cara baca foto thorax

8/10/2019 cara baca foto thorax

1/23

RADIOLOGY LECTURES BY DR TUMUSIIME CRESCENT MAX (RADIOLOGIST)

CHEST IMAGING

1. PLAIN X-RAYS

THE CHEST FILMA Chest X-ray (CXR) is normally taen ere!t an" PA (#osterior anterior) at a "istan!e o$ % or & $eet ('% or !m)* The anterior!hest +all is a,ainst the $ilm !assette an" the X-ray t.e .ehin" the #atient aime" to+ar"s the $ilm* There are se/eral reasons $or

this0

Erect0 the $ilm is taen ere!t .e!ase0

It re#ro"!es the normal state o$ the ln,s 1 me"iastinm* 2hen the #atient is lyin, "o+n the ##er lo.e /essels are +i"er

than in the ere!t #osition* The me"iastinm may loo to .e #atholo,i!ally +i"ene" an" is more "i$$i!lt to assess*

Air rises to the a#i!al re,ion3 main, it easy to re!o,nise a #nemothora4* In a s#ine $ilm $ree air lies anteriorly an" is

"i$$i!lt to "ete!t

Fli" rns "o+n+ar"s3 #ro"!in, a le/el at the .ase +ith a !r/e" line (menis!s)* In a s#ine $ilm3 the $li" a!!mlates

#osteriorly3 o.s!rin, the ln,* It is "i$$i!lt to "ete!t 1 assess the amont

The "ia#hra,ms are lo+er sho+in, more o$ the ln, .ases an" the heart si5e !an .e a!!rately assesse"*

Posteror!"#teror

The $ilm is taen PA .e!ase0

It is easier to !lear the s!a#lae $rom the ln, $iel"s .y mo/in, the shol"ers $or+ar"

There is less ma,ni$i!ation o$ the heart .e!ase the heart is lyin, a"6a!ent to the $ilm

2hen the #atient is too si! to stan" nai"e" or na.le to ee# still the X-ray is taen s#ine* It is .etter to ha/e a ,oo" AP semi

ere!t or s#ine $ilm than a #oor 7ality or rotate" PA*

*IS IT A GOOD PA CHEST X!RAY$

'* The #atient shol" not .e rotate"* Loo at the anterior en"s o$ the !la/i!les* They shol" .e

e7i"istant $rom the s#inos #ro!esses* I$ the #atient is rotate" one si"e o$ the !hest +ill loo

#aler than the other 1 the me"iastinm +ill a##ear a.normal

* The $ilm shol" .e taen on $ll ins#iration* To !he! $or this !ont the nm.er o$ ri.s

sho+in, a.o/e the "ia#hra,m* The to# o$ the R "ia#hra,m shol" lie .elo+ the anterior en" o$the &th ri,ht ri.* The le$t "ia#hra,m is sally lo+er*

8* The ri.s shol" .e slo#in, an" not hori5ontal* I$ they lie hori5ontally3 it may .e that the #atient +as leanin, .a!+ar"s an"

the "ia#hra,ms +ill o.literate the ln, .ases* The anterior en" o$ the $irst ri. shol" lie 6st .elo+ the !la/i!le*

%t&"#teror r' s&o* 'e see# "'o+e *",&r"-

'

T&e *st"#ce / s&o*

'e e0" o# t&e s*es

A#teror r's "re

s&o2# *"r3. Posterorr's e ore

&or4o#t"

A#teror e#* o5 5rst r' s&o*

e 6st 'eo2 t&e e*" e#* o5

c"+ce

%t&r' "#teror7

A,,e"r"#ce o5 r's 2&e#

t&e 5 s t"3e# 2t& t&e

,"te#t e"##-

'"c32"r*s (or*otc)


2/23

9* The s!a#lae shol" not o/erlay the ln, $iel"s*

%* The s#inos #ro!esses shol" .e $aintly /isi.le thro,h the heart sha"o+ so that lesions .ehin" or in $ront o$ the heart +ill

not .e misse"* The .ony "etail shol" not .e /isi.le .e!ase the ln,s +ill then a##ear too "ar* The .loo" /essels in the

lo+er lo.e shol" 6st .e seen thro,h the heart*&* The +hole o$ the ln, $iel"s shol" .e $lly in!l"e" on the $ilm* Mae sre that #art o$ the !osto-#hreni! an,les 1 a#i!es

ha/e not .een misse"*

EXPIRAT:RY FILM0This is taen +hen the #atient has .reathe" ot*

This may hel# to sho+ .ron!hial o.str!tion +ith air tra##in, (e*,* inhale" $orei,n .o"y in a !hil")0

LATERAL FILM0A lateral $ilm shol" ne/er .e #art o$ a stan"ar" !hest e4amination es#e!ially $or me"i!al #r#oses or $or $ollo+ # o$ a no+n

lesion* The PA $ilm shol" .e e4amine"* I$ there is an a.normality3 a lateral $ilm may then .e se$l in the $ollo+in,0

I$ the $ilm is too li,ht 1 a lesion is ss#e!te" !lini!ally

Frther assessment 1 lo!alisation o$ a.normalities seen or ss#e!te" on the PA $ilm*

Earlier "ete!tion o$ small #leral e$$sions i$ ltrason" is not a/aila.le

:;LIIE2S0

These are hel#$l in assessin, ri. lesions 1 some #nemothora!es*

DIAGNOSTIC ASSESSMENT O8 THE CHEST X!RAY9

N:RMAL STR=CT=RES T: L::? F:R0

' '* S:FT TISS=ES AN@ ;:NES* Loo at the .reast sha"o+s3 ri.s3 !la/i!les3 s#ine an" shol"ers $or si,ns o$ "isease For e4am#le $ollo+in, maste!tomy the ln, on that si"e +ill a##ear "arer* Mae sre the #atient is strai,ht 1 the $ilm

8 taen in $ll ins#iration*

. @IAPHRAMS* These ha/e a smooth otline an" are !on/e4 #+ar"s* The ri,ht"ome lies '-!m hi,her than the le$t* =sally at or .elo+ the le/el o$ the 'th#osterior

ri. or &thanterior ri. (The #osterior ri.s are "i$$erentiate" $rom the anterior ri.s .y

.ein, more hori5ontal*)* There may .e a $at #a" (lo+ "ensity sha"o+) a"6a!ent to theheart .or"er in o.ese #atients* A "ia#hra,mati! hm# (lo!alise" .l,e) is a normal

/ariant*The !osto#hreni! an,le shol" .e a!te 1 !lear

:. FISS=RES. :n the PA /ie+ sally only the hori5ontal $issre +ill .e seen .t not in e/ery #atient* This se#arates theanterior se,ment o$ the R ##er lo.e $rom the mi""le lo.e* It normally lies at the le/el o$ the 9thanterior ri. an" rns

hori5ontally to the hilm* The o.li7e $issres +ill sally only .e seen on a lateral CXR .t are !learly seen on hi,h

7ality $ilms* They #ass #+ar"s an" .a!+ar"s $rom 6st .ehin" the sternm to the 9th"orsal /erte.ra* The le$t $issreis stee#er than the ri,ht .e!ase it .e,ins a little $rther .a! $rom the sternm than the ri,ht* :!!asionallyan a!!essory$issre B the a5y,os $issre +ill .e /isi.le !rossin, the ri,ht ##er lo.e* It !ontains the a5y,os /ein*

Costo,&re#c

"#-e s&o* 'e

ce"r ; "cte

A47-os 5ssre ,rese#t # "

s" ,erce#t"-e o5 ,"te#ts.

I#5eror7 t co#t"#s t&e

"47-os +e#< 2&c& s&o2s "s

" s" o,"ct7. T&e o'e

s&o* #ot 'e st"3e# 5or

"# "'#or"t7.

O'0e 5ssre o#

t&e L s*e ,"ss#-

5ro 'e* t&ester# to "ro#*

t&e e+e o5 T=.

Hor4o#t" ;

o'0e 5ssres #

t&e R #- o#

"ter" +e2. T&e

&or4o#t" 5ssre,"sses "#teror7

5ro t&e &.

Lesser 5ssre r###-

&or4o#t"7 to t&e & "t t&e

e+e o5 t&e =t&"#teror r'


3/23

=. L=N HILAE* The le$t hilm normally lies *% B '*%!m hi,her than the ri,ht* They are o$ similar "ensity an" si5e +ith!on!a/e .or"ers* They are !om#ose" o$ the #lmonary arteries an" /eins* Normal lym#h no"es are not seen*

>. ME@IASTIN=M B- the tr"c&e"shol" .e !entral in #osition*- the s'c"r#" "#-e< (n"er the "i/ision o$ the tra!hea)3 is normally &- "e,rees*- the &e"rt si5e shol" not measre ,reater than '9*%D'% !ms in "iameter in +omen3 or '%*%D'&!m in men* Some #eo#le

se the !ar"io-thora!i! ratio (CT ratio) +hi!h shol" not .e ,reater than %* In other +or"s3 the trans/erse "iameter o$

the heart shol" not e4!ee" hal$ the trans/erse "iameter o$ the thora4 at the le/el o$ the "ia#hra,ms

- the heart .or"ers shol" .e !learly /isi.le3 the ri,ht .or"er shol" .e seen to the ri,ht o$ the s#ine*- The "ort" "es!en"s 6st to the le$t o$ the s#ine an" is more or less #arallel +ith it*

%. PARASPINAL LINE * This re#resents the me"iastinal #leral re$le!tion seen en" on* It is o$ten only seen !learly on theL si"e +here it sho+s as a thin +hite line #arallel to the s#ine* It shol" lie +ithin '!m o$ the lateral .or"er o$ the s#inenless there is aorti! n$ol"in,* In this !ase3 it shol" not lie $rther laterally than mi"+ay .et+een the s#ine an" the

"es!en"in, aorta*

*

?. RE>IE2 AREAS B lesions lyin, in some areas on !hest X-ray are more liely to .e o/erlooe" than others* These are!alle" the re/ie+ areasG an" are0 t&e ",ces< e*"st#< &"e< retroc"r*"c ; retro*",&r"-"tc "re"s ; t&e

'o#es

8

R ",c" tor. T&ere s o,"ct7 "t t&e R

",e/ ("rro2) 2&c& s *55ct to ",,rec"te

't t&ere s "ssoc"te* r' *estrcto#. T&e

",c" re-o# s " *55ct "re" *e to

o+er7#- r's. It soetes &e,s to co+er

t&e rest o5 t&e #-s "3#- t e"ser to

co,"re t&e t2o s*es.

Cose , o5 t&e ",c" re-o#s. @&e# t&e rest o5 t&e #-s

"re e/c*e*< t&e o,"ct7 'ecoes ore o'+os.

T&ere s "# o,"ct7 # t&e R o2er o'e 7#-

'e* t&e *",&r"-. T&s 2"s sse*. Do#t

5or-et t&"t t&e #- *,s *o2# 'e* t&e

*",&r"- ; t&s s 2&ere " "ter" +e2 2o*

&e,

Cose , o5 t&e #o*e # t&e R o2er o'e. A "ter" +e2 co#5#e*

ts ,rese#ce. It 2"s " et"st"ss.


4/23

. L=NS Nor" #- "r3#-s (lines or sha"o+s seen a!ross the ln,s) are "e to0a* #lmonary /essels

.* $issre

;ron!hi are normally only /isi.le near the hilae +here the +all is thi! eno,h to see an" the +all o$ a .ron!hs shol" only .e

'mm or less in thi!ness* ;ron!hi seen en"-on near the hilae shol" ro,hly .e the same "iameter as a /essel* ;ron!hi are hollo+

rin, sha"o+s 1 /essels are soli" ,rey "is!s* In the ere!t $ilm lo+er 5one /essels are lar,er than those in the ##er lo.e* In thes#ine !hest X-ray3 ##er lo.e /essels are the same si5e as the lo+er lo.e /essels* The ln,s shol" .e o$ e7al transra"ian!y*

THE ABNORMAL CHEST X!RAY

A;N:RMAL SHA@:2IN :N A CXR MAY ;E @=E T:

- A;N:RMALITY :F THE :>ERLYIN S:FT TISS=ES :R RI; CAE3 CL:THIN :R ;AN@AES- L=N @ISEASE- @ISEASE :F THE PLE=RA

OPACITY DUE TO OVERLYING SOFT TISSUES OR RIB ABNORMALITIES

Masses in the .reast or other so$t tisses o$ the thora4 may #ro"!e sha"o+in, on a !hest X-ray3 +hi!h !an .e mistaen $or

#lmonary "isease* Marin,s s#erim#ose" on ea!h other !an also mimi! ln, "isease s!h as the s!a#la o/erlyin, a #osteriorri.* ;ttons or other $asteners on #atients !lothes may !ast !on$sin, sha"o+s 1 .ttons in #arti!lar may loo lie #lmonary

"e#osits* Sa$ety #ins are easier to re!o,nise as .ein, e4trinsi! .t in !hil"ren in #arti!lar it is im#ortant not to assme that an

o#a!ity is on the !lothin,* This shol" .e !on$irme" .y re#eat PA $ilm +ithot !lothes* A lateral $ilm is sometimes ne!essary* It is

im#ortant to mention any so$t tisse or !hest +all a.normality on the re7est $orm to a/oi" misinter#retation* Ri. $ra!tres or"e#osits in the ri.s !ommonly sho+ a #eri#heral o#a!ity relate" to the ri.*

9

PA c&est X!r"7. T&e 5 s

t"3e# str"-&t 2t& c"+ces

e0*st"#t. T&e costo!,&re#c

"#-es "re "cte "#* ce"r. T&e

5 s t"3e# o# -oo*

#s,r"to#< t&e %t&"#teror r'

("rro2) s +s'e "'o+e t&e

*",&r"-. T&e &e"rt s4e s

ess t&"# > o5 t&etr"#s+erse *"eter o5 t&e

c&est.


5/23

L=N SHA@:2IN

The $ine net+or o$ the ln,s is ma"e # o$0 a) the al/eoli or air s#a!es .) the interstitim (i*e* the so$t tisses .et+een the al/eoli

in +hi!h the .ron!hi 1 .loo" /essels lie)@isease #ro!esses may in/ol/e the al/eoli3 the interstitim3 or .oth* It is im#ortant .t "i$$i!lt to "i$$erentiate al/eolar $rom

interstitial sha"o+in,*

There are im#ortant si,ns3 +hi!h hel# to inter#ret ln, sha"o+in,*

'* T&e s&oette s-#

* T&e "r 'ro#c&o-r"

It is only #ossi.le to see the otline o$ any tisse in the !hest .e!ase there is air in the ln,3 either ne4t to it or srron"in, it* I$

the air s#a!e is $ille" .y $li" or tmor .or"ers .e!ome o.literate"* Sometimes it is the $irst si,n o$ an a.normality an" sho+s

+hi!h #art o$ the ln, is a$$e!te"* It is !alle" the s&oette s-#.e!ase the normal silhoette is lost* For e4am#le the ri,ht

heart .or"er +ill "isa##ear +hen there is !olla#se or !onsoli"ation o$ the ri,ht mi""le lo.e an" the ri,ht aorti! .or"er +ill .e lost+ith o#a!ity in the anterior se,ment o$ the ri,ht ##er lo.e an" mi""le lo.e* The otline o$ the "ia#hra,ms +ill .e lost +hen

there is !onsoli"ation in the lo+er lo.e or $li" a"6a!ent to the "ia#hra,m*

Normally3 the air $ille" .ron!hi +ithin the ln, $iel"s are in/isi.le .e!ase they are srron"e" .y air $ille" al/eoli an" the

.ron!hial +alls too thin* They +ill .e seen i$ the srron"in, air-$ille" al/eoli are !lear an" the .ron!hi are $ille"3 as +ith m!sor #s* E7ally3 .ron!hi +ill .e seen i$ the +alls are thi!ene"* They are also seen +hen the srron"in, al/eoli are $ille" +ith

$li" (oe"ema or #s) .t the .ron!hi remain !lear an" $ille" +ith air* The .ron!hi may then .e seen as "arer lines +ithin theln, sha"o+in, "e to the air $ille" .ron!hi !ontrastin, +ith the srron"in, airless ln,* This is !alle" an "r 'ro#c&o-r"an"

is a $eatre o$ al/eolar sha"o+in,*

%

Nor" #-.

Bro#c& #ot see#

Bro#c& 5e* 2t&5*,s "#* "re +s'e

Bro#c& +s'e'ec"se t&e7 &"+e

t&c3e#e* 2"s

Bro#c& +s'e 'ec"se t&e

"r # t&e srro#*#-

"+eo &"s 'ee# re,"ce*

'7 5*.


6/23

INTRAPULMONARY SHADOWING(DENSITIES)

Sha"o+in, in the ln,s is "e to0'* Al/eolar "isease

* Interstitial "isease

This "istin!tion is "i$$i!lt an" there is o$ten o/erla# .et+een the t+o .t it "oes hel# in inter#retation an" "e!i"in, the #ossi.le!ase o$ an a.normality* There are o$ten $eatres o$ .oth*

A. ALFEOLAR SHADO@ING(AIRSPACE DENSITIES)

I$ the al/eoli are in/ol/e" in a "isease #ro!ess3 they $ill +ith $li" or soli" tisse* In the /ery early sta,es it may .e that the al/eolisho+ as small se#arate ron"e" &mm o#a!ities .t these ra#i"ly .e!ome !on$lent sha"o+in, +ith $l$$y ill "e$ine" mar,ins* The

/essels are o.s!re" an" there may sometimes .e an air .ron!ho,ram* There may also .e a silhoette si,n* 2hen the al/eoli $ill

+ith $li" or other s.stan!es3 it is !alle" co#so*"to#* The main $eatres o$ "+eo"r s&"*o2#- are0

In the early sta,es it may #resent as a $aint homo,enos ha5e or ,ron" ,lassG a##earan!e

Sha"o+in, may .e homo,enos3 #at!hy or .lot!hy in a##earan!e

Fl$$y3 ill "e$ine" areas o$ o#a!i$i!ation

Areas o$ sha"o+in, ten" to !oales!e an" .e!ome !onsoli"ation

#atterns o$ "istri.tion o!!r0 '* Se,mental or lo.ar * .ats+in,G* The latter sho+s as .ilateral sha"o+in, s#rea"in,

$rom the hilar re,ions into the ln,s +ith relati/e s#arin, o$ the #eri#heral ln, $iel"s* This o!!rs ty#i!ally in #lmonary

oe"ema +hen #atients are s#ine* It is non- se,mental*

Air .ron!ho,rams may .e /isi.le* These are not seen in #leral3 me"iastinal3 or some interstitial "isease* Most !ommonly

seen +ith al/eolar sha"o+in, se!on"ary to #nemonia*

* CA=SES :F AL>E:LAR SHA@:2IN0

1. TRANS=@ATE0

&


7/23

- - the al/eoli .e!ome $ille" +ith a !lear trans"ate o$ lo+ #rotein !ontent an" this o!!rs in- ,o#"r7 oe*e". MISCELLANE:=S0

B As,r"to#o$ ,astri! !ontents is an im#ortant !ase* :ther !ases are #&"e* 5ore-# 'o*73oeso,&"-e" e"3< oeso,&"-e" strctre *e to c"rc#o" or corros+e3 r"*"to# t&er",7an"in .a.ies &7"#e e'r"#e *se"se.

N;0 THESE ALL PR:@=CE THE SAME APPEARANCE :N THE CHEST X-RAY AN@ CAN :NLY ;E

@IFFERENTIATE@ ;Y THE @ISTRI;=TI:N AN@ THE CLINICAL FEAT=RES*


8/23

PATTERNS :F AL>E:LAR SHA@:2IN

'* Lo'"rse-e#t" ,"tter#0 some !ommon !ases0

- in$e!tion- #lmonary in$ar!t

- al/eolar !ell !ar!inoma- !ontsion

Al/eolar sha"o+in,3 +hi!h is #rely lo.ar +ill .e .on"e" .y the $issres an" "e#en"in, on the se,ments may #ro"!e a shar#

otline o$ one .or"er ne4t to a $issre*

In the a.o/e X-ray the +hole o$ the mi""le lo.e +as in/ol/e" lo.ar !onsoli"ation

In the !ase .elo+3 only one se,ment o$ the lo.e is in/ol/e" se,mental !onsoli"ation

P"tter# see# o# PA

5 2t& co#so*"to#

o5 t&e e*" se-e#t

o5 t&e **e o'e o#7

P"tter# see# o# PA 5

2t& co#so*"to# o5 t&e

"ter" se-e#t o#7.

P"tter# see# o# PA 5

# **e o'e

co#so*"to#

P"tter# see# o# "ter"

5 # **e o'e

co#so*"to#

P"tter# # R ,,er o'e

co#so*"to# (PA)

P"tter# # R ,,er o'e

co#so*"to# (L"ter")

Co#so*"to# "#teror

se-e#t o#7 !PA

Co#so*"to# ",c"

se-e#t o#7 ! PA


9/23

* B"ts 2#- ,"tter#0

") "cte0

- Plmonary oe"ema

') c&ro#c9

- Lym#homaDleaemia- Sar!oi"osis .t the interstitial $orm is m!h !ommoner- Plmonary al/eolar #roteinosis

- Al/eolar !ell !ar!inoma .t the lo!alise" $orm is m!h !ommoner

:. No#e o5 t&e "'o+e9

Al/eolar sha"o+in, may not $it into any o$ the a.o/e #atterns e*,*

- ;ron!ho#nemonia as in sta#hylo!o!!al se#ti!aemia or #lmonary t.er!losis*- Fat em.olism (o!!rs '- "ays $ollo+in, ma6or trama3 #arti!larly $ra!tres o$ the lar,e .ones o$ the lo+er lim.s)

- Eosino#hili! #nemonia

;* INTERSTITIAL SHA@:2IN0

This is "e to "isease in the interstitim i*e* the tisse in +hi!h the .loo" /essels an" .ron!hi lie +ithin the ln,s* This lea"s to a

non homo,enos #attern o$ sha"o+in, +hi!h may tae many $orms* The al/eoli are still aerate" an" there$ore there is no air

J

Co#so*"to# ,osteror

se-e#t o#7 PA


10/23

.ron!ho,ram or silhoette si,n* The normally /isalise" .loo" /essels .e!ome ill "e$ine" or o.s!re"* The "isease may .e

"i$$se or lo!alise".

There are many !ases o$ interstitial "isease* These "iseases o$tenloo i"enti!al on X-ray .t the "istri.tion is im#ortant* Some are

!hara!teristi!ally more #re"ominant in the lo+er 5ones an" others

in the ##er 5ones* Interstitial "isease is no+ o$ten ima,e" .y hi,h

resoltion CT s!annin, to hel# in "i$$erentiation* Some !ases !anonly .e "ia,nose" on ln, .io#sy* It is im#ortant that as many

!lini!al $eatres as #ossi.le are a/aila.le at the time o$ re#ortin,*

@iseases may also .e !lassi$ie" on the .asis o$ +hether a!te or

!hroni! as +ell as the "istri.tion in the ln,s*

Soe o5 t&e coo# ,"tter#s "re0

Linear

Miliary

Reti!lo-no"lar

Honey!om.

No"lar

1. L#e"r P"tter#

Is "e$ine" as an a.normal net+or o$ $ine lines rnnin, thro,h the lines "e to thi!ene" !onne!ti/e tisse se#tae* The most

!ommon are01. ?erley A lines0 lon, thin lines in the ##er lo.es3 seen in .oth PA 1 lateral /ie+s(n"er the sternm in the

latter). ?erley ; lines0 short thin lines #re"ominantly in the #eri#hery o$ the lo+er 5ones e4ten"in, '-!m hori5ontally

in+ar"s $rom the ln, sr$a!e*:. ?erley C lines0 "i$$se linear #attern thro,h the entire ln,0 these !an .e "i$$i!lt to re!o,nise* Cases are

interstitial #lmonary oe"ema an" lym#han,itis !ar!inomatosis*

'

B"s" #terstt"

c&"#-es. Not e

oss o5 +"sc"r

"r3#-s ;

retco!#o*"r

,"tter#. te*55ere#t t&"#

"+eo"r

s&"*o2#- 2&c&

s ore

co#5e#t. I#

#terstt"

*se"se t&e

"+eo re"#

"er"te*

Nor" #terstt. T&e ot#e o5 t&e

'oo* +esse s *st#ct

I#terstt" *se"se. T&e ot#e o5 t&e 'oo*

+esse s #*st#ct ; ost # t&e srro#*#-

s&"*o2#-

Retco #o*"r ,"tter#. A

/tre o5 #es ; s" #o*es

Ho#e7co' ,"tter#.

C7stc s,"ces

L#e"r ,"tter# No*"r ,"tter#. S"

#terstt" *e,osts

Jere7 C #es

Jere7 A

#es

Jere7 B #es


11/23

:ther linear lines may .e !ase" .y !hroni! "isease s!h as t.er!losis3 the early sta,es o$ sili!osis 1 sar!oi"*

C"ses o5 #e"r s&"*o2#-

AC=TE0

Plmonary oe"ema B !ar"ia!3 non !ar"ia! !ases

In$e!tions B #arti!larly /irses3 #nemo!ystis3 measles3 malaria 1 t.er!losis (less o$ten)

CHR:NIC0

Lym#han,itis Car!inomatosis B may .e nilateral*

:$ten asso!iate" hilar a"eno#athy

Sar!oi"osis

Early sili!osis 1 as.estosis

Aller,i! al/eolitis 1 #lmonary oesino#hilia

@r,s e*,* amio"arone3 !ytoto4i!s3 .sl#han0 also

inhale" irritants s!h as !hlorine or tear ,as

Conne!ti/e "isor"ers0 Rhematoi" arthritis3

s!lero"erma3 systemi! l#s3,ralomatosis

Mis!ellaneos0 histio!ytosis3 t.eros s!lerosis

;ron!hie!tasis0 sally a mi4e" al/eolarDinterstitial

#attern

9

* No*"r P"tter#0

- interstitial no"les are small ('-%mm)3 +ell "e$ine"3 an" not asso!iate" +ith air .ron!ho,rams*- o$ten /ery nmeros an" "istri.te" e/enly thro,h the ln,s*- i$ lo+ in "ensity may .e "i$$i!lt to a##re!iate in the early sta,es

''

Cose , o5 Jere7 B #es "t t&e R

'"se


12/23

C"ses9

AC=TE0

I#5ecto#s sc& "s t'ercoss3 !hi!en#o4

Plmonary oe"ema

A!te e4trinsi! aller,i! al/eolitis

Fat em.oli

LESS AC=TE

C"rc#o"tossB es#e!ially thyroi" !ar!inoma3 !horione#ithelioma3 .reast*

CHR:NIC

Sar!oi"osis B #re"ominantly mi" 5ones*

Coal miners #nemo!oniosis3 sili!osis

Fi.rosin, al/eolitis

Dse"ses 2&c& "7 c"se t"r7 s&"*o2#- i*e* mlti#le small o#a!ities less than %mm in "iameter are0

'* T'ercoss

* M"r7 et"st"ses any #rimary site .t es#e!ially thyroi" 1 !horion e#ithelioma8* Chi!en#o4

9* Pnemo!ystis Carinii #nemonia3 Cytome,ali! in$e!tion%* Sar!oi"osis

&* Dst #&""to#B #nemo!onioses* Haemosi"erosis

* E4trinsi! aller,i! al/eolitis3 eosino#hilia

J* Fi.rosin, al/eolitis

Certain $eatres may hel# in "ia,nosis* For e4am#le in miliary t.er!losis the tiny o#a!ities are sally o$ lo+ "ensity 1 e/enly"istri.te" thro,hot the ln,s in!l"in, the a#i!es* In #nemo!oniosis there is s#arin, o$ the .ases +ith ,reater #re"ominan!e

in the mi""le 5ones* In the early sta,es3 the !han,es are s.tle 1 it may .e "i$$i!lt to "e!i"e +hether there is a.normality or not*

I$ the /essels are not seen !learly3 this is a se$l si,n in"i!atin, that "isease is most liely #resent* I$ in "o.t al+ays re X-ray

a$ter a $e+ "ays* In$e!tions sally .e!ome more o./ios +hile #lmonary eosino#hilia +ill alter its "istri.tion

:. Retco!#o*"r ,"tter#9

'


13/23

- this "e to /ery $ine no"lar o#a!ities s#erim#ose" on a $ine net+or o$ short lines* This may .e seen in sili!osis3rhematoi" ln, "isease an" $i.rosin, al/eolitis as +ell as "r, in"!e" ln, !han,es* It is sally more o./ios at the

.ases*

=. Ho#e7co' ,"tter#9

- re#resents the en" sta,e o$ many interstitial #ro!esses an" im#lies e4tensi/e "estr!tion o$ #lmonary tisse*- ln, #aren!hyma re#la!e" .y !ysts3 +hi!h ran,e in si5e $rom tiny # to !m "iameter* These are se#arate" .y !oarse

linear interstitial marin,s*

- !ysts ha/e /ery thin +alls- normal #lmonary /as!latre !annot .e seen

- may .e !om#li!ate" .y #nemothora4*

E4am#les are0 Chroni! heart $ailre3 Rhematoi"3 S!lero"erma3 Fi.rosin, al/eolitis3 1 Histio!ytosis*

E"r7 #terstt" *se"se "7 ,rese#t "s " -ro#* -"ss &"4e o+er t&e #-s. I5 '"ter"< t "7 'e *55ct to ",,rec"te

t&"t "# "'#or"t7 s ,rese#t.

;R:NCHIECTASIS

=sally o!!rs se!on"ary to in$e!tion* It is !ase" .y #ostnasal "ri#s in !hroni! sinsitis an" $ollo+s #ertssis* It also o!!rs

$ollo+in, t.er!losis or #nemonia o$ any in" an" any !ase o$ se,mental atele!tasis* The .ron!hi .e!ome in$e!te"3 "ilate#eri#herally an" "e/elo# thi! +alls /isi.le on !hest X-rays* Commonly seen in the lo+er 5ones3 the .ron!hi a##ear as thi!

lines +ith thi!ene" +alls en!losin, the aerate" lmen* I$ seen in !ross se!tion the .ron!hi loo "ilate" srron"e" .y a +hite

!$$3 +hi!h re#resents the thi!ene" +all* There is o$ten s#er-a""e" in$lammatory !han,es a##earin, as al/eolar sha"o+in, in

a""ition* ;ron!hie!tasis may in/ol/e any lo.e or se,ment3 #arti!larly i$ it has !olla#se"3 .t is !ommoner at the .ases* I$se!on"ary to as#er,ills in$e!tion3 it taes a sli,htly "i$$erent a##earan!e +ith "ilatation o$ the #ro4imal .ron!hi3 +hi!h may loo

lie the $in,ers o$ a ,lo/e*

'8

Cose ,

T&c3 2"e*

'ro#c& 2t&

*"te* ter#"

'ro#c&


14/23

S:ME SPECIFIC PNE=M:NIAS0

AC=TE PNE=M:NIA0

'* ;ACTERIAL 0 in!l"in, t.er!losis an" other my!o.a!teria B !ases al/eolar sha"o+in,

* N:N ;ACTERIAL B my!o#lasma3 #roto5oa3 /iral sally starts as interstitial sha"o+in, .t may .e!ome al/eolar*

>iral is sally interstitial nless there is a se!on"ary .a!terial in$e!tion* Sha"o+in, is o$ten less "ense than .a!terial

in$e!tions*

A!te #nemonia is sally lo!alise"* I$ .ilateral or mlti$o!al thin o$ t.er!losis3 o##ortnisti! in$e!tion orsta#hylo!o!!s*

Lo'"r ,#eo#"9Cases $airly ni$orm al/eolar sha"o+in, o$ all or #art o$ a

lo.e* It starts as a lo!alise" in$e!tion o$ the terminal air s#a!es3

the in$lammatory oe"ema s#rea"in, to the a"6a!ent ln,* Its

$eatres are0

'* Lo.ar or se,mental in "istri.tion .t may.e not in/ol/in,the +hole o$ the lo.e or se,ment*

* Al/eolar in ty#e8* Limite" .y the $issres

9* May .e an air .ron!ho,ram in early sta,es* ;e!omes lesso./ios as the in$e!tion +orsens%* No loss o$ /olme

&* Silhoette si,n may .e #ositi/e

* It may .e ron"e" in a##earan!e3 es#e!ially in !hil"ren** @i$$se ha5e in the early sta,es3 !han,in, +ithin a $e+ "ays

From no+le",e o$ the se,mental 1 lo.ar "istri.tion3 it is o$ten #ossi.le to

"e"!e +hi!h #art o$ the ln, is in/ol/e" $rom the PA $ilm alone3 altho,h a

lateral /ie+ +ol" "etermine it more a!!rately*

For instan!e in the !ase illstrate"3 +e !an see $rom the "istri.tion o$ the

se,ments that the a#i!al se,ment is not in/ol/e"*

'9

Ste o5 s&"*o2#- 5 o#7

t&e ",c" se-e#t o5 t&e

o2er o'e s #+o+e*

S&"*o2#- 5 "

t&e o2er o'e s

#+o+e*

A,,e"r"#ce 5 t&e

"ter" '"s"

se-e#t "o#e s

#+o+e*

Dstr'to# o5

s&"*o2#- 2t&

"#teror '"s" se-e#t

#+o+ee#t

Dstr'to# 2t&

,osteror '"s"

se-e#t

#+o+ee#t


15/23

Classi! a!te lo.ar #nemonia is sally !ase" .y the #nemo!o!!s* ?le.siellamay !ase lo.ar #nemonia in those +ho ha/e

,oo" resistan!e* In the immnos##resse"3 it has a "i$$erent #attern +ith .ilateral #at!hy al/eolar s#rea" #ro,ressin, to a.s!ess

$ormation +ith a !a/ity an" $li" le/el* Sta#hylo!o!!s may #resent as a lo.ar #nemonia i$ "e to an air.orne in$e!tion

altho,h in !hil"ren mlti#le small a.s!esses are !ommoner*In lo.ar #nemonia .y any or,anism3 there may .e a small asso!iate" #leral e$$sion #resent 1 em#yema may "e/elo#*

In !hil"ren3 #nemoni! !onsoli"ation may assme

a ron"e" a##earan!e mimi!in, a #lmonary

mass*

Bro#c&o,#eo#"9

This is a mlti$o!al #ro!ess in/ol/in, the terminal .ron!hioles3 +hi!h s#rea"s se,mentally !asin, #at!hy !onsoli"ation*It is o$ten "e to the sta#hylo!o!!s or ,ram ne,ati/e or,anisms s!h as #se"omonas* It is asso!iate" +ith le.siella in$e!tions

in the immno"e#resse" (AI@S) an" t.er!losis is a !ommon !ase* It is o$ten asso!iate" +ith #ertssis an" measles*

Sta#hylo!o!!al #nemonia may !om#li!ate any o$ the $ollo+in,0

In$len5aSe#ti!aemia

:steomyelitis

Inhalation

I> "r, [email protected]

'%


16/23

Ca/itation is !ommon3 also #leral e$$sions3 atele!tasis3 em#yema an" #nemothora4 may o!!r* ;ron!ho#nemonia "oes not

ha/e the same a##earan!e as lo.ar #nemonia an" is sel"om as !on$lent* It may in/ol/e one lo.e or .oth ln,s* The

"istri.tion is sometimes hel#$l3 i$ mainly in one or .oth ##er lo.es thin o$ t.er!losis* I$ .loo" .orne in se#ti!aemia it issally +i"es#rea" +ith #at!hy sha"o+in, in/ol/in, most lo.es +hi!h is not n!ommon in !hil"ren +ith #yo,eni! osteomyelitis*

Sta#hylo!o!!al #nemonia is !ommoner in !hil"ren3 o$ten lea"in, to #nemato!eles (thin +alle" !a/ities or !ysts)3 sally in the

healin, #hase* These #nemato!eles may r#tre lea"in, to #nemothora4*

'&

P#eot&or"/


17/23

The a##earan!e o$ ln, in$e!tion in !hil"ren is o$ten "i$$erent than a"lts* Chest X-rays o$ !hil"ren are more "i$$i!lt to inter#ret

"e to the $ollo+in, reasons0

The heart may normally o!!#y more than % o$ the trans/erse thora!i! "iameter

The s#erior me"iastinm may a##ear +i"ene" "e to a #ersistent thyms

The "ia#hra,ms sally lie hi,her

The ri.s are .roa"er 1 lie more hori5ontallyIt is "i$$i!lt to o.tain a $ilm on $ll ins#iration in the yon,er !hil"*

Perihilar sha"o+in, is a !ommon #resentation o$ #nemonia in !hil"ren an" may .e nilateral or .ilateral*

It is not #ossi.le to .e sre o$ the or,anism res#onsi.le $or #nemonia on !hest X-ray a##earan!es alone*

P#eoc7sts c"r# #5ecto#9

This o$ten .e,ins as interstitial sha"o+in, .e!omin, more !on$lent 1 al/eolar in a##earan!e +hen it may mimi! #lmonaryoe"ema* The "istri.tion is o$ten #eri-hilar or in/ol/in, the mi" an" lo+er 5ones .ilaterally or there may 6st .e a ,ron" ,lass

ha5e* It may s#rea" to in/ol/e the entire ln, an" #nemothora4 !an o!!r* There are no s#e!i$i! $eatres to "istin,ish it e4!e#t

that a !hara!teristi! $eatre is that the #atient is sally m!h si!er !lini!ally than the !hest X-ray +ol" s,,est*

P=LM:NARY T=;ERC=L:SIS0Pr"r7 #5ecto#0This sally o!!rs in !hil"ren !hara!teristi!ally #ro"!in, an area o$ in$lammatory sha"o+in, in the ln, asso!iate" +ith hilar

or me"iastinal a"eno#athy (#rimary !om#le4)* The #nemoni! !onsoli"ation !an o!!r any+here in the ln, an" .e small (hon

$o!s) or in/ol/e an entire lo.e* The enlar,e" lym#h no"es may #ress on a .ron!hs !asin, !olla#se o$ a lo.e3 or e/en a +hole

ln,*

Primary #lmonary t.er!losis may also #resent as0

- em#yema- massi/e #leral e$$sion

- miliary sha"o+in,- s#ontaneos .ron!ho#leral $istla +ith hy"ro#nemothora4- #eri!ar"ial e$$sion

Ca/itation is rare in !hil"ren* :n healin, the ln, $o!s an" the lym#h no"es may !al!i$y*

'


18/23

'


19/23

Post ,r"r7 or "*t ,o#"r7 t'ercoss9

May #resent as0

Pat!hy .ron!ho#nemonia3 sally the !onsoli"ation is restri!te" in site3 !ommonly o!!rrin, in the ##er lo.es or a#i!al

se,ments o$ the lo+er lo.es* Ho+e/er3 there may .e .ron!ho#nemoni! s#rea" an" no"lar sha"o+in, o!!rrin, any+here

in the ln,s*

Ca/itation is !ommon an" a hallmar o$ the "isease*

=sally there is no a"eno#athy nless the #atient has a!7ire" immne "e$i!ien!y syn"rome (AI@S)*

There may .e /olme loss an" $i.rosis o!!rrin, alon, +ith !a/itation* May #resent as an e$$sion or em#yema in yon, a"lts or a #yo-#nemothora4 "e to a r#tre" $o!s*

Miliary sha"o+in,3 "is!rete '- mm no"les "istri.te" e/enly thro,hot the ln,s

As healin, #ro,resses $eatres +hi!h may .e re!o,nise" are $i.rosis an" /olme loss (shrina,e)3 !al!i$ie" $o!i3 t.er!loma

(a lo!alise" ,ranloma o$ten !ontainin, !al!i$i!ation)3 an" #leral !al!i$i!ation

NB Plmonary t.er!losis in AI@S #atients o$ten #resents in an aty#i!al +ay +ith lo+er lo.e #nemonia3 me"iastinal

a"eno#athy 1 air $li" le/els "e to ln, a.s!esses* Miliary t.er!losis is !ommoner in these #atients as are lar,e e$$sions*

'J

C"+t"to#

Co#so*"to#

H"r

7,&"*e#o,"t&7

M"r7 s&"*o2#-

8'ross

C"c5c"to#s

Gr"#o"

(t'erco")

Perc"r*"

e55so#

Per" e55so#


20/23

*

T'ercoss # " ,"te#t 2t& AIDS.


21/23

*

As,r"to# ,#eo#"9 a !hemi!al #nemonia "e to as#iration o$ a!i" ,astri! !ontents3 sally "rin, anaesthesia* There is an

intense .ron!hos#asm $ollo+e" .y a $loo" o$ oe"ema* Inhalation o$ the +ater sol.le .t hy#ertoni! io"ine !ontrast a,ent !alle"astro,ra$in also !ases a similar !on"ition an" shol" ne/er .e se" in #atients +ith "ys#ha,ia or s+allo+in, "i$$i!lty*

As#iration o$ /omit may o!!r in #atients +hose !o,h re$le4 is "e#resse" .y0

St#or@r,s

Al!ohol

As#iration !ases irritation an" oe"ema $ollo+e" .y s#era""e" in$e!tion o$ten +ith a "e,ree o$ atele!tasis* The ri,ht lo+er lo.e

is a !ommon site*

CAFITATION RING SHADO@9 ABSCESS 8ORMATION

A !a/ity is a !ir!lar transra"iant air s#a!e sally srron"e" .y an area o$ sha"o+in,* Ca/itation o!!rs +hen an area o$

ne!rosis !ommni!ates +ith a #atent air+ay3 the "estroye" ln, tisse .ein, re#la!e" .y air* The !a/ity +all may not .e /isi.le i$

srron"e" .y !onsoli"ation in the a"6a!ent ln,* Parti!lar $eatres may hel# to "e!i"e the !ase0

Lo!ation 0 i$ a#i!al ss#e!t t.er!losis

:tline 0 i$ irre,lar .t !learly seen +ith a thi! +all may .e a tmor

2all thi!ness - i$ thi! +alle" most liely a.s!ess or ne!roti! tmor

Fli" le/el0 in"i!ates the #resen!e o$ #s in a ln, a.s!ess

Content0 i$ it !ontains a .all o$ soli" tisse most liely a my!etoma "e to As#er,ills in$e!tion

Satellite lesions - sally .ron!ho#nemonia se!on"ary to sta#hylo!o!!s or t.er!losis

The !ommonest !ases are0

'


22/23

T.er!losis

Sta#hylo!o!!al in$e!tion

Car!inoma

?le.siellaram ne,ati/e in$e!tion B E !oli

Amoe.iasis

*

T.er!los !a/ities sally ha/e $airly thin +alls*As#iration is !ommoner in the lo+er lo.es*

Sta#hylo!o!!al in$e!tions may ha/e mlti#le !a/ities* Pnemato!eles ha/e /ery thin +alls*

Amoe.i! a.s!esses are nearly all in the lo+er lo.es* I$ there is ten"er he#atome,aly thin o$ amoe.iasis*

Primary !ar!inoma is solitary* I$ !a/itation o!!rs the !a/ity is o$ten irre,lar +ith thi! +alls*Se!on"ary !ar!inoma o!!asionally !a/itates as "o #lmonary in$ar!ts*

Posto# o5 t&e c"+t7 o#

t&e "ter" +e2. It s 7#-

# t&e ",c" se-e#t o5 t&eo2er o'e.

Lesser

5ssre


23/23

L=N A;SCESS0

A ln, a.s!ess is an in$e!te" !a/ity3 o$ten !ontainin, a $li" le/el* Res#onsi.le or,anisms may .e0

- Sta#hylo!o!!s

- Pse"omonas- ?le.siella

- T.er!losis B sel"om a $li" le/el nless !om#li!atin, AI@S

8

Contine" in #art

Cli! here to retrn to !ontents #a,e
http://var/www/apps/conversion/tmp/Contents%20page.dochttp://var/www/apps/conversion/tmp/Contents%20page.doc

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