THE THORAX
THE CHEST
METHODS OF EXAMINATION
Radiography
Standard examination :
- PA + lateral projection;
- full inspiration.
Fluoroscopy
dynamic study of the cardiovascular system,
diafragmatic motion.
Disadvantage: high radiation dose.
Bronchography
the study of the bronchial tree by means of the
introduction of opaque material into the bronchi.
Replaced by CT, fiberoptic bronchoscopy, brush biopsy
THE CHEST
METHODS OF EXAMINATION
Fluoroscopy
1933 2000
THE CHEST
METHODS OF EXAMINATION
Computed tomography indications for the lung:
- Evaluation and staging of primary pulmonary neoplasms
- Detection of metastasis from non-pulmonary primary
tumors.
- Characterization of solitary pulmonary nodules as benign or
malignant
- High-resolution CT evaluation of interstitial lung
disease, bronchiectasis, emphysema, cystic lung disease.
THE CHEST
METHODS OF EXAMINATION
Computed tomography
Indications for the mediastinum:
- Causes of mediastinal widening
- Characterization of mediastinal masses cysts, solid,
vascular, fat.
- Staging of tumors that spread to the mediastinum
Other indications:
Pleura plaques, masses, loculated fluid, calcification, chest
wall masses.
THE CHEST
METHODS OF EXAMINATION-
Computed tomography
1975 1995
THE CHEST
METHODS OF EXAMINATION
Ultrasonography
fluid can be localized and differentiated
from solid pleural masses;
- lesions in contact with the chest wall
- lesions near the diafragm.
THE CHEST
METHODS OF EXAMINATION
Magnetic resonance imaging indications:
- congenital and acquired heart conditions
- intracardiac and paracardiac masses.
- pericardial diseases.
- extention of the posterior mediastinal masses, especially
those with intraspinal extension
- brachial plexopathy.
- dissection of the aorta, aneurysm
- diafragm and peridiafragmatic processes.
- chest-wall lesions.
- breast implants and breast masses.
MRI
MAGNET
Coils
THE CHEST
METHODS OF EXAMINATION
Pulmonary and bronchial angiography:
- thromboembolic disease,
- arterial or venous anomalies.
Scintigraphy
Gr.I
MILIARY tuberculosis
Nodular opacities
Nodular opacities
FELSON sign
EMPHYSEMA PNEUMOTHORAX
CIRCUMSCRIBED LUCENCIES
1
3
1
Chist hidatic
2
3
2 3 4
1.Emphysema - bulla
2. Aeric cyst
3. Cavity- TB
4. Cavity - cancer
HYDRO - AERIC IMAGE
RUPTURED
ABSCESS HYDATID CYST
CHEST INFECTIONS
Acute pulmonary infections
- Caused by S.pneumoniae.
- roentgen findings can be observed within 6 to 12 hours after
onset of symptoms.
Chest x-ray:
- triangular opacity, the tip towards the hilum, the base
towards the periphery of the lung.
- all the elements in the diseased lobe may be affected
except the large bronchi air bronchogram.
- Resolution is rapid if there are no complications the
opacity becomes more irregular and patchy, the intensity
decreases.
Chest x-ray:
-nodular opacities, 1-10mm
-poorly defined
-with the center more opaque compared to the periphery.
Chest x-ray:
- Consolidation rapidly spreads to involve a whole lobe
bronchi are obscured by exudatethe air brohogram is rarely
seen.
- Abscess formation; coalescense of small abscesses.
- Pleural effusion, empyema, pneumothorax.
- The disease is usually bilateral
Interstitial pneumonia
Chest x-ray:
- Bronchopneumonic type.
BRONHOPNEUMONIA
SEGMENTAL PNEUMONIA
Lung abscess
- lung abscess = an acute pulmonary infectious process breaks
down to form a cavity.
- Primary / secondary.
Chest x-ray
- round opacity, irregular, poorly defined borders.
- when bronchial communication is established the fluid
content of the cavity is replaced by air hydro-aeric
image with orizontal fluid level.
CT useful to define the inner and outer walls, for
complications (rupture into the pleural space).
Differential diagnosis:
- early stage pneumonia;
- cavity tbc, cancer, hydatid cyst, fungal infection.
Oval hydroaeric image
horizontal air fluid level
Thick, well defined wall = old
abscess = fibrosis
pleural effusion
- Mycobacterium tuberculosis
Evolution:
- Healing
- Fibrosis
- Calcification
Complications:
- Cavitation
- Miliary TB
- TB pneumonia
- TB bronchopneumonia
- Pleural effusion
Secondary TB
Cavitation 40%
Fibro-caseous TB
Fibrothorax, tuberculoma
Secondary TB
Complications:
1. Miliary TB
2. Bronchogenic spread
3. Pneumonia
4. Bronchial stenosis
5. Bronchiectasis
6. Pneumothorax
Clinical:
- Lymphadenopathy
- Incidental infections
- Tumors: lymphoma, Kaposi sarcoma
- Other manifestations: interstitial pneumonia,
spontaneous pneumothorax, septic emboli
AIDS
Spectrum of chest manifestations: