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CHS3101: CARDIOVASCULAR AND RESPIRATORY
DISORDERS: RADIOLOGICAL IMAGING
Semester I, 2013/2014
Presentation outline
 The different imaging modalities for investigation of
cardiovascular and respiratory disorders
 Indications for the different modalities
 Definition of some common terminologies used in
radiography and ultrasonography
 Illustration of radiological appearances of some of the
cardiovascular and respiratory system disorders
 Emergencies of the cardiovascular & respiratory systems
that are demonstrable on radiological imaging
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 2
What is the role of radiological imaging in
cardiovascular and respiratory disorders?
 To demonstrate the location of the
disease/abnormality
 To show the extent of disease/abnormality
 It complements the clinical findings and other
investigations in making a diagnosis
 Used to follow-up response to treatment
 For image guided procedures such as ultrasound
guided biopsy of pleural mass, or ultrasound guided
drainage of loculated pleural effusion
 For interventional treatment procedures such as stent
placement for treatment of vascular stenosis
What are the different imaging modalities available for
investigation of cardiovascular and respiratory disorders?
 Plain x-ray
 Contrast studies using fluoroscopy:
Conventional angiography (arteriography & venography)
 Ultrasound scan (including Doppler ultrasound)
 Computer tomography (CT) scan (including CT
angiography)
 Magnetic resonance imaging (MRI)-including MR
angiography
 Radionuclide imaging
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 4
Indications for the various radiological imaging modalities for
investigation of cardiovascular and respiratory disorders
Plain X-ray
Indications:
Chest infections & inflammatory diseases
Chest trauma
Chest neoplasm
Cardiac disease
Foreign body in airway
Congenital abnormalities e.g tracheoesophageal
fistulas, congenital pulmonary hypoplasia
Imaging modalities & indications cont.
CT scan
Indications:
 Chest infections & inflammatory diseases
 Chest trauma
 Chest neoplasm
 Cardiac disease
 Foreign body in airway
 Congenital abnormalities e.g tracheoesophageal fistulas,
congenital pulmonary hypoplasia
 Pulmonary embolism using CT angiography
 Vascular diseases such as aneurysm and vascular stenosis by
using CT angiography
Imaging modalities & indications cont.
Ultrasound
Indications:
Pleural effusion/loculated pleural effusion
Peripheral lung masses & chest wall masses
Ultrasound guided aspiration of pleural effusion
Ultrasound guided biopsy of peripheral lung mass &
chest wall mass
Evaluation of the heart (echocardiography)
Doppler ultrasound for vascular diseases such as deep
vein thrombosis (DVT), aneurysm, and vascular
stenosis
Imaging modalities & indications cont.
Radionuclide imaging
Indications:
Pulmonary embolism
Pulmonary infarcts
Angiography (Conventional angiography, CT
angiography & MR angiography)
Indications:
Pulmonary infarcts
Coronary artery disease
Vascular diseases and abnormalities
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 9
Common terminologies used to describe chest x-
ray (CXR) findings
 Opacity: opaque/dense area
on a CXR- appears white
 This chest radiograph
shows an oval opacity in
the left mid lung zone
(white arrows)
Common terminologies used to describe chest x-
ray (CXR) findings
 Homogenous opacity: Area of uniform
opaqueness/density on CXR- appears as uniform
whiteness
 Heterogeneous opacity: Area of non-uniform
opaqueness/density on CXR- appears as non-uniform
whiteness
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 11
Common terminologies used to describe chest x-
ray (CXR) findings
 Lucency: Non opaque area
on CXR- appears as dark/
black area
 This part of the chest x-ray
shows lucency of the left
hemithorax which is the
normal appearance of the
lung
Common terminologies used to describe
computer tomography (CT) findings
 Hypodense:
Area with a lower density in comparison to another
area-appears dark/black
 Hyperdense:
Area with a higher density in comparison to
another area-appears bright/white
 Isodense:
Area with same density in comparison to another
area-similar appearance
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 12
Common terminologies used to describe
computer tomography (CT) findings: chest CT
 Normal lung tissue (A) is
hypodense to the
heart(B).
 Lung consolidation
black (arrow heads) is
hyperdense to normal
lung tissue.
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 13
A B
Common terminologies used to describe
ultrasound findings
 Echogenicity: Intensity of echoes reflected by tissues
or structures from inside the body
 Hyperechoic: An area with higher intensity echoes in
comparison to another area-appears brighter
 Hypoechoic: An area with lower intensity echoes in
comparison to another area-appears darker/blacker
 Anechoic: An area with no echoes-appears black
 Isoechoic: An area with same/similar echo intensity
in comparison to another area-similar appearance
Common terminologies used to describe
ultrasound findings: chest ultrasound
 Pleural effusion (e) is
hypoechoic to the liver
(l)
 The diaphragm (d) is
hyperechoic to the liver
(l)
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 15
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 16
Normal CXR
On a chest x-ray, the ribs
and spine will absorb
much of the radiation
and appear white or
light gray on the image.
Lung tissue absorbs
little radiation and will
appear dark on the
image.
Radiological appearances of some of the
respiratory system disorders
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 17
1. Lobar pneumonia: chest x-ray (CXR)
 Chest x-ray showing:
 Homogenous opacity
in the right upper and
middle lung zones
 This is consolidation
of lobar pneumonia
2. Lobar pneumonia: chest CT scan
 Axial (transverse) CT
image at the level of the
upper lobes shows
consolidation in a segment
of the right upper lobe (red
arrow) in lobar pneumonia
caused by Streptococcus
pneumoniae, in a 65-year-
old male, 3 days after the
onset of fever, cough &
dyspnoea
Friday, April 20, 2018 19
Cardiovascular & Respiratory System Disorders:
Radiological Imaging
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 20
3. Bronchopneumonia: CXR
 Chest x-ray showing:
 Nodules
(heterogeneous
opacities) in all lung
fields
 This appearance can
be seen in
bronchopneumonia
4. Miliary TB: CXR
 Chest x-ray in a child
with miliary TB
Friday, April 20, 2018 21
Cardiovascular & Respiratory System Disorders:
Radiological Imaging
5. Miliary TB: CXR
 High-resolution chest
CT scan shows numerous
small nodules in random
distribution in a patient
with miliary tuberculosis
Friday, April 20, 2018 22
Cardiovascular & Respiratory System Disorders:
Radiological Imaging
6. Lung metastasis from ca colon: CXR
 Chest CT scan shows
large lesions in the lungs
of varying sizes
 The patient had cancer
of the colon with
metastasis to the lungs
Friday, April 20, 2018 23
Cardiovascular & Respiratory System Disorders:
Radiological Imaging
7. Lung cavity: CXR
 Chest x-ray showing a
cavity in the right upper
lung zone
 A cavity appears as ring
opacity with central
lucency
 Lung cavity is commonly
seen in pulmonary TB
especially secondary TB
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 24
8. Lung cavity: CXR
 Chest x-ray showing a
cavity in the left middle
lung zone
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 25
9. Multiple lung cavities: chest CT
 Axial chest CT
scan showing
multiple lung
cavities
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 26
10. Multiple lung cavities & pleural effusion: chest CT
 Chest CT scan: coronal
re-construction
showing multiple thin-
walled cavities & right
pleural effusion
Friday, April 20, 2018 27
Cardiovascular & Respiratory System Disorders:
Radiological Imaging
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 28
15. Pleural effusion: CXR
 Chest x-ray showing:
 Homogenous opacity in the
right lower lung zone &
along the right lateral chest
wall giving a meniscus sign
 Obliterated right
costophrenic angle & right
hemidiaphragm
 This is right pleural effusion
16. Pleural effusion: CXR
 Chest x-ray showing left
pleural effusion
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 29
17. Pleural effusion: chest ultrasound
 Chest ultrasound image
of a large right pleural
effusion
 The dark area (e) is the
effusion which has
completely displaced the
lung
 The bright band (d) is
the diaphragm
 l is the liver
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 30
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 31
11. Hilar adenopathy: CXR
 Chest x-ray showing
bilateral lobulated hilar
opacities (red arrows) due
to bilateral hilar
adenopathy
12. Hilar adenopathy: CXR
 Chest x-ray showing
bilateral hilar
adenopathy
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 32
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 33
13. Pneumothorax: CXR
 Chest x-ray showing:
 Increased translucency in
the right hemithorax with
no lung markings
 There is mediastinal shift
to the left shown by shift of
trachea and cardiac
shadow
 This is tension
pneumothorax
 The pneumothorax is on
the right side
14. Pneumothorax: CXR
 Chest x-ray showing
increased translucency
in the right hemithorax
peripherally, with no
lung markings
 This is right
pneumothorax
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 34
Radiological appearances of some of the
cardiovascular system disorders
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 35
1. Cardiomegaly: CXR
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 36
2. Cardiomegaly: CXR
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 37
3. Pericardial effusion: CXR
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 38
4. Aneurysm: CT angiogram
 CT angiogram: coronal
3-dimensional image
shows a large aortic
aneurysm (arrow) in a
60-year-old man
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 39
5. Pulmonary embolism: CT angiogram
 CT pulmonary
angiogram
demonstrates an
embolus within the
right main pulmonary
artery
 It appears as a filling
defect (red arrow)
within the right main
pulmonary artery
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 40
Some emergencies of cardiovascular and respiratory
systems demonstrable on radiological imaging
 Tension pneumothorax
 Confirm diagnosis with CXR
 Massive pleural effusion
 Confirm diagnosis with chest US, or CXR
 Pulmonary oedema
 Confirm diagnosis with CXR
 Cardiac tamponade
 Confirm diagnosis with echocardiography
 Pulmonary embolism
 Confirm diagnosis with CT angiography
 Deep vein thrombosis
 Confirm diagnosis with venous Doppler ultrasound scan
Friday, April 20, 2018
Cardiovascular & Respiratory System Disorders:
Radiological Imaging 41

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Radiology chs 3101 cardiovascular and respiratory system disorders

  • 1. CHS3101: CARDIOVASCULAR AND RESPIRATORY DISORDERS: RADIOLOGICAL IMAGING Semester I, 2013/2014
  • 2. Presentation outline  The different imaging modalities for investigation of cardiovascular and respiratory disorders  Indications for the different modalities  Definition of some common terminologies used in radiography and ultrasonography  Illustration of radiological appearances of some of the cardiovascular and respiratory system disorders  Emergencies of the cardiovascular & respiratory systems that are demonstrable on radiological imaging Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 2
  • 3. What is the role of radiological imaging in cardiovascular and respiratory disorders?  To demonstrate the location of the disease/abnormality  To show the extent of disease/abnormality  It complements the clinical findings and other investigations in making a diagnosis  Used to follow-up response to treatment  For image guided procedures such as ultrasound guided biopsy of pleural mass, or ultrasound guided drainage of loculated pleural effusion  For interventional treatment procedures such as stent placement for treatment of vascular stenosis
  • 4. What are the different imaging modalities available for investigation of cardiovascular and respiratory disorders?  Plain x-ray  Contrast studies using fluoroscopy: Conventional angiography (arteriography & venography)  Ultrasound scan (including Doppler ultrasound)  Computer tomography (CT) scan (including CT angiography)  Magnetic resonance imaging (MRI)-including MR angiography  Radionuclide imaging Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 4
  • 5. Indications for the various radiological imaging modalities for investigation of cardiovascular and respiratory disorders Plain X-ray Indications: Chest infections & inflammatory diseases Chest trauma Chest neoplasm Cardiac disease Foreign body in airway Congenital abnormalities e.g tracheoesophageal fistulas, congenital pulmonary hypoplasia
  • 6. Imaging modalities & indications cont. CT scan Indications:  Chest infections & inflammatory diseases  Chest trauma  Chest neoplasm  Cardiac disease  Foreign body in airway  Congenital abnormalities e.g tracheoesophageal fistulas, congenital pulmonary hypoplasia  Pulmonary embolism using CT angiography  Vascular diseases such as aneurysm and vascular stenosis by using CT angiography
  • 7. Imaging modalities & indications cont. Ultrasound Indications: Pleural effusion/loculated pleural effusion Peripheral lung masses & chest wall masses Ultrasound guided aspiration of pleural effusion Ultrasound guided biopsy of peripheral lung mass & chest wall mass Evaluation of the heart (echocardiography) Doppler ultrasound for vascular diseases such as deep vein thrombosis (DVT), aneurysm, and vascular stenosis
  • 8. Imaging modalities & indications cont. Radionuclide imaging Indications: Pulmonary embolism Pulmonary infarcts Angiography (Conventional angiography, CT angiography & MR angiography) Indications: Pulmonary infarcts Coronary artery disease Vascular diseases and abnormalities
  • 9. Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 9 Common terminologies used to describe chest x- ray (CXR) findings  Opacity: opaque/dense area on a CXR- appears white  This chest radiograph shows an oval opacity in the left mid lung zone (white arrows)
  • 10. Common terminologies used to describe chest x- ray (CXR) findings  Homogenous opacity: Area of uniform opaqueness/density on CXR- appears as uniform whiteness  Heterogeneous opacity: Area of non-uniform opaqueness/density on CXR- appears as non-uniform whiteness
  • 11. Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 11 Common terminologies used to describe chest x- ray (CXR) findings  Lucency: Non opaque area on CXR- appears as dark/ black area  This part of the chest x-ray shows lucency of the left hemithorax which is the normal appearance of the lung
  • 12. Common terminologies used to describe computer tomography (CT) findings  Hypodense: Area with a lower density in comparison to another area-appears dark/black  Hyperdense: Area with a higher density in comparison to another area-appears bright/white  Isodense: Area with same density in comparison to another area-similar appearance Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 12
  • 13. Common terminologies used to describe computer tomography (CT) findings: chest CT  Normal lung tissue (A) is hypodense to the heart(B).  Lung consolidation black (arrow heads) is hyperdense to normal lung tissue. Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 13 A B
  • 14. Common terminologies used to describe ultrasound findings  Echogenicity: Intensity of echoes reflected by tissues or structures from inside the body  Hyperechoic: An area with higher intensity echoes in comparison to another area-appears brighter  Hypoechoic: An area with lower intensity echoes in comparison to another area-appears darker/blacker  Anechoic: An area with no echoes-appears black  Isoechoic: An area with same/similar echo intensity in comparison to another area-similar appearance
  • 15. Common terminologies used to describe ultrasound findings: chest ultrasound  Pleural effusion (e) is hypoechoic to the liver (l)  The diaphragm (d) is hyperechoic to the liver (l) Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 15
  • 16. Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 16 Normal CXR On a chest x-ray, the ribs and spine will absorb much of the radiation and appear white or light gray on the image. Lung tissue absorbs little radiation and will appear dark on the image.
  • 17. Radiological appearances of some of the respiratory system disorders Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 17
  • 18. 1. Lobar pneumonia: chest x-ray (CXR)  Chest x-ray showing:  Homogenous opacity in the right upper and middle lung zones  This is consolidation of lobar pneumonia
  • 19. 2. Lobar pneumonia: chest CT scan  Axial (transverse) CT image at the level of the upper lobes shows consolidation in a segment of the right upper lobe (red arrow) in lobar pneumonia caused by Streptococcus pneumoniae, in a 65-year- old male, 3 days after the onset of fever, cough & dyspnoea Friday, April 20, 2018 19 Cardiovascular & Respiratory System Disorders: Radiological Imaging
  • 20. Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 20 3. Bronchopneumonia: CXR  Chest x-ray showing:  Nodules (heterogeneous opacities) in all lung fields  This appearance can be seen in bronchopneumonia
  • 21. 4. Miliary TB: CXR  Chest x-ray in a child with miliary TB Friday, April 20, 2018 21 Cardiovascular & Respiratory System Disorders: Radiological Imaging
  • 22. 5. Miliary TB: CXR  High-resolution chest CT scan shows numerous small nodules in random distribution in a patient with miliary tuberculosis Friday, April 20, 2018 22 Cardiovascular & Respiratory System Disorders: Radiological Imaging
  • 23. 6. Lung metastasis from ca colon: CXR  Chest CT scan shows large lesions in the lungs of varying sizes  The patient had cancer of the colon with metastasis to the lungs Friday, April 20, 2018 23 Cardiovascular & Respiratory System Disorders: Radiological Imaging
  • 24. 7. Lung cavity: CXR  Chest x-ray showing a cavity in the right upper lung zone  A cavity appears as ring opacity with central lucency  Lung cavity is commonly seen in pulmonary TB especially secondary TB Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 24
  • 25. 8. Lung cavity: CXR  Chest x-ray showing a cavity in the left middle lung zone Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 25
  • 26. 9. Multiple lung cavities: chest CT  Axial chest CT scan showing multiple lung cavities Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 26
  • 27. 10. Multiple lung cavities & pleural effusion: chest CT  Chest CT scan: coronal re-construction showing multiple thin- walled cavities & right pleural effusion Friday, April 20, 2018 27 Cardiovascular & Respiratory System Disorders: Radiological Imaging
  • 28. Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 28 15. Pleural effusion: CXR  Chest x-ray showing:  Homogenous opacity in the right lower lung zone & along the right lateral chest wall giving a meniscus sign  Obliterated right costophrenic angle & right hemidiaphragm  This is right pleural effusion
  • 29. 16. Pleural effusion: CXR  Chest x-ray showing left pleural effusion Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 29
  • 30. 17. Pleural effusion: chest ultrasound  Chest ultrasound image of a large right pleural effusion  The dark area (e) is the effusion which has completely displaced the lung  The bright band (d) is the diaphragm  l is the liver Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 30
  • 31. Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 31 11. Hilar adenopathy: CXR  Chest x-ray showing bilateral lobulated hilar opacities (red arrows) due to bilateral hilar adenopathy
  • 32. 12. Hilar adenopathy: CXR  Chest x-ray showing bilateral hilar adenopathy Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 32
  • 33. Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 33 13. Pneumothorax: CXR  Chest x-ray showing:  Increased translucency in the right hemithorax with no lung markings  There is mediastinal shift to the left shown by shift of trachea and cardiac shadow  This is tension pneumothorax  The pneumothorax is on the right side
  • 34. 14. Pneumothorax: CXR  Chest x-ray showing increased translucency in the right hemithorax peripherally, with no lung markings  This is right pneumothorax Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 34
  • 35. Radiological appearances of some of the cardiovascular system disorders Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 35
  • 36. 1. Cardiomegaly: CXR Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 36
  • 37. 2. Cardiomegaly: CXR Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 37
  • 38. 3. Pericardial effusion: CXR Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 38
  • 39. 4. Aneurysm: CT angiogram  CT angiogram: coronal 3-dimensional image shows a large aortic aneurysm (arrow) in a 60-year-old man Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 39
  • 40. 5. Pulmonary embolism: CT angiogram  CT pulmonary angiogram demonstrates an embolus within the right main pulmonary artery  It appears as a filling defect (red arrow) within the right main pulmonary artery Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 40
  • 41. Some emergencies of cardiovascular and respiratory systems demonstrable on radiological imaging  Tension pneumothorax  Confirm diagnosis with CXR  Massive pleural effusion  Confirm diagnosis with chest US, or CXR  Pulmonary oedema  Confirm diagnosis with CXR  Cardiac tamponade  Confirm diagnosis with echocardiography  Pulmonary embolism  Confirm diagnosis with CT angiography  Deep vein thrombosis  Confirm diagnosis with venous Doppler ultrasound scan Friday, April 20, 2018 Cardiovascular & Respiratory System Disorders: Radiological Imaging 41