Mitral disease

B Kerley lines

Pulmonary edema
Aortic insufficiency
 CLINICAL RADIOLOGY
Ischemic heart disease

Conventional angiography CT coronarography

 before Stent angioplasty after

during
before after 6 month after
baloon angioplasty
ortostatism decubitus

Pericardial effusion
Constrictive pericarditis
Aortic aneurysm
PTA of the common iliac artery
with expandable stent
Baloon angioplasty of the superficial femoral artery
- perforation appears as pneumoperitoneum = semilunar radiolucency located
under the right diaphragm cupola sign;
- adynamic or mechanical ileus appeara as a lot of hydroaeric images air-fluid
levels, above the level of the intestinal obstruction.
Foreign bodies
Foreign bodies
achalasia dischinesia
Diverticulum
Postcaustic stenosis
PEPTIC stenosis
INFILTRANT VEGETANT

CANCER ESOFAGIAN
 Esophageal varices

- commonly encountered in the

distal half of the esophagus are
consequent to portal hypertension

-Rg: linear tubular filling defects

represent distended veins from
shunting due to cirrhosis and
portal hypertension.
A B

Hiatus hernia:A) sliding hernia; B)paraesophageal type

HERNII HIATALE PRIN ALUNECARE (TIP III)
HERNII HIATALE:BRAHIESOFAG
 Gastric volvulus
-> twisting of the stomach either in an organoaxial
(longitudinal) or mesenteroaxial (transversal)
direction, due to failure of the fixation ligaments of
the stomach.
Gastroduodenal ulcers
Gastroduodenal ulcers
Early gastric cancer
Malignant tumors
Malignant tumors
 GASTRIC CARCINOMA

Note: Narrowed lumen

of gastric antrum by
infiltrating carcinoma-
typical adenocarcinoma
Linitis Plastica
GASTRITA GASTRITA MENETRIER
CROHN'S DISEASE

Narrowed
distal ileum
due to
chronic
inflammation
is typical for
Crohns
disease.
CROHN: mucosal granularity, ulceration, cobblestoning, luminal narrowing
 ABSCESS

Catheter has been placed

using CT guidance draining
abscess collection.

DRAINAGE
TUBERCULOZA ILEO-CECALA-DEBUT:
HIPERTROFIE PLACI PEYER;MICROULCERATII
Ileocecal tuberculosis: a conical
and shrunken cecum retracted out
of the iliac fossa by contraction of
the mesocolon. Narrowing of the
terminal ileum.
Double-contrast barium enema: marked
retraction of the ileocecal area, along
with an incompetent ileocecal valve.
CT: circumferential thickening of the cecum and terminal ileum with inflammatory
changes that extends through the peritoneum into the psoas muscle.
 DIVERTICULOSIS

Balloon in rectum to
Help control barium. Barium extends from lumen
outward into diverticulum.
RECTOCOLITA
ULCERO-HEMORAGICA
ST I:
HARTA GEOGRAFICA
RECTOCOLITA ULCERO-HEMORAGICA
ST II:ULCERATII & PSEUDOPOLIPI
RECTOCOLITA ULCERO-HEMORAGICA:
PSEUDOPOLIPI & ULCERATII
RECTOCOLITA
ULCERO-
HEMORAGICA:
ST III:FORMA
STENOTICA=>
MICROCOLON
 polyps

3d

1c
 COLON POLYP

Polyp on wall without

stalk is coated and
outlined by barium
COLON POLYP
Malignant diseases of the colon
Malignant diseases of the colon
Malignant
diseases of
the colon
 Malignant
diseases of
the colon

apple core
 Hemangioma

Flash filling hemangioma in unenhanced, Liver lesion showing nodular

arterial and portal venous phase. Notice it enhancement, progressive fill in and
matches the bloodpool. delayed enhancement.
Small HCC seen only in arterial Large HCC with mozaik pattern in a non
phase in a patient with cirrhosis. cirrhotic patient.

Diffusely enhancing tumor

thrombus in HCC with portal
vein invasion.
Enhancing adenoma with
fat in the center

Adenoma showing
capsule in delayed
phase
NECT: large lesion that is only slightly hypoattenuating relative to the surrounding liver tissue.
Within the lesion, a central scar can be seen. Arterial contrast-enhanced CT intense homogeneous
enhancement of the lesion, except for the central scar . Portal contrast-enhanced CT lesion has
become isoattenuating relative to the liver. The central scar has not yet fully enhanced.

typical FNH with a central scar that is hypodense in the portal venous phase and
hyperdens in the equilibrium phase.
The lesion is hypodens in the arterial and portal
venous phase with some peripheral enhancement.
It is hyperdense in the equilibrium phase indicating
dens fibrous tissue and it causes retraction of the Hepatic and delayed
liver capsule phase in multifocal
cholangiocarcinoma
causing retraction of liver
capsule.
Hypervascular
metastases: early
enhancement, but not
as bright as in
hemangioma. In
venous and delayed
phase the
enhancement is
almost isodense to the
liver.

Hypovascular
metastases: rim
enhancement that
occurs represents viable
tumor peripherally, which
appears against a less
viable or necrotic center
Liver abscess - large irregular fluid-
density lesion within the right lobe of the
liver with rim enhancement. There are
multiple smaller peripheral lesions with
similar characteristics. Some of these
appear coalescent.
Coronal intravenous
contrast-enhanced MR cholangiopancreatography
reformatted image from CT
data
MRI T2 weighted imaging & MRCP: filling defects on dilated biliary
tree.
 Biliary Stones

CT: mildly dilated CBD

with a lamellated stone in
a dependent location

MRCP: numerous calculi in the CBD

MRI for Hilar cholangiocarcinoma
(Klatskin tumor)
Distal duct cholangiocarcinoma.
CT for gall bladder carcinoma
 Caroli Disease

Caroli disease is a congenital nonobstructive

saccular dilatation of the intrahepatic bile
ducts, which usually is segmental.
 Choledochal cyst
A choledochal cyst is a congenital dilatation of the
extrahepatic bile duct.
CT%MRI: dilated cystic lesion which
communicates with the bile duct and is separate
from the gall bladder.
MRI: Choledocal cyst with incidental Intraductal Papillary Mucinous Tumor of the
Pancreas.
 Primary sclerosing
cholangitis: MRCP and
ERCP

PSC: multifocal areas of stenosis and dilatation giving the beaded appearance.
Normal pancreas
pancreatic oedema and fluid tracking within the anterior pararenal space. This is
subsequently complicated 3 weeks later by a large collection with areas of haemorrhage.

Acute pancreatitis with peri-

pancreatic fluid, oedema
and areas of necrosis.
 atrophic distal pancreas, with two
discreet cysts; thrombosis of the splenic
vein

Features typical of chronic pancreatitis with duct calculi on CT and MRI

Pleura effution
Bilateral pleura effution
Pneumo thorax
Pneumothorax
Bronchia pneumonia,
Bacterial pneumonia
lobar pneumonia
Hydatic cyst
 Mass vs. Infiltrate

The basic diagnostic instance is to detect an abnormality. In both of the cases above,
there is an abnormal opacity. It is most useful to state the diagnostic findings as
specifically as possible, then try to put these together and construct a useful differential
diagnosis using the clinical information to order it.
In each of the cases above, there is an abnormal opacity in the left upper lobe. In the
case on the left, the opacity would best be described as a mass because it is well-
defined. The case on the right has an opacity that is poorly defined. This is airspace
disease such as pneumonia.
 Mass Location
Intraparenchymal vs. pleural vs. extrapleural

This diagram shows three CT showing a mass that is likely CT showing bone
locations that a mass can pleural based (red arrow). destruction
exist in the thoracic Note the pleural effusion indicative of an
cavity. posteriorly. extrapleural mass.
A = intraparenchymal
B = pleural
C = extrapleural
Silhouette sign
 Air bronchogram
Air bronchogram sign: Bronchi, which are not normally seen, become visible
as a result of opacification of the lung parenchyma. Branching, tubular
lucencies of bronchi are seen in an opacified lung. This sign shows that the
pathology is in the lung parenchyma itself

Consolidation with air bronchograms (due to radiation pneumonitis)

at the upper lobe of the right lung.
 Atelectasis

CXR: left lower lobe atelectasis followed by partial resolution

Atelectasis
Atelectasis Right Lung:
- Homogenous density right
hemithorax
- Mediastinal shift to right
- Right hemithorax smaller
- Right heart and diaphragmatic
silhouette are not identifiable
Pneumococcal Pneumonia
Lobar Pneumonia
Middle lobe pneumonia
Superior lobe pneumonia
Aeric bronchogram sign

Acute bacterian pneumonia

RESORBTION
 Bronhopneumonia
- Multiple foci of alveolar lobular opacities
diseminated In both lung in imuno- compromised
patients (new-borns, AIDS).
 Klebsiella Pneumonia

Klebsiella: confluent alveolar opacities in right lung; isolated density in

the basal region of the left lung
STAPHYLOCOCCAL PNEUMONIA

Staphylococcal
pneumonia: Dense
area in the upper right
lobe with abscess
formation
Pneumatocele

Staphylococcal pneumonia:
Pneumatocoele
Lung Abscess
Lung Abscess
 LUNG ABSCESS

Pulmonary abscess -
Chest x-ray and CT:
left lower lobe
parenchymal
infiltrates associated
with cavitery lesion
with air-fluid level.
 Primary pulmonary tuberculosis

Chest x-ray: consolidation in the left upper lobe.

Two densely calcified granulomas are also present on the left, one near
the hilum and the second in the left lower lobe.
No convincing lymph node enlargement.
 Primary pulmonary tuberculosis

CXR & CT: diffuse micronodules demonstrated throughout both lung fields =
Miliary tuberculosis
 Primary pulmonary tuberculosis

Primary progressive pulmonary tuberculosis: consolidation and bilateral

pleural effusions
 Primary pulmonary
tuberculosis sequelae

CXR: bilateral calcified (healed)

granulomas with fibrotic apical
changes and lung volume
reduction (more pronounced on
the right side).
Post-primary
pulmonary tuberculosis

CXR: extensive patchy reticulonodular opacities

particularly on the left. Parenchymal cavity in the
left subclavicular region.
CT: confirms the cavity and extensive
endobronchial spread particularly within the left
upper lobe.
 Post-primary pulmonary tuberculosis

CXR: right-upper lung bullous disease CT: thick-walled, left-lower lung cavity
and a posible left-lower lung (LLL) cavity. with an air-fluid level; a smaller, more
medial cavity; and some lung
parenchymal opacities.
 Post-primary pulmonary tuberculosis

CXR: clumped nodular and linear
areas of increased opacity in
both upper lobes and in the right
middle lobe; Accompanying
volume loss in the right upper
lobe; apical pleural thickening
Axial CT: bilateral diffuse, coarse,
linear, and nodular areas of increased
attenuation with cavitation
Fibroproliferative disease
 Post-primary pulmonary tuberculosis

CXR & CT: cavity in the left upper lobe with a dependent area of soft-
tissue opacity => Cavitary tuberculosis associated with aspergilloma.
 Bronchiectasis

Different types of bronchiectasis.

1. normal bronchial tree;
2. cystic bronchiectasis
3. cylindrical bronchiectasis;
4. multiple successive dilatations
("varicose" bronchiectasis)
BRONCHIECTASIS

Bronchiectasis in
Cystic Fibrosis :
- Tubular shadows
- Tram line
- Multiple cavities
- Peribronchial fibrosis
- Prominent hilum
 Bronchiectasis

Cystic bronchiectasis
 Congenital bronchiectasis

Bibasilar bronchiectasis and dextrocardia =

Kartagener syndrome
Bronchiolitis

Frontal and lateral chest radiographs

show mild peribronchial cuffing
(arrows) which is typical for small
airways disease.
Diagnosis: Viral bronchiolitis
Bronchiolitis

Bacterial bronchiolitis: peribronchial

thickening. The high-resolution
computed tomography depicts
bronchiectasis, centrilobular
nodularity/"tree-in-bud" mosaic
attenuation in the same patient
 ASTHMA

CXR of an asthmatic during an episode of bronchospasm. Lungs are

hyperinflated due to air trappping.
This normalizes once bronchospasm is controlled.
 EMPHYSEMA

Emphysema: Hyperlucent lung fields, Multiple blebs, Avascular zones

Prominent pulmonary arteries, AP diameter increased, Flat diaphragms.
 EMPHYSEMA

The CTs demonstrate paraseptal and centrilobular emphysema;

the bullae present as areas of decreased attenuation involving the peripheral
alveolar ducts and sacs or surrounding the bronchiolovascular core of a
secondary pulmonary lobule..
 BRONCHOGENIC CARCINOMA

CXR: mass with irregular

borders in the right parahilar
area
CT: tisular lesion located in
the right apico-dorsal segment
of the RUL with mediastinal
adenopathy
 BRONCHOGENIC CARCINOMA

CXR: large opacity in the right upper zone consistent with collapse of the
RUL secondary to a hilar mass. Note the (compensatory) hyperlucency of
the hyperexpanded right lower and middle lobe, and elevation of the right
hemidiaphragm, either due to volume loss or less likely phrenic nerve
paralysis.
 BRONCHOGENIC CARCINOMA

CXR: soft tissue mass CT : large left apico-

arising in the superior
sulcus of the left lung.
(associated with some loss
of the normal fat planes in
the supraclavicular soft
tissues.
dorsal mass which
invades into the chest
wall and adjacent
supraclavicular soft
tissues.
BRONCHOGENIC CARCINOMA

Bronhogenic
adenocarcinoma with
liver metastases,
pleuresy and
pulmonary embolism
 Pulmonary metastases

CXR: Canon-ball pulmonary

metastases from a breast CT: Lung
primary. metastases from
testicular tumour
 Pulmonary metastases

CXR: Diffuse bipulmonal metastasation of a histologically proven

gastric carcinoma.
Sarcoidosis

Sarcoidosis st. I:
mediastinal and
bihilar adenopathy
Sarcoidosis

Sarcoidosis stage II
CXR: upper zone reticulonodular opacities
with extensive mediastinal and hilar nodal
enlargement.
CT: diffuse areas of nodularity
predominantly in a peribronchial
distribution with patchy areas of
consolidation particularly in the upper
lobes. Marked mediastinal and perihilar
adenopathy is present.
 Sarcoidosis

Sarcoidosis end stage

Extensive perilymphatic nodularity,
paraseptal emphysema, peripheral
honeycombing , multiple calcified
granulomata are present bilaterally;
Calcified left hilar nodes.
 Silicosis

CXR & CT: characteristic upper zone mass-like

scarring with calcification and volume loss.
Hilar and mediastinal lymph node calcification
is also demonstrated. Features are in keeping
with silicosis and progressive massive fibrosis.
 Pleural Effusion

PA and lateral film of a patient with bilateral pleural effusions.

Note the concave menisci blunting both posterior costophrenic angles.
 Pleural Effusion

Massive Left-Sided Pleural Effusion Lateral decubitus right pleural

effusion. (the arrow A shows
fluid layering in the pleural cavity;
the B arrow shows the normal
width of the lung in the cavity
Pleural Effusion
 Pleural Effusion

Loculated pleural effusions.

Occasionally, pleural effusions may become loculated in the fissures ->
lenticular opacities, with a long axis oriented along either the major or the
minor fissure.
 Pleural Effusion

Empyema. A computed tomography scan

Pleural effusions with shows a posterior left pleural fluid
secondary atelectasis on collection (arrow) containing air (dark) and
computed tomography scan. surrounded by thickened pleura. The
thickened pleura appears to be split by the
lenticular fluid collection.
 Pneumothorax

Pneumothorax.
A thin line caused by the visceral pleura is seen separated from the lateral chest
wall and no pulmonary vessels are seen beyond this line.
Pneumothorax
 Hydropneumothorax

Hydropneumothorax.
The air/fluid interface is easily seen as
a straight, horrizontal; line extended all
the way from the medial to the lateral
aspect of the hemithorax.
Large hydro-pneumothorax,
unilocular, some pleural thickening.
Associated collapse of right lung.
 TUMORS OF THE PLEURA

Pleural lipoma
CXR: homogeneous, low density, well defined left lateral mass located
extrapulmonary (obtuse angle)
CT scan: pleural based, smooth fat density lesion
 Pleural
mesothelioma

CT: circumferential nodular soft tissue

encasement of the left lung. There is
volume loss with elevation of the
hemidiaphragm and shift of the
mediastium. A number of enlarged
mediastinal nodes are noted.
 Anterior mediastinal mass

CXR: large mass located in the left hilar region.

The hilum can be seen through the mass. It is
not a hilar mass.

CT: demonstrate
the mass in the
anterior
mediastinum at the
aortopulmonary
window ->
thymoma.
Anterior mediastinal mass

biopsy proven T cell lymphoma

of the anterior mediastinum.
Middle mediastinal mass
CXR: lobulated paratracheal
stripe on the right, overlying the
ascending aorta and filling the
retrosternal space.
These findings indicate a mass in
the anterior aswell as in the
middle mediastinum.

CT: confirms the presence of

lymphadenopathy in both the
anterior and the middle
mediastinum.
(lymphoma)
 Middle mediastinal mass

CXR: large rounded opacity projecting from the mediastinum laterally on the
left. Note is also made of cardiomegaly and calcific atherosclerotic disease of
the arch of the aorta.
CT: large saccular aneurysm arising from the left side of the aortic arch.
 Posterior mediastinal mass

CXR: mass along the

superomedial part of the right
lung.
MRI: mass is extrapleural and
associated with the spinal
nerves (schwannoma)
Posterior mediastinal mass

CXR&MRI&CT: large mass in the right

side of the posterior mediastinum with
no rib destruction => ganglioneuroma
 Posterior mediastinal mass

CXR&MRI&CT: an oblong, left-sided posterior mediastinal paraspinal mass

that encircles the aorta -> Ganglioneuroblastoma
 Posterior mediastinal mass

CXR: a left hilar well-defined shadow.

CT: dissecting aortic aneurysm.
 ????

What are the potential causes of unilateral white-out of a

hemithorax?
 Answer
- pleural fluid e.g. hemothorax, chylothorax, pleural effusion.
- complete collapse of one lung (e.g. due to obstruction of a main
bronchus)
- dense consolidation of one lung
- an entire hemithorax full of cancer

In this case the entire hemithorax is filled

with cancer.
CT: shows the tumour mass.
Osteolysis
Geographic lesion:
bone cyst
Osteoporosis
Pagets
Disease
Acute osteomyelitis often is seen in children, localized in the metaphyses.
Conventional radiography initially may be negative, but after a few days or
1-2 weeks, irregular osteolytic regions are seen, together with a periosteal
reaction.
Chronic
osteomyelitis
Iatrogenic osteomyelitis
Avascular necrosis
of the femoral head
DEGENERATIVE HIP DISEASE
DEGENERATIVE
KNEE LESIONS
 T2 EG
Sagital

T2 fat sat
coronal

MRI: complex meniscus lesion

OSTEOCHONDROMA : similar in structure with the cancellous bone,
being covered by a cortex; continuity between the tumor and the cortex and the
cancellous part of the bone in which it develops; affects the long bones, near the
growth plate, especially knee joint.
CHONDROMAS: well-defined lytic lesions that enlarge the bone,
or only the cortex , located in the short bones of the hand.
 Bone cyst: well-defined,
Fibroma: radiolucent area, with an radiolucent area
osteosclerotic internal margin and a
thin, well-defined external contour.
Giant cell tumor: excentric radiolucent image that modify the bone
shape; inhomogeneous structure due to some thin linear opacities
(trabeculae)
Frontal sinus osteoma
Chondrosarcoma
Osteosarcoma : osteogenetic and myxoid
Parosteal osteosarcoma
Multiple myeloma
Metastasis (osteolitic and osteogenetic forms)
Ectopic kidneys Megaureter Pelvic and ureteric
duplication

Policystic kidneys Horseshoe kidney

Coral stone IVU: transparent stone
 Stone protocol CT shows tiny stone obstructing left
distal ureter (arrow). Notice soft tissue around the
stone indicating this stone is in fact in the ureter (soft
tissue rim sign) and not a calcified pelvic vein (i.e., a
phlebolith).

Delayed CT scan with soft tissue windows and bone

windows shows normal excretion of contrast from left
kidney (LK) but dilated collecting system in the right
kidney (arrows) with delayed excretion. Bone windows
reveal a stone obstructing the right kidney at the UPJ.

Gray scale ultrasound of right kidney shows dilated

renal pelvis (p) from obstructing ureteropelvis
junction stone (S).
Axial CT scan through the pelvis Bladder stones
are seen in bone windows before and after the Gray scale ultrasound of the bladder in a patient
excretion of contrast material into the bladder. with a stone in the distal left ureterovesicular
The stones are initially seen as high density foci junction. Arrow shows dilated left distal ureter
in the bladder but following contrast excretion
the stones are seen as filling defects in the
bladder contrast
Ureteral-Pelvic Junction Obstruction in a juvenile Hidronephrosis due to lithiasis
patient

169
Contrast enhanced CT scan -> ill defined linear
enhancement abnoramlity in the left mid pole arteriorly
(arrows) known as "striated nephrogram" which is a finding
seen in acute pyelonephritis.

Contrast enhanced CT scan -> shows left intrarenal fluid

collection with areas of poor or no enhancement consistent
with intrarenal abscess (arrows) with perinephric extension
(*).
 Renal TB: parenchymal
Renal TB: IVU->Erosion of the tips of the calyces calcification

Sclerosing
bladder,
ureteral
and
urethral
strictures

Renal TB: IVU->cavitary lesions in the right kidney

 Same patient. Contrast enhanced CT scan through right kidney upper pole (1) shows a simple cyst (C) which is <20HU. Ultrasound of
right upper pole cyst (2) showing classic features of a simple cyst. MRI with gadolinium (3) and on T2 weighted axial images show no
enhancement in this cyst and high signal fluid (C), respectively.

Contrast enhanced CT scan through the kidneys shows a
large fatty mass (similar attenuation to the surrounding
retroperitoneal fat (R) emanating from the anterior
aspect of the right mid kidney (arrows). Fatty mass
arising from the kidney is pathognomic of
angiomyolipoma (AML).
Contrast enhanced CT in a patient with ADPKD shows
bilateral slightly enlarged kidneys which are nearly totally
replaced by small renal cystic lesions, many of which contain
calcifications in the cyst walls (arrows).
Gray scale ultrasound and enhanced CT scan show a large right renal mass. The mass (M) is distorting the renal contour
and is hyperechoic. On CT, the mass has varying attenuation: low areas consistent with necrosis (n) and enhancing areas
consistent with viable tumor (t). Note that the enhancing tumor is less enhancing than normal functional renal
parenchyma (p).
Intravenous pyelogram CT scan demonstrating right renal pelvis TCC.
(IVP) demonstrating an Contrast in the renal pelvis is displaced by the
upper calyx filling defect tumor.
characteristic of TCC.

Urothelial
tumor in the
pelvic segment
of the left
ureter

CT scan demonstrating left distal ureteral transitional cell

carcinoma (TCC). The left ureter is dilated and a medial
filling defect is noted
 Non contrast CT scan of the pelvis shows focal
infiltrative thickening of the posterolateral bladder
wall (arrows).

Delayed contrast enhanced CT scan of the pelvis

Bladder carcinoma: conventional IVU shows shows a focal polypoid mass at the left UVJ (M). The
masslike filling defect being outlined by excretion polypoid mass is seen as a filling defect outlined by
contrast in the bladder (arrows). the excreted urine in bladder.
Contrast enhanced CT scan and delayed images through the kidneys following trauma shows an approximately 2 cm long
laceration of the left medial reanl cortex (arrows) consistent with a grade III (AAST) renal laceration that does not involve
the collecting system (no extravastion of urine from opacified collecting system on delayed images).

Expanding subcapsular
hematoma compressing the
kidney, grade IV (AAST) renal
trauma