L9 Pulmonary Imaging

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Author:
jknell
ID:
199180
Filename:
L9 Pulmonary Imaging
Updated:
2013-02-09 15:05:50
Tags:
Pulmonary II
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Description:
Pulmonary II
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  1. Basic Radiographic Film Densities
    • Air: Black
    • Fat: Near Black
    • Soft Tissue: Shades of Gray
    • Bone: White
    • Metal: White
    • Calcium: White

    Air --> Fat --> Soft Tissue --> bone
  2. Radiographic Densities
    -density determines how much of the xray beam is absorbed or attenuated

    -as the density of an object increases, fewer xrays pass through it
  3. Chest Radiographs
    -heart positioned against the screen (to avoid magnifying the heart)

    • -Anterior-Posterior
    • -Lateral

  4. Summation of Shadows
    -radiograph is a summation of a complex 3D object in a single plane
  5. Approach
    • 1. Tubes/lines
    • 2. Lung
    • 3. Mediastinum
    • 4. Abdomen
    • 5. Soft Tissue
    • 6. Bones

    A,B,Cs
  6. Pulmonary Opacities
    Non-specific, can be many things

    • -Water
    • -Blood
    • -Cells
    • -Pus
    • -Inflammation (rarely)
  7. Recognizing causes of opacified hemithorax
    • DDx:
    • 1. Atelectasis of entire lung (Shifting towards)
    • 2. Large Pleural Effusion (Shifting away)
    • 3. Pneumonia of entire lung (No Shift)
    • 4. Post-pneumonectomy (Shfiting towards)

    • Shifting includes mobile structures:
    • -trachea
    • -heart
    • -hemidiaphragm
  8. Silhouette Sign
    • -when two abutting objects are of similar density it is difficult to identify their boundaries
    • -an interface between isodense materials in contact is non-resolvable radiographically
  9. Review of Lung Anatomy
  10. EG: How to determine which Lobe is affected
    • Left Lower Lobe
    • -can see R hemidiaphragm
    • -heart border is clear

  11. Pulmonary Edema Signs and Sx
    • -dyspnea on exertion
    • -orthopnea
    • -paroxysmal nocturnal respiratory distress
    • -weight gain
    • -lower extremity edema
    • -cough
    • -hemoptysis
  12. Pulmonary Edema Etiologies
    • 1. Cardiogenic
    • 2. Neurogenic
    • 3. Increased Permeability
    •      -Toxin inhalation
    •      -High altitude sickness
    •      -Aspiration
    •      -Contusion
    •      -Fat embolism
    •      -Amniotic Fluid embolism
  13. Pulmonary Edema Imaging Findings
    • -patchy inflitrates
    • -Kerley B lines
    • -Interlobar fissure thickening
    • -pleural fluid
    • -redistribution (increased size of vessels to upper lobes)
    • -Parahilar zone bronchial cuffing
    • -Parahilar vessels less distinct
    • Pulmonary Edema
    • -blunting of costophrenic angle
    • -haziness throughout
    • -enlarged heart
  14. Kerley B lines

    Pulmonary Edema
  15. Pulmonary edema

    • Decreased lung volume
    • -should see 9-10 ribs with deep inspiration
    • NOT pulmonary edema
    • -aspiration of water from near drowning
    • -distinguish based on history
  16. Pneumothorax Etiologies
    • 1. Traumatic
    • 2. Iatrogenic
    •      -thoracoscopy
    •      -thoracentesis
    •      -placement of central venous lines
    •      -artificial ventilation
    •      -post thoracic surgery
    •      -transthoracic and bronchial bx
    • 3. Spontaneous
    •      -rupture of bleb/bullae
    •      -secondary to pulm disease
    •      -secondary to pneumomediastinum
  17. Pneumothorax Imaging Findings
    • -visceral pleura is visible when air gets in
    • -thin white line
    • -absence of lung markings NOT sufficient for dx

  18. NOT pneumothorax

    the line is due to air trapped within a skin fold
  19. Tension Pneumothorax
    -air gets trapped in pleural space and leads to displaced mediastinal structures

  20. Hydropneumothorax
    • -horizontal line
  21. Pneumothorax

    Deep sulcus Sign: in patients that lay supine the air accumulates posteriorly and anteriorly
    • Bilateral pneumothorax
    • -air has moved into the subcutaneous tissue leading to subcutaneous lucency
  22. Pneumothorax is accentuated with expiration
    • Inspiration:

    • Expiration:

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