cardiomegaly Pleural effusion Vascular pedicle
98
Chest Radiology Critical Care Radiography
Pulmonary Edema Interstitial pulmonary edema Kerley A, B and C lines Interlobular septal thickening Subpleural edema along fissures,pleura Peribronchial cuffing Perihilar haze Interstitial veiling Ground-glass opacities
99
Interstitial Pulmonary Edema
100
Chest Radiology Critical Care Radiography
Alveolar Edema Air-space consolidation Acinar or air-space ill-defined nodules Peri-hilar or “batwing” distribution Peripheral sparing Rapid clearance with theraphy Occasionally a clinical lag in onset and clearance
101
Chest Radiology Critical Care Radiography
Increased Permeability Edema or ARDS and DAD Alveolar-capillary leak, normal left atrial pressure Multiple etiologies Occurs in stages Latent period Air-space consolidation Homogeneous confluence and air bronchogram Decreased lung volumes and pulmonary compliance compliance Slow clearance Organizing chronic changes--fibrosis
102
Chest Radiology Critical Care Radiography
Barotrauma Mechanical ventilation and increased airway resistance, high ventilatory pressures, CPAP and others Extra-alveolar air Pulmonary interstitial emphysema Pneumomediastinum Pneumothorax Subcutaneous emphysema
103
Chest Radiology Cardiac
Cardiac CT Calcium scoring Coronary artery angiography-CTA Congenital Heart Disease Anatomical applications Triple rule-out
104
LAD Stenosis
105
CT Coronary Angiography
106
LAD Stenosis
107
Calcium LAD
108
3D Workstation
109
CTA Coronary Artery
110
Right Coronary Artery
111
LAD-Soft Plaque
112
Multiplanar Reconstruction
113
Anomalous Left Coronary Artery
114
Consensus A negative test may be consistent with a low risk of a cardiovascular event in the next two to five years A high calcium score may be consistent with a moderate to high risk of a cardiovascular event within the next two to five years
115
Chest Radiology Airways Disease Trachea
Bronchiectasis-cylindrical, varicose, cystic Cystic Fibrosis ABPA and asthma Chronic bronchitis Bronchiolitis
116
Chest Radiology Emphysema Centrilobular emphysema Panlobular emphysema
Paraseptal emphysema Bullous emphysema Saber-sheath trachea
117
Chest Radiology Pneumonia
Lobar pneumonia Peripheral opacity to homogenous consolidation Bronchopneumonia Airway mucosa to alveoli Interstitial pneumonia Reticular opacities to confluent infection Lung abscess Cavitation
118
Chest Radiology Tuberculosis
Primary tuberculosis Post-primary tuberculosis HIV-associated tuberculosis
119
Chest Radiology Lung Cancer
Early Detection National Lung Cancer Screening Trial Chest x-ray vs. low-dose CT International Early Lung Cancer Action Project—I-ELCAP Low-dose screening CT 92% survival rate, stage I NEJM 355: , Oct. 26, 2006
120
Chest Radiography Cardiac
Cardiac MRI Myocardial function Myocardial viability Valvular heart disease Systolic heart failure Diastolic heart failure Myocarditis Pericardial diseases
121
Chest Radiology Thank you John W. Renner, M.S., M.D.
Clinical Professor of Radiology Department of Radiology UCSD Medical Center San Diego, California
Similar presentations
