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Basics of Chest Imaging
Rebecca Peterson, M. D. Associate Professor Department of Radiology University of Ottawa
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Anatomy
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Normal PA
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Normal Lateral
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The Chest X-ray in Disease
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Basic Patterns of Disease
Air-Space Disease VS Interstitial Disease
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Pulmonary Acinus
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Air space disease
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Consolidation Means “solid lung”
Implies that there is “air-space disease” May occur with or without volume loss
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Consolidation without volume loss
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Air Bronchogram
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Air Bronchogram
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Characteristics of Air Space Disease
Acinar shadow Homogeneous density (consolidation) “Silouette”sign Loss of distinct margins next to consolidation Air bronchogram Non-segmental distribution
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Consolidation RML abnormal normal
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Consolidation RML normal abnormal
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Causes of Airspace Disease
Infection Hemorrhage Edema Neoplasm Idiopathic
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Consolidation with volume loss
“Atelectasis” or “collapse”
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Collapse LLL Normal
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Collapse LLL
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Direct signs of volume loss
Movement of a fissure
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Indirect signs of volume loss
Upward shift of the diaphragm Mediastinal shift to that side Movement of main-stem bronchus Hypovascularity of remaining lung due to hyperinflation Lung looks darker
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Collapse RUL complete incomplete
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Collapse RUL incomplete complete
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Collapse LUL incomplete complete
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Collapse LUL incomplete complete
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Collapse LLL
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Collapse LLL
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Collapse RML
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Collapse RML
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TEST
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Basic Patterns of Disease
Air-Space Disease VS Interstitial Disease
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Interstitial Lung Disease
Perivascular VS Parenchymal
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Pulmonary Acinus
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Perivascular Interstitial Disease
Pulmonary Edema
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Interstitial Pulmonary Edema
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Interstitial Pulmonary Edema
normal abnormal
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Interstitial Pulmonary Edema
normal abnormal
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Interstitial Edema
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Interstitial Edema
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Kerley “B” Lines
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Kerley “B” Lines
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Signs of Interstitial Edema
Vessels look larger and indistinct Peribronchial cuffing Fluid in fissures Kerley”B” lines Pleural effusions
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Acute Airspace Edema
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Airspace Edema
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Acute Airspace Edema Consolidation is bilateral
Consolidation is symmetrical Consolidation is gravity dependent
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Parenchymal Interstitial Disease
Usual Interstitial Pneumonia Asbestosis Sarcoidosis
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Parenchymal Interstitial Disease
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Usual Interstitial Pneumonia
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UIP NORMAL ABNORMAL
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UIP
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UIP
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Asbestosis
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Asbestosis
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Sarcoidosis
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Sarcoidosis
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Patterns of Pneumonia Lobar Pneumonia Bronchopneumonia
Interstitial Pneumonia
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Lobar Pneumonia Hematogenous spread Begins at lung periphery
Involves whole lobe of lung Unilateral Commonest pathogen Strept Pneumoniae
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Lobar Pneumonia
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Lobar Pneumonia
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Lobar Pneumonia
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Bronchopneumonia Central bronchial inflammation
Patchy airspace consolidation distally Due to inflammation Due to mucous plugs Bilateral, asymetrical Commonest pathogen Staph Aureus
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Bronchopneumonia
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Bronchopneumonia
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Bronchopneumonia
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Bronchopneumonia
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Bronchopneumonia
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Interstitial Pneumonia
Involves interstitial parenchymal space “ground glass” opacity both lungs Bilateral, symmetrical Leads to airspace consolidation Commonest pathogens mycoplasma and Pneumocystis Carinii Pattern seen in SARS
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Interstitial Pneumonia
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Interstitial Pneumonia
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Ground Glass
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End stage Interstitial Pneumonia
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End stage Interstitial Pneumonia
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TEST
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