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Chest surgical pathology &x rays

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  • Tension pnemothorax
  • Complete Lt. Lung Collaps
  • Canon ball metastesis
  • Thoracic aortic aneurism & pulmonary TB
  • Transcript

    • 1. Surgical Pathology & X-rays for Medical Students Chest Surgery 2008
    • 2. Index •Normal Chest X-ray •Pneumothorax •Pleural Effusion •Hydro-pnemothorax •Complete Lung Collapse •Opacified Hemithorax •Bronchogenic Carcinoma •Cavitary Lung Lesions •Lung Abscess •Fibro-caseous TB •Pulmonary Metastasis 2 •Aortic Arch Aneurysm © Vascular 2007
    • 3. NormalChest X ray Index
    • 4. AA SVC PAPARA LV CoPhS Index
    • 5. Pneumothorax5 © Vascular 2007 Index
    • 6. Lt. side pneumothorax 6 © Vascular 2008 Index
    • 7. Rt. side pneumothorax Normal for comparison•Marked difference in X-ray transparency (density) between the left and right thoracic cavities.•Complete radio-translucency (manifest as greater film density or darker lung field on the image) of the 7 © Vascular 2007Rt. thorax with absence of vascular markings Index
    • 8. Note: NoteLt. tension pneumothorax •The marked density difference between the left and right thoracic cavities. •The complete translucency on the left with absence of vascular markings •Shifting of the mediastinum •What appears as a left hilar mass is in fact the collapsed left lung retracted into a small central density 8 Index NormalVascular 2007 ©
    • 9. Lt. Tensionpneumothorax Index
    • 10. Lt. side tensionpneumothoraxBasis of Diagnosis:•Hyperresonance ofaffected hemithorax•Decreased orabsence of breathsounds•Tracheal deviation tothe other side ofpneumothorax•Respiratory distress•Hypotension•Tachypnea•Hypoxia•Distended neckveins (unless thepatient is hypovolemic) Index
    • 11. Rt. side tensionpneumothorax in an infant Index
    • 12. Tension Pneumothorax12 © Vascular 2007 Index
    • 13. Emergency treatment of tension pneumothoraxNeedle decompression (thoracostomy) with large-bore needle in thesecond intercostal space in the midclavicular line to convert the tensionpneumothorax into a simple pneumothorax, then prepare for intercostaltube insertionThis simple procedure can save the patient’s life 13 © Vascular 2007 Index
    • 14. Severe Rt. tension Mechanism: The air enters to the pleuralpneumothorax space and cannot escape The intrapleural pressure increases and the lung becomes collapsed with secondary shift of the mediastinal contents to the opposite side. 14 © Vascular 2007 Index After treatment
    • 15. Pleural Effusion15 © Vascular 2007 Index
    • 16. Rt. pleural effusion oFlat opacified line at the right hemidiaphragm with obliteration of the costo-phrenic angle oThe right middle lobe fissure is more sharply visible which tends to occur when (there is fluid in that fissure)16 © Vascular 2007 Index
    • 17. Lt. pleural effusion oThe left base is showing a curved density in place of the normally convex diaphragm. oThat curvature is characteristic of a pleural effusion17 © Vascular 2007 Index
    • 18. Lt. pleural effusion18 © Vascular 2007 Index
    • 19. Lt. massivepleural effusion Normal Massive effusions usually have an accompanying mediastinal shift to the contralateral side If a massive effusion does not shift the mediastinum, suspect malignant effusion where the mediastinum is fixed. Index
    • 20. Massive Lt. pleural effusion20 © Vascular 2007 Index
    • 21. Massive Right Pleural Effusion The right hemithorax is opaque There is a shift of the heart and trachea away from the side of opacification Index
    • 22. Rt. lung effusionIf an effusion (whateverthe fluid is) fills the entirehemithoraxIt acts like a massPushing the heart andtrachea away from theside of opacification Index
    • 23. Hydro- pneumothorax23 © Vascular 2007 Index
    • 24. Rt. hydro-pneumothoraxHydropneumothorax in three different views: PA LateralThe PA, lateral, and right decubetus reveal a horizontal air and fluid level. Rt. decubetus 24 © Vascular 2007 Index
    • 25. Lt. Massive hydro-pneumothorax25 © Vascular 2007 Index
    • 26. Lung Collapse26 © Vascular 2007 Index
    • 27. Index Normal For comparisonMassive pleural effusion Left Plural Tap was NEGATIVE Complete Lt. Lung Collapse
    • 28. Complete Lt. Lung Collapse o40-year-old woman with tuberculous bronchial stricture oChest radiograph shows complete collapse of left lung and deviation (arrows) of trachea to left lung28 © Vascular 2007 Index
    • 29. Lt. Lung CollapseThere is a shift ofheart andhemidiaphragmtoward side ofopacification(toward side of volume loss) Normal Index
    • 30. Compare Rt. lung Lt. lung30 effusion Index collapse
    • 31. Compare Lt. tension Lt. lung pnemothorax collapse31 © Vascular 2007 Index
    • 32. Compare Rt. pleural effusion Lt. lung collapse32 © Vascular 2007 Index
    • 33. Massive Pneumonia33 © Vascular 2007 Index
    • 34. Lt. lung pneumonia The hemithorax isopaque and there isno shift of the heart or trachea Index
    • 35. Pneumonia of the Left upper lobeThe left hemithorax isopaqueThere is no shift ofthe heart or tracheaThe opacifiedhemithorax containsair bronchograms Index
    • 36. Lt. lung collapse Rt. lung effusion Causes of an Opacified HemithoraxLt. lung pneumonia The arrow Lt. neumonectomy shows mediastinal shift No Index
    • 37. Which is this? Atelectasis Pneumonia Effusion Index
    • 38. Bronchogenic Carcinoma38 © Vascular 2007 Index
    • 39. Bronchogenic Carcinoma Fungating, hard solid white mass arising from the bronchial lining invading into the left bronchus and surrounding tissues. This is the lung of a 74-year-old man who first presents with cough, chest pain, wheezing, hemoptysis and progressive dyspnea Can you relate his symptoms39 to the pathology seen? 2007 © Vascular Index
    • 40. Cough: infection distal to airway blocked by tumor. Hemoptysis: ulceration of tumor in bronchus. Dyspnoea: local extension of tumor. Chest pain: involvement of pleura and chest wall. Wheeze: narrowing of airway.40 © Vascular 2007 Index
    • 41. 72-year-old man with bronchogenic carcinoma : Bone scintigraphy study shows multiple sites ofincreased uptake in left tibia, fibula and foot (metastasis) 41 © Vascular 2007 Index
    • 42. Lung Carcinoma42 © Vascular 2007 Index
    • 43. Lung Carcinoma oA large, well- defined mass in the right upper lobe oExtensive emphysematous change43 © Vascular 2007 Index
    • 44. Squamous cell carcinoma A portion of the tumor demonstrates central cavitation, probably because the tumor outgrew its blood supply44 © Vascular 2007 Index
    • 45. Cavitary Lung Lesion oThe air-fluid level indicates communication with the airway - hence sputum is likely to be helpful in diagnosis. oThe appearance of the lesion could be a carcinoma or an abscess. o Sputum cytology was squamous cell bronchogenic carcinoma. oCavitation is a typical morphologic feature of this form of lung cancer. 45 © Vascular 2007 Index
    • 46. Cavitary Lung Lesions Bronchogenic Cavitating staphylococcal Fibro-caseous carcinoma pneumonia Note left lower lobe cavitary TB consolidation with large cavity and air-fluid level46 © Vascular 2007 Index
    • 47. Lung Abscess47 © Vascular 2008 Index
    • 48. Fibro-caseous Pulmonary TB48 © Vascular 2007 Index
    • 49. Fibro-caseous TB of both superiorlobes with cavitations on the Rt. side49 © Vascular 2007 Index
    • 50. Pulmonary Metastasis50 © Vascular 2007 Index
    • 51. Multiple Pulmonarysecondaries Index
    • 52. Renal adenocarcinoma with multiple pulmonary metastasis52 © Vascular 2007 Index
    • 53. Lung metastasis from CA colon53 © Vascular 2007 Index
    • 54. Can you identify the pulmonary metastasis?54 © Vascular 2007 Index
    • 55. Aortic Arch Aneurysm55 © Vascular 2007 Index
    • 56. The mediastinal shadow is dominated by the dilation of the aorta.Better definition of the aortic anatomy is achieved with the CT scan Index
    • 57. Pulmonary Thoracic T.B. aortic aneurysm Index

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