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3B2010 Subject: Radiology Topic: Chest Radiology

Date: June 13, 2008 Lecturer: Dra. Irene Bandong Trans Group: Riz, Alphe, AM

CHEST RADIOLOGY
 The cornerstone of radiologic diagnosis Special Radiographic Techniques:
is the CHEST RADIOGRAPH. 1. Inspiratory-Expiratory radiography
 The most satisfactory basic or routine -main indication is the investigation of
radiographic views evaluation of the air trapping either general or local
chest are:  General air trapping- exemplified
o Posterioranterior and by asthma or emphysema
o Left lateral projections  Local air trapping- there is
 The optimal chest radiograph is bronchial obstruction, or lobar
obtained emphysema
nd
o In the posterior-anterior (AP) view -2 indication= when pneumothorax is
o At a target-to-film distance of 72 suspected and the visceral pleural
pleural line is not visible
inches
2. Valsalva and Muller maneuvers
o With the patient in the upright
-may aid in determining the vascular or
position
solid nature of intrathoracic mass
o At maximum inspiration
3. Bedside radiography
 ADEQUATE PENETRATION BY -in patients who are too ill to stand,
RADIATION anteroposterior (AP) upright or supine
o Thoracic spine should be barely projections offer an alternative
seen thru the heart
o Bronchovascular structures can COMPUTED TOMOGRAPHY
usually be seen thru the heart Most common indication for the use of
o Spine appears to be darker CT scan
caudally. This is due to more air 1. Evaluation of suspected mediastinal
in lung in the lower lobes and abnormalities identified on standard
less chest wall chest radiograph
o Sternum should be seen edge on 2. Search for occult thymic lesions
o Posteriorly there should be two 3. Determination of the presence and
sets of ribs extent of neoplastic
Non-standard chest radiography 4. Search for diffuse or central calcification
 Lordotic Projection in a pulmonary nodule
It is advocated in 3 situations:
1. For improving visibility of the lung Miscellaneous indications:
apices, superior mediastinum and 1. Assisting in the percutaneous biopsy of
thoracic outlet a lesion such as mediastinal, pleural or
2. For locating a lesion by parallax pulmonary masses
3. For identifying the minor fissure in 2. Localization of loculated collections of
these suspected cases of atelectasis of fluid within the pleural space
the right middle lobe 3. Assessment of the size and
 Lateral Decubitus configuration of the thoracic aorta
-particularly helpful for the
identification of small pleural effusions Main indication for the use of HRCT
-useful to demonstrate a change in 1. Diagnosis of bronchiectasis
position of an air fluid level in a cavity 2. Detection of parenchymal lung disease
-to ascertain whether a structure that
forms part of a cavity represents a ATELECTASIS
freely mowing intracavitary loose body -state of incomplete expansion of lung or any
(fungus ball) portion of it
 Oblique Projection -loss of lung volume
-useful in locating a disease process
(pleural plaque) Causes of Collapse
 Intrinsic mass
-primary or metastatic neoplasms or
eroding lymph nodes
 Intrinsic stenosis
-TB, inflammatory processes, fracture of
a bronchus
 Extrinsic pressure
-enlarged LN, mediastinal tumor, aortic
aneurysm, cardiac enlargement
 Bronchial plugging
-FB or mucus accumulation

Types
1. Resorption/ obstructive atelectasis
-occurs when communication between
the trachea and alveoli is obstructed
-may be intrinsic, caused by a tumor,
foreign body, inflammatory disease,
heavy secretions
-extrinsic pressure on bronchi caused
by tumor or enlarged nodes or bronchial
constriction secondary to inflammatory
disease

2. Passive atelectasis
-intrapleural abnormalities
-caused by space occupying process
that can compress the lung
-pneumothorax, pleural fluid,
diaphragmatic elevation, herniation of
the abnormalities viscera into the
thorax, large intrathoracic tumors

3. Compressive atelectasis
-intrapulmonary abnormalities
-is a secondary effect of compression of
normal lung by a primary, space-
occupying abnormality
-bullous emphysema, lobar emphysema

4. Adhesive atelectasis
-occurs when the luminal surfaces of
the alveolar walls stick together
-hyaline membrane disease, pulmonary
embolism, acute radiation pneumonitis,
uremia

5. Cicatrization atelectasis
-is primarily the result of fibrosis and
scar tissue formation in the
interalveolar space
-classic cause: TB