Imaging of the lung - u-szeged.hu of the lung Department of Radiology, Faculty of General Medicine,...

Department of Radiology, Faculty of General Medicine, University of Szeged, Hungary

Imaging of the lung


Methods of examination

X-ray (radiography, fluoroscopy, tomosynthesis)

mediastinal contours and position

lung structure

– vessels

– bronchi

– interstitium

– alveoli

pleura, chest wall

diaphragm


radiogram

fluoroscopy


Tomosynthesis



Ultrasound (point of care ultrasound, PoCUS)

chest wall

pleura (fluid and gas)

diaphragm

consolidations close to lung surface


PoCUS

normal ptx pleural effusion

http://westjem.com/wp-content/uploads/2013/04/wjem-14-103-g001.png



Computed tomography

mediastinal structures

lung structure (high resolution CT = HRCT)

– vessels

– bronchi

– interstitium

– alveoli

pleura, chest wall

diaphragm


HRCT



Magnetic resonance imaging

mediastinal structures

pleura, chest wall

diaphragm

solid lung lesions


MRI



PET/CT

lesions with high FDG uptake


PET-CT



Ventillation/perfusion scintigraphy

– comparison of

patency of ventillation

patency of circulation

– „mismatch” = pulmonary embolism


Ventilation-perfusion scintigraphy



Interventional procedures

sampling/drainage of fluid accumulations

sampling/ablation of solid lesions

visualisation/recanalisation/occlusion of vessels


Lung biopsy

http://www.vascularinterventions.net/procedures/non-vascular-procedures/ct-usg-guided-rfa-and-biopsy/attachment/cdr0000531057/


Anatomy


Anatomy


Basic radiographic changes of the lung

deformity

decreased transparency

(focal, diffuse) tumor, metastasis, consolidation,

atelectasia, edema, fibrosis, effusion,

callus, abscess

increased transparency

(focal, diffuse) emphysema, bulla, cyst, ptx, decreased

circulation

change of pattern

(vascular, interstitial)


– alveolar

– interstitial

– ground-glass opacity

– air-trapping

– tree-in-bud

HRCT patterns of transparency

changes


• congenital malformations

• physical injury (radiation, heat)

• chemical injury (toxic, irritative, allergic)

• inflammations (bacterial, tuberculotic, viral, fungal)

• degenerative

• autoimmune, granulomatous

• pulmonary embolism

• tumors (benign, primary malignant, metastatic)

Diseases of the lung:


Chest deformity – pectus excavatus


Chest deformity - scoliosis


Elevated diaphragm


Total opacification of the left hemithorax


Hydrothorax


Pneumothorax


Hydro-ptx


Irradiation pneumonitis


Interstitial pattern


Alveolar pattern


Ground-glass opacity


Pneumonia


Abscess


Tuberculosis


Miliary TBC


Focal decreased transparency


Lung cancer


Lung cancer


Lung cancer


Metastases


Pulmonary embolism

http://en.wikipedia.org/wiki/File:Pulmonary_embolism_scintigraphy_PLoS.png

http://en.wikipedia.org/wiki/File:Pulmonary_embolism_scintigraphy_PLoS.png


Pulmonary embolism – 24 hours later


COPD


Senile emphysema



Imaging of mediastinal diseases



– x-ray

– ultrasound

– computed tomography

– magnetic resonance imaging

– interventional procedures

– scintigraphy


• vascular dilatation / malposition

• thyroid enlargement

• thymus enlargement

• lymph node enlargement (inflammatory, benign

primary and secondary malignant)

• other space occupying lesions (neurogenic tumor,

cyst, dermoid, hiatus hernia)

• inflammation

• injury

Diseases of the mediastinum:




– thymus hyperplasia (large thymus without focal

changes, no progression (normal: > 20 ys: < 13 mm, > 30 ys:

concave conturs)), thymolipoma, thymoma

– thymus carcinoma, lymphoma

– thyroid gland (goiter, adenoma, carcinoma)

– germ cell tumors (teratoma (70 %), seminoma,

choriocarcinoma, embrional cell carcinoma)

– other (pleuro-prericardial fat, pericardial cyst and

tumor, diaphragmatic herniation)

Anterior mediastinal tumors





– esophagus (tumor, diverticulum, hiatus

hernia)

– bronchogenic cyst

– enterogenic cyst

Middle mediastinal masses



– neurogenic tumors (Shwannoma,

neurofibroma, ganglion tumors)

– lateral meningomyelocele

– extramedullary hematopoiesis

Posterior mediastinal tumors




– malignant lymphoma (Hodgkin, non-Hodgkin)

– metastasis

– inflammation (TBC, virus, hystoplasma, etc.)

– silicosis

– sarcoidosis

– Castleman disease

Lymph node enlargement




Vascular lesions

– variations (right aortis arch, vascular ring, etc.)

– aortic coarctation

– aortic dilatation high blood pressure, arteriosclerosis (ectasia)

aortic valve disease

aneurysma (fusiform, saccular, dissection) – sclerotic

– traumatic

– luetic aortitis

– Marfan sy.

– vein dilatation (VCS, v. azygos)




Mediastinal injuries

– pneumomediastinum asthma

barotrauma

ptx

tracheobronchial laceration

esophagus perforation, rupture

mediastinitis

intra-, retroperitoneal gas collection

– bleeding

– mediastinitis, abscess




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Imaging of the lung - u-szeged.hu of the lung Department of Radiology, Faculty of General Medicine,...

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