呼吸系統(tǒng)放射影像學(xué)課件

1、Radiology of Respiratory SystemAimsBasicsBest exam resultsAppreciate the role radiology plays? Instill an interest in radiologyBefore Class:TextbookReference bookLiteratureInternetAppsTeacher & classmateHistology and EmbryologyAnatomyPathologyInternal MedicineSurgeryGynecologyPediatricsNeurology。Eve

2、rything。U need to knowmethodsX-rayCTMRDSAUSNuclear Medicine PET/CT Radionuclide ventilation perfusion imagingX-ray TechniquesPA （posteroanterior) & LateralMore informationTwo viewsStandardizedDistancePt needs to be stablePortableQuickAnywhereOne shotNo standardizationTechniques - ProjectionP-A (rela

3、tion of x-ray beam to patient)Techniques - Projection (continued)A-P Supine/ErectTechniques - Projection (continued)Lateral DecubitusObliqueTechnical DetailsTypeOrientationRotation Inspiration/expirationPenetrationRotationPenetrationInspiration/ExpirationDensities The big two densities are: (1) WHIT

4、E - Bone (2) BLACK - AirThe 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-madeAnatomyAnatomyCross-sectional Anatomy of Lung Segments （CT）Lobes Right upper lobe:Lobes (continued) Right lower lobe:Lobes (continued) Lef

5、t lower lobe:Lobes (continued) Left upper lobe with Lingula:Lobes (continued) Lingula:Lobes (continued) Left upper lobe - upper division:HeartRight border: Edge of (r) Atrium3. Left border: (l) Ventricle + Atrium4. Posterior border: Reft Ventricle5. Anterior border: Right VentricleHeart (continued 。

6、)Heart ITS NOT MINE.HilumMade of:1. Pulmonary Art.+Veins2. The Bronchi Left Hilum higher (max 1-2,5 cm)Identical: size, shape, densityHilumRibsReview areas: Apices Behind the heart Costophrenic angle (CPA) Below the diaphragm Soft tissues ( breast, surgical emphysema) Ribs & clavicle Vertebrae Abnor

7、malsLung findingsDarker areasradiolucentPneumothoraxCysts/bullaAir bronchogramsLighter areasOpacitiesAtelectasis“infiltrates”BloodPusWaterNodules or massOpacitiesLobar or not.PneumoniaPulmonary Edema“fluffy,” diffuse, “bat wing” distributionHemorrhageCant tell by x-ray, need bronchRML pneumoniaOpaci

8、tiesRLL pneumoniaOpacitiesRUL pneumonia LLL pneumoniaConsolidation on CTThe Enlarged HilaCauses:1. Adenopathies (neoplasia, infection)2. Primary Tumor3. Vascular4. SarcoidosisMass Hilar Lymphadenopathy - BL Multiple MassesMetasPleural EffusionPulmonary FibrosisHeart failure， Kerley A/B line（Intersti

9、tial lung hyperplasia edema）Heart failurePneumothoraxEmphysemaCavitating lesionThin-walled Cavitating lesionThick-walled Cavitating lesion 3mmBronchiectasisMiliary shadowingCalcificationBenign Patterns of Calcification Within a Solitary Pulmonary NoduleChest Tube, NG Tube, Pulm. artery cathCT Indica

10、tionsKeyClinical FactorsGrowth PatternSizeMargin (Border) CharacteristicsDensityContrast-Enhanced CTOther findingsPulmonary Infectionairspace opacification air bronchogramsdense multifocal segmentalpneumonialung abscesscavitationLobar/segmental consolidationPneumonia findingTuberculosisinfiltratesMi

11、liary shadowingTuberculomaChronic fibro-cavitary TBCAUSES OF SOLITARY PULMONARY NODULES （SPN） Neoplastic: MalignantBronchogenic carcinomaSolitary metastasisLymphomaCarcinoid tumorNeoplastic: BenignHamartomaBenign connective tissue and neural tumors (e.g., lipoma, fibroma, neurofibroma)InflammatoryGr

12、anulomaLung abscessRheumatoid noduleInflammatory pseudotumor (plasma cell granuloma)CongenitalArteriovenous malformationLung cystBronchial atresia with mucoid impactionMiscellaneousPulmonary infarctIntrapulmonary lymph nodeMucoid impactionHematomaAmyloidosisNormal confluence of pulmonary veinsMimics

13、 of SPNNipple shadowCutaneous lesion (e.g., wart, mole)Rib fracture or other bone lesion loculated pleural effusionNeoplastic: BenignHamartomaNeoplastic: MalignantBronchogenic carcinomaNeoplastic: MalignantBronchogenic carcinomaInflammatoryGranulomachest radiograph shows a small, well-circumscribed,

14、 round opacity at the right lung base (arrows).Lateral view shows that the opacity 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

15、left upper lobe nodule in a 62-year-old woman with biopsy-proven lung cancer shows a lobulated contour with positive enhancement of 50 H after contrast administrationMalignant SPNBronchogenic Carcinoma（Clinical）Age at diagnosis: 55-60 years (range 40-80 years); M:F = 1.4:1asymptomatic (10-50%) usual

16、ly with peripheral tumorssymptoms of central tumors:cough (75%), wheezing, pneumoniahemoptysis (50%), dysphagia (2%)symptoms of peripheral tumors:pleuritic/local chest pain, dyspnea, coughPancoast syndrome, superior vena cava syndromehoarsenesssymptoms of metastatic disease (CNS, bone, liver, adrena

17、l gland)paraneoplastic syndromes:cachexia of malignancyclubbing + hypertrophic osteoarthropathynonbacterial thrombotic endocarditismigratory thrombophlebitisectopic hormone production: hypercalcemia, syndrome of inappropriate secretion of antidiuretic hormone, Cushing syndrome, gynecomastia, acromeg

18、alyRisk factorsCigarette smoking (squamous cell carcinoma + small cell carcinoma)鈥搑elated to number of cigarettes smoked, depth of inhalation, age at which smoking began85% of lung cancer deaths are attributable to cigarette smoking!Passive smoking may account for 25% of lung cancers in nonsmokers!R

19、adon gas: may be the 2nd leading cause for lung cancer with up to 20,000 deaths per yearIndustrial exposure: asbestos, uranium, arsenic, chlormethyl etherConcomitant disease:chronic pulmonary scar + pulmonary fibrosisScar carcinoma45% of all peripheral cancers originate in scars! Incidence: 7% of lu

20、ng tumors; 1% of autopsies Origin: related to infarcts (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 + nonsmokersIntermediate malignant potential (slow growth, high i

21、ncidence of early metastases)almost invariably develops in periphery; frequently found in scars (tuberculosis, infarction, scleroderma, bronchiectasis) + in close relation to preexisting bullaesolitary peripheral subpleural mass (52%)/alveolar infiltrate/multiple nodulesmay invade pleura + grow circ

22、umferentially around lung mimicking malignant mesotheliomaupper 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 pleuraAdenocarcinoma Presenting as Solitary Pulmonary

23、 Nodule. Cone-down view of posteroanterior 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 massSquamous c

24、ell carcinoma (30-35%)Strongly associated with cigarette smokingCentral location within main/lobar/segmental bronchus (2/3)large central mass & cavitationdistal atelectasis & bulging fissure (due to mass)postobstructive pneumoniaAll cases of pneumonia in adults should be followed to complete radiolo

25、gic resolution!airway obstruction 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 wallSquamous cell carcinoma is the most common cell type to cause Pancoast tumorCentral lung

26、cancerSquamous Cell Carcinoma. 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 bronchograms within the atelectatic lung (curved arrow)Squamous Cell CarcinomaSmall cell undifferentiated carcinoma (15%)Strongly associated with cigarette smokingRapid growth + high metastatic potential typically large hilar/perihilar mass often associated with mediastinal widen