Chest surgical pathology &x rays


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  • Tension pnemothorax
  • Complete Lt. Lung Collaps
  • Canon ball metastesis
  • Thoracic aortic aneurism & pulmonary TB
  • Chest surgical pathology &x rays

    1. 1. Surgical Pathology & X-rays for Medical Students Chest Surgery 2008
    2. 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. 3. NormalChest X ray Index
    4. 4. AA SVC PAPARA LV CoPhS Index
    5. 5. Pneumothorax5 © Vascular 2007 Index
    6. 6. Lt. side pneumothorax 6 © Vascular 2008 Index
    7. 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. 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. 9. Lt. Tensionpneumothorax Index
    10. 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. 11. Rt. side tensionpneumothorax in an infant Index
    12. 12. Tension Pneumothorax12 © Vascular 2007 Index
    13. 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. 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. 15. Pleural Effusion15 © Vascular 2007 Index
    16. 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. 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. 18. Lt. pleural effusion18 © Vascular 2007 Index
    19. 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. 20. Massive Lt. pleural effusion20 © Vascular 2007 Index
    21. 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. 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. 23. Hydro- pneumothorax23 © Vascular 2007 Index
    24. 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. 25. Lt. Massive hydro-pneumothorax25 © Vascular 2007 Index
    26. 26. Lung Collapse26 © Vascular 2007 Index
    27. 27. Index Normal For comparisonMassive pleural effusion Left Plural Tap was NEGATIVE Complete Lt. Lung Collapse
    28. 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. 29. Lt. Lung CollapseThere is a shift ofheart andhemidiaphragmtoward side ofopacification(toward side of volume loss) Normal Index
    30. 30. Compare Rt. lung Lt. lung30 effusion Index collapse
    31. 31. Compare Lt. tension Lt. lung pnemothorax collapse31 © Vascular 2007 Index
    32. 32. Compare Rt. pleural effusion Lt. lung collapse32 © Vascular 2007 Index
    33. 33. Massive Pneumonia33 © Vascular 2007 Index
    34. 34. Lt. lung pneumonia The hemithorax isopaque and there isno shift of the heart or trachea Index
    35. 35. Pneumonia of the Left upper lobeThe left hemithorax isopaqueThere is no shift ofthe heart or tracheaThe opacifiedhemithorax containsair bronchograms Index
    36. 36. Lt. lung collapse Rt. lung effusion Causes of an Opacified HemithoraxLt. lung pneumonia The arrow Lt. neumonectomy shows mediastinal shift No Index
    37. 37. Which is this? Atelectasis Pneumonia Effusion Index
    38. 38. Bronchogenic Carcinoma38 © Vascular 2007 Index
    39. 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. 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. 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. 42. Lung Carcinoma42 © Vascular 2007 Index
    43. 43. Lung Carcinoma oA large, well- defined mass in the right upper lobe oExtensive emphysematous change43 © Vascular 2007 Index
    44. 44. Squamous cell carcinoma A portion of the tumor demonstrates central cavitation, probably because the tumor outgrew its blood supply44 © Vascular 2007 Index
    45. 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. 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. 47. Lung Abscess47 © Vascular 2008 Index
    48. 48. Fibro-caseous Pulmonary TB48 © Vascular 2007 Index
    49. 49. Fibro-caseous TB of both superiorlobes with cavitations on the Rt. side49 © Vascular 2007 Index
    50. 50. Pulmonary Metastasis50 © Vascular 2007 Index
    51. 51. Multiple Pulmonarysecondaries Index
    52. 52. Renal adenocarcinoma with multiple pulmonary metastasis52 © Vascular 2007 Index
    53. 53. Lung metastasis from CA colon53 © Vascular 2007 Index
    54. 54. Can you identify the pulmonary metastasis?54 © Vascular 2007 Index
    55. 55. Aortic Arch Aneurysm55 © Vascular 2007 Index
    56. 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. 57. Pulmonary Thoracic T.B. aortic aneurysm Index