RADIOLOGY OF THE

RESPIRATORY SYSTEM
ADNAN M
DEPART OF RADIOLOGY
MED FAC UNHAS

THE LOWER RESPIRATORY

SYSTEM (= CHEST)

RADIOLOGY OF THE :
LUNG PARENCHYME
PLEURA
DIAPHRAGM
MEDIASTINUM (TUMORS)

ANATOMY-1
LUNGS : LOBES & SEGMENS

ANATOMY-2

ANATOMY-3

ACINUS-PATCHIES

NORMAL

INFLAMMATION

RADIOLOGICAL METHODS OF
INVESTIGATION

PLAIN FILM/ CHEST X-RAYS

CT SCAN
MRI
ULTRASONOGRAPHY (USG)
NUCLEAR MEDICINE

RADIOLOGICAL METHODS OF
INVESTIGATION

ARTERIOGRAPHY
MCS(=MASS CHEST SURVEY)
TOMOGRAPHY
FLUOROSCOPHY
BRONCHOGRAPHY

CHEST X-RAYS: VIEWS

POSTEROANTERIOR (PA)ROUTINE
LEFT LATERAL (LL/RL)
RIGHT/LEFT ANTERIOR OBLIQUES
(RAO/LAO)
RIGHT/LEFT LATERAL DECUBITUS
(RLD/LLD)
TOP LORDOTIK

POSTERO-ANTERIOR (PA)
VIEW

LEFT LATERAL VIEW

RIGHT LATERAL VIEW

CHEST : LAO VIEW

CHEST: RAO VIEW

RIGHT/LEFT LATERAL
DECUBITUS
RLD

LLD

L
L

DBD/DHF
D

TOP LORDOTIC VIEW

COMPUTED TOMOGRAPHYC
(CT) SCAN

MRI=MAGNETIC
RESONANCE IMAGING

NUCLEAR MEDICINE

TOMOGRAPHY

BASIC DEVOLOVEMENT OF CT

MASS CHEST SURVEY (MCS)

FLUOROSCOPHY

BRONCHOGRAPHY

NORMAL CHEST
PARENCHYME : RADIOLUCENT
P

PPLEURA : INVISIBLE
P
L
H
HE
HILAR
: LEFT < RIGHT
I
U
L
R
A
R

DIAPHRAGM : RIGHT > LEFT

SINUS PHRENICO COSTALIS <

NORMAL CHEST

RADIOLUCENT

D=DIAPH

PA=HILAR

DISEASES OF THE LUNG

PARENCHYME (1)

INFLAMMATORY
LUNG ABSCESS
ATELECTASIS
LUNG EDEMA

DISEASES OF THE LUNG

PARENCHYME (2)

EMPHYSEMA
CHRONIC BRONCHITIS
BRONCHIECTASIS
RESPIRATORY DISTRESS OF
THE NEW BORN (RDN)
LUNG TUMORS

INFLAMMATORY
TUBERCULOSIS (TBC)
PRIMARY TBC
POST PRIMARY TBC
NON TBC /ANON SPESIFIC
PNEUMONIA
BRONCHOPNEUMONIA

TERMINAL BRONCHIOLES
NORMAL-INFLAMMATORY

5 MM

5
5

NORMAL
N

INFLAMMATORY
P

PRIMARY PULMONARY TBC

PRIMARY COMPLEX OF RANKE
CHEST X-RAYS
PRIMARY FOCUS (=GHON)
LYPHANGITIS
HILAR NODES > OR
CALCIFICATION

ALVEOLI-PATCHIES

NORMAL

PATHOLOGIS

ACINAR SHADOWS

NORMAL & INFLAMMATION

N
NORMAL

PATCHIES
P

PRIMARY PULMONARY TBC

 GHON FOCUS & RANKE

COMPLEX

PERIFERAL AIRWAYS &

ACINUS

2
22,2 CM22

PRIMARY TBC & PNEUMONIA

ACTIVE SIGNS:
POST PRIMARY TBC

CHEST X-RAYS
PATCHIES
CONFLUENSOPACITIES
CLOUDY HAZINESS
CAVITY CAVITIES

TERMINAL BR.RESPIR BR.

ACINUS-CONFLUENS
PNEUMONIA

POST PRIMARY TBC(ADULT)

CAVITY

INHOMOGENEOUS OPACITY
I

ACINUSINFLAMMATION

TBC : CAVITY AT LUL

POST PRIMARY TBC :

QUIESCENT
FIBROSISRETRACTION
CALCIFICATIONS

NORMAL CHEST &

INFLAMMATORY

INACTIVE (OLD) TBC:

FIBROSIS & CALCIFICATION

OLD / INACTIVE TBC

TBC COMPLICATION :
MILIAR TBC

BRONCHOPNEUMONIA
& MILIAR TBC

SCHEME LOBUS
PNEUMONIA

PNEUMONIA AT RUL:
POST PRIMARY TBC

SPONDYLITIS TBC & PARA

VERTEBRAL ABSCESS

HERNIASI : DESTROYED
LUNG

PNEUMONIA ( NON TB)

RELATIVELY HOMOGENOUS
CONSOLIDAZATION
CLOUDY HAZINESS LOBAR
SEGMENTALS .
SHARP BORDER
AIR BRONCHOGRAM SIGN (ABS+/-)
SILHOUETE SIGN (+/- )

CONSOLIDATION OF THE
LUNG PARENCHYME

PNEUMONIALOBAR/SEGMENS

OBSTRUCTIVE-PNEUMONITIS

CHEST X-RAYS : RML

PNEUMONIA (S SIGN +)

TENDENCY TO THE LOWER/ MIDDLE LOBES

AIR BRONCHOGRAM SIGN

(ABS)

PNEUMONIA/HMD
P

RUL PNEUMONIA : S-SIGN (+)

PNEUMONIC ASPIRATION

RML PNEUMONIA

BRONCHOPNEUMONIA
(NON TB)
CHEST X-RAYS
D

DENSITIES
D

PATCHIES
POORLY DEFINED
INHOMOGENOUS
IRREGULAR SCATTERED

DDD
D

C
TENDENCY
TO THE LOWER LOBE

ACINUS-CONSOLIDATION

RADIOGRAPHYC SHADOWS/
OPACITY ?

BRONCHOPNEUMONIA
ACINUS

NORMAL
N

BP

BRONCHOPNEUMONIA
RLLL

BILATERAL
BRONCHOPNEUMONIA
PATCHIES
P

IRREGULAR SCATTERED
I

BRONCHOPNEUMONIA

RIGHT PLEUROPNEUMONIA

PNEUMONIA

++

+
P+

PLEURAL EFFUSION

LUNG ABSCESS

CAVITY WITH ONE CHAMBER

OR NODUL WITH
FLUID LEVEL,
THICK WALL
IRREGULAR BORDER

LUNG ABSCESS:
AIR FLUID LEVEL

LUL NODUL& ABSCESS

NODUL

33DAYS LATER
3

LUNG ABSCESS

ABSCESS : THICK &

IRREGULAR WALL

PRIMARY SQUAMOUS CELLS

CARC

DD : CARC .CAVITIES

ATELECTASIS
ALVEOLAR COLLAPS
CAUSED BY :
MECHANISMS:

OBSTRUCTION / RESOR PTION

COMPRESSION/PASSIVE/RELAXATION
CONSTRICTION / CICATRIZATION
ADEHESIVE /MICROATELECTASIS

MECHANISME OF
ATELECTASIS

DIRECT SIGN : ATELECTASIS

CHEST X-RAYS
DISPLACED SEPTA
LOSS OF AERATION / RADIOPACITY
OR LOCAL INCREASE IN DENSITY
VASCULAR & BRONCHIAL SIGNS :
CROWDING BRONCHIAL OR
VASCULAR MARKING

RUL ATELECTASIS

RML ATELECTASIS

INDIRECT SIGN :
ATELECTASIS

HEMIDIAPHRAGM ELEVATION
MEDIASTINUM DISPLACEMENT
HILAR DISPLACEMENT
COMPENSATORY OVERAERATION
NARROWING OF THE RIB CAGE

RLL ATECTASIS

LUL ATELECTASIS

RIGHT/LEFT MASSIVE
ATELECTASIS :HERNIASI

RIGHT & LEFT MASSIVE

ATELECTASIS

AGENESIS OF THE RIGHT &

LEFT LUNG

LUNG EDEMA
CHEST X-RAYS :

EDEMA
INTERSTITIAL
ALVEOLAR

RADIOLOGY OF THE LUNG

EDEMA
INTERSTITIEL EDEMA
CHEST X-RAYS
KERLEYS A LINE
KERLEY B LINE
PERIHILAR HAZE

RAD. OF THE INTERSTITIAL

EDEMA : KERLEY A LINE
K

KERLEY A LINE

INTERSTITIAL EDEMA :KERLEYS B LINE

EDEMA:
RIGHT PERIHILAR HAZE

RADIOLOGY OF THE
ALVEOLAR EDEMA
CHEST X-RAYS
BATWING APPEARANCE
BUTTERFLY APPEARANCE
HAZINESS

EDEM :BATWING / UREMIC

LUNG

RADIOLOGY OF EDEMA:
BUTTERFLY APPEARANCE

CHEST X-RAYS EDEMA :

NODULES/HAZINESS

COR PULMONAL:
VENOUS HYPERTENSION

COR PULMONAL

RO.CHRONIC BRONCHITIS :
VASCULAR MARKING

CHRONIC BRONCHITIS &

BRONCIECTASIS

BRONCHOGRAPHY

CHRONIC BRONCHITIS

CPOD: LUNG EMPHYSEMA

NORMAL CHEST

LOCAL EMPHYSEMA :BULLAE

ALVEOLAR EMPHYSEMA
ALVEOLAR EMPHYSEMA

GIANT BULLAE
PNEUMATOCELE

LOBAR EMPHYSEMA

PREOPERATIVE

POST OPERATIVE

BRONCHIECTASIS:
BRONCHIOLI

BRONCHIECTASIS-ANATOMY

BROCHIECTASIS : HONEY
COMB APPEARANCE

BRONCHIECTASES
BRONCHOGRAPHY

BRONCHIECTASIS
CHRONIC BRONCHITIS

RESPIRATORY DISTRESS
OF THE NEW BORN (RDN)
HMD :HYALINE MEMBRANE DISEASES
LACK OF SURFACTAN PRODUCTION
ALVEOLI COLLAPS
PREMATUREHIPOXIA CAPILARY
BROKEN HBMEMBRANE
HYALINE MUCOSE OF TBDUCTUS
ALVEOLAR

CHEST X-RAYS :-HMD

ALVEOLI COLLAPS :
FINE GRANULAR
HIPOAERATION
HIPERAERATION TBDA :
AIR BRONCHOGRAM SIGN POS

RDN : HMD / IRDN

HIPOAERATION

FINE GRANULARS

CHEST X-RAYS : HMD

AA
A

AIR BRONCHOGRAM
SIGN (=ABS) POS

TRANSTIEN TRESPIRATORY
DISTRESS OF THE NEW BORN
TRDN

IMPAIRED

PROLONGED
DELAYED

FLUID CLEARANCE
EDEMA

CHEST X RAYS:
TRDN

TRDNEDEMA
COARSE GRANULARNODULES
HYPOAERATION
PERIHILAR HAZE
PLEURAL EFFUSION,

CHEST X RAYS : TRDN

TRDN
2 HOURS AGE ,
ALVEOLAR EDEM
CAECARIAN

TRDN
AGE :1 HOUR
ALVEOLAR FLUID
PNEUMONIA

12 HOURS LATER
1
1
CLEAR
2
2

PNEUMOCONIOSIS:-SILICOSIS

NODULATIONS
E

EGGSHELLS

SILICOSIS-A

SILICOSIS-B

SILICOSIS-C

PNEUMOCONIOSIS :
SILICOSIS

TUMORS / NEOPLASMS
CHEST X-RAYS
TUMORS
PRIMER
T
BENIGN

MALIGNANT

SECUNDARY/
METASTASE

BENIGN TUMOR
CHEST X-RAYS
SOLITER NODUL ( COIN LESION)
CALCIFICATIONS
SMOOTH CONTOUR / MARGIN

BENIGN TUMOR :
CALCIFICATION FORM
NODUL SOLITER
NN
/COIN
LESION

CT SCAN: CALCIFICATIONS &

CONTOUR TUMORS

MALIGNANT TUMOR
CHEST X-RAYS :

SOLITER NODUL
NO (VERY RARE) CALCIFICATION
IRREGULAR CONROUR/ MARGIN
SPECIAL SIGN :
GOLDEN SIGN
RIGLER NOTCH SIGN
EXCENTRIC CAVITY ECT

LUNG CARCINOMA

MALIGNANT: GOLDEN OR
INVERTED S SIGN

MALIGNANT:
RIGLER NOTCH SIGN

MALIGNANT : EXCENTRIC
CAVITY / HILAR MASS

CT: ADENOCARCINOMA
BRONCHUS

LUNG CARC : VERTEBRAL

DESTRUCTION

 TUMOR METASTASES:
HEMATOGENEOUSLY
CHEST X-RAYS/CT

MULTIPLE NODULS

CHEST TUMOR METASTASE

DD:HEMATOGENOUS
LYMPHATIC METASTASES

CT : METASTASEMULTIPLE
NODULS

METASTASES : LYMHPATIC

DD: MULTIPLE NODULES

WEGENER DISEASE

DD:MULTIPLE NODULS
RHEUMATOID LUNG

MEDIASTINAL TUMORS
2.THYMIC TUMORS 20%

1.NEUROGENIC
TUMORS 20%

22

3.BENIGN
CYST 20%

4. LIMPHONONODUS 15%

2
2

MEDIASTINAL TUMORS

5.TERATODERMOID
TUMORS 10%
1
33

6.THYROID TUMORS 5%

7.MESENCHYMAL 5%

8.MISCELLANEOUS MASSES 5%

RADIOLOGY OF THE
MEDIASTINAL TUMORS

CHEST X-RAYS
SHARP BORDER
INCOMPLETE TUMOR BORDER
TAPERING MARGINS
COVEXITY TOWARD LUNG
NOT AFFECT ONPLEURA &RIBS

RADIOLOGY OF MEDIASTINAL
TUMORS

HODGKIN LYMPHOMA:
MEDIASTINAL TUMOR

MALIGNANT LIMPHOMA

MEDIASTINAL TERATOMA

MEDIASTINAL POSTERIOR
TUMOR : NEUROFIBROMA

PNEUMOMEDIASTINUM &
PNEUMOTHORAX

PLEURAL SPACE

PLEURAL EFFUSION
HAEMOTHORAX
PYOTHORAX / EMPHYEMA
PNEUMOTHORAX
HYDROPNEUMOTHORAX

MILD & LAMELLAR PLEURAL

EFFUSION

BLUNT SINUS

LAMELLAR EFFUSION

LEFT SUBPULMONARY
EFFUSIONLLD

SUBPULMONARY EFFUSION
BILATERAL

RO: MODERATE PLEURAL

EFFUSION
CHEST X-RAYS: ERECT VIEW
WATER DENSITY
MENISCUS SIGN
SINUS & DIAPHRAGM INVISIBLE

MODERATE & MASSIVE

PLEURAL EFFUSION

MASSIVE PLEURAL EFFUSION

MEDIASTINAL
COMPRESSION
TO ANOTHER SIDE

LOCAL EMPHYEMA

PNEUMOTHORAX
AIR IN THE PLEURAL SPACE
CHEST X-RAYS
HYPERLUSENHYPERAERATION
AVASCULER
MEDIAL LUNG COLLAPS
WHITE LINE OF THE VISCERAL
PLEURA

PNEUMOTHORAX

LOCAL PNEUMOTHORAX

LEFT TENSION
PNEUMOTHORAX

HYDROPNEUMOTHORAX

HYDROPNEUMOTHORAX

TENSION PNEUMOTHORAX

TBC &
HYDROPNEUMOTHORAX

ABNORMALITY OF THE
DIAPHRAGM
ABNORMALITY OF :
FUNCTION
POSITION
INTEGRITY ECT

RADIOLOGY OF THE
DIAPHRAGMA
PHRENIC PALSY
MORGAGNI DIAPHRAMATIC HERNIA
BOCHDALEK DIAPHRAGMATIC
HERNIA
TRAUMATIC HERNIA
CONGENITAL/AGENESIS DIAPHRAGM
HERNIA

PHRENIC PALSY / PARALYSE

DIAPHRAGM : CAUDAL VIEW

HERNIA CONGENITAL:
AGENESIS LEFT DIAPHRAGM

CONGENITAL DIAPH HERNIA

MORGAGNI HERNIA

MORGAGNI D. HERNIA

BOCHDALEK D. HERNIA

BOCHDALEK HERNIA

SHORT ESOPHAGEAL HERNIA

PARAESOPHAGEAL HERNIA

HERNIA HIATUS
ESOPHAGEAL

SLIDING HERNIA

TRAUMATIC HERNIA

T
M H
A
N
K

MERCY BEAUCOUX
TERIMA KASIH