Chest Radiology

Chest Radiology

Paul M Taylor Manchester Royal Infirmary

Investigations
Chest Radiograph  PA  AP
± Ill patient 

Lateral
± Mass localisation, cardiac chambers, hila 

Expiratory

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1 2 1 2 3 4 5 3 4 5 6 7 6 7 8 9 10 .

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Cardiothoracic Ratio (CTR) A+B/C A B C .Heart size .

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Investigations  CT ± Focal masses ± Diffuse lung disease ± Pulmonary emboli   Ultrasound ± Diaphragm. pleura Magnetic Resonance ± Mediastinum ± Lung apex  Intervention ± Biopsy. Drainage .

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Conventional CT Slice width .

Spiral CT .

Bone Water Air .

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What can we see? The outer edges of the heart and mediastinum  The walls of the larger airways  The pulmonary vessels  The skeleton  .

Scruffy¶s Triangle .

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What pathology can we see?  Consolidation  Pulmonary masses  Collapse  Pleural effusions/pneumothorax .

efusions . temperature.Consolidation  Air Bronchogram ± Infection ± Oedema Clincal features Oedema.WCC Radiological features Heart size.

Air bronchogram  Air filled bronchus surrounded by waterlogged lung .

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Lung Masses Solitary  Carcinoma. ± Age 40 15% malignant ± Age 80 98% malignant Metastases  Granuloma  Hamartoma       Adenoma Fistulae Rh Nodules Hydatid Wegeners .

Lung Masses Multiple  Metastases  Abscesses  Infarcts    PMF Rheumatoid nodules Caplans nodules .

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Lung Masses Diagnosis  Clinical  CT ± Rarely characteristic  Biopsy ± Fluoroscopy ± CT Ultrasound .

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Lobar collapse  Primary signs ± Displacement of Fissures  Secondary signs ± Elevation of diaphragm ± Crowding of ribs ± Increased density of lobe ± Compensatory emphysema ± Displacement/rotation of hila ± Mediastinal µshift¶ .

Right Upper Lobe Collapse .

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Left Lower lobe Collapse .

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Pleural Abnormalities  Pleural Fluid ± Haemothorax ± Effusion » Transudate » Exudate  Pleural soft tissue Same densities but may be different shape .

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inadequate films  Don¶t rely on one excellent film  Radiology provides anatomy not pathology  Look at all the film  Accept your limitations  .And finally Don¶t rely on poor.

That¶s it Any Questions ? .

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