This document discusses various radiographic signs seen on chest x-rays. It begins by defining atelectasis as the loss of air in the alveoli, requiring a density representing lung devoid of air and signs of loss of lung volume. It then describes different types of atelectasis including absorption, relaxation, adhesive, cicatricial, and round atelectasis. General signs of loss of lung volume from atelectasis are also outlined, such as mediastinal shift, elevated diaphragm, drooping shoulder, and crowded ribs. The document emphasizes how movement of fissures can help identify atelectasis and requires a lateral view.
In this presentation our agenda is
Brief introduction
Radiological Modalities
Radiological Features
Radiological Imaging Of Complications of lung cancer.
I followed Dahnert and try to describe all findings in lung cancer.
Hope it will prove an atlas in Lung cancer imaging.
Radiographic representation of pulmonary tuberculosis with specific focus on HRCT chest as an awareness campaign for general practitioner on World TB day
PowerPoint presentation on the topic HRCT Chest. This presentation is divided into 5 different parts. 1)Introduction to HRCT chest 2)Technichal aspects of HRCT 3) Relevant anatomy for HRCT interpretation 4)Pattern of lung disease in HRCT 5)HRCT pattern in various ILD’s
In this presentation our agenda is
Brief introduction
Radiological Modalities
Radiological Features
Radiological Imaging Of Complications of lung cancer.
I followed Dahnert and try to describe all findings in lung cancer.
Hope it will prove an atlas in Lung cancer imaging.
Radiographic representation of pulmonary tuberculosis with specific focus on HRCT chest as an awareness campaign for general practitioner on World TB day
PowerPoint presentation on the topic HRCT Chest. This presentation is divided into 5 different parts. 1)Introduction to HRCT chest 2)Technichal aspects of HRCT 3) Relevant anatomy for HRCT interpretation 4)Pattern of lung disease in HRCT 5)HRCT pattern in various ILD’s
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
It contains :
- Notes on Embryology, Anatomy and Physiology of respiratory system
- Cardinal symptoms in respiratory diseases
- Diagnostic procedures
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
Oxygen Therapy is not Beneficial in COPD Patients with Moderate HypoxaemiaGamal Agmy
A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation
The Long-Term Oxygen Treatment Trial Research Group*
N Engl J Med. 2016 October 27; 375(17): 1617–1627
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
13. Extra Pleural Sign
Cancer Lung
Density in periphery
Sharp inner margin
Indistinct outer margin
Angle of contact with chest wall
Expanding destructive rib lesion
Paratracheal widening
This is an example of an RUL lesion
17. Lateral Chest
There is valuable information that can be obtained by a chest
lateral view. A few of them are listed below:
Sternum
Vertebral column
Retrosternal space
Localization of lung lesions
Lobes of lungs
Oblique fissures
Pulmonary artery
Heart
Aorta
Mediastinal masses
Diaphragm
Volume measurements
SPN
Radiologic TLC
Tracheoesophageal stripe
18. Tuberculosis of Spine
Loss of intervertebral space
Vertebral collapse
Cold abscess is not present in this case. PA view is not diagnostic.
20. RML Atelectasis
Vague density in right lower lung field, almost normal
RML atelectasis in lateral view, not evident in PA view
21. Atelectasis Left Upper
Lobe
Hazy density over left
upper lung field
Loss of left heart
silhouette
Tracheal shift to left
A: Forward movement of oblique
fissure
C: Atelectatic LUL
B: Herniated right lung
22. Localization
When a lesion is not contiguous to a
silhouette, it is not possible to localize it
without a lateral view. This is a case of a
solitary pulmonary nodule with popcorn
calcification: Hamartoma.
23.
24.
25.
26.
27. Air Bronchogram
• In a normal chest x-ray, the tracheobronchial tree is not
visible beyond the 4th order. As the bronchial tree
branches, the cartilaginous rings become thinner, and
eventually disappear in respiratory bronchioles. The
lumen of the bronchus contains air and the surrounding
alveoli contain air. Thus, there is no contrast to visualize
the bronchi.
• The air column in the bronchi beyond the 4th order
becomes recognizable if the surrounding alveoli is filled,
providing a contrast or if the bronchi get thickened
• The term air bronchogram is used for the former state
and signifies alveolar disease.
28.
29. Silhouette Sign
Adjacent Lobe/SegmentSilhouette
RLL/Basal segmentsRight diaphragm
RML/Medial segmentRight heart margin
RUL/Anterior segmentAscending aorta
LUL/Posterior segmentAortic knob
Lingula/Inferior segmentLeft heart margin
LLL/Superior and basal segmentsDescending aorta
LLL/Basal segmentsLeft diaphragm
Cardiac margins are clearly seen because there is contrast between the fluid
density of the heart and the adjacent air filled alveoli. Both being of fluid density,
you cannot visualize the partition of the right and left ventricle because there is no
contrast between them. If the adjacent lung is devoid of air, the clarity of the
silhouette will be lost. The silhouette sign is extremely useful in localizing lung
lesions.
30.
31. Atelectasis Right Lung
Homogenous density right hemithorax
Mediastinal shift to right
Right hemithorax smaller
Right heart and diaphragmatic silhouette are not identifiable
32. Atelectasis Left Lung
Homogenous density left hemithorax
Mediastinal shift to left
Left hemithorax smaller
Diaphragm and heart silhouette are not identifiable
33. Lateral
Movement of oblique and transverse
fissures
Atelectasis Right Upper Lobe
Homogenous density right upper lung
field
Mediastinal shift to right
Loss of silhouette of ascending aorta
34. Atelectasis Left Upper
Lobe
Hazy density over left
upper lung field
Loss of left heart
silhouette
Tracheal shift to left
Lateral
A: Forward movement of
oblique fissure
B: Herniated right lung
C: Atelectatic LUL
35. Consolidation Right
Upper Lobe /
Density in right upper lung
field
Lobar density
Loss of ascending aorta
silhouette
No shift of mediastinum
Transverse fissure not
significantly shifted
Air bronchogram
36. Consolidation Left Lower Lobe
Density in left lower lung field
Left heart silhouette intact
Loss of diaphragmatic silhouette
No shift of mediastinum
Pneumatocele
One diaphragm only visible
Lobar density
Oblique fissure not significantly
shifted
37. Left Upper Lobe Consolidation
Density in the left upper lung field
Loss of silhouette of left heart margin
Density in the projection of LUL in lateral view
Air bronchogram in PA view
No significant loss of lung volume
38. Vague density right lower lung field
Indistinct right cardiac silhouette
Intact diaphragmatic silhouette
Density corresponding to RML
No loss of lung volume
RML pneumonia
39. S Curve of Golden
When there is a mass
adjacent to a fissure, the
fissure takes the shape
of an "S". The proximal
convexity is due to a mass,
and the distal concavity is
due to atelectasis. Note the
shape of the transverse
fissure.
This example represents a
RUL mass with atelectasis
40. Tracheal Shift
Trachea is index of upper mediastinal position. The pleural pressures on either
side determine the position of the mediastinum. The mediastinum will shift
towards the side with relatively higher negative pressure compared to the
opposite side. Tracheal deviation can occur under the following conditions:
• Deviated towards diseased side
– Atelectasis
– Agenesis of lung
– Pneumonectomy
– Pleural fibrosis
• Deviated away from diseased side
– Pneumothorax
– Pleural effusion
– Large mass
• Mediastinal masses
• Tracheal masses
• Kyphoscoliosis
41. Atelectasis Right Lung
• Homogenous density
right hemithorax
• Mediastinal shift to right
• Right hemithorax smaller
• Right heart and
diaphragmatic silhouette
are not identifiable
•
42. Pleural Effusion Massive
• Unilateral homogenous
density
• Mediastinal shift to right
• Left diaphragmatic and
left heart silhouettes lost
• Left hemithorax larger
45. Air Bronchogram
• In a normal chest x-ray, the tracheobronchial tree is not
visible beyond the 4th order. As the bronchial tree
branches, the cartilaginous rings become thinner, and
eventually disappear in respiratory bronchioles. The
lumen of the bronchus contains air and the surrounding
alveoli contain air. Thus, there is no contrast to visualize
the bronchi.
• The air column in the bronchi beyond the 4th order
becomes recognizable if the surrounding alveoli is filled,
providing a contrast or if the bronchi get thickened
• The term air bronchogram is used for the former state
and signifies alveolar disease.
46.
47. Bowing Sign
• In LUL atelectasis or
following resection, as in
this case, the oblique
fissure bows forwards
(lateral view). Bowing
sign refers to this feature.
The arrow points to the
forward movement of the
left oblique fissure.
48. Doubling Time
• Time to double in volume (not diameter)
• Useful in determining the etiology of solitary
pulmonary nodule
• Utility
– Less than 30 days: Inflammatory process
– Greater than 450 days: Benign tumor
– Malignancy falls in between
49. Eccentric Location of Cavity in a
Mass
• Thick wall and irregular lumen can be
seen in both malignancy and
inflammatory lesions.
• However eccentric location of cavity is
diagnostic of malignancy.
50. • This is an example of
squamous cell
carcinoma lung.
• LUL mass
• Thick walled cavity
• Eccentric location of
cavity
• Fluid level
• This is diagnostic of
malignancy.
51. Cortical Distribution
• Mirror image of pulmonary edema
• Alveolar disease of outer portion of lung
• Encountered in:
– Eosinophilic pneumonia
– Bronchiolitis obliterans with pneumonia
52. Medullary Distribution
• It is also called "butterfly pattern"
• Note the sparing of lung periphery both in
the CT, PA and lateral views
• This is one of the radiologic signs
indicative of diffuse alveolar disease
• This is an example of alveolar proteinosis.
53. Note the sparing of lung periphery both in the CT, and PA view
This is one of the radiologic signs indicative of diffuse alveolar disease
This is an example of alveolar proteinosis.
54. Diffuse Alveolar Disease
Radiological Signs
• Butterfly distribution / Medullary distribution
• Lobar or segmental distribution
• Air bronchogram
• Alveologram
• Confluent shadows
• Soft fluffy edges
• Acinar nodules
• Rapid changes
• No significant loss of lung volume
• Ground glass appearance on HRCT
58. Acinar Nodules
InterstitialAcinar
Same size
Sharp edges
smaller
Varying in size
Indistinct edges
Larger than interstitial nodules
Acinar nodules are difficult to distinguish from interstitial
nodules. Some distinguishing characteristics are as follows:
59.
60. Cut Off Sign
• When you see an abrupt ending of visualized
bronchus, it is called a "cut off sign". It indicates
an intrabronchial lesion. This is useful to identify
the etiology of atelectasis . Be careful as the
tracheobronchial tree is three dimensional and
the finding need to be confirmed with tomogram.
In the modern era, a CT scan will take care of
this.
62. Wedge Shaped Density
The wedge's base is pleural
and the apex is towards the
hilum, giving a triangular
shape. You can encounter
either of the following:
Vascular wedges :
Infarct
Invasive aspergillosis
Bronchial wedges :
Consolidation
Atelectasis
63. Polycyclic Margin
The wavy shape of
the mediastinal mass
margin indicates that
it is made up of
multiple masses,
usually lymph nodes.
This is a case of
lymphoma.
64. Open Bronchus Sign / Alveolar Atelectasis
The right lung is atelectatic. You can see air bronchogram, which indicates
that the airways are patent .This case is an example of adhesive alveolar
atelectasis.
65. Pulmonary Artery Overlay
Sign
This is the same concept as
a silhouette sign. If you can
recognize the interlobar
pulmonary artery, it means
that the mass seen is either
in front of or behind it.
This is an example of a
dissecting aneurysm.
66. S Curve of Golden
When there is a mass
adjacent to a fissure, the
fissure takes the shape
of an "S". The proximal
convexity is due to a mass,
and the distal concavity is
due to atelectasis. Note the
shape of the transverse
fissure.
This example represents a
RUL mass with atelectasis
67. Tracheoesophageal Stripe
The posterior wall of the trachea (T)
and the anterior wall of the esophagus
(E) are in close contact and form the
tracheoesophageal stripe in the lateral
view (arrow).
It is considered abnormal when it is
wider than __ mm.
Common causes for thickening of
tracheoesophageal stripe are:
Esophageal disease
Nodal enlargement
70. The definition of atelectasis is loss of air in the alveoli;
alveoli devoid of air (not replaced).
A diagnosis of atelectasis requires the following:
1-A density, representing lung devoid of air
2-Signs indicating loss of lung volume
Atelectasis
71. 1-Absorption Atelectasis
When airways are obstructed there is no further
ventilation to the lungs and beyond. In the early
stages, blood flow continues and gradually the
oxygen and nitrogen get absorbed, resulting in
atelectasis.
Types of Atelectasis:
72. 2-Relaxation Atelectasis
The lung is held close to the chest wall because of the
negative pressure in the pleural space. Once the
negative pressure is lost the lung tends to recoil due
to elastic properties and becomes atelectatic. This
occurs in patients with pneumothorax and pleural
effusion. In this instance, the loss of negative
pressure in the pleura permits the lung to relax, due
to elastic recoil. There is common misconception that
atelectasis is due to compression.
Types of Atelectasis:
73. 3-Adhesive Atelectasis :
Surfactant reduces surface tension and keeps the
alveoli open. In conditions where there is loss of
surfactant, the alveoli collapse and become
atelectatic. In ARDS this occurs diffusely to both
lungs. In pulmonary embolism due to loss of blood
flow and lack of CO2, the integrity of surfactant
gets impaired.
Types of Atelectasis:
75. .
5-Round Atelectasis
An instance where the lung gets trapped by
pleural disease and is devoid of air.
Classically encountered in asbestosis.
Types of Atelectasis:
76. Generalized
1-Shift of mediastinum: The trachea and heart gets shifted
towards the atelectatic lung.
2-Elevation of diaphragm: The diaphragm moves up and
the normal relationship between left and right side gets
altered.
3-Drooping of shoulder.
4-Crowding of ribs: The interspace between the ribs is
narrower compared to the opposite side.
Signs of Loss of Lung Volume:
77. Movement of Fissures
You need a lateral view to appreciate the movement of
oblique fissures. Forward movement of oblique fissure in
LUL atelectasis. Backward movement in lower lobe
atelectasis.
Movement of transverse fissure can be recognized in the
PA film.
Signs of Loss of Lung Volume:
78. Movement of Hilum
The right hilum is normally slightly lower than the left.
This relationship will change with lobar atelectasis.
Signs of Loss of Lung Volume:
80. Alterations in Proportion of Left and
Right Lung
The right lung is approximately 55% and left lung 45%. In
atelectasis this apportionment will change and can be a
clue to recognition of atelectasis. .
Signs of Loss of Lung Volume:
81. Hemithorax Asymmetry
In normals, the right and left hemithorax are equal in size.
The size of the hemithorax will be asymmetrical and
smaller on the side of atelectasis
Signs of Loss of Lung Volume:
82. Signs of Loss of Lung Volume:
Generalized
Shift of mediastinum: The trachea and heart gets shifted towards the atelectatic lung.
Elevation of diaphragm: The diaphragm moves up and the normal relationship between left
and right side gets altered.
Drooping of shoulder.
Crowding of ribs: The interspace between the ribs is narrower compared to the opposite side.
Movement of Fissures
You need a lateral view to appreciate the movement of oblique fissures. Forward movement of
oblique fissure in LUL atelectasis. Backward movement in lower lobe atelectasis.
Movement of transverse fissure can be recognized in the PA film.
Movement of Hilum
The right hilum is normally slightly lower than the left. This relationship will change with lobar
atelectasis.
Compensatory Hyperinflation
Compensatory hyperinflation as evidenced by increased radiolucency and splaying of vessels
can be seen with the normal lobe or opposite lung.
Alterations in Proportion of Left and Right Lung
The right lung is approximately 55% and left lung 45%. In atelectasis this apportionment will
change and can be a clue to recognition of atelectasis.
Hemithorax Asymmetry
In normals, the right and left hemithorax are equal in size. The size of the hemithorax will be
asymmetrical and smaller on the side of atelectasis
83. Atelectasis Right Lung
Homogenous density right hemithorax
Mediastinal shift to right
Right hemithorax smaller
Right heart and diaphragmatic silhouette are not identifiable
84. Atelectasis Left Lung
Homogenous density left hemithorax
Mediastinal shift to left
Left hemithorax smaller
Diaphragm and heart silhouette are not identifiable
85. Left Lower Lobe Atelectasis
• Inhomogeneous cardiac density
• Left hilum pulled down
• Non-visualization of left diaphragm
• Triangular retrocardiac atelectatic LLL
86. Atelectasis Left Lower Lobe
Double density over heart
Inhomogenous cardiac density
Triangular retrocardiac density
Left hilum pulled down
Other findings include:
Pneumomediastinum
87. Atelectasis Left
Upper Lobe
Mediastinal shift to left
Density left upper lung field
Loss of aortic knob and left hilar
silhouettes
Herniation of right lung
Atelectatic left upper lobe
Forward movement of left
oblique fissure "Bowing sign"
88. Atelectasis Left Upper
Lobe
Hazy density over left
upper lung field
Loss of left heart
silhouette
Tracheal shift to left
Lateral
A: Forward movement of
oblique fissure
B: Herniated right lung
C: Atelectatic LUL
89. Lateral
Movement of oblique and transverse
fissures
Atelectasis Right Upper Lobe
Homogenous density right upper lung
field
Mediastinal shift to right
Loss of silhouette of ascending aorta
90. Lateral
Movement of oblique and transverse
fissures
Atelectasis Right Upper Lobe
Homogenous density right upper lung field
Mediastinal shift to right
Loss of silhouette of ascending aorta
91. RML Atelectasis
Vague density in right lower lung field, almost normal
RML atelectasis in lateral view, not evident in PA view
92. Vague density in right lower lung field (almost a normal film).
Dramatic RML atelectasis in lateral view, not evident in PA view. Movement of
transverse fissure.
Other findings include: Azygous lobe
93. Atelectasis Right Lower Lobe
Density in right lower lung field
Indistinct right diaphragm
Right heart silhouette retained
Transverse fissure moved down
Right hilum moved down
94. Adhesive Atelectasis
Alveoli are kept open by the integrity of surfactant. When there is loss
of surfactant, alveoli collapse. ARDS is an example of diffuse alveolar
atelectasis.
Plate-like atelectasis is an example of focal loss of surfactant.
95. Relaxation Atelectasis
The lung is held in apposition to the chest wall because of negative pressure
in the pleura. When the negative pressure is lost, as in pneumothorax or
pleural effusion, the lung relaxes to its atelectatic position. The atelectasis is
a secondary event. The pleural problem is primary and dictates other
radiological findings.
96. Round Atelectasis
Mass like density
Pleural based
Base of lungs
Blunting of costophrenic angle
Pleural thickening
Pulmonary vasculature curving
into the density
Esophageal surgical clips
97. Round Atelectasis
Mass like density
Pleural based
Base of lungs
Blunting of costophrenic angle, pleural thickening
Pulmonary vasculature curving into the density
106. Bronchiectasis
Left lung atelectasis due to mucus plugging
Mucus plugs suctioned with bronchoscopy
Bronchogram done after bronchoscopy
Saccular bronchiectasis in bronchogram below
107. Bronchogram
Bronchograms are rarely done nowadays. The need for it
disappeared with the invention of the fiberoptic
bronchoscopy and high resolution CT scan. View these
images to get a greater understanding of a three
dimensional view of a bronchial tree..
108. Bronchogram
Bronchograms are rarely done nowadays. The need for it disappeared with the
invention of the fiberoptic bronchoscopy and high resolution CT scan.
122. Number:
Multiple bilateral cavities would raise
suspicion for either bronchiogenous or
hematogenous process. You should consider:
Aspiration lung abscess
Septic emboli
Metastatic lesions
Vasculitis (Wegener's)
Coccidioidomycosis, tuberculosis
123. Location:
• Classical locations for aspiration lung abscess
are superior segment of the lower lobes
posterior segments of upper lobes.
• Tuberculous cavities are common in superior
segments of upper and lower lobes or posterior
segments of upper lobes.
• When a cavity in anterior segment is
encountered, a strong suspicion for lung cancer
should be raised. TB and aspiration lung
abscess are rare in anterior segments. Cancer
lung can occur in any segment.
124. Wall Thickness:
• Thick walls are seen in:
– Lung abscess
– Necrotizing squamous cell lung cancer
– Wegener's granulomatosis
– Blastomycosis
125. Wall Thickness:
• Thin walled cavities are seen in:
• Coccidioidomycosis
• Metastatic cavitating squamous cell
carcinoma from the cervix
• M. Kansasii infection
• Congenital or acquired bullae
• Post-traumatic cysts
• Open negative TB
126. Contents:
• The most common cause for air fluid level is
lung abscess. Air fluid levels can rarely be
seen in malignancy and in tuberculous
cavities from rupture of Rasmussen's
aneurysm.
• A fungous ball should make you consider
aspergillosis. A blood clot and fibrin ball will
have the same appearance.
• Floating Water Lily: The collapsed membrane
of a ruptured echinococcal cyst, floats giving
this appearance.
127. Lining of Wall:
The wall lining is irregular and nodular in
lung cancer or shaggy in lung abscess
128. Evolution of Lesion:
Many times review of old films to assess the
evolution of the radiological appearance of
the lesion extremely helpful. Examples
• Infected bullae
• Aspergilloma
• Sub acute necrotizing aspergillosis
• Bleeding from Rasmussen's aneurysm in a
tuberculous cavity
131. Bulla
Definition
•Thin-walled–less than 1 mm
•Air-filled space
•In the lung> 1 cm in size and up to 75% of lung
•Walls may be formed by pleura, septa,
or compressed lung tissue.
•Results from destruction, dilatation and
confluence of airspaces distal to terminal
bronchioles.
132. •Bullous disease may be primary or associated
with emphysema or interstitial lung disease.
• Primary bullous lung disease may be familial
and has been associated with Marfan's, Ehler's
Danlos, IV drug users, HIV infection, and
vanishing lung syndrome.
•Bullae may occasionally become very large
and compromise respiratory function. Thus
has been referred as vanishing lung syndrome,
and may be seen in young men.
137. Pneumatocele is a benign air containing cyst of lung, with
thin wall < 1mm as bulla but with different mechanism
Infection with staph aureus is the commonest cause ( less
common causes are, trauma, barotrauma) lead to necrosis
and liquefaction followed by air leak and subpleural
dissection forming a thin walled cyst.
138. •Honeycombing is defined as multiple cysts < 1cm in diameter,with
well defined walls, in a background of fibrosis, tend to form
clusters and is considered as end stage lung .
•It is formed by extensive interstitial fibrosis of lung with residual
cystic areas.
139.
140. A cyst is a ring
shadow > 1 cm in
diameter and up to
10 cm with wall
thickness from 1-3
mm.
143. A cavity is > 1cm
in diameter, and its
wall thickness is
more than 3 mm.
144. •A central portion necrosis and communicate to bronchus.
•The draining bronchus is visible (arrow). CT (2 mm slice thickness)
shows discrete air bronchograms in the consolidated area.
Mechanism
167. Consolidation Right
Upper Lobe /
Density in right upper lung
field
Lobar density
Loss of ascending aorta
silhouette
No shift of mediastinum
Transverse fissure not
significantly shifted
Air bronchogram
169. Radiation Pneumonia
Post Mediastinal Radiation
Air space disease (air bronchogram)
Over radiation port (vertical and paramediastinal)
Bilateral
Progression to fibrosis
173. Consolidation / Lingula
Density in left lower lung field
Loss of left heart silhouette
Diaphragmatic silhouette intact
No shift of mediastinum
Blunting of costophrenic angle
Lateral
Lobar density
Oblique fissure not
significantly shifted
Air bronchogram
174. Consolidation Left Lower Lobe
Density in left lower lung field
Left heart silhouette intact
Loss of diaphragmatic silhouette
No shift of mediastinum
Pneumatocele
One diaphragm only visible
Lobar density
Oblique fissure not significantly
shifted
175. Left Upper Lobe Consolidation
Density in the left upper lung field
Loss of silhouette of left heart margin
Density in the projection of LUL in lateral view
Air bronchogram in PA view
No significant loss of lung volume
176. Vague density right lower lung field
Indistinct right cardiac silhouette
Intact diaphragmatic silhouette
Density corresponding to RML
No loss of lung volume
RML pneumonia
177. Consolidation Right Upper Lobe /
Air Bronchogram
Density in right upper lung field
Lobar density
Loss of ascending aorta silhouette
No shift of mediastinum
Transverse fissure not significantly shifted
Air bronchogram
180. Alveolar Cell Carcinoma - Progression
Old film on left
Solitary pulmonary nodule resected
Onset of diaphragmatic paralysis
Progression to multicentric acinar nodules
181. Hyperlucent Lung
Factors
Vasculature: Decrease
Air: Excess
Tissue : Decrease
Bilateral diffuse
Emphysema
Asthma
Unilateral
Swyer James syndrome
Agenesis of pulmonary artery
Absent breast or pectoral muscle
Partial airway obstruction
Compensatory hyperinflation
Localized
Bullae
Westermark's sign : Pulmonary embolus
182. Agenesis of Left Pulmonary Artery
Missing vascular markings in left lung
Left hilum not seen
Entire cardiac output to right lung
195. Achalasia of
esophagus
• Inhomogeneous
cardiac density:
Right half more
dense than left
• Density crossing
midline (right black
arrow)
• Right sided inlet to
outlet shadow
• Right para spinal line
(left black arrow)
• Barium swallow
below: Dilated
esophagus
200. Dissecting Aneurysm
Mediastinal widening
Inlet to outlet shadow
on left side
Retrocardiac: Intact
silhouette of left heart
margin
Pulmonary artery
overlay sign: Density
behind left lower lobe
Wavy margin
228. of PE Diagnostic Algorithm
1. Patients with normal chest radiographic findings
are evaluated with a perfusion scan and, if
necessary, an aerosol ventilation scan. Patients
with normal or very low probability scintigraphic
findings are presumed not to have pulmonary
emboli .
2-Patients with a high-probability scan usually
undergo anticoagulation therapy. All other patients
should be evaluated with helical CT pulmonary
angiography, conventional pulmonary
angiography, or lower-extremity US, depending on
the clinical situation
229. of PE Diagnostic Algorithm
3-Patients with abnormal chest radiographic findings, are
unlikely to have definitive scintigraphic findings. These
patients undergo helical CT pulmonary angiography as well
as axial CT of the inferior vena cava and the iliac, femoral,
and popliteal veins. If the findings at helical CT pulmonary
angiography are equivocal or technically inadequate (5%–
10% of cases) or clinical suspicion remains high despite
negative findings, additional imaging is required.
4-Patients who have symptoms of deep venous thrombosis
but not of pulmonary embolism initially undergo US, which
is a less expensive alternative. If the findings are negative,
imaging is usually discontinued; if they are positive, the
patient is evaluated for pulmonary embolism at the
discretion of the referring physician.
249. Potential Sources of Mediastinal Air
Intrathoracic
Trachea and major bronchi
Esophagus
Lung
Pleural space
Extrathoracic
Head and neck
Intraperitoneum and retroperitoneum
250.
251.
252.
253. Radiographic Signs of Pneumomediastinum
Subcutaneous emphysema
Thymic sail sign
Pneumoprecardium
Ring around the artery sign
Tubular artery sign
Double bronchial wall sign
Continuous diaphragm sign
Extrapleural sign
Air in the pulmonary ligament
265. The CT features of benign
mediastinal cyst are
(a) a smooth, oval or tubular mass with a well-
defined thin wall that usually enhances after
intravascular administration of contrast
material,
(b) homogeneous attenuation, usually in the
range of water attenuation (0–20 HU),
(c) no enhancement of cyst contents, and
(d) no infiltration of adjacent mediastinal
structures.
266. Cysts that contain serous fluid typically have
long T1 and T2 relaxation values, which
produce low signal intensity on T1-weighted
MR images and high signal intensity on T2-
weighted images.
267.
268. Because cysts containing nonserous
fluid can have high attenuation at CT,
they may be mistaken for solid
lesions. MR imaging can be useful in
showing the cystic nature of these
masses because these cysts continue
to have characteristically high signal
intensity when imaged with T2-
weighted sequences regardless of the
nature of the cyst contents
269. Radionuclide imaging can be helpful in
detecting functioning thyroid tissue
(iodine-123 or I-131) or parathyroid
tissue (technetium-99m sestamibi) in
the mediastinal cystic mass . gallium-
67 scintigraphy may show increased
radiotracer uptake in the cystic
malignancy owing to necrosis such as
lymphoma or metastatic carcinoma.
270. Ultrasonography (US) can be useful in
evaluating a mass adjacent to the
pleural surface or cardiophrenic angle.
At US, the benign cysts typically
appear as anechoic thin-walled
masses with increased through
transmission