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Radiological signs of Disease

Radiological signs of Disease. Air Fluid Levels You can encounter air fluid levels in chest x-rays in the following conditions: Cavitary lung lesions Loculated empyema Hydropneumothorax Esophageal obstruction Mediastinal abscess Hydropneumopericardium Hiatal hernia Chest wall abscess.

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Radiological signs of Disease

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  1. Radiological signs of Disease

  2. Air Fluid LevelsYou can encounter air fluid levels in chest x-rays in the following conditions:Cavitary lung lesions Loculated empyema Hydropneumothorax Esophageal obstruction Mediastinal abscess Hydropneumopericardium Hiatal hernia Chest wall abscess

  3. Most disease processes will either increase or decrease the density of the lung parenchyma

  4. A mediastinal lesion should have a sharp margin convex towards the lungs and its base abutting the mediastinum .

  5. A pleural lesion should be seen as a homogenously dense opacity abutting the pleural surface, without air bronchogram. If the pleural lesion is free fluid, it will gravitate to the dependant lung parts first to form a miniscus (concavity) along its upper surface. • An extra pleural lesion demonstrates a homogenous density which makes obtuse angles with the chest wall, or may appear similar to pleural disease.

  6. A lung opacity may be due to a mass or lung- parenchymal opacification. Identification of clear margins vs indistinct or diffuse opacification is important in making the differentiation.If the diffuse opacification demonstrates lucencies or air bronchogram within it, it is most likely air space disease (consolidation).

  7. Signs of lobar collapse • Local increase in density due to non-aerated lung. • Decreased lung volume. • Displacement of pulmonary fissures. • Elevation of hemidiaphragm. • Displacement of hila.

  8. Pleural effusion + lobar densities • Pneumonia with empyema • Pulmonary infarction • Bronchogenic carcinoma • Tuberculosis

  9. Pleural effusion + subsegmental atelectasis • Postoperative (thoracotomy, splenectomy, renal surgery) secondary to thoracic splinting + small airway mucous plugging • Pulmonary infarction • Abdominal mass • Ascites • Rib fractures

  10. Upper lung zone distribution • Cystic fibrosis • Ankylosing spondylitis • Sarcoidosis • Silicosis • Histiocytosis (Langerhan's cell) • TB, fungal • Radiation pneumonitis ( cancers of head/neck and breast)

  11. Peripheral lung zone distribution • BOOP (bronchiolitis obliterans organizing pneumonia) • UIP (usual interstitial pneumonitis, and DIP desquamative interstitial pneumonitis) • Infarcts • Eosinophilic pneumonia • Alveolar sarcoidosis • Contusions

  12. 'Bat's wing distribution AcuteChronic * Pulmonary oedema: * Atypical pneumonia - cardiac * Lymphoma/Leukemia - non cardiac * Sarcoidosis: interstitial * Pneumonia: form much more common - often 'unusual' etiology; * Pulmonary alveolar - pneumocystis carinii (AIDS); proteinosis - TB, viral pneumonias; * Alveolar cell carcinoma: - mycoplasma. localised form more common * Pulmonary haemorrhage: - Goodpasture's syndrome; Wegner's and other vasculitides - anticoagulants; - bleeding diathesis: haemophilia, DIC;  extensive contusion.

  13. LUNG VOLUME *Reduced • Idiopathic pulmonary fibrosis. • Chronic interstitial pneumonia • Asbestosis • Collagen vascular disease • Chronic pulmonary tuberculosis *Normal • Sarcoidosis • Histiocytosis *Increased • Bronchial Asthma • Emphysema • Lymphangioleiomyomatosis

  14. Reticulations & Hilar Adenopathy • - Sarcoidosis • Silicosis • - Lymphoma/leukemia • - Lung primary: particulary oat cell carcinoma • - Metastases: lymphatic obstuction/spread • - Fungal disease • - Tuberculosis • - Viral pneumonia (rare combination)

  15. Lung mass • of more than Clinical history and patient’s age . • Mass borders . • Comparison with previous examinations. • Presence of calcifications. • Associated adjacent rib erosions, pleural effusion, hilar or mediastinal nodal enlargement. • Presence of more than one mass.

  16. SIGNS OF INTERSTITIAL DISEASE

  17. Distribution of opacities • Unifocal or multifocal. • Lobar. • Segmental. • Perihilar. • Peripheral. • Upper, middle or lower zones.

  18. Lung fields appear dark because of air. Ninety-nine percent of the lung is air. The pulmonary vasculature, interstitium constitute 1% and give the lacy lung pattern.

  19. You have to know what is normal before you can recognize abnormalities. Knowledge of anatomy is essential for this purpose.

  20. Which lung is larger? Which diaphragm is higher and why? What is the normal size of the heart? What is the normal size and shape of the aorta?

  21. Silhouette sign is extremely useful in localizing lung lesions

  22. Hyperlucent Lung • Factors • Vasculature: Decrease • Air: Excess • Tissue : Decrease • Bilateral diffuse • Emphysema • Asthma • Unilateral • Swyer James syndrome • Agenesis of pulmonary artery • Absent breast or pectoral muscle • Partial airway obstruction • Compensatory hyperinflation • Localized • Bullae • Westermark's sign : Pulmonary embolus .

  23. Honeycombing • Seen in end stage lung disease • Indicative of diffuse interstitial fibrosis • Due to bronchiolectasia • Most of the time in bases • Upper lobe distribution seen in eosinophilic granuloma

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