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1、Radiology of Respiratory System,Aims,BasicsBest exam resultsAppreciate the role radiology plays?Instill an interest in radiology,Before Class:,TextbookReference bookLiteratureInternetAppsTeacher&classmate,Histology and EmbryologyAnatomyPathologyInternal MedicineSurgeryGynecologyPediatricsNeurology。E
2、verything。U need to know,methods,X-rayCTMRDSAUSNuclear Medicine PET/CT Radionuclide ventilation perfusion imaging,X-ray Techniques,PA（posteroanterior)&LateralMore informationTwo viewsStandardizedDistancePt needs to be stable,PortableQuickAnywhereOne shotNo standardization,PA,Portable,Techniques-Proj
3、ection,P-A(relation of x-ray beam to patient),Techniques-Projection(continued),A-P Supine/Erect,Techniques-Projection(continued),Lateral,Techniques-Projection(continued),Lateral Decubitus,Oblique,Technical Details,TypeOrientationRotation Inspiration/expirationPenetration,Rotation,Rotation(continued)
4、,Penetration,Inspiration/Expiration,Things to see,ABCDEAirwaysTrachea,endotracheal tube,etcBonesClavicles,ribs,etcCardiacDiaphragm(Right hemidiaphragm slightly higher(1.5 cm)Everything else(tubes),effusions,Densities,The big two densities are:(1)WHITE-Bone(2)BLACK-AirThe others are:(3)DARK GREY-Fat(
5、4)GREY-Soft tissue/water And if anything Man-made is on the film,it is:(5)BRIGHT WHITE-Man-made,Anatomy,Anatomy,Bronchopulmonary Anatomy,Cross-sectional Anatomy of Lung Segments（CT）,Lobes,Right upper lobe:,Lobes(continued),Right middle lobe:,Lobes(continued),Right lower lobe:,Lobes(continued),Left l
6、ower lobe:,Lobes(continued),Left upper lobe with Lingula:,Lobes(continued),Lingula:,Lobes(continued),Left upper lobe-upper division:,Heart,Right border:Edge of(r)Atrium3.Left border:(l)Ventricle+Atrium4.Posterior border:Reft Ventricle5.Anterior border:Right Ventricle,Heart(continued。),Heart,ITS NOT
7、MINE.,Hilum,Made of:1.Pulmonary Art.+Veins2.The Bronchi Left Hilum higher(max 1-2,5 cm)Identical:size,shape,density,Hilum,Ribs,Review areas:,Apices Behind the heart Costophrenic angle(CPA)Below the diaphragm Soft tissues(breast,surgical emphysema)Ribs&clavicle Vertebrae,Abnormals,Lung findings,Darke
8、r areasradiolucentPneumothoraxCysts/bullaAir bronchograms,Lighter areasOpacitiesAtelectasis“infiltrates”BloodPusWaterNodules or mass,Opacities,Lobar or not.PneumoniaPulmonary Edema“fluffy,”diffuse,“bat wing”distributionHemorrhageCant tell by x-ray,need bronch,RML pneumonia,Opacities,RLL pneumonia,Op
9、acities,RUL pneumonia,LLL pneumonia,Consolidation on CT,The Enlarged Hila,Causes:1.Adenopathies(neoplasia,infection)2.Primary Tumor3.Vascular4.Sarcoidosis,Mass,Hilar Lymphadenopathy-BL,Multiple Masses,Metas,Pleural Effusion,Pulmonary Fibrosis,Heart failure，Kerley A/B line（Interstitial lung hyperplas
10、ia edema）,Heart failure,Pneumothorax,Emphysema,Cavitating lesion,Thin-walled Cavitating lesion,Thick-walled Cavitating lesion,3mm,Bronchiectasis,Miliary shadowing,Calcification,Benign Patterns of Calcification Within a Solitary Pulmonary Nodule,Chest Tube,NG Tube,Pulm.artery cath,CT Indications,Key,
11、Clinical FactorsGrowth PatternSizeMargin(Border)CharacteristicsDensityContrast-Enhanced CTOther findings,Pulmonary Infection,airspace opacification,air bronchograms,dense multifocal segmental,pneumonia,lung abscess,cavitation,Lobar/segmental consolidation,Pneumonia finding,Tuberculosis,infiltrates,M
12、iliary shadowing,Tuberculoma,Chronic fibro-cavitary TB,CAUSES OF SOLITARY PULMONARY NODULES（SPN）,Neoplastic:MalignantBronchogenic carcinomaSolitary metastasisLymphomaCarcinoid tumorNeoplastic:BenignHamartomaBenign connective tissue and neural tumors(e.g.,lipoma,fibroma,neurofibroma)InflammatoryGranu
13、lomaLung abscessRheumatoid noduleInflammatory pseudotumor(plasma cell granuloma)CongenitalArteriovenous malformationLung cystBronchial atresia with mucoid impactionMiscellaneousPulmonary infarctIntrapulmonary lymph nodeMucoid impactionHematomaAmyloidosisNormal confluence of pulmonary veinsMimics of
14、SPNNipple shadowCutaneous lesion(e.g.,wart,mole)Rib fracture or other bone lesion loculated pleural effusion,Neoplastic:Benign,Hamartoma,Neoplastic:Malignant,Bronchogenic carcinoma,Neoplastic:Malignant,Bronchogenic carcinoma,Inflammatory,Granuloma,chest radiograph shows a small,well-circumscribed,ro
15、und opacity at the right lung base(arrows).,Lateral view shows that the opacity is within the lung on two views(posterior segment of the right lower lobe)and thus represents a pulmonary nodule(arrow).,Contrast CT in Malignant Solitary Pulmonary Nodule.Thin-collimation(3-mm)CT scans through left uppe
16、r lobe nodule in a 62-year-old woman with biopsy-proven lung cancer shows a lobulated contour with positive enhancement of 50 H after contrast administration,Malignant SPN,Bronchogenic Carcinoma（Clinical）,Age at diagnosis:55-60 years(range 40-80 years);M:F=1.4:1asymptomatic(10-50%)usually with perip
17、heral tumorssymptoms of central tumors:cough(75%),wheezing,pneumoniahemoptysis(50%),dysphagia(2%)symptoms of peripheral tumors:pleuritic/local chest pain,dyspnea,coughPancoast syndrome,superior vena cava syndromehoarsenesssymptoms of metastatic disease(CNS,bone,liver,adrenal gland)paraneoplastic syn
18、dromes:cachexia of malignancyclubbing+hypertrophic osteoarthropathynonbacterial thrombotic endocarditismigratory thrombophlebitisectopic hormone production:hypercalcemia,syndrome of inappropriate secretion of antidiuretic hormone,Cushing syndrome,gynecomastia,acromegaly,Risk factors,Cigarette smokin
19、g(squamous cell carcinoma+small cell carcinoma)鈥搑elated to number of cigarettes smoked,depth of inhalation,age at which smoking began85%of lung cancer deaths are attributable to cigarette smoking!Passive smoking may account for 25%of lung cancers in nonsmokers!Radon gas:may be the 2nd leading cause
20、for lung cancer with up to 20,000 deaths per yearIndustrial exposure:asbestos,uranium,arsenic,chlormethyl etherConcomitant disease:chronic pulmonary scar+pulmonary fibrosisScar carcinoma45%of all peripheral cancers originate in scars!Incidence:7%of lung tumors;1%of autopsies Origin:related to infarc
21、ts(50%),tuberculosis scar(25%)Histo:adenocarcinoma(72%),squamous cell carcinoma(18%)Location:upper lobes(75%),Types:,Adenocarcinoma(50%)Most common cell type seen in women+nonsmokersIntermediate malignant potential(slow growth,high incidence of early metastases)almost invariably develops in peripher
22、y;frequently found in scars(tuberculosis,infarction,scleroderma,bronchiectasis)+in close relation to preexisting bullaesolitary peripheral subpleural mass(52%)/alveolar infiltrate/multiple nodulesmay invade pleura+grow circumferentially around lung mimicking malignant mesotheliomaupper lobe distribu
23、tion(69%)air broncho-/bronchiologram on HRCT(65%)calcification in periphery of mass(1%)smooth margin/spiculated margin due to desmoplastic reaction with retraction of pleura,Adenocarcinoma Presenting as Solitary Pulmonary Nodule.Cone-down view of posteroanterior radiograph shows nodule in the right
24、mid-lung(arrow).Thin-section CT shows 12-mm nodule with spiculated margins(arrow)in the superior segment of the right lower lobe.Transthoracic needle biopsy revealed adenocarcinoma.,solitary peripheral mass,Squamous cell carcinoma(30-35%)Strongly associated with cigarette smokingCentral location wit
25、hin main/lobar/segmental bronchus(2/3)large central mass&cavitationdistal atelectasis&bulging fissure(due to mass)postobstructive pneumoniaAll cases of pneumonia in adults should be followed to complete radiologic resolution!airway obstruction with atelectasis(37%)Solitary peripheral nodule(1/3)char
26、acteristic cavitation(in 7-10%)Squamous cell carcinoma is the most common cell type to cavitate!invasion of chest wallSquamous cell carcinoma is the most common cell type to cause Pancoast tumor,Central lung cancer,Squamous Cell Carcinoma.Posteroanterior chest film in a 58-year-old male smoker with
27、hemoptysis shows a left hilar mass with left upper lobe atelectasis.Enhanced CT scan shows the left hilar mass occluding the left upper lobe bronchus with an endobronchial component(straight arrow).Note the presence of mucus bronchograms within the atelectatic lung(curved arrow),Squamous Cell Carcin
28、oma,Small cell undifferentiated carcinoma(15%)Strongly associated with cigarette smokingRapid growth+high metastatic potential typically large hilar/perihilar mass often associated with mediastinal widening(from adenopathy)extensive necrosis+hemorrhagesmall lung lesion(rare),Large undifferentiated c
29、ell carcinoma(6 cm(50%)large area of necrosispleural involvementlarge bronchus involved in central lesion(50%),Large-cell bronchogenic carcinoma,small-cell bronchogenic carcinoma,Ground-glass Opacity,the pattern was shown to be caused by predominantly interstitial diseases in 54%of cases,equal invol
30、vement of the interstitium and airspaces in 32%,and predominantly airspace disease in 14%GGO is an important finding.In certain clinical circumstances,it can suggest a specific diagnosis,indicate a potentially treatable disease,and guide a bronchoscopist or surgeon to an appropriate area for biopsy,Pure GGO（Ground-glass Opacity）,Early stage,98,6,17,12*8mm,Lobular resection,8 yrs alive,Lung cancer:solid nodules,Self test？,MR Indications,Never stop looking,carry on with your systematic approach!,
