Complex clinical imagine of radiological system ( inflammatory diseases)

1. MEDICAL RADIOLOGY
Omoregie Iyobosa Sonia
Topic : Complex clinical imaging of the respiratory
system (inflammatory)
Kyiv medical university

2. Diagnostic radiology
of respiratory system

3. Lobes of the lungs

4. The methods of chest examination:
1. Direct visualization methods of lungs morphology and function:
 Fluoroscopy
 X-ray television examination
2. Radiographic methods:
 Plan radiography
 Spot radiography
 Radiography with direct magnification of image.
3. Analytic methods of examination:
 Conventional tomography
 Computed tomography
4. Special methods of examination with the use of artificial contrasting of organs
and spaces:
 Bronchography
 Angiopulmonography
 Diagnostic pneumothorax
 Pneumomediastinum
 Phelbography
 Examination of esophagus,stomach and bowel.

5. 5.Functional methods of examination:
 Kymography of external respiration
 X-ray polygraphy of external respiration.
6. Flurography.
7.Radionuclide imaging.
8.Termography.
9.Magnetic resonance imaging MRI
10. Ultrasonography.

6. X-ray

7.  A PA radiograph obtained in deep inspiration provides
most information about the chest, and is the 'gold
standard' to aim for. A number of additional
projections may be used under certain
circumstances. Any lesion shown on a PA radiograph
may be localised or assessed further using additional
projections or alternative techniques, e.g. CT, MRI.

8. X-ray of respiratory system is divided on:
1 - with radiopaque contrast
(bronchography, angiopulmonography, artificial
pneumothorax, pleurography,
pneumomediastinography, fistulography and others).
2 - without radiopaque contrast
(fluoroscopy, conventional X-ray, fluorography,
planar tomography).
3 - functional X-ray
(there are methods which use X-ray imaging in the
different respiratory phase).

9. X-ray of chest (marked elements of anatomic formations):1-trachea; 2-
cupulaes of diaphragm; 3-right and left main bronches; 4-arc of the right auricle; 5-
descendence part of aorta; 6-aortal arc; 7-view of subclavial arteries; 8-left heart
border (from above to down of the arc: ascending part of aorta, the cone of
pulmonary artery, auricle of the left auricle and left ventricle); 9-azygos vein; 10-
horizontal interlobar fissura; 11-intermediate pulmonary artery; 12-left main
pulmonary artery; 13-lungs roots; 14-segmentar arteries(sub-root area); 15-vessels
of a 2nd intervertebral interval (in the norm 3 mm in a diameter); 18-back bends of
pleura;19-clavicules;

10. Intrathorasic lymphatic
nodes

11. Diagram of the structures
shown on a normal chest
radiograph:
1.Trachea. 2. First rib
(left). 3. Right clavicle.
4. Left main bronchus. 5.
Right main bronchus. 6.
Left hilum. 7. Right
hilum. 8. Heart. 9. Right
lung. 10.Left lung
11. Right
hemidiaphragm. 12. Air
in gastric fundus .

12. b
Effect of expiration on chest film. Two films of the same
patient taken one after the other, (a) Expiration, (b)
Inspiration. On expiration the heart appears larger and
the lung bases are hazy.

13.  Fluoroscopy
The image at fluoroscopy is poor compared to that which can be
achieved with x-ray film. It is rarely used and is limited to observing
the movement of the diaphragm and demonstrating air trapping in
cases of suspected inhalation of a foreign body.

14. Radiological features
of lung’s disease

15. Symptoms of lungs disease are divided on morphological symptoms and functional
symptoms.
Among of the numerous symptoms of the lungs pathology are defined the changing
of:
 lung’s radiolucency
 lungs’ roots
 lung pattern
 position of diaphragm
 mediastinum.

16.  Pneumonia

17. Apical cancer

19. Indications for a CT Scan:
1. In the case of diagnosis of bronchiectasis.
2. Detailed diagnosis of interstitial lung disease.
3. Detailed diagnosis of solitary (single) nodules in the lings.
4. In the case of suspected interstitial lung disease in patients with normal or
nonspecific changes in chest radiograph/x-ray.

20. Uses for MRI
MRI gives high quality image anatomy of blood vessels and
the formation of multi dimensional MRI images is the best
way to diagnose congenital cardiovascular anomalies and
aortic aneurysm ruptures’
1. Assessment of neurovascular structures in the pancoast
rumor, evaluation of operability.
2. Differential diagnosis of recurrent lymphoma and fibrosis
appeared after the treatment of lymphoma.
3. Diagnosis of lung tumor invasion into the chest wall, the
roots of the lungs, mediastinum
4. Congenital cardiovascular anomalies
5. Diagnosis of pericardiatis.

22. Pneumothorax
The diagnosis of pneumothorax depends on recognising:
•the line of pleura forming the lung edge separated from the chest wall,
mediastinum or diaphragm by air;
•the absence of vessel shadows outside this line.
Lack of vessel shadows alone is insufficient evidence on which to make the diagnosis,
since there may be few, or no, visible vessels in emphysematous bullae. Unless the
pneumothorax is very large, there may be no appreciable increase in the density of
he underlying lung.
The detection of a small pneumothorax can be very difficult. The cortex of the
normal ribs takes a similar course to the line of the pleural edge, so the abnormality
may not strike the casual observer. Sometimes a pneumothorax is more obvious on a
ilm taken in expiration.
Once the presence of a pneumothorax has been noted, the next step is to decide
whether or not it is under tension. This depends on detecting mediastinal shift and
lattening or inversion of the hemidiaphragm. It is worth noting that tension
pneumothoraces are usually large because the underlying lung collapses due to
ncreased pressure in the pleural space.

23.  Pleural tumours
 Pleural tumours produce lobulated masses based on the pleura.
Malignant pleural tumours, both primary (malignant mesothelioma)
and secondary, frequently cause pleural effusions which may obscure
the tumour itself.
 Sometimes the predominant feature is pleural effusion with no
visible masses on any imaging examinations. The commonest pleural
tumours are metastatic carcinoma, breast carcinoma being the most
frequent primary tumour to spread to the pleura. Primary pleural
tumours are relatively uncommon.

24.  Ultrasound.
 Pleural fluid can be recognized as a transonic area between the lung
and diaphragm. Since the diaphragm is so well seen there is no
confusion with ascites. Ultrasound is a convenient method of imaging
control for pleural fluid aspiration or drainage oculated pleural fluid
Pleural effusions may become loculated by pleural adhesions. Although
loculation occurs in all types of effusion, it is a particular feature of
empyema. Such loculations may either be at the periphery of the lung
or within the fissures between the lobes. A loculated effusion may
simulate a lung tumour on chest radiographs.
 Ultrasound can be particularly useful in defining the presence, size and
shape of any pleural collection loculated against the chest wall or
diaphragm. Pleural aspiration and drainage of such collections may be
performed under ultrasound guidance.

25.  Air-space filling
 Air-space filling means the replacement
of air in the alveoli by fluid or, rarely, by
other materials. 'Infiltrate' is a
commonly used but less satisfactory
term. The fluid can be either a
transudate (pulmonary oedema) or an
exudateThe signs of air-space filling are:
 A shadow with ill-defined borders
except where the disease process is in
contact with a fissure, in which case the
shadow has a well-defined edge.
 An air bronchogram. Normally, it is not
possible to identify air in the bronchi
within normally aerated lung substance
because the walls of the bronchi are too
thin and air-filled bronchi are
surrounded by air in the alveoli, but if
the alveoli are filled with fluid, the air in
the bronchi contrasts with the fluid in
the lung. This sign is seen to great
advantage on CT scans.
 The silhouette sign, namely loss of
visualization of the adjacent mediastinal
or diaphragm outline.
Air-space filling. In this
case the consolidation in
the left lung is due to a
pulmonary infarct.
The air bronchogram sign.
An extensive air
bronchogram is seen in this
patient with pneumonia.
The arrow points to some
bronchi that are
particularly well seen.

26.  Pulmonary collapse (atelectasis)
 The common causes of collapse (loss of volume of a lobe or lung) are:
bronchial obstruction; pneumothorax or pleural effusion.
 Collapse caused by bronchial obstruction
 Collapse caused by bronchial obstruction occurs because air cannot get
into the lung in sufficient quantities to replace the air absorbed from
the alveoli. The end result is lobar (or lung) collapse. The signs of lobar
collapse are: displacement of structures; the shadow of the collapsed
lobe - consolidation almost invariably accompanies lobar collapse, so
the resulting shadow is usually obvious; the silhouette sign. The
silhouette sign not only helps diagnose lobar collapse when the
resulting shadow is difficult to appreciate, it also helps when deciding
which lobe is collapsed. The commoner causes of lobar collapse are:
 1. Bronchial wall lesions: usually primary carcinoma; rarely, other
bronchial tumours such as carcinoid; rarely, endobronchial
tuberculosis.
 2. Intraluminal occlusion: mucus plugging, particularly in
postoperative, asthmatic or unconscious patients, or in patients on
artificial ventilation; inhaled foreign body.
 3. Invasion or compression by an adjacent mass: malignant tumour;
enlarged lymph nodes.

27. Trachea deviated
to right
1
2
Collapse of the right
lower lobe. (In this
example the apical
segment is relatively well
aerated.)
1.Position of oblique
fissure;
2. Horizontal fissure
pulled down.
3.Oblique fissure pulled
down.
4.Right lower lobe on
heart.