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Describes cross sectional anatomy of the mediastinum , and lobar and segmental anatomy of the lung with teaching points and radiological guidelines and multiple examples of lobar and segmental pathologies and how we localize these pathologies .Also the types of chest CT images and indications of chest CT.
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.
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In this presentation our agenda is
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Radiological Features
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Oxygen Therapy is not Beneficial in COPD Patients with Moderate HypoxaemiaGamal Agmy
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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.
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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.
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O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
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36. Flat waist Sign
This sign refers to flattening of the contours of the aortic knob and adjacent
main pulmonary artery .
It is seen in severe collapse of the left lower lobe and is caused by leftward
displacement and rotation of the heart
37.
38. Juxtaphrenic peak sign
The juxtaphrenic peak sign refers to the peaked or
tented appearance of a hemidiaphragm which can
occur in the setting of lobar collapse. It is caused by
retraction of the lower end of diaphragm at an inferior
accessory fissure (most common), major fissure
or inferior pulmonary ligament. It is commonly seen
in upper lobe collapse but may also be seen in middle
lobe collapse.
39.
40. Fallen Lung Sign
This sign refers to the appearance
of the collapsed lung occurring
with a fractured bronchus .
The bronchial fracture results in
the lung to fall away from the
hilum, either inferiorly and laterally
in an upright patient or posteriorly,
as seen on CT in a supine patient.
DD:
Pneumothorax causes a lung to
collapse inward toward the hilum.
41.
42. Luftsichel Sign
•German for sickle of air (luft: air sichel:
crescent)
•Paramediastinal lucency due to
interposition of lower lobe apex between
mediastinum and shrunken upper lobe
•Occurs more commonly on the left than in
the right
43. Comet Tail Sign
•Seen on CT of the chest
•Consists of curvilinear opacity extending
from subpleural mass toward hilum
•Produced by the distortion vessels and
bronchi that lead to adjacent rounded
atelectasis
44.
45. (posterioranterior) position. Note
that the x-ray tube is 72 inches
away.
the supine AP (anteriorposterior)
position the x-ray tube is 40 inches
from the patient.
46.
47. Dee method for approximating the position o f the carina can
be used. This involves defining the aortic arch and then
drawing a line Inferomedially through the middle of the arch
at a 45 degree angle to t he midline
48. The Ideal position for endotracheal tubes is in the
mid trachea, 5cm from the carina, when the head is
neither flexed nor extended. This allows for
movement of the tip with head movements. The
minimal safe distance from the carina is 2cm.
49.
50.
51. Notice the increased lucency of the cardiophrenic sulci in this patient
with inferior anteromedial pneumothoraces. A CT scan confirms the
diagnosis
52. a hyperlucent upper
quadrant with
visualization of the
superior surface of the
diaphragm and
visualization of the
inferiorvena cava.
double-diaphragm
sign
53. Antero lateral air may
increase the
radiolucency at the
costo phrenicsulcus.
This is called the deep
sulcus sign.
55. shifting of the heart
border,
the superior vena cava,
and the inferior vena
cava.
The shifting of these
structures can lead to
decreased venous return.
56. •Mediastinal shifT is
usually
seen in a tension
pneumothorax.
•The most reliable sign of
tension pneumothorax is
depression of a
hemidiaphragm.
57. 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
58.
59.
60.
61.
62.
63.
64.
65. Ginkgo leaf sign
• The ginkgo leaf sign is a chest plain radiography
appearance which is seen at extensive subcutaneous
emphysema of the chest wall. Air outlines the fibers of
the pectoralis major muscle and creates a branching
pattern that resembles the branching pattern in the
veins of a ginkgo leaf.
68. The terminal bronchiole in the center
divides into respiratory bronchioles with
acini that contain alveoli.
Lymphatics and veins run within the
interlobular septa
Centrilobular area in blue (left)
and perilymphatic area in yellow
(right)
71. ARE NODULES IN CONTACT
WITH PLEURA
NO
CENTRILOBULAR
YES
PERILYMPHATIC RANDOM
72.
73. Size, Distribution, Appearance
Nodules and Nodular Opacities
Size
Small Nodules: <10 mm Miliary - <3 mm
Large Nodules: >10 mm Masses - >3 cms
Appearance
Interstitial opacity:
Well-defined, homogenous,
Soft-tissue density
Obscures the edges of vessels or adjacent structure
Air space:
Ill-defined, inhomogeneous.
Less dense than adjacent vessel – GGO
small nodule is difficult to identify
75. RANDOM: no consistent relationship to any structures
PERILYMPHATIC: corresponds to distribution of lymphatic
CENTRILOBULAR: related to centrilobular structuresDistribution
75
77. Notice the nodules along the fissures indicating a
perilymphatic distribution (red arrows).
The majority of nodules located along the bronchovascular
bundle (yellow arrow).
80. Centrilobular distribution
Hypersensitivity pneumonitis
Respiratory bronchiolitis in
smokers
infectious airways diseases
(endobronchial spread of
tuberculosis or
nontuberculous
mycobacteria,
bronchopneumonia)
Uncommon in
bronchioloalveolar
carcinoma, pulmonary
edema, vasculitis
81. Random distribution
Small random nodules
are seen in:
Hematogenous
metastases
Miliary tuberculosis
Miliary fungal infections
Sarcoidosis may mimick
this pattern, when very
extensive
Langerhans cell
histiocytosis (early
nodular stage)
90. Inconsistent with UIP
pattern (any one of
seven features
Possible UIP pattern (all
three features)
UIP pattern (all four
features)
•Upper or mid lung
predominance
subpleural basal
predominance
•subpleural basal
predominance
•peribronchovascular
predominance
reticular abnormality•reticular abnormality
•extensive ground glass
abnormality (extent > reticular
abnormality)
•honeycombing with or
without traction
bronchiectasis
•profuse micronodules
(bilateral, predominantly upper
lobes
Absence of features
listed as inconsistent
with UIP pattern
Absence of features
listed as inconsistent
with UIP pattern
•discrete cysts (multiple
bilateral, away from areas of
honeycombing)
•diffuse mosaic attenuation/air
trapping (bilateral in three or
more lobes)
•consolidation in broncho-
pulmonary segment(s)/lobe(s)
Radiological features of idiopathic pulmonary fibrosis: 2011
99. Langerhans Cell Histiozytosis
Key Features
Upper lobe predominance
Combination of cysts and noduli
Characteristic stages
Increased Lung volume
Sparing of costophrenic angle
S
M
O
K
I
N
G
104. LIP
= Lymphocytic Interstitial Pneumonia
Rarely idiopathic
In association with:
Sjögren’s syndrome
Immune deficiency syndromes, AIDS
Primary biliary cirrhosis
Multicentric Castlemean’s disease
105. Sjoegren disease
Dry eye and dry mouth
Fibrosis, bronchitis and bronchiolitis
LIP
Overlap
Sarcoid, DM/PM, MXCT
SLE, RA (pleural effusion)
Up to 40 x increased risk for lymphoma (mediastinal
adenopathy) and
2 x times increased risk for neoplasma
115. Linear Pattern
A linear pattern is seen when there is
thickening of the interlobular septa,
producing Kerley lines.
Kerley B lines
Kerley A lines
The interlobular septa contain
pulmonary veins and lymphatics.
The most common cause of interlobular
septal thickening, producing Kerley A
and B lines, is pulmonary edema, as a
result of pulmonary venous
hypertension and distension of the
lymphatics.
Kerley B lines
Kerley A lines
116. DD of Kerly Lines:
Pulmonary edema is the most common cause
Mitral stenosis
Lymphangitic carcinomatosis
Malignant lymphoma
Congenital lymphangiectasia
Idiopathic pulmonary fibrosis
Pneumoconiosis
Sarcoidosis
117. HRCT of the lung
Reticular pattern – HRCT
numerous, clearly visible interlobular septa
outlining lobules of characteristic size and shape
interlobular septal thickening
very fine network of lines within visible lobules
intralobular interstitial thickening
several layers of air-filled cysts, 3-10 mm in diameter,
with thick walls (1-3 mm)
honeycombing
119. Reticular pattern
Interlobular septal thickening – pulmonary edema
smooth septal thickening, isolated or in combination
with ground-glass opacity
peribronchovascular and subpleural interstitial th.
perihilar and gravitational distribution, bilateral
findings of CHF
120. Reticular pattern
Interlobular septal th. – lymphangitic carcinomatosis
smooth or nodular septal thickening
smooth or nodular thickening of peribronchovascular
interstitium and fissures
thickening of the intralobular axial interstitium
focal or asymmetric distribution
122. Reticular pattern
Honeycombing – significance
air-containing cystic spaces having thick,
fibrous walls lined by bronchiolar
epithelium
fibrosis is present
UIP is likely the histologic pattern
IPF is very likely, in the absence of a
known disease
123. Reticular pattern
Honeycombing – differential diagnosis
basal
distribution
middle/upper
distribution
chronic HP
sarcoidosis
IPF
collagen vasc. dis.
asbestosis
drugs
125. Reticular pattern
adapted from: Webb RW – HRCT of the lung, III ed; 2001
honeycombing
•IPF (60%)
•collagen vascular dis.
•drug reaction
•asbestosis (uncommon)
subpleural, posterior
LL predominance
•sarcoidosis
•chronic HP
•radiation
other distribution
(UL; parahilar)
126. Head cheese sign
It refers to mixed
densities which includes
# consolidation
# ground glass
opacities
# normal lung
# Mosaic perfusion
• Signifies mixed
infiltrative and
obstructive disease
127. Head cheese sign
Common cause are :
1. Hypersensitive pneumonitis
2. Sarcoidosis
3. DIP
127
128. Headcheese sign
Headcheese sign in
hypersensitivity
pneumonitis.
HRCT scan shows lung with
a geographic appearance,
which represents a
combination of patchy or
lobular ground-glass opacity
(small arrows) and mosaic
perfusion (large arrows).
131. Where is the pathology ???????
in the areas with increased density
meaning there is ground glass
in the areas with decreased density
meaning there is air trapping
132. Pathology in black areas
Airtrapping: Airway
Disease
Bronchiolitis obliterans (constrictive bronchiolitis)
idiopathic, connective tissue diseases, drug reaction,
after transplantation, after infection
Hypersensitivity pneumonitis
granulomatous inflammation of bronchiolar wall
Sarcoidosis
granulomatous inflammation of bronchiolar wall
Asthma / Bronchiectasis / Airway diseases
134. Pathology in white Areas
Alveolitis / Pneumonitis
Ground glass
desquamative intertitial pneumoinia (DIP)
nonspecific interstitial pneumonia (NSIP)
organizing pneumonia
In expiration
both areas (white and black) decrease in
volume and increase in density
DECREASE IN CONTRAST
DIFFERENCES