1. RADIOLOGY - IMAGING OF THE THORAX

2. METHODS OF EXAMINATION
THE CHEST
 METHODS OF EXAMINATION
Radiography
Standard examination :
- PA + lateral projection;
- tube-film distance – 1,5 m to minimize divergent distorsion
and magnification;
- full inspiration.
Apical lordotic view –
- is used to see diseases in the pulmonary apices, which may
be obscured by the clavicle and the first rib;
- AP wiew with the patient leaning backward on the cassette
holder.
Supine radiographs – intensive care units.

3. DIGITAL RADIOGRAPHY

4. METHODS OF EXAMINATION
THE CHEST
 METHODS OF EXAMINATION
Fluoroscopy
–dynamic study of the cardiovascular system,
diafragmatic motion. Disadvantage: high radiation dose.
Bronchography
– the study of the bronchial tree by means of the
introduction of opaque material into the bronchi.
Replaced by CT, fiberoptic bronchoscopy, brush biopsy,
percutaneous biopsy
Tomography
– it is possible to examine a single layer of tissue and to
blur the tissues above and below the level by motion
(the tube and the film move in opposite directions).
- replaced by CT.

5. THE CHEST METHODS OF EXAMINATION Fluoroscopy
1933
2000

6. THE CHEST METHODS OF EXAMINATION Tomography
Tub Rx
Caseta/film

7. THE CHEST METHODS OF EXAMINATION
Computed tomography – indications for the lung:
- Evaluation and staging of primary pulmonary neoplasms
- Detection of metastasis from non-pulmonary primary tumors.
Characterization of solitary pulmonary nodules as benign or malignant
Characterization of focal and diffuse lung disease for
diagnosis.

8. METHODS OF EXAMINATION
THE CHEST
 METHODS OF EXAMINATION
Computed tomography
Indications for the mediastinum:
- Causes of mediastinal widening
- Staging of tumors that spread to the mediastinum
- Characterization of mediastinal masses – cysts, solid,
vascular, fat.
Other indications:
Pleura plaques, masses, loculated fluid, occult
calcification, chest wall masses.
High-resolution CT – evaluation of interstitial lung
disease, bronchiectasis, emphysema, cystic lung disease.

9. THE CHEST METHODS OF EXAMINATION- Computed tomografy
1975
1995

10. THE CHEST METHODS OF EXAMINATION
Ultrasonography
– fluid can be localized and differentiated from solid pleural masses;
mediastinal lesions in contact with the chest wall
lesions near the diafragm.

11. METHODS OF EXAMINATION
THE CHEST
 METHODS OF EXAMINATION
Magnetic resonance imaging – indications:
dissection of the aorta, aneurysm
congenital and acquired heart conditions
intracardiac and paracardiac masses.
pericardial diseases.
brachial plexopathy.
diafragm and peridiafragmatic processes.
chest-wall lesions.
breast implants and breast masses.
Extention of the posterior mediastinal masses, especially those with intraspinal extension.

12. MRI
MAGNET
Coils

13. METHODS OF EXAMINATION
THE CHEST
 METHODS OF EXAMINATION
Pulmonary and bronchial angiography – arterial or venous anomalies; thromboembolic disease.
Scintigraphy
Single Photon Emission Computed Tomography (SPECT )
- Tc 99m – iv injection - pulmonary perfusion
- Xe gas is inhaled – pulmonary ventilation

14. - Bony thorax – ribs, clavicles, scapulae, thoracic vertebrae
How to analyze the chest X-ray
- Soft tissues
- Bony thorax – ribs, clavicles, scapulae, thoracic vertebrae
- Mediastinum
- Lungs – hilum, vessels, apices
- Pleura
- Diafragm
Roentgen observations must be correlated with all the available clinical information

15. Gr.I
Nodular opacities
MILIARY tuberculosis

18. Lesion in the lung
Lesion in the mediastinum
FELSON sign

19. PNEUMONIA
Diffuse opacities
ATELECTASIS
PLEURAL FLUID

20. PLEURAL FLUID
ATELECTASIS

21. LINEAR OPACITIES

22. DIFFUSE HYPERLUCENCIES
PNEUMOTHORAX
EMPHYSEMA
DIFFUSE HYPERLUCENCIES

23. CIRCUMSCRIBED HYPELUCENCIES1 3 1
Chist hidatic 2 3 2 3 4
CIRCUMSCRIBED HYPELUCENCIES
Bulla
2. Aeric cyst
3. Cavity- TB
4. Cvity - cancer

24. RUPTURED HYDATID CYST
ABSCESS

25. Acute pulmonary infections
CHEST INFECTIONS
Acute pulmonary infections
Lobar pneumonia – the organism reaches the periphery of the lung via the airways.Alveolar transudation is followed by migration of leucocytes into the alveolar fluid.
Bronchopneumonia (lobular pneumonia) – often observed in staphyloccocal infection of the lung. The disease originates in the airways and spreads to peribronchial alveoli.
Interstitial pneumonia – usually caused by a virus or a mycoplasma.
Mixed pneumonia – is a combination of lobar, bronchopneumonia and interstitial pneumonia.

26. Pneumococcal pneumonia
- Caused by S.pneumoniae.
- roentgen findings can be observed within 6 to 12 hours after onset of symptoms.
Chest x-ray:
triangular opacity, the tip towards the hilum, the base towards the periphery of the lung.
all the elements in the diseased lobe may be affected except the large bronchi– “air bronchogram”.
Resolution is rapid if there are not complications – the opacity becomes more irregular and patchy, the intensity decreases.
- Complications – delayed resolution, lung abscess, pleural effusion.

34. Bronchopneumonia
– staphyloccocal infection of the lung
- It is the most commonly found in the very young or very old
- The inflammatory disease does not cross septal boundaries  the pattern of disease is discontinous or patchy.
Chest x-ray:
nodular opacities, 1-10mm,
poorly defined
with the center more opaque compared to the periphary.
- It is particularly difficult to define and diagnose when it occurs as a complication in case of cardiac failure.

37. Staphylococcal pneumonia
– caused by Staphylococcus aureus
- the infection may be primary in the lungs or secondary to a primary staphylococcal infection elsewhere in the body.
- Usually occurs in debilitated adults or in the first year of life.
- Consolidation rapidly spreads to involve a whole lobe and bronchi are obscured by exudate, so the air brohogram is rarely seen.
- Abscess formation may occur; coalescense of small abscesses is frequent.
- Pleural effusion, empyema and pneumothorax are frequent
- Pneumatocele – a check-valve obstruction develops between the lumen of a small bronchus and the pulmonary parenchyma.
- The disease is usually bilateral

39. Interstitial pneumonia
- usually caused by a virus or Mycoplasma pneumoniae (is responsible for a significant percentage of primary atypical pneumonia in children and young adults).
- Roentgen findings:
- Peribronchial or interstitial type – streaky densities
extending from the hilum following the vascular markings.
- Bronchopneumonic type.
- Segmental or lobar types
- Diffuse type – bilateral reticulo-nodular pattern
DD - interstitial pneumonia  bacterial pneumonia:
- delay in radiological onset
- lack of pleural involvement,
- the tendency to clear in one area and to spread in another, bilaterality.

40. Acute interstitial pneumonia : influenza

41. Acute interstitial pneumonia

42. Acute interstitial pneumonia COMPLICATIONS
BRONHOPNEUMONIA
SEGMENTAL
PNEUMONIA

43. Lung abscess
- lung abscess = when an acute pulmonary infectious process breaks down to form a cavity.
- Primary / secondary.
Chest x-ray
opacity confined to one segment, round, irregular borders.
When bronchial communication is established the fluid content of the cavity is replaced by air – hydro-aeric image with orizontal fluid level.
CT – Very useful to define the inner and outer walls, for complications (rupture into the pleural space).
Differential diagnosis:
early stage – pneumonia;
cavity – tbc, cancer, hydatid cyst, fungal infection

47. TUBERCULOSIS
- Transmitted by inhalation of infected droplets of Mycobacterium tuberculosis
- Target population: patients of low economic scale, alcoholics, elderly, AIDS
Primary TB
Rancke (primary) complex :
Ghon focus – nodular opacity (1-7cm), irregular borders, non-homogeneous, low intensity, lower lobe
Lymphadenopathy – hilar and paratracheal, 95%
Lymphangitis – linear opacities

48. Primary TB
Evolution:
- Healing
- Fibrosis
- Calcification
- Cavitation
Complications:
- Miliary TB
- TB pneumonia
- TB bronchopneumonia
- Pleural effusion

53. Typically limited to the upper lobes No adenopathy
Secondary TB
- active disease in adults most commonly represents reactivation of a primary focus; the disease tends to be progressive
Typically limited to the upper lobes
No adenopathy
Radiographic features
Early infiltrate – low intensity, poorly defined opacities
Cavitation – 40%
Fibro-caseous TB
Fibrotic TB – sharply circumscribed linear densities radiating to hilum;
Fibrothorax, tuberculoma

54. Secondary TB
Complications:
Miliary TB
Bronchogenic spread
Bronchial stenosis
Bronchiectasis
Pneumothorax
Pleural effusion – often loculated

65. ASPERGILOMA

68. AIDS Known routes of HIV transmission: - Blood and blood products
- Sexual activity
- In utero transmission
- During delivery
Clinical:
- Lymphadenopathy
- Incidental infections
- Tumors: lymphoma, Kaposi sarcoma
- Other manifestations: interstitial pneumonia, spontaneous pneumothorax, septic emboli

69. AIDS
Spectrum of chest manifestations:
Nodules – Kaposi sarcoma (usually associated with skin lesions), septic infarcts, fungal infections (Cryptoccocus, Aspergillus)
Large opacity: consolidation, mass – hemorrhage, pneumonia
Linear or interstitial opacities – atypical pneumonia, Kaposi sarcoma
Lymphadenopathy – Mycobacterial infections, Kaposi sarcoma, lymphoma
Pleural effusion – Kaposi sarcoma, fungal infection, pyogenic empyema