呼吸系统放射影像学ppt课件

1、Radiology of Respiratory SystemAimsBasicsBest exam resultsAppreciate the role radiology plays? Instill an interest in radiologyBefore Class:TextbookReference bookLiteratureInternetAppsTeacher & classmateHistology and EmbryologyAnatomyPathologyInternal MedicineSurgeryGynecologyPediatricsNeurology

2、。Everything。U need to knowmethodsX-rayCTMRDSAUSNuclear Medicine PET/CT Radionuclide ventilation perfusion imagingX-ray TechniquesPA （posteroanterior) & LateralMore informationTwo viewsStandardizedDistancePt needs to be stablePortableQuickAnywhereOne shotNo standardizationPA PortableTechniques -

3、ProjectionP-A (relation of x-ray beam to patient)Techniques - Projection (continued)A-P Supine/ErectTechniques - Projection (continued)LateralTechniques - Projection (continued)Lateral DecubitusObliqueTechnical DetailsTypeOrientationRotation Inspiration/expirationPenetrationRotationRotation (continu

4、ed)PenetrationInspiration/ExpirationThings to seeABCDEAirwaysTrachea, endotracheal tube, etcBonesClavicles, ribs, etcCardiacDiaphragm (Right hemidiaphragm slightly higher (1.5 cm)Everything else (tubes), effusionsDensities The big two densities are: (1) WHITE - Bone (2) BLACK - AirThe others are: (3

5、) DARK GREY- Fat (4) GREY- Soft tissue/water And if anything Man-made is on the film, it is: (5) BRIGHT WHITE - Man-madeAnatomyAnatomyBronchopulmonary AnatomyCross-sectional Anatomy of Lung Segments （CT）Lobes Right upper lobe:Lobes (continued) Right middle lobe:Lobes (continued) Right lower lobe:Lob

6、es (continued) Left lower lobe:Lobes (continued) Left upper lobe with Lingula:Lobes (continued) Lingula:Lobes (continued) Left upper lobe - upper division:HeartRight border: Edge of (r) Atrium3. Left border: (l) Ventricle + Atrium4. Posterior border: Reft Ventricle5. Anterior border: Right Ventricle

7、Heart (continued 。)Heart ITS NOT MINE.HilumMade of:1. Pulmonary Art.+Veins2. The Bronchi Left Hilum higher (max 1-2,5 cm)Identical: size, shape, densityHilumRibsReview areas: Apices Behind the heart Costophrenic angle (CPA) Below the diaphragm Soft tissues ( breast, surgical emphysema) Ribs & cl

8、avicle Vertebrae AbnormalsLung findingsDarker areasradiolucentPneumothoraxCysts/bullaAir bronchogramsLighter areasOpacitiesAtelectasis“infiltrates”BloodPusWaterNodules or massOpacitiesLobar or not.PneumoniaPulmonary Edema“fluffy,” diffuse, “bat wing” distributionHemorrhageCant tell by x-ray, need br

9、onchRML pneumoniaOpacitiesRLL pneumoniaOpacitiesRUL pneumonia LLL pneumoniaConsolidation on CTThe Enlarged HilaCauses:1. Adenopathies (neoplasia, infection)2. Primary Tumor3. Vascular4. SarcoidosisMass Hilar Lymphadenopathy - BL Multiple MassesMetasPleural EffusionPulmonary FibrosisHeart failure， Ke

10、rley A/B line（Interstitial lung hyperplasia edema）Heart failurePneumothoraxEmphysemaCavitating lesionThin-walled Cavitating lesionThick-walled Cavitating lesion 3mmBronchiectasisMiliary shadowingCalcificationBenign Patterns of Calcification Within a Solitary Pulmonary NoduleChest Tube, NG Tube, Pulm

11、. artery cathCT IndicationsKeyClinical FactorsGrowth PatternSizeMargin (Border) CharacteristicsDensityContrast-Enhanced CTOther findingsPulmonary Infectionairspace opacification air bronchogramsdense multifocal segmentalpneumoniacavitationLobar/segmental consolidationPneumonia findingTuberculosisinf

12、iltratesMiliary shadowingTuberculomaChronic fibro-cavitary TBCAUSES OF SOLITARY PULMONARY NODULES CAUSES OF SOLITARY PULMONARY NODULES （SPNSPN） Neoplastic: MalignantBronchogenic carcinomaSolitary metastasisLymphomaCarcinoid tumorNeoplastic: BenignHamartomaBenign connective tissue and neural tumors (

13、e.g., lipoma, fibroma, neurofibroma)InflammatoryGranulomaLung abscessRheumatoid noduleInflammatory pseudotumor (plasma cell granuloma)CongenitalArteriovenous malformationLung cystBronchial atresia with mucoid impactionMiscellaneousPulmonary infarctIntrapulmonary lymph nodeMucoid impactionHematomaAmy

14、loidosisNormal confluence of pulmonary veinsMimics of SPNNipple shadowCutaneous lesion (e.g., wart, mole)Rib fracture or other bone lesion loculated pleural effusionNeoplastic: BenignHamartomaNeoplastic: MalignantBronchogenic carcinomaNeoplastic: MalignantBronchogenic carcinomaInflammatoryGranulomac

15、hest radiograph shows a small, well-circumscribed, round opacity at the right lung base (arrows).Lateral view shows that the opacity is within the lung on two views (posterior segment of the right lower lobe) and thus represents a pulmonary nodule (arrow). Contrast CT in Malignant Solitary Pulmonary

16、 Nodule. Thin-collimation (3-mm) CT scans through left upper lobe nodule in a 62-year-old woman with biopsy-proven lung cancer shows a lobulated contour with positive enhancement of 50 H after contrast administrationMalignant SPNBronchogenic CarcinomaClinical）Age at diagnosis: 55-60 years (range 40-

17、80 years); M:F = 1.4:1Age at diagnosis: 55-60 years (range 40-80 years); M:F = 1.4:1asymptomatic (10-50%) usually with peripheral tumorsasymptomatic (10-50%) usually with peripheral tumorssymptoms of central tumors:symptoms of central tumors:cough (75%), wheezing, pneumoniacough (75%), wheezing, pne

18、umoniahemoptysis (50%), dysphagia (2%)hemoptysis (50%), dysphagia (2%)symptoms of peripheral tumors:symptoms of peripheral tumors:pleuritic/local chest pain, dyspnea, coughpleuritic/local chest pain, dyspnea, coughPancoast syndrome, superior vena cava syndromePancoast syndrome, superior vena cava sy

19、ndromehoarsenesshoarsenesssymptoms of metastatic disease (CNS, bone, liver, adrenal gland)symptoms of metastatic disease (CNS, bone, liver, adrenal gland)paraneoplastic syndromes:paraneoplastic syndromes:cachexia of malignancycachexia of malignancyclubbing + hypertrophic osteoarthropathyclubbing + h

20、ypertrophic osteoarthropathynonbacterial thrombotic endocarditisnonbacterial thrombotic endocarditismigratory thrombophlebitismigratory thrombophlebitisectopic hormone production: hypercalcemia, syndrome of inappropriate secretion ectopic hormone production: hypercalcemia, syndrome of inappropriate

21、secretion of antidiuretic hormone, Cushing syndrome, gynecomastia, acromegalyof antidiuretic hormone, Cushing syndrome, gynecomastia, acromegalyRisk factorsCigarette smoking (squamous cell carcinoma + small cell carcinoma)Cigarette smoking (squamous cell carcinoma + small cell carcinoma)鈥搑鈥搑elated t

22、o number of cigarettes smoked, depth of inhalation, age at which elated to number of cigarettes smoked, depth of inhalation, age at which smoking begansmoking began85% of lung cancer deaths are attributable to cigarette smoking!85% of lung cancer deaths are attributable to cigarette smoking!Passive

23、smoking may account for 25% of lung cancers in nonsmokers!Passive smoking may account for 25% of lung cancers in nonsmokers!Radon gas: may be the 2nd leading cause for lung cancer with up to 20,000 Radon gas: may be the 2nd leading cause for lung cancer with up to 20,000 deaths per yeardeaths per ye

24、arIndustrial exposure: asbestos, uranium, arsenic, chlormethyl etherIndustrial exposure: asbestos, uranium, arsenic, chlormethyl etherConcomitant disease:Concomitant disease:chronic pulmonary scar + pulmonary fibrosischronic pulmonary scar + pulmonary fibrosisScar carcinomaScar carcinoma45% of all p

25、eripheral cancers originate in scars!45% of all peripheral cancers originate in scars! Incidence: 7% of lung tumors; 1% of autopsies Incidence: 7% of lung tumors; 1% of autopsies Origin: related to infarcts (50%), tuberculosis scar (50%), tuberculosis scar (25%) Histo: adenocarcinoma (72%), Histo: a

26、denocarcinoma (72%), squamous cell carcinoma (18%) squamous cell carcinoma (18%) Location: upper lobes (75%) Location: upper lobes (75%)Types:Adenocarcinoma (50%) Most common cell type seen in women + nonsmokersIntermediate malignant potential (slow growth, high incidence of early metastases)almost

27、invariably develops in periphery; frequently found in scars (tuberculosis, infarction, scleroderma, bronchiectasis) + in close relation to preexisting bullaesolitary peripheral subpleural mass (52%)/alveolar infiltrate/multiple nodulesmay invade pleura + grow circumferentially around lung mimicking

28、malignant mesotheliomaupper lobe distribution (69%)air broncho-/bronchiologram on HRCT (65%)calcification in periphery of mass (1%)smooth margin/spiculated margin due to desmoplastic reaction with retraction of pleuraAdenocarcinoma Presenting as Solitary Pulmonary Nodule. Cone-down view of posteroan

29、terior radiograph shows nodule in the right mid-lung (arrow). Thin-section CT shows 12-mm nodule with spiculated margins (arrow) in the superior segment of the right lower lobe. Transthoracic needle biopsy revealed adenocarcinoma.solitary peripheral massSquamous cell carcinoma (30-35%)Strongly assoc

30、iated with cigarette smokingCentral location within main/lobar/segmental bronchus (2/3)large central mass & cavitationdistal atelectasis & bulging fissure (due to mass)postobstructive pneumoniaAll cases of pneumonia in adults should be followed to complete radiologic resolution!airway obstru

31、ction with atelectasis (37%)Solitary peripheral nodule (1/3)characteristic cavitation (in 7-10%)Squamous cell carcinoma is the most common cell type to cavitate!invasion of chest wallSquamous cell carcinoma is the most common cell type to cause Pancoast tumorCentral lung cancerSquamous Cell Carcinom

32、a. Posteroanterior chest film in a 58-year-old male smoker with hemoptysis shows a left hilar mass with left upper lobe atelectasis.Enhanced CT scan shows the left hilar mass occluding the left upper lobe bronchus with an endobronchial component (straight arrow). Note the presence of mucus bronchograms within the atelectati