Download Thoracic radiology

Thoracic radiology
Dr.Khaleel Ibraheem
MBChB,DMRD,CABMS-rad
Approach to chest x ray
Chest consolidation
Diffuse lung lesions
Differentiating the Causes of an Opacified Hemithorax
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Atelectasis of an entire lung
A large pleural effusion
Pneumonia of an entire lung
And a fourth cause: Post-pneumonectomy –
removal of an entire lung
Atelectasis of the Lung
• There is a shift of heart and hemidiaphragm
toward side of opacification (toward side of
volume loss)
Pleural Effusion
• It acts like a mass
• Pushing the heart and trachea away from
the side of opacification
pneumonia
• The hemithorax is opaque and there isno shift
of the heart or trachea
• There may be an air bronchogram sign present
postpnemonectomy
• The hemithorax eventually fibroses and
becomes opaque
• Clues: There is frequently a resected fifth
rib and/or surgical clips
quiz
Pleural effusion
• Subpulmonary
On the frontal film, the highest point of
the apparent right hemi diaphragm
is displaced laterally (it is usually in
the center).
Blunting of CP angle
Normally there are 2-10cc of fluid in the
pleural space
When >75cc accumulate, the posterior
costophrenic (CP) sulci, seen on the
lateral film, become blunted
When 200-300cc accumulate, the CP
sulci on the frontal film become blunted
Meniscus sign
• Pleural fluid tends to rise higher along its
edge producing a meniscus shape medially and laterally
• Usually only lateral meniscus can be seen
• The meniscus is a good indicator of the presence of a pleural effusion
Loculated effusion
• Occurs secondary to adhesions which
form between visceral and parietal pleura
• Adhesions more common with blood(hemothorax) and pus (empyema)
• Loculated effusions have unusual shapes or positions in thorax
hydropneumothorax
• If both a pneumothorax and a pleural effusion occur together, it is called a
hydropneumothorax
• A hydropneumothorax is usually due to
trauma, surgery, bronchopleural fistula
• It is characterized by an air-fluid level in the hemithorax
A straight edge,indicative of a fluid
interface, in this case an air-fluid
interface, is seen on the right.
pneumothorax
• When air enters the pleural space, the
parietal and visceral pleura separate
making the visceral pleura visible
• The thin white line of the visceral pleura
is called the visceral pleural white line
• You must see the visceral pleural white
line to make diagnosis of pneumothorax!
Simple pneumothorax
In a simple pneumothorax, there is no
shift of the heart or mediastinal
structures (trachea)
Air in left hemithorax balances the air in
the right hemithorax
Tension pneumothorax
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Progressive loss of air into pleural space
causing a shift of the heart and mediastinal
structures away from side of pneumothorax
Opposite lung is compressed
Respiratory function severely compromised