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Imaging the normal and abnormal lung

Imaging the normal and abnormal lung There is minimal descriptive text in the presenter’s notes field Please email me if you have questions Dr I Runcie Consultant Radiologist PRH Ian.runcie@bsuh.nhs.uk http://alberich4.tripod.com/index.html. Chest X-ray CT scan

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Imaging the normal and abnormal lung

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  1. Imaging the normal and abnormal lung There is minimal descriptive text in the presenter’s notes field Please email me if you have questions Dr I Runcie Consultant Radiologist PRH Ian.runcie@bsuh.nhs.uk http://alberich4.tripod.com/index.html

  2. Chest X-ray • CT scan • Ventilation and perfusion imaging

  3. This is a radiograph of what appears to be a bunch of grapes. Would you / could you eat these grapes?

  4. Grape in a cup of air

  5. Grape in a cup of water

  6. What is in this cup of water?

  7. The radiologist’s radiographic world view Water - all body fluids and tissues except fat and bone Fat Gas High atomic number calcium iodine barium metals

  8. Pulmonary arteries ✓ Pulmonary veins ✓ Bronchi ?

  9. CT scan of the lungs • Shows greater detail • Resolve small structures • Resolve small differences in attenuation

  10. CT thorax and HRCT lung • Slice thickness • Resolution • Thin section (1mm) is the optimal technique for demonstrating lung • CT thorax 5-8mm slice thickness

  11. 2 4 1 4 5 3

  12. Structure and function The primary pulmonary lobule and acinus 6-10mm Secondary pulmonary lobule 5-20mm diam is the functional unit of the lung. 300M alveoli per adult – total area 143m2

  13. CTS connective tissue septum art pulmonary artery v+l vein & lymphatic tb terminal bronchus rb respiratory bronchus alv alveolus ven venule ac acinus tru terminal respiratory unit or primary bronchiole pok Pore of Khon alv Alveolus Secondary Pulmonary Lobule

  14. 2 1

  15. What are lungs for? How could we image function?

  16. Lung function - Gas exchange Ventilation - move air in and out Perfusion - move blood in and out Diffusion - moves gases between alveoli and blood

  17. How could we obtain a picture of the distribution of ventilation in the lungs?

  18. Ventilation Radioactive gas - Xenon-133, Krypton-81m Radioactive aerosol - Tc99m-DTPA, Radioactive dry carbon particles 20nm (0.02 microns) 50micrograms Tc99m (2 0rders of magnitude below 24 hour permitted atmospheric pollution)

  19. Normal lung scan

  20. How could we produce a steady state image of lung blood flow?

  21. If you inject particles into a peripheral vein where will they stop? Does this carry any risk?

  22. Lung perfusion 2-500,000 intravenous particles 16-90 micron diameter Macroaggregated human serum albumen Occlude <1% of pulmonary circulation

  23. What patient posture would achieve the most uniform distribution of particles throughout the lungs? Upright? Lying on the right side? Lying flat on back?

  24. Normal lung scan

  25. A few test cases

  26. R What has happened to the right lung

  27. What are the round white objects in the lower part of each lung field?

  28. High temperature & cough

  29. Lung imaging A danger of DIY How is the patient breathing? What might her blood gases be like?

  30. Air space shadowing = consolidation • Fluffy blobs • About 1cm dia • Tending to confluence • Could be oedema /transudate / exudate / pus / blood • +/- air bronchogram

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