呼吸系统课件：RespiratorySystems

DiagnosticRadiologyofRespiratorySystemDiagnosticRadiologyof1LEARNINGOBJECTIVES

Masterdegree

(*):X-rayandCTappearanceofpneumonia,pulmonarytuberculosisandlungcancerLEARNINGOBJECTIVESMasterdeg2CommonimagingmethodsChestplainfilming√Computedtomography

(CT)√

Commonimagingmethods3CTPlainfilmDifferencebetweenX-rayplainfilmingandCTCTPlainfilmDifferencebetween4Posteroanteriorchest(P-A)ChestplainfilmimgRightLeftPosteroanteriorchest(P-A)C5NormalchestCTNormalchestCT6CommonabnormalimagingpatternsandlesionsAtelectasisConsolidationNoduleMassCalcificationCavityInterstitiallesionPleuraleffusionPneumothoraxPleuralthickeningandcalcificationCommonabnormalimagingpatter7DiagnosisofCommonDisease(I)

Inflammatorylesions:---Bronchiectasis---Pneumonia&abscess---TuberculosisDiagnosisofCommonDisease(I8BronchiectasisChronicirreversibledilatationofdiseasedbronchi.Causes

Post-infectious:bacteria,viruses,etc.Mechanicalobstruction:foreignbody,mucoidimpaction,tumour,inflammatorystenosis.CongenitalImmunodeficiencyGranulomasandfibrosisIdiopathicBronchiectasisChronicirrevers9BronchiectasisClinicalfeaturesProductionoflargevolumesofpurulentsputumRecurrenthaemoptysisFrequentinfectiveexacerbationBronchiectasis10

BronchiectasisTypesofbronchiectasis（*）：(a)Cylindricalbronchiectasis(b)Varicosebronchiectasis(c)CysticbronchiectasisBronchiectasis11BronchiectasisX-rayfindingsPlainfilmIncreasingandthickeningoflungmarkings.CTCylindrical,varicose,orcysticappearance.BronchiectasisX-rayfindings12BronchiectasisCysticbronchiectasisCylindricaldilationdenseinfiltrationofthebothlungBronchiectasisCysticbronchiec13Bronchiectasisshowsdilatedbronchiandbronchioles,forminga“clusterofgrapes”

Signetringsignnormalarterybronchus“clusterofgrapes”

Bronchiectasisshowsdilatedbr14Pneumonia---infectiveconsolidationofthelungClassificationbyanatomy(*)

Lobarpneumonia

Lobularpneumonia

InterstitialpneumoniaPneumonia---infectiveconsolid15Lobarpneumonia

Causes

pneumococcus（usually）Clinicalmanifestation

Commonestinyoungandadults

suddenonsethighfever(>39℃)shakingchillcoughwithrustycolorsputum

Lobarpneumonia16

Lobarpneumonia

Dividedinto4

stages(*):Congestivestage(in24hafteronset)RedconsolidationstageGrayconsolidationstageResolutionstage(2weeks)X-rayfindings(*)

Thetypicalradiologicalpattern—Air-spaceconsolidationinvolvinganentirelobe

AirbronchogramsignLobar17homogeneousair-spaceconsolidationinvolvingtheentirerightlowerlobehomogeneousair-spaceconsolid18Lobarpneumonia

AirbronchogramsignLobarpneumoniaAirbronchogra19Causes

StaphylococcusaureusGram-negativeorganismssuchasPseudomonasaeruginosaLobularpneumonia

CausesLobularpneumonia20ClinicalmanifestationsHistoryofacutebronchitisCommonlyseeninchildrenandeldlypeople，

orthepatientswithpredisposingfactor.FeverProductivecough,Infected(yelloworgreen)sputum.CorsecrepitationsDullnesstopercussionBronchialbreathingLobularpneumonia

ClinicalmanifestationsLobular21PathologicalchangesLobularconsolidationEdemaandthickeningofwallsofthesmallerbronchioles.X-rayfindings(*)Ascatteredappearanceofheterogeneousorhomogeneousopacitiesincompleteresolution：fibrosisLobularpneumonia

PathologicalchangesLobularpn22Lobularpneumonia

ill-defined，scatteredappearance，heterogeneousshadowsLobularpneumoniaill-defined，23Lobularpneumonia

multifocalareasofconsolidationLobularpneumoniamultifocala24Interstitialpneumonia---Involvementoftheinterstitialtissueoflungs---Occursaroundthebronchialtree,bloodvessels,thealveolarsepta,andinterlobularsetpa.X-rayfindings(*)Linear,reticular,orhoneycombingshadowsinbothlungfields.Interstitialpneumonia25Interstitialpneumoniastreak-likeandreticular,net-likeshadowsInterstitialpneumoniastreak-l26InterstitialpneumoniaHoneycombingpattern.tractionbronchiectasissub-pleuralcystsInterstitialpneumoniaHoneycom27Pulmonaryabscess--Focalareasofnecrosis

causedbyvarioussuppurativeinflammation,thendevelopslungabscessPathwaysAspiratedHaematogenousInfectiveClinicalmanifestations

Fever,shakingchill,foulsmellingsputum.Pulmonaryabscess28Acutestage

Exudativeandconsolidativeshadow.SubacutestageAbscesscavitywithfluidlevel;Thewallthickandirregular.ChronicstageThickandwell-definedwall;.

a

b

cPulmonaryabscessAcutestageabcPulmonaryabs29Pulmonaryabscess*air-fluidlevelPulmonaryabscess*air-fluidl30Pulmonarytuberculosis

(*)Causes:Mycobacteriumtuberculosisaffectspredominantlythelungs,lumphnodesandgut.ClassicSymptoms：Fever，nightsweetsandcoughSomefeaturesofthediseasevarywiththepatient’ssensitivitytotuberculin.Pulmonarytuberculosis(*)31PulmonarytuberculosisClassification(*)TypeIPrimarypulmonaryTBTypeIIHemo-disseminatedpulmonaryTBTypeIIIPost-primarypulmonaryTBTypeIVTuberculouspleuritisTypeVOtherPulmonarytuberculosis32PrimarypulmonaryTB(TypeI)---infectionwithM.tuberculosisinnonsensitivepatients（inchildren

andyoungpeople）thosewhohavenotpreviouslybeeninfected.Pathology(*)PrimaryfocusLymphangitisLymphadenitisPrimarypulmonaryTB(TypeI)33Primarycomplex(*)Definition---thecombinationoftheprimarypulmonarytuberculousfocus，lymphangitisandintrathoraciclymphadenitisX-rayFindings(*)Consolidation/exudationinthelung（pulmonarytuberculousfocus）

Ipsilateralenlargementofhilar/mediastinallymphnodes（lymphadenitis）

Streakyshadowsleadingfromtheexudationtothehilar（lymphangitis）

“Dumbbell-like”signPrimarycomplex(*)“Dumbbell-34A:

amanwithfever,hemoptysis,andweightloss,showsbilateralpatchyairspaceopacities,withareasofcavitationintheupperlobes(arrows).B:

9monthslatershowschangesofhealinginupperlobesconsistingoflinearopacities(straightarrow)andthin-walledcavities(curvedarrows).Primarytuberculosis

ABA:

amanwithfever,hemoptysi35

CTshowstheenlargementofhilar

withamountsofenlarged，necroticandlow-densitylymphnodesIntrathoraciclymphnodeTB

CTshowstheenlargementofh36Hemo-disseminatedpulmonaryTB

(TypeII)Twotypes：AcutemiliaryTB

SubacuteorchronicdisseminatedTB

X-rayFindings(*)

alotoffine，pin-pointmottlingopacities，withsamesize，

samedensityanddiffuseddistributionHemo-disseminatedpulmonaryTB37Hemo-disseminatedpulmonaryTB(TypeII)AcutemiliaryTB

showsdiffusesmallnodulesintherightlung,andcavitarydiseaseontheleftresultofhematogenousspreadHemo-disseminatedpulmonaryTB38Post-primarypulmonaryTB(TypeIII)mostcommontype，chieflyinadultsX-rayfindings

Caseouslesionencapsulatedbyconnectivetissue.Round,solitarynodules;Commonlyintheapicalregions;Associated“satellite”lesionPost-primarypulmonaryTBmost39Post-primarypulmonaryTB(TypeIII)cavityand“satellite”lesionPost-primarypulmonaryTBcavit40Chronicfibro-cavitarypulmonarytuberculosisChronicfibro-cavitary41TypeIPrimarypulmonaryTBTypeIIHemo-disseminatedpulmonaryTBTypeIIIPost-primarypulmonaryTBTypeIVTuberculouspleuritisTypeVOtherTypeIPrimarypulmonaryTB42DiagnosisofCommonDisease(II)

Tumorlikelesions:---Primarylungcancer:PrimaryBronchogeniccarcinoma)---Secondarylungcancer:Metastaticpulmonarytumors)DiagnosisofCommonDisease(I43PrimaryBronchogeniccarcinoma*Histology(*)Squamouscellcarcinoma（commonest）AdenocarcinomaSmallcellcarcinomaLargecellanaplasticcarcinomaPrimaryBronchogeniccarcinoma44Bronchogeniccarcinoma*Classificationbyposition(*)Centralbronchogeniccarcinoma

Peripheralbronchogeniccarcinoma

DiffusebronchogeniccarcinomaBronchogeniccarcinoma*45Centralbronchogeniccarcinoma---originatedfrommainbronchi，lobarbronchiorsegmentalbronchi

andlocatedintheareaofhilumX-rayFindings(*)Directsign：hilarmassIndirectsigns：

ObstructiveemphysemaObstructivepneumonitisObstructiveatelectasisenlargementofhilar/mediastinallymphnodesCentralbronchogeniccarcinoma46Chestradiographsofa46ywomanwithsymptomsofpneumoniashowamassintheleftupperlobe.

CTshowsa7.8-cmmassarisingfromtheleftupperlobebronchus(arrow)

CentraltumorChestradiographsofa46ywom47A:

PAchestradiographofa48ymanshowsanirregularmassintherightupperlobeabuttingthemediastinum.CTshowsthemassextendingintothemediastinum.Thecenterofthemassisoflowattenuation,secondarytotumornecrosis.

CTwithlungwindowingshowsthespiculatedmass

CentraltumorA:

PAchestradiographofa4848ReverseSSign（GlodenSsign）Rightupperlobebronchusisobstructedbyanendo-bronchialmass,causingcollapseoftherightupperlobe,theminorfissureiselevated.:ShapeofareverseS。ReverseSSign（GlodenSsig49

CentraltumorcollapseoftherightlungCentraltumorcollapseofthe50Peripheralbronchogeniccarcinoma---locatedintheperipherallungfieldX-rayFindings(*)Directsign：Massornodule-likelesionsHomogeneousdensityhazyorlobulated,notched，spiculatedmarginmasswitheccentricandirregularcavityIndirectsigns：enlargementofhilar/mediastinallymphnodes

Peripheralbronchogeniccarcin51

PAchestradiographofa72-ymanwitha53yearhistoryof

smokingshowsamassintherightupperlobe.

CTshowsaspiculatedmass.

Peripheralbronchogeniccarcinomaspiculatedmass

PAchestradiographofa72-y52CTscanshowsalobulated,spiculatednoduleintherightupperlobe(arrow).PeripheralbronchogeniccarcinomaLobulatedlesionCTscanshowsalobulated,spi53Metastaticpulmonarytumors（secondary）

Sources：Thebreast,colon,kidney,uterus,prostate,headandneck.Choriocarcinoma,osteosarcoma,Ewing’ssarcoma,testiculartumours,melanomaandthyroidcarcinoma.Metastaticpulmonarytumors（se54

X-rayfindings

multiplenodulespredominantlydistributedintheperipheryofthelungs.Usuallywell-definedoutlinesLymphangeitis--beadingchanges

MetastaticpulmonarytumorsMetastaticpulmonarytumors55numerousbilateralwell-definednodulesofvaryingsizesTesticularcarcinomanumerousbilateralwell-define56multiplewelldefinedandvarioussizenodulesinbothlungscomefromhepaticcarcinomamultiplewelldefinedandvari57brief

summaryDiseasesXrayfeaturesBronchiectasisSignetringsign,clusterofgrapesPneumoniaAirbronchogramsignPulmonaryabscessCavitywithfluidlevelPrimarycomplexTB“Dumbbell-like”signAcutemiliaryTBalotoffine，pin-pointmottlingopacities，withsamesizeandsamedensityCentralbronchogeniccarcinomacausingcollapseoftherightupperlobeReverseSSignMetastaticpulmonarytumorsnumerousbilateralwell-definednodulesofvaryingsizesbrief

summaryDiseasesXrayfea58Thanksforyourattention!http://www.radiologyassistant.nl/Thanksforyourattention!http59DiagnosticRadiologyofRespiratorySystemDiagnosticRadiologyof60LEARNINGOBJECTIVES

Masterdegree

(*):X-rayandCTappearanceofpneumonia,pulmonarytuberculosisandlungcancerLEARNINGOBJECTIVESMasterdeg61CommonimagingmethodsChestplainfilming√Computedtomography

(CT)√

Commonimagingmethods62CTPlainfilmDifferencebetweenX-rayplainfilmingandCTCTPlainfilmDifferencebetween63Posteroanteriorchest(P-A)ChestplainfilmimgRightLeftPosteroanteriorchest(P-A)C64NormalchestCTNormalchestCT65CommonabnormalimagingpatternsandlesionsAtelectasisConsolidationNoduleMassCalcificationCavityInterstitiallesionPleuraleffusionPneumothoraxPleuralthickeningandcalcificationCommonabnormalimagingpatter66DiagnosisofCommonDisease(I)

Inflammatorylesions:---Bronchiectasis---Pneumonia&abscess---TuberculosisDiagnosisofCommonDisease(I67BronchiectasisChronicirreversibledilatationofdiseasedbronchi.Causes

Post-infectious:bacteria,viruses,etc.Mechanicalobstruction:foreignbody,mucoidimpaction,tumour,inflammatorystenosis.CongenitalImmunodeficiencyGranulomasandfibrosisIdiopathicBronchiectasisChronicirrevers68BronchiectasisClinicalfeaturesProductionoflargevolumesofpurulentsputumRecurrenthaemoptysisFrequentinfectiveexacerbationBronchiectasis69

BronchiectasisTypesofbronchiectasis（*）：(a)Cylindricalbronchiectasis(b)Varicosebronchiectasis(c)CysticbronchiectasisBronchiectasis70BronchiectasisX-rayfindingsPlainfilmIncreasingandthickeningoflungmarkings.CTCylindrical,varicose,orcysticappearance.BronchiectasisX-rayfindings71BronchiectasisCysticbronchiectasisCylindricaldilationdenseinfiltrationofthebothlungBronchiectasisCysticbronchiec72Bronchiectasisshowsdilatedbronchiandbronchioles,forminga“clusterofgrapes”

Signetringsignnormalarterybronchus“clusterofgrapes”

Bronchiectasisshowsdilatedbr73Pneumonia---infectiveconsolidationofthelungClassificationbyanatomy(*)

Lobarpneumonia

Lobularpneumonia

InterstitialpneumoniaPneumonia---infectiveconsolid74Lobarpneumonia

Causes

pneumococcus（usually）Clinicalmanifestation

Commonestinyoungandadults

suddenonsethighfever(>39℃)shakingchillcoughwithrustycolorsputum

Lobarpneumonia75

Lobarpneumonia

Dividedinto4

stages(*):Congestivestage(in24hafteronset)RedconsolidationstageGrayconsolidationstageResolutionstage(2weeks)X-rayfindings(*)

Thetypicalradiologicalpattern—Air-spaceconsolidationinvolvinganentirelobe

AirbronchogramsignLobar76homogeneousair-spaceconsolidationinvolvingtheentirerightlowerlobehomogeneousair-spaceconsolid77Lobarpneumonia

AirbronchogramsignLobarpneumoniaAirbronchogra78Causes

StaphylococcusaureusGram-negativeorganismssuchasPseudomonasaeruginosaLobularpneumonia

CausesLobularpneumonia79ClinicalmanifestationsHistoryofacutebronchitisCommonlyseeninchildrenandeldlypeople，

orthepatientswithpredisposingfactor.FeverProductivecough,Infected(yelloworgreen)sputum.CorsecrepitationsDullnesstopercussionBronchialbreathingLobularpneumonia

ClinicalmanifestationsLobular80PathologicalchangesLobularconsolidationEdemaandthickeningofwallsofthesmallerbronchioles.X-rayfindings(*)Ascatteredappearanceofheterogeneousorhomogeneousopacitiesincompleteresolution：fibrosisLobularpneumonia

PathologicalchangesLobularpn81Lobularpneumonia

ill-defined，scatteredappearance，heterogeneousshadowsLobularpneumoniaill-defined，82Lobularpneumonia

multifocalareasofconsolidationLobularpneumoniamultifocala83Interstitialpneumonia---Involvementoftheinterstitialtissueoflungs---Occursaroundthebronchialtree,bloodvessels,thealveolarsepta,andinterlobularsetpa.X-rayfindings(*)Linear,reticular,orhoneycombingshadowsinbothlungfields.Interstitialpneumonia84Interstitialpneumoniastreak-likeandreticular,net-likeshadowsInterstitialpneumoniastreak-l85InterstitialpneumoniaHoneycombingpattern.tractionbronchiectasissub-pleuralcystsInterstitialpneumoniaHoneycom86Pulmonaryabscess--Focalareasofnecrosis

causedbyvarioussuppurativeinflammation,thendevelopslungabscessPathwaysAspiratedHaematogenousInfectiveClinicalmanifestations

Fever,shakingchill,foulsmellingsputum.Pulmonaryabscess87Acutestage

Exudativeandconsolidativeshadow.SubacutestageAbscesscavitywithfluidlevel;Thewallthickandirregular.ChronicstageThickandwell-definedwall;.

a

b

cPulmonaryabscessAcutestageabcPulmonaryabs88Pulmonaryabscess*air-fluidlevelPulmonaryabscess*air-fluidl89Pulmonarytuberculosis

(*)Causes:Mycobacteriumtuberculosisaffectspredominantlythelungs,lumphnodesandgut.ClassicSymptoms：Fever，nightsweetsandcoughSomefeaturesofthediseasevarywiththepatient’ssensitivitytotuberculin.Pulmonarytuberculosis(*)90PulmonarytuberculosisClassification(*)TypeIPrimarypulmonaryTBTypeIIHemo-disseminatedpulmonaryTBTypeIIIPost-primarypulmonaryTBTypeIVTuberculouspleuritisTypeVOtherPulmonarytuberculosis91PrimarypulmonaryTB(TypeI)---infectionwithM.tuberculosisinnonsensitivepatients（inchildren

andyoungpeople）thosewhohavenotpreviouslybeeninfected.Pathology(*)PrimaryfocusLymphangitisLymphadenitisPrimarypulmonaryTB(TypeI)92Primarycomplex(*)Definition---thecombinationoftheprimarypulmonarytuberculousfocus，lymphangitisandintrathoraciclymphadenitisX-rayFindings(*)Consolidation/exudationinthelung（pulmonarytuberculousfocus）

Ipsilateralenlargementofhilar/mediastinallymphnodes（lymphadenitis）

Streakyshadowsleadingfromtheexudationtothehilar（lymphangitis）

“Dumbbell-like”signPrimarycomplex(*)“Dumbbell-93A:

amanwithfever,hemoptysis,andweightloss,showsbilateralpatchyairspaceopacities,withareasofcavitationintheupperlobes(arrows).B:

9monthslatershowschangesofhealinginupperlobesconsistingoflinearopacities(straightarrow)andthin-walledcavities(curvedarrows).Primarytuberculosis

ABA:

amanwithfever,hemoptysi94

CTshowstheenlargementofhilar

withamountsofenlarged，necroticandlow-densitylymphnodesIntrathoraciclymphnodeTB

CTshowstheenlargementofh95Hemo-disseminatedpulmonaryTB

(TypeII)Twotypes：AcutemiliaryTB

SubacuteorchronicdisseminatedTB

X-rayFindings(*)

alotoffine，pin-pointmottlingopacities，withsamesize，

samedensityanddiffuseddistributionHemo-disseminatedpulmonaryTB96Hemo-disseminatedpulmonaryTB(TypeII)AcutemiliaryTB

showsdiffusesmallnodulesintherightlung,andcavitarydiseaseontheleftresultofhematogenousspreadHemo-disseminatedpulmonaryTB97Post-primarypulmonaryTB(TypeIII)mostcommontype，chieflyinadultsX-rayfindings

Caseouslesionencapsulatedbyconnectivetissue.Round,solitarynodules;Commonlyintheapicalregions;Associated“satellite”lesionPost-primarypulmonaryTBmost98Post-primarypulmonaryTB(TypeIII)cavityand“satellite”lesionPost-primarypulmonaryTBcavit99Chronicfibro-cavitarypulmonarytuberculosisChronicfibro-cavitary100TypeIPrimarypulmonaryTBTypeIIHemo-disseminatedpulmonaryTBTypeIIIPost-primarypulmonaryTBTypeIVTuberculouspleuritisTypeVOtherTypeIPrimarypulmonaryTB101DiagnosisofCommonDisease(II)

Tumorlikelesions:---Primarylungcancer:PrimaryBronchogeniccarcinoma)---Secondarylungcancer:Metastaticpulmonarytumors)DiagnosisofCommonDisease(I102PrimaryBronchogeniccarcinoma*Histology(*)Squamouscellcarcinoma（commonest）AdenocarcinomaSmallcellcarcinomaLargecellanaplasticcarcinomaPrimaryBronchogeniccarcinoma103Bronchogeniccarcinoma*Classificationbyposition(*)Centralbronchogeniccarcinoma

Peripheralbronchogeniccarcinoma

DiffusebronchogeniccarcinomaBronchogeniccarcinoma*104Centralbronchogeniccarcinoma---originatedfrommainbronchi，lobarbronchiorsegmentalbronchi

andlocatedintheareaofhilumX-rayFindings(*)Directsign：hilarmassIndirectsigns：

ObstructiveemphysemaObstructivepneumonitisObstructiveatelectasisenlargementofhilar/mediastinallymphnodesCentralbronchogeniccarcinoma105Chestradiographsofa46ywomanwithsymptomsofpneumoniashowamassintheleftupperlobe.

CTshowsa7.8-cmmassarisingfromtheleftupperlobebronchus(arrow)

CentraltumorChestradiographsofa46ywom106A:

PAchestradiographofa48ymanshowsanirregularmassintherightupperlobeabuttingthemediastinum.CTshowsthemassextendingintothemediastinum.Thecenterofthemassisoflowattenuation,secondarytotumornecrosis.

CTwithlungwindowingshowsthespiculatedmass

CentraltumorA:

PAchestradiograph