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System
A- Imaging
- Plain CXR
A PA film provides information on the lung fields , heart
,mediastinum , vascular structures and the thorathic
cage. additional information can be obtained from a
lateral film.
Structures of CXRs
1- Trachea , that should be central
2- Mediastinum, can be widened in many diseases like
( retrosternal goiter, Lymph nodes enlargement, aortic
aneurysm and oesophageal dilatation)
3- The diaphragm , Rt side is usually slightly higher than
the Lt side.
CT scan
It is superior to CXR in determining the position and size of
a pulmonary lesion and whether calcification or
cavitations is present.
It is now routinely used in the assessment of patients with
suspected lung cancer and facilitate guided
percutaneous needle biopsy.
HRCT (high resolution), that uses thin section to provide a
detail assessment of pulmonary parenchymal diseases
( interstitial lung disease , bronchiectasis)
B- Endoscopic Examinations;
Laryngoscopy; larynx may be inspected directly with a
mirror or indirectly with a laryngoscope.
Bronchoscopy;
The trachea , large bronchi and lung segments can all be
inspected by either flexible or rigid bronchoscope.
Diagnostic indication of flexible bronchoscopy;
- Suspected cases of Lung ca,
- slowly resolving pneumonia,
- pneumonia in the immunocompramised patients,
- interstitial lung disease, and
- collecting lavage for AFB and culture in suspected cases
of TB , with ve sputum.
Mediastinoscopy;
Through a small incision at the supra sternal notch under
GA, to get an access to the mediastinum.
C- Other investigations
Plural aspiration and biopsy.
Sputum examination , for microbiological ( AFB, Culture,
Gram stain ) and cytological examinations
Pulse oximetry
Allow a non invasive assessment of peripheral O2
saturation, it provides a useful tool for monitoring those
who are acutely ill or at risk of deterioration.