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RADIOLOGY
Louis Allan P. Serrano, MD, FPCR
“You only see what you know.”
- Lawrence R. Goodman, MD
Felson’s Principles of Chest Roentgenology
Normal Chest, Adult
(AP and Lateral views)
Normal Chest (PA view)
Normal Chest (Lateral View)
Normal Chest, Pediatric
(AP and Lateral views)
Normal Thymus Gland, Pediatric
“sail sign”
Normal Thymus Gland, Pediatric
Day 1 Day 3
Day 2 Day 4
LUNG ABSCESS
Occurs when suppurative lung infections
break down to form a cavity
majority are bronchogenic in origin
most often due to anaerobic organisms
On x-ray:
1. Bronchogenic
2. Hematogenous - miliary TB,
extrapulmonary lesions throughout the
body
3. Lymphangitic - common in Primary
TUBERCULOSIS
Healing of PTB:
- complete resolution, decrease in
thickness and size of cavitation,
fibrosis, calcification
PRIMARY TUBERCULOSIS
- seen as primary complex on x-ray:
* Ghon’s tubercle
* Hilar adenopathy
* Lymphangitis
PRIMARY
TUBERCULOSIS
TUBERCULOSIS
TUBERCULOSIS
Tuberculosis, healing
TUBERCULOMAS
MILIARY TUBERCULOSIS
CONGENITA
L
DISORDERS
TRACHEOMALACIA
Is a rare expiratory problem
it is due to the presence of extremely
frail and underdeveloped tracheal
cartilage, hence adequate support is
lacking and exaggerated expiratory
collapse of the entire trachea occurs
TRACHEOMALACIA
CONGENITAL LOBAR
EMPHYSEMA
Male predominance 3:1
left upper and right middle lobes are
most often involved
lower lobes are rarely affected
On X-ray:
BOCHDALEK HERNIA
- posterolateral in position
- common on the left side (2:1)
- loops of bowel herniates causing
respiratory distress and unilateral
hypoplasia
Diaphragmatic Hernia
(Bochdalek)
Diaphragmatic Hernia
(Bochdalek)
Diaphragmatic Hernia
(Bochdalek)
MORGAGNI HERNIA
occurs mainly on the right through
the retrosternal Morgagni’s foramen
(Larrey’s space)
small and contains omentum
often seen as a basal mass shadow
usually in the cardiohepatic region
MORGAGNI HERNIA
UPPER AIRWA
Y
DISEASE
CROUP
Common inflammatory
conditions of the larynx and
upper trachea in childhood
usually caused by a virus and
usually occurs in children from
6 months to 3 years of age
CROUP
On X-ray:
- typical lateral view finding are those
of pronounced hypopharyngeal
overdistention, indistinctness and
thickening of the vocal cords,
prominence of the laryngeal ventricle
and subglottic tracheal narrowing
- on frontal view - slit-like narrowing of
the glottis is seen termed as the
“steeple” or “funnel” sign
CROUP (“Steeple” or “Funnel”
Sign)
CROUP (“Steeple” or “Funnel”
Sign)
EPIGLOTTITIS
also a common inflammatory condition of
the larynx and upper trachea in childhood
due to Haemophilus influenzae
On X-ray:
“thumb
sign”
LOWER AIRWA
Y
D I S E A S ES
BRONCHOPNEUMONIA
lobular pneumonia
originates in the airways and
spread to peribronchial alveoli
often presents at the extremes
of life
has variety of x-ray patterns
caused by a number of
organisms
BRONCHOPNEUMONIA
AIR - BRONCHOGRAM
SIGN
BRONCHIECTASIS
persistent dilatation of the
bronchi
can be cylindrical, varicose or
saccular
X-ray:
1. Centrilobular (centriacinar) -
destruction of parenchyma
predominates in central portion of
secondary lobule
- most frequently associated with
cigarette smoking
2. Panlobular (panacinar) - more
diffuse; associated with α-1
antitrypsin deficiency
PULMONARY
EMPHYSEMA
BULLOUS EMPHYSEMA
COR PULMONALE
Term used to indicate right
ventricular hypertrophy that may
lead to right sided heart failure,
produced by any disease abnormality
(exclusive of primary cardiac
disease)
Usually leads to pulmonary
hypertension
Pulmonary emphysema – most
common cause.
COR PULMONALE
Other causes of cor pulmonale:
- congenital and acquired
alterations in the thorax
(kyphoscoliosis and
thoracoplasty)
- COPD, PTB, pneumoconioses,
recurrent pulmonary emboli
COR PULMONALE
Roentgen findings:
- enlarged pulmonary infundibulum
& pulmonary arteries with increase
in size of hilar arteries bilaterally
- when RVH is marked, there may
be convexity of the lower right
anterior cardiac silhouette and the
apex may be elevated and rounded.
- pulmonary emphysema is often
present
COR PULMONALE
NEOPLASTIC
DISEASES
BENIGN TUMORS
HAMARTOMA
On X-ray:
- well circumscribed,
pulmonary parenchymal nodule
< 4 cm in diameter
- (+) calcification in 25-30%
of cases, “popcorn calcification”
HAMARTOMA
“popcorn calcification”
MALIGNANT TUMORS
BRONCHOGENIC CARCINOMA
Classification:
1. EPIDERMOID OR SQUAMOUS CELL
CA
> in males with ratio of 2 or 3:1
accounts for almost 1/3 of all bronchogenic
tumors
tends to occur in relatively older age group
often arises in or immediately adjacent to
lobar and segmental bronchi but is
occasionally peripheral
when a primary tumor is noted to invade
the thoracic wall, it is more likely to be
epidermoid
MALIGNANT TUMORS
2. ADENOCARCINOMA
1. LARGE CELL CA
5. BRONCHOALVEOLAR CA
a form of adenocarcinoma
two (2) forms:
No 5% <5% 0% 0%
abnormaliti
es
Multiple 35% 30% 65% 45%
abnormaliti
es
SOLITARY PULMONARY
NODULE
BENIGN MALIGNANT
PATIENT AGE* <35 >50
Cavitation No Yes
“spinnake
r sail sign”
PNEUMOMEDIASTINUM
MEDIASTINUM
THYMOMA
ANTERIOR MEDIASTINAL MASS
MIDDLE MEDIASTINAL
MASS
reticular pattern
Stage IV: white lung
SURFACTANT DEFICIENCY
DISEASE
SURFACTANT DEFICIENCY
DISEASE
SURFACTANT DEFICIENCY
DISEASE
THE END
Have a nice day!