Mediastnum ppt

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  • Images are usually displayed using "lung windows," in which air appears black, aerated lung dark grey, and other structures white
  • This image of normal left lung shows central, branching pulmonary arteries and bronchi. The bronchovascular bundles are made up of these paired structures and their surrounding interstitium (connective tissue). In cross section, the bronchus is a thin-walled, white circle with central air (black), and the adjacent artery appears as a solid, white circle. More peripherally, numerous small "dots" and a few branching lines represent small pulmonary arteries and veins. Throughout, arteries branch at acute angles, and veins branch at 90° angles. The pleura of the major interlobar fissure is a thin, horizontal line traversing the lung. The peripheral pleural surface, which cannot be seen, is smooth.
  • This image shows complete opacification of most of the left upper lobe. Vessels are not visible in this area. When the bronchi remain aerated, they are seen as branching lucencies called air-bronchograms, which are present in this image. This image represents infectious pneumonia, which is limited by the major fissure, resulting in a sharp border. The advancing anteromedial margin shows ground-glass opacity
  • This image shows patchy ground-glass opacities throughout both lungs. Note that in the regions of ground-glass, one can see the vessels.
  • Mediastnum ppt

    1. 1. MEDIASTINUM
    2. 2. MEDIASTINUM DEFINITION BOUNDRIES DIVISIONS NORMAL LINES & STRIPES
    3. 3. NORMAL ANATOMY
    4. 4. TECHNIQUE HIGH KVP TECH [120 ]--above 120 coefficient of x ray absorption of bone & soft tissue approach each other at high kvp & so lungs are not obscured by bones.--better penetration of mediastnum--short exposure-less scatter radiation ,sharp detail outline of structure is obtained. WEDGE FILTER
    5. 5. Normal mediastinum on plain radiograph* Rt mediastinum above azygous vein is formed by right brachiocephalic vein &s v c.*In case of aortic or brachiocephalic artery ectasia or unfolding either these veins will be pushed laterally or mediastinal border is formed by aorta or bracheocephalic artery.*Right paratrcheal stripe-between tracheal air column & lung . < 5 mm .*azygous vein-outlined by air in lung at the lower end of paratracheal stipe.
    6. 6. * Oesophageal-pleural stripe -lung posterior to trachea contact rt wall of oesophagus.if oesophagus at this level contain air ,rt wall of oesophagus is seen as this stripe.*Azygo-oesophageal recess—on rt side below azygous arch the rt lower lobe make contact with rt wall of esophagus & azygous vein .and the interface is known as azygo esophageal stripe.---concave to rt side-normal----convex to rt side—abnormal.subcarinal mass, left atrial enlargement
    7. 7. Normal mediastinum Paraspinal lines –lymph nodes and intercostal veins occupy this space between spine lung, Normal paraspinal stripe—1 to 2 mm wide. Aortico pulmonary window—pleura covering the angle between mid portion of aortic arch & main pulm artery & left pulm artery is---- Aorticopulmonary mediastinal stripe. Aorticopulmonary window is sensitive place to look for lymph node enlargement.
    8. 8. The junctional lines Anteror junctional line –when small amount of fat anterior to ascending aorta,two lungs may be seperated by more than four layers of pleura. Never extend lower than where it envelopes rt outflow tract. Posterior junctional line—lungs are close together behind the oesophagus forms this line.line seperates to envelope the aortic arch. When the lines are seen ,excludes mass or space occupying process at junctional areas
    9. 9. DIVISIONS OF MEDIASTINUM
    10. 10. COMMON CONDITIONS
    11. 11. APPROACH MEDIASTNUM WIDENING OR NORMAL PARENCHYMAL OR MEDIASTNAL ANTERIOR ,MIDDLE OR POSTEROR COMPARTMENT VASCULAR OR NONVASCULAR ORGAN OF ORIGIN.
    12. 12. Mediastinal /parenchymal
    13. 13. Mediastinal mass No air bronchogram Margins with lung obtuse Mediastinal lines will be disrupted. Can be associated spinal ,costal or sternal abnormalities
    14. 14. DIFF SIGN FOR LOCALISATION SILHOUETTE SIGN HILUM OVERLAY SIGN HILUM CONVERGENCE SIGN CERVICO-THORACIC SIGN THORACO ABDOMINAL SIGN
    15. 15. Silhouette sign I If an intrathoracic opacity is situated in anatomic contact with a border of heart or aorta ,will obscure that border. A radioopacity causes obliteration of rt border of heart , is anterior in location ,Anterior mediastinum. If it overlaps but does not obliterates , it lies in posterior or middle mediastinum.
    16. 16. Silhouette sign
    17. 17. Hilum overlay sign Differentiates cardic enlargement from mediastinal mass In mediastinal mass if Hilar vessels are seen through the mass indicates that the mass does not arise from hilum For accuracy the film should be true frontal ,slight obliquity may project normal pulmonary artery medialy
    18. 18. Hilum overlay sign
    19. 19. Cervicothoracic signWell defined mass seen above the clavicle isalways situated in posterior compartment ,theanterior compartment mass being in contactwith soft tissue rather than aerated lung is illdefined
    20. 20. Cervicothoracic sign
    21. 21. Hilum convergence sign
    22. 22. Anterior mediastinal masses Displaced anterior junctional lines Obliterated cardiophrenic angle Obliterated retrosternal clear space Hilum overlay sign
    23. 23. ANTERIOR MEDIASTINUM RETROSTERNAL  PLEUROPERICARD GOITER IAL CYST TORTUOS  MORGAGNI INNOMINATE HERNIA ARTERY FAT DEPOSITION  STERNAL MASSES ENLARGED LYMPH  PARATHYROID NODES ADENOMA ASCENDING AORTA ANEURYSM THYMOMA GERM CELL TUMOUR
    24. 24. Ant mediastinal mass--lymphoma
    25. 25. Retrosternal goiter
    26. 26. Retrosternal goiter
    27. 27. ASCENDING AORTA ANEURYSM
    28. 28. Thymoma
    29. 29. Thymoma
    30. 30. Benign teratoma
    31. 31. Middle mediastinal masses Widened paratrcheal stripes Displaced azygo oesophageal recess on right side Mass on posterior trachea Lateral doughnut
    32. 32. MIDDLE MEDIASTINUM LYMPH NODE  TRACHEAL ENLARGEMENT LESIONS AORTIC ARCH  CARDIAC ANEURYSM TUMOURS ENLARGED PULM ARTERY DILATATION OF SVC BRONCHOGENSTIC
    33. 33. Anterior and middle mediastinal lymph node enlargement
    34. 34. Tuberculosis
    35. 35. Pulm hypertension / sarcoidosis
    36. 36. Thoracic aorta aneurysm
    37. 37. Recurrent bronchogenic cyst
    38. 38. Esophageal duplication cyst
    39. 39. POSTERIOR MEDIASTINUM NEUROGENIC  PARAVETEBRAL TUMORS MASSES PHARYNGO  NEUREENTERIC ESOPHAGEAL CYSTS POUCH  BOCHDALEK HIATUS HERNIA HERNIA DESCENDING  PANCREATIC AORTA PSEUDOCYST ANEURYSM  ABCESSES , OESOPHAGEAL FIBROSIS DIALATION
    40. 40. Neuroenteric cyst
    41. 41. Neuroenteric cyst
    42. 42. Bochdaleks hernia
    43. 43. More than one compartment Since no tissue plane in diff compartments in some conditions multiple comp are involved Enlarged lymph nodes. Mediastinitis Hematomas Vascular entities Bronchogenic cancer Metastates lymphangiomas
    44. 44. Characterization of mass on C T  Does it contain fat  Does it contain fluid?  Does it enhance following the administration of i v contrast
    45. 45. Thank you
    46. 46. Cystic hygroma TECHNIQUE  Transverse images of thin slices of lung (1 to 1.5 mm thick) are obtained at non- contiguous intervals, In routine CT, slices 3 to 10 mm thickcm apart, usually 1 to 2 are obtained throughout. contiguously, imaging 100% of the lung
    47. 47. HRCT Mediastinal window: C/W = 35/350 Lung window: C/W = -450/1350 Bone window: C/W = 500/1800
    48. 48. NORMAL ANATOMY
    49. 49. The junctional lines
    50. 50. Cystic hygroma
    51. 51. Germ cell tumour
    52. 52. Thymic cyst
    53. 53. NORMAL VARIANT Azygous Lobe:- Area of lung medial to the azygous fissure
    54. 54. BronchoPulmonarySegments Right Lung 10 Segments Upper Lobe :- apical anterior posterior Middle Lobe :- medial lateral Lower Lobe :- superior anterior basal medial basal lateral basal posterior basal
    55. 55. BronchoPulmonarySegments Lef superior inferior Lower lobe :- superior anterior basal lateral basal
    56. 56. VASCULAR ANATOMY
    57. 57.  The bronchial arteries provide systemic blood to the lung tissue Arising from the aorta; supply nearly all lung tissue The alveoli are supplied by the pulmonary circulation
    58. 58. Secondary Pulmonary Lobule
    59. 59. INDICATIONS OF HRCT
    60. 60. Descending aorta aneurysm
    61. 61. Consolidation
    62. 62. Posterior mediastinum
    63. 63. BRONCHIECTASIS
    64. 64. EMPHYSEMA Abnormal permanent enlargement of air spaces distal to terminal bronchioles with destruction of alveolar walls without obvious fibrosis
    65. 65. EMPHYSEMA Types Centilobular Panacinar Paraseptal or subpleural
    66. 66. EMPHYSEMA
    67. 67. EMPHYSEMA
    68. 68. INTERLOBULAR SEPTAL THICKENING Seen in patients with interstitial lung disease. Types :- smooth nodular / irregular
    69. 69. INTERLOBULAR SEPTAL THICKENING
    70. 70. SEPTAL THICKENING (SMOOTH)  Pulmonary edema Lymphangitic spread of carcinoma Amyloidosis
    71. 71. SEPTAL THICKENING (NODULAR/IRREGULAR) Lymphangitic spread of carcinoma Pulmonary Fibrosis Rare: amyloidosis & asbestosis Sarcoidosis
    72. 72. NODULES Smallest diameter detected 1-2 mm Classification Appearance - well-defined (likely interstitial) ill-defined (likely air-space) Distribution - centrilobular perilymphatic, or random
    73. 73. CENTRILOBAR MICRONODULES Centrilobular nodules can be identified in close association to pulmonary artery branches Centrilobular nodules are often centered 5-10 mm from the pleural surface Centrilobular nodules are usually of similar size and spaced at regular distances from each other.
    74. 74. CENTRILOBAR MICRONODULES Endobronchial tuberculosis Any bronchopneumonia Endobronchial spread of timor Silicosis or Coal workers’ pneumoconiosis
    75. 75. PERILYMPHATIC NODULES Perilymphatic nodules are usually well-defined and occur in relation to the lymphatics. They often affect the pleural surfaces and the peribronchovascular, interlobular septa, and centrilobular interstitial components.
    76. 76. PERILYMPHATIC MICRONODULES Sarcoidosis Lymphangitic spread of carcinoma Silicosis & coal workers’ pneumoconiosis Lymphoid interstitial pneumonitis (rare) Amyloidosis (rare)  
    77. 77. RANDOMLY DISTRIBUTED NODULES Random nodules are usually well-defined and appear diffuse, but uniform in distribution.
    78. 78. RANDOMLY DISTRIBUTED MICRONODULES Miliary tuberculosis Fungal infections Hematogenous metastasis Sarcoidosis (when diffuse)
    79. 79. TREE-IN-BUD "Tree-in-bud" appearance represents dilated and fluid-filled (i.e. pus, mucus, or inflammatory exudate) centrilobular bronchioles. Abnormal "tree-in-bud" bronchioles appear more irregular , lack of tapering or knobby/bulbous appearance at the tip of their branches.
    80. 80. TREE-IN-BUD Infection: Tuberculosis, mycobacterium avium intracellulare complex (MAC), bacterial, fungal Airway disease (i.e. cystic fibrosis or bronchiectasis) Allergic bronchopulmonary aspergilosis (rare)
    81. 81. Ground-glass Opacity Ground-glass , increased hazy opacity within the lungs that is not associated with obscured underlying vessels . Minimal thickening of the septal or alveolar interstitium, thickening of alveolar walls, or the presense of cells or fluid filling the alveolar spaces.
    82. 82. GROUND GLASS OPACITY (ACUTE) Pulmonary edema Hemorrhage Pneumocystic pneumonia (PCP) Acute interstitial pneumonia Hypersensitivity pneumonia Early idiopathic pulmonary fibrosis (IPF)
    83. 83. GROUND GLASS OPACITY (CHRONIC) Desquamative interstitial pneumonitis Idiopathic pulmonary fibrosis Alveolar proteinosis Hypersensitivity pneumonitis - chronic Sarcoidosis Lipoid pneumonia Bronchoalveolar carcinoma
    84. 84. MOSAIC ATTENUATION Decreased attenuation which results from regional differences in lung perfusion secondary to airway disease or pulmonary vascular disease. Distribution is often patch, hence the designation "mosaic." Pulmonary arteries will be reduced in size in the lucent lung fields thus allowing mosaic perfusion to be distinguished from ground-glass opacities.
    85. 85. MOSAIC ATTENUATION Bronchiolitis Obliterans Cystic fibrosis Chronic PE
    86. 86. AIR TRAPPING Abnormal retention of gas within the lung following expiration. On HRCT, the lung parencyhma remains lucent on expiration, while normal lung areas show increased attenuation. Inspiration scans can be completely normal in air trapping.
    87. 87. AIR TRAPPING Obliterative bronchiolitis Asthma Hypersensitivity pneumonitis Normal variant (seen in superior segement of left lobe, middle lobe or lingula)
    88. 88. HONEYCOMBING Honeycombing extensive lung fibrosis alveolar destruction cystic appearance on gross pathology. Honeycombing presence of thich-walled, air-filled cysts, usually between the size of 3mm to 1cm in diameter.
    89. 89. HONEYCOMBING Interstitial fibrosis (IPF, RA, scleroderma, drug reaction, asbestosis, end stage hypersensitivity pneumonitis) End stage sarcoidosis
    90. 90. APPROACH TO DIAGNOSISAn acute appearance suggests pulmonary edema or pneumonia
    91. 91. APPROACH TO DIAGNOSISReticulonodular lower lung predominant distribution with decreased lung volumes suggests: (APC)1. Asbestosis2. Aspiration (chronic)3. Pulmonary fibrosis (idiopathic)4. Collagen vascular disease
    92. 92. APPROACH TO DIAGNOSIS A middle or upper lung predominant distribution suggests:1. Mycobacterial or fungal disease2. Silicosis3. Sarcoidosis4. Langerhans Cell Histiocytosis
    93. 93. APPROACH TO DIAGNOSISAssociated lymphadenopathy suggests :1. Sarcoidosis2. Neoplasm (lymphangitic carcinomatosis, lymphoma, metastases)3. Infection (viral, mycobacterial, or fungal)4. Silicosis
    94. 94. APPROACH TO DIAGNOSIS Associated pleural thickening and/or calcification suggest asbestosis.
    95. 95. APPROACH TO DIAGNOSISAssociated pleural effusion suggests :1. Pulmonary edema2. Lymphangitic carcinomatosis3. Lymphoma4. Collagen vascular disease
    96. 96.

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