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1、Radiology of Respiratory System,Aims,Basics Best exam results Appreciate the role radiology plays ? Instill an interest in radiology,Before Class:,Textbook Reference book Literature Internet Apps Teacher & classmate,Histology and Embryology Anatomy Pathology Internal Medicine Surgery Gynecology Pedi
2、atrics Neurology 。 Everything。U need to know,methods,X-ray CT MR DSA US Nuclear Medicine PET/CT Radionuclide ventilation perfusion imaging,X-ray Techniques,PA （posteroanterior) & Lateral More information Two views Standardized Distance Pt needs to be stable,Portable Quick Anywhere One shot No standa
3、rdization,PA,Portable,Techniques - Projection,P-A (relation of x-ray beam to patient),Techniques - Projection (continued),A-P Supine/Erect,Techniques - Projection (continued),Lateral,Techniques - Projection (continued),Lateral Decubitus,Oblique,Technical Details,Type Orientation Rotation Inspiration
4、/expiration Penetration,Rotation,Rotation (continued),Penetration,Inspiration/Expiration,Things to see,ABCDE Airways Trachea, endotracheal tube, etc Bones Clavicles, ribs, etc Cardiac Diaphragm (Right hemidiaphragm slightly higher (1.5 cm) Everything else (tubes), effusions,Densities,The big two den
5、sities are: (1) WHITE - Bone (2) BLACK - Air The others are: (3) DARK GREY- Fat (4) GREY- Soft tissue/water And if anything Man-made is on the film, it is: (5) BRIGHT WHITE - Man-made,Anatomy,Anatomy,Bronchopulmonary Anatomy,Cross-sectional Anatomy of Lung Segments （CT）,Lobes,Right upper lobe:,Lobes
6、 (continued),Right middle lobe:,Lobes (continued),Right lower lobe:,Lobes (continued),Left lower lobe:,Lobes (continued),Left upper lobe with Lingula:,Lobes (continued),Lingula:,Lobes (continued),Left upper lobe - upper division:,Heart,Right border: Edge of (r) Atrium 3. Left border: (l) Ventricle +
7、 Atrium 4. Posterior border: Reft Ventricle 5. Anterior border: Right Ventricle,Heart (continued 。),Heart,ITS NOT MINE.,Hilum,Made of: 1. Pulmonary Art.+Veins 2. The Bronchi Left Hilum higher (max 1-2,5 cm) Identical: size, shape, density,Hilum,Ribs,Review areas:,Apices Behind the heart Costophrenic
8、 angle (CPA) Below the diaphragm Soft tissues ( breast, surgical emphysema) Ribs & clavicle Vertebrae,Abnormals,Lung findings,Darker areas radiolucent Pneumothorax Cysts/bulla Air bronchograms,Lighter areas Opacities Atelectasis “infiltrates” Blood Pus Water Nodules or mass,Opacities,Lobar or not. P
9、neumonia Pulmonary Edema “fluffy,” diffuse, “bat wing” distribution Hemorrhage Cant tell by x-ray, need bronch,RML pneumonia,Opacities,RLL pneumonia,Opacities,RUL pneumonia,LLL pneumonia,Consolidation on CT,The Enlarged Hila,Causes: 1. Adenopathies (neoplasia, infection) 2. Primary Tumor 3. Vascular
10、 4. Sarcoidosis,Mass,Hilar Lymphadenopathy - BL,Multiple Masses,Metas,Pleural Effusion,Pulmonary Fibrosis,Heart failure， Kerley A/B line （Interstitial lung hyperplasia edema）,Heart failure,Pneumothorax,Emphysema,Cavitating lesion,Thin-walled Cavitating lesion,Thick-walled Cavitating lesion,3mm,Bronc
11、hiectasis,Miliary shadowing,Calcification,Benign Patterns of Calcification Within a Solitary Pulmonary Nodule,Chest Tube, NG Tube, Pulm. artery cath,CT Indications,Key,Clinical Factors Growth Pattern Size Margin (Border) Characteristics Density Contrast-Enhanced CT Other findings,Pulmonary Infection
12、,airspace opacification,air bronchograms,dense multifocal segmental,pneumonia,lung abscess,cavitation,Lobar/segmental consolidation,Pneumonia finding,Tuberculosis,infiltrates,Miliary shadowing,Tuberculoma,Chronic fibro-cavitary TB,CAUSES OF SOLITARY PULMONARY NODULES （SPN）,Neoplastic: Malignant Bron
13、chogenic carcinoma Solitary metastasis Lymphoma Carcinoid tumor Neoplastic: Benign Hamartoma Benign connective tissue and neural tumors (e.g., lipoma, fibroma, neurofibroma) Inflammatory Granuloma Lung abscess Rheumatoid nodule Inflammatory pseudotumor (plasma cell granuloma) Congenital Arteriovenou
14、s malformation Lung cyst Bronchial atresia with mucoid impaction Miscellaneous Pulmonary infarct Intrapulmonary lymph node Mucoid impaction Hematoma Amyloidosis Normal confluence of pulmonary veins Mimics of SPN Nipple shadow Cutaneous lesion (e.g., wart, mole) Rib fracture or other bone lesion locu
15、lated pleural effusion,Neoplastic: Benign,Hamartoma,Neoplastic: Malignant,Bronchogenic carcinoma,Neoplastic: Malignant,Bronchogenic carcinoma,Inflammatory,Granuloma,chest radiograph shows a small, well-circumscribed, round opacity at the right lung base (arrows).,Lateral view shows that the opacity
16、is within the lung on two views (posterior segment of the right lower lobe) and thus represents a pulmonary nodule (arrow).,Contrast CT in Malignant Solitary Pulmonary Nodule. Thin-collimation (3-mm) CT scans through left upper lobe nodule in a 62-year-old woman with biopsy-proven lung cancer shows
17、a lobulated contour with positive enhancement of 50 H after contrast administration,Malignant SPN,Bronchogenic Carcinoma（Clinical）,Age at diagnosis: 55-60 years (range 40-80 years); M:F = 1.4:1 asymptomatic (10-50%) usually with peripheral tumors symptoms of central tumors: cough (75%), wheezing, pn
18、eumonia hemoptysis (50%), dysphagia (2%) symptoms of peripheral tumors: pleuritic/local chest pain, dyspnea, cough Pancoast syndrome, superior vena cava syndrome hoarseness symptoms of metastatic disease (CNS, bone, liver, adrenal gland) paraneoplastic syndromes: cachexia of malignancy clubbing + hy
19、pertrophic osteoarthropathy nonbacterial thrombotic endocarditis migratory thrombophlebitis ectopic hormone production: hypercalcemia, syndrome of inappropriate secretion of antidiuretic hormone, Cushing syndrome, gynecomastia, acromegaly,Risk factors,Cigarette smoking (squamous cell carcinoma + sma
20、ll cell carcinoma) 鈥搑elated to number of cigarettes smoked, depth of inhalation, age at which smoking began 85% of lung cancer deaths are attributable to cigarette smoking! Passive smoking may account for 25% of lung cancers in nonsmokers! Radon gas: may be the 2nd leading cause for lung cancer with
21、 up to 20,000 deaths per year Industrial exposure: asbestos, uranium, arsenic, chlormethyl ether Concomitant disease: chronic pulmonary scar + pulmonary fibrosis Scar carcinoma 45% of all peripheral cancers originate in scars! Incidence: 7% of lung tumors; 1% of autopsies Origin: related to infarcts
22、 (50%), tuberculosis scar (25%) Histo: adenocarcinoma (72%), squamous cell carcinoma (18%) Location: upper lobes (75%),Types:,Adenocarcinoma (50%) Most common cell type seen in women + nonsmokers Intermediate malignant potential (slow growth, high incidence of early metastases) almost invariably dev
23、elops in periphery; frequently found in scars (tuberculosis, infarction, scleroderma, bronchiectasis) + in close relation to preexisting bullae solitary peripheral subpleural mass (52%)/alveolar infiltrate/multiple nodules may invade pleura + grow circumferentially around lung mimicking malignant me
24、sothelioma upper lobe distribution (69%) air broncho-/bronchiologram on HRCT (65%) calcification in periphery of mass (1%) smooth margin/spiculated margin due to desmoplastic reaction with retraction of pleura,Adenocarcinoma Presenting as Solitary Pulmonary Nodule. Cone-down view of posteroanterior
25、radiograph shows nodule in the right mid-lung (arrow). Thin-section CT shows 12-mm nodule with spiculated margins (arrow) in the superior segment of the right lower lobe. Transthoracic needle biopsy revealed adenocarcinoma.,solitary peripheral mass,Squamous cell carcinoma (30-35%) Strongly associate
26、d with cigarette smoking Central location within main/lobar/segmental bronchus (2/3) large central mass & cavitation distal atelectasis & bulging fissure (due to mass) postobstructive pneumonia All cases of pneumonia in adults should be followed to complete radiologic resolution! airway obstruction
27、with atelectasis (37%) Solitary peripheral nodule (1/3) characteristic cavitation (in 7-10%) Squamous cell carcinoma is the most common cell type to cavitate! invasion of chest wall Squamous cell carcinoma is the most common cell type to cause Pancoast tumor,Central lung cancer,Squamous Cell Carcino
28、ma. Posteroanterior chest film in a 58-year-old male smoker with hemoptysis shows a left hilar mass with left upper lobe atelectasis. Enhanced CT scan shows the left hilar mass occluding the left upper lobe bronchus with an endobronchial component (straight arrow). Note the presence of mucus broncho
29、grams within the atelectatic lung (curved arrow),Squamous Cell Carcinoma,Small cell undifferentiated carcinoma (15%) Strongly associated with cigarette smoking Rapid growth + high metastatic potential typically large hilar/perihilar mass often associated with mediastinal widening (from adenopathy) e
30、xtensive necrosis + hemorrhage small lung lesion (rare),Large undifferentiated cell carcinoma (6 cm (50%) large area of necrosis pleural involvement large bronchus involved in central lesion (50%),Large-cell bronchogenic carcinoma,small-cell bronchogenic carcinoma,Ground-glass Opacity,the pattern wa
31、s shown to be caused by predominantly interstitial diseases in 54% of cases, equal involvement of the interstitium and airspaces in 32%, and predominantly airspace disease in 14% GGO is an important finding. In certain clinical circumstances, it can suggest a specific diagnosis, indicate a potentially treatable disease, and guide a bronchoscopist or surgeon to an appropriate area for biopsy,Pure GGO（ Ground-glass Opacity）,Early stage,98,6,17,12*8mm ,Lobular resection,8 yrs alive,Lung cancer:solid nodules,Self test？,MR Indications,Never stop looking, carry on with your systematic approach!,