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SWU CXR interpretation

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    SWU  CXR interpretation SWU CXR interpretation Document Transcript

    • CHEST Radiology อ.พญ.วิรณา อางทอง ภาควิชารังสีวิทยา มหาวิทยาลัยศรีนครินทรวิโรฒ 1.Pneumothorax. 1.2 Simple pneumothorax. Findings: - There is thin white visceral pleural line at left side hemithorax. - No lung marking distal to visceral line. - Collapse of left lung field. - No shifting of mediastinum. Deep sulcus sign Findings: Supine CXR of neonate demonstrates abnormal deepening and lucency of the left lateral costophrenic angle. Pneumothorax ในทานอน airจะลอยขึ้นมาใน สวนnondependent portionของpleural cavity ซึ่งคือตําแหนงlateral costophrenic angle ทําใหบริเวณดูดําลงและขยายลึกลงมาทางดาน ทองมากขึ้น
    • 1.2 Tension pneumothorax: Findings: - There is thin white visceral pleural line at left side hemithorax. - Marked collapse and distortion of let lung. - Shifting of mediastinum to the right side which is compatible with tension pneumothorax. ***Small pneumothorax is easier seen on an expiration film, due to reduce lung volume which make pneumothorax look relatively larger. 2. Pneumomediastinum Findings: -There is linear radiolucency of air density outlining the left subclavian artery and the left carotid artery (tubular arterysign). (จะเห็นairอยูรอบ ๆหลอดเลือดที่อยูใน mediastinum) -Lateral radiograph demonstrates the “ring around the artery” sign. (จะเห็นair density โอบลอมรอบหลอดเลือดในmediastinumเปนรูปวงแหวน ภาพดานบนโอบรอบright pulmonary artery.
    • The continuous diaphragm sign (เห็นเปนair density ทางดานลาง ของmediastinum ซึ่งair นี้จะเซาะอยู ทางดานหนาของpericardial cavity จึง เห็นเหมือนเปนเงาของdiaphragmที่ ตอเนื่อง) Findings: -Air in the subcutaneous tissues of the neck (subcutaneous emphysematous) -Thymic sail sign: thymus is out line by air. (airในmediastinumเซาะตามขอบของ thymus) 3. Pleural effusion. Findings: -Homogeneous density -Concave at upper border -Meniscus shape at edge of right pleural effusion ( Higher lateral than medial) -If large amount of pleural effusion will displace the mediastinum towards the contralateral side.
    • 4. Loculated pleural effusion Findings: - Haziness of right hemithorax (density not corresponding to lobar anatomy ). - Lateral film below shows loculated fluid overlying vertebral column Findings: - Unusual shape (lentiform) or unusual position in the thorax cavity. Large right pleural effusion Findings: -The right hemithorax is opaque. - There is shift of heart and trachea away from the side of opacification.
    • 5. Hydropneumothorax -There is opacification at left lower thorax with air-fluid level. 6. CHF 6.1 Pulmonary interstitial edema - Kerley B lines - Kerley A lines (Kerley – thicken connective tissue septa ) - Peribronchial cuffing: thicken bronchial wall and peribronchial sheath. - Thickening of the fissures - Pleural effusion - Perihilar haze: blurring of hilar shadows. - Blurring of pulmonary vascular markings
    • Kerley B line: -Faint multiple white lines perpendicular to the pleural surface and 1-2 cm long. Kerley A line: -Relatively long linear shadows in upper lung, deep within lung parenchyma. Peribronchial cuffing: -Bronchial wall thickening
    • Fluid in minor fissure 6.2 Pulmonary alveolar edema Findings: -Symmetrical bilateral opacification spreading from the hilar regions into the lungs with sparing of peripheral lung fields is called butterfly or bat wing configuration. -Cardiomegaly. Findings: -Bilateral air space infiltration (or alveolar infiltration) at bilateral perihilar region -Air bronchogram is seen. -Cardiomegaly.
    • 7. Metastasis Findings: -Multiple well-defined pulmonary nodules scatter both lung fields which are vary in size. 8. Bronchiectasis Findings: -There are multiple thin wall cystic areas at perihilar region of both lung fields which some of them show air-fluid level.
    • 9. Emphysema Findings: -Over expanded lungs -Flat diaphragms lying below the 6th rib anteriorly. -Increase retrosternal airspace on lateral film -Decreased vascular markings of lung fields -Increase AP diameter of cheast and anterior bowing of sternum -Narrow mediastinum 10. Mediatinal mass 10.1 Anterior mediastinal mass -The anterior mediastinum is bounded anteriorly by the sternum; posteriorly by the pericardium, aorta, and brachiocephalic vessels; superiorly by the thoracic inlet; and inferiorly by the diaphragm -Its contents include the thymus, lymph nodes, adipose tissue, and internal mammary vessels
    • Findings: lymphoma in anterior mediastinal mass -There is a large lobulated mass causes obliteration of cardiac shadow which could be anterior mediastinal mass. -The descending aorta is clearly seen which indicating that this mass not within posterior mediastinm. 10.2 Middle mediastinal mass
    • -The middle mediastinum is bounded anteriorly by the pericardium, posteriorly by the pericardium and posterior tracheal wall, superiorly by the thoracic inlet, and inferiorly by the diaphragm -Its contents include the heart and pericardium; the ascending and transverse aorta; the superior vena cava (SVC) and inferior vena cava (IVC); the brachiocephalic vessels; the pulmonary vessels; the trachea and main bronchi; lymph nodes; and the phrenic, vagus, and left recurrent laryngeal nerves. Findings: lymph node in middle mediastinum -There is right paratracheal soft tissue mass. 10.3 Posterior mediastinal mass -The posterior mediastinum is bounded anteriorly by the posterior trachea and pericardium, anteroinferiorly by the diaphragm, posteriorly by the vertebral column, and superiorly by the thoracic inlet. -The contents include the esophagus, descending aorta, azygos and hemiazygos veins, thoracic duct, vagus and splanchnic nerves, lymph nodes, and fat.
    • Findings: Descending aortic aneurysm in posterior mediastinum. -There is lateral displacement of lateral margin of descending thoracic aorta due to aortic aneurysm. 11. Atelectasis Pattern of pulmonary collapse or atelectasis General signs of lobar collapse - Decrease lung volume - Displacement of fissure - Local increase in density of lobar collapse due to non-aerated lung - Elevation of hemidiaphragm - Displacement of hilar vessel - Displacement of mediastinum - Compensatory overinflation of adjacent lobes. Specific sign of lobar collapse 1. RUL-Collapse upwards and anteriorly Minor fissure Findings: -Opacity in right upper lung due to reduce volume of non-areated lung -Elevation of minor fissure -Elevation of right hilum -Tracheal deviation to the right
    • 2. RML Minor f Major f Findings: -Increase density in right middle lung zone with loss of definition of right cardiac border -Lateral film: triangular shape opacity projected over the heart (Triangular shapeเกิดจากการdisplacementของminorและmajor fissureเขาหาlobar collapse) 3. LUL-Collapses upwards and anteriorly Major fissure Findings: PA film -Decrease volume with increase density of LUL -Loss of definition of left cardiac border and of left hilum -Elevation of left hilum -Tracheal deviation to the left Lateral film -Increase opacity anteriorly (due to collapse lobe), which has well-defined posterior margin due to left major fissure
    • 4. LLL-Collapses downwards and posteriorly 12 Abnormal infiltration 12.1 Air space/ alveolar infiltration Findings: -Fluffy, ill-defined areas of opacification (เห็นเปนปุยๆที่มีขอบเขตไมชัด) -Area of consolidation tend to coalesce -Air bronchograms: airที่อยูในbronchus ถูก ลอมรอบดวยconsolidated lung การเห็นair bronchogramsนั้นบงบอกวาdieseaseนั้นอยูใน lung parenchyma ไมใช pleura หรือ mediastinum. แบงออกเปน -Segmental/lobar alveolar pattern: DDx -Pneumonia -Segmental/lobar collapse -Pulmonary infarction -Alveolar carcinoma -Contusion (associated with rib fracture, pneumothorax ect)
    • -Diffuse pattern: DDx -Cardiogenic pulmonary edema -ARDS -Fluid overload -Pulmonary hemorrhage -Pneumonia: PCP, Mycoplasma 12.2 Interstitial infiltration - Linear pattern Findings: fine lines running to the lung -Kerley A lines. -Kerley B lines. (ดูในเรื่องCHF) -Nodular pattern Findings: -intersitial nodules are small (1-5mm), well-defined border -Not associated with air bronchograms
    • -Honeycomb pattern -Represent end-stage of disease -Imply extensive pulmonary destruction. -There are multiple cysts that range in size from tiny up to 2 cm. -Very thin wall cysts -Normal vasculature cannot be seen. 13 Pulmonary TB -Primary TB -Usually asymptomatic -Heal pulmonary lesion Findings: -Heal tiny calcific pulmonary nodule (Calcific granuloma at LUL) -Heal calcific hilar lymph node -Post-primary pulmonary TB (reactivation TB) Findings: -Cavitation: Thick-walled, irregular cavity with/or without air-fluid level
    • Findings: -Reticulonodular infiltration at apical and posterior segment of upper lobe and superior segment of lower lobe. -Volume loss at both upper lobes from fibrotic change -Calcification may occur in fibrosis
    • NEURORADIOLOGY 1.Epidural hematoma Finings: -There is lens shape (or biconcex shape) hyperdensity fluid (HU=50-100) at left parietal region. -Displacement of left lateral ventricle -Usually not cross suture except associated with diastatic fracture . 2. Subdural hematoma Findings: -There is crescentric shape hyperdensity fluid at left fronto-parieto-temporal region. - Can cross suture - Not cross falx or dura 3. Subarachnoid hemorrhage Findings: -There is hyperdensity fluid in sulci and cistern (eg suprasella cistern, sylvain cistern) -There is intraventricular hemorrhage -Communicating hydrocphalus
    • 4.Hypertensive hemorrhage Findings: -There is hyperdensity of acute hematoma at right basal ganglia and thalamus and extends to ventricular system (intraventricular hemorrhage). -Displacement of right lateral ventricle -Midline shifting to the left side 5.Acute cerebral infarction Findings: -Hyperdense artery sign on noncontrast CT scan represented of intraluminal thrombus in middle cerebral artery
    • Insular ribbon sign Findings: -There is wedge shape hypodensity area involving both gray and white matter at left frontoparietal region -Loss of gray white differentiation -Insular ribbon sign: loss of gray white differentiation at left insular cortex. Findings: -There is wedge shape of hypodensity area of both gray and white matter at left fronto-parietotemporal region which compatible with left MCA territory -Pressure effect to left lateral ventricle and midline shifting
    • 6.Subacute cerebral infarction Findings: -There is well-defined hypodensity area at left parietal region. -Decrease degree of pressure effect-After contrast administration reveals gyral enhancement (abnormal enhancementตามgyri จากการสูญเสียblood brain barrier) 7. Chronic cerebral infarction Findings: -There is very low density area at right basal ganglia which compatible with old basal ganglia infarction. -Sign of volume loss: Ipsilateral dilatation of right ventricular system