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PULMONARY RADIOLOGY

PULMONARY RADIOLOGY. พญ. ปาณยา ทุมสท้าน ภาควิชารังสีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น. PULMONARY OPACITY. “area that preferentially attenuates the x-ray beam” Area that more opaque than the surrounding area CLASSIFIED INTO Airspace opacities Atelectasis (collapse)

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PULMONARY RADIOLOGY

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  1. PULMONARY RADIOLOGY พญ. ปาณยา ทุมสท้าน ภาควิชารังสีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น

  2. PULMONARY OPACITY • “area that preferentially attenuates the x-ray beam” • Area that more opaque than the surrounding area • CLASSIFIED INTO • Airspace opacities • Atelectasis (collapse) • Nodules and masses • Linear and band like opacities • Cysts and bullae • Nodular and reticulonodular opacities and honeycombing

  3. AIRSPACE OPACITIES • Acinar shadow • Consolidation • Solitary airspace opacity • Multifocal airspace opacity

  4. DIFFERENTIAL DIAGNOSIS OF AIRSPACE OPACITES SOLITARY AIRSPACE OPACITY Pneumonia Atelectasis Infarction Hemorrhage Neoplasms - BAC - Lymphoma Radiation fibrosis Pulmonary contusion, vasculitis, drug reaction, etc.

  5. DIFFERENTIAL DIAGNOSIS OF AIRSPACE OPACITES MULTIFOCAL AIRSPACE OPACITIES • Exudate and transudates • Pneumonia, OP, infarction, connective tissue disease and vasculitis, inhalation of noxious gases or liquids, drug reaction, alveolar proteinosis • Hemorrhage • Pulmonary contusion/hematoma, infarction, vasculitis • Neoplasm • BAC, lymphangiticcarcinomatosa, metastases, lymphoma

  6. RML PNEUMONIA

  7. bronchopneumonia

  8. PULMONARY EDEMA

  9. RadioGraphics, Infectious pneumonia in a 35-year-old patient with hypogammaglobulinemia. November 2009 RadioGraphics, 29, 1909-1920.

  10. Small focus of pulmonary consolidation caused by pulmonary infarction David Hansell et al, Imaging of diseases of the chest, 5th edition, 2010

  11. Widespread, uniform airspace opacities in acute respiratory distress syndrome David Hansell, Imaging of diseases of the chest, 5th edition, 2010

  12. ATELECTASIS • Most frequent cause is bronchial obstruction • Bronchial obstruction in adult • Usually the result of a bronchial neoplasm or mucus plug • Occasionally, FB aspiration, broncholiths, extrinsic compression e.g. enlarged LNs, aortic aneurysm • Passive atelectasis • Discoid atelectasis( Platelike or linear atlectasis) • A form of adhesive atelectasis • Usually abuts the pleura and is perpendicular to pleural surface

  13. Golden S sign

  14. David Hansell, Imaging of diseases of the chest, 5th edition, 2010

  15. Left upper lobe collapse due to bronchial carcinoma. Note that the carcinoma has caused ‘rat tail’ narrowing of the left upper bronchus. David Hansell, Imaging of diseases of the chest, 5th edition, 2010

  16. Fluid bronchogram at CT. Fluid-filled bronchi beyond a carcinoma in the atelectatic lower left lobe are clearly visible.  David Hansell, Imaging of diseases of the chest, 5th edition, 2010

  17. ROUND ATELECTASIS • A form of chronic atelectasis that resembles a mass • Main DDx is BCA • “bronchi and vessels curving into the periphery and converging toward a mass and area of pleural thickening (Comet tail sign)”

  18. David Hansell, Imaging of diseases of the chest, 5th edition, 2010

  19. SOLITARY PULMONARY NODULE/MASS • Pulmonary nodule : lesion up to 3 cm in diameter. • DDx of SPN/mass • Neoplasm • BCA, metastasis, lymphoma, carcinoid tumor, hamartoma, etc • Inflammatory • Infection: TB, fungus, round pneumonia, lung abscess, septic emboli • Non infection: RA, Wegener granulomatosis

  20. SOLITARY PULMONARY NODULE/MASS • DDx of SPN/mass • Congenital • Pulmonary AVM, sequestration, lung cyst, bronchial atresia with mucoid impaction • Miscellaneous • Organizing pneumonia, pulmonary infarction, round atelectasis, etc. • Mimics of SPN • External object • Bone island or rib, healing rib fracture • Pleural plaque • Loculated pleural fluid

  21. Patient with a known extrathoracic malignant neoplasm • Patients with CA of H&N, bladder, breast, cervix, bile ducts, esophagus, ovary, prostate, or stomach with SPN • “primary lung CA were more likely than metastasis” • Patients with known salivary glands, adrenals, colon, kidney, thyroid, thymus or uterus • “fairly even odds” • Patients with known melanoma, sarcoma, or testicular cancer • “solitary metastasis is more likely than primary lung CA”

  22. Features which can be diagnostically helpful • Calcification • Fat density within a nodule • Ground glass opacity • Size • Shape • Cavitation • Air bronchogram and bubblelikelucencies • Enhancment

  23. BENIGN CALCIFICATION Concentric calcification Popcorn calcification Uniform calcification David Hansell et al, Imaging of diseases of the chest, 5th edition, 2010

  24. David Hansell et al, Imaging of diseases of the chest, 5th edition, 2010

  25. Fat in hamartoma David Hansell et al, Imaging of diseases of the chest, 5th edition, 2010

  26. Density of the nodule March 2007 RadioGraphics, 27, 391-408.

  27. Size and shape David Hansell et al, Imaging of diseases of the chest, 5th edition, 2010

  28. Fleischner society recommendations MacMahon et al. Radiology 237:395, Nov 2005

  29. Contrast enhancement • Rate of growth • Adjacent bone destruction

  30. Air crescent sign

  31. Silva et al. The teaching files chest. 82-83. 2010.

  32. Multiple pulmonary nodules Neoplasm • metastatic CA or sarcoma, lymphoma, BAC • Hamartomas, laryngeal papillomatosis Inflammatory • Infective • Granulomas (TB, histoplasmosis, nocardiosis) • Lung abscesses, septic emboli,etc. • Noninfective • RA, Wegener granulomatosis Congenital : AVM Miscellaneous • Hematomas, pulmonary infarction, mucoid impaction

  33. Miliary TB Metastasis thyroid CA Silva et al, The teaching files chest. 40-41, 2010. SILICOSIS

  34. Centrilobular nodules in Subacute hypersensitivity pneumonitis Silva et al, The teaching files chest, 2010.

  35. Tree-in-bud in infective bronchiolitis Silva et al, The teaching files chest, 46-47,2010.

  36. RANDOM DIST NODULES Pulmonary metastasis Miliary TB Silva et al, The teaching files chest, 48-49, 2010.

  37. ABNORMAL LUCENCY LESION • Cyst, cavity, bleb, bulla, emphysema • CYST; • any round circumscribed space that is surrounded by an epithelial or fibrous wall of variable thickness • CAVITY; • a gas-filled space, seen as a lucency or low-attenuation area, within pulmonary consolidation, a mass, or a nodule • usually produced by the expulsion or drainage of a necrotic part of the lesion via the bronchial tree • Cavity is not a synonym for abscess.

  38. BLEB; • a small gas-containing space within the visceral pleura or subpleural lung, not > 1 cm in diameter • CT: a thin-walled cystic airspace contiguous with the pleura • BULLA; • An airspace measuring > 1 cm – usually several centimeters – in diameter • sharply demarcated by a thin wall that is no greater than 1 mm in thickness. • usually accompanied by emphysematous changes in the adjacent lung. • Bullous emphysema is bullous destruction of the lung parenchyma • usually on a background of paraseptal or panacinar emphysema

  39. EMPHYSEMA; • permanently enlarged airspaces distal to the terminal bronchiole with destruction of alveolar walls • CT; focal areas or regions of low attenuation, usually without visible walls.[

  40. cyst

  41. Silva et al, The teaching files chest, 2010

  42. BULLA

  43. BLEB

  44. EMPHYSEMA IMAGE : WIKIPEDIA

  45. Paraseptal and centrilobular emphysema Imagingconsult.com

  46. BRONCHIECTASIS

  47. HONEYCOMBING

  48. CYSTIC BRONCHIECTASIS HONEYBOMBING

  49. LINEAR AND BAND-LIKE OPACITIES • Mucoid impaction • Septal lines • Bronchial wall (peribronchial) thickening

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