CHEST İMAGİNG

Department of Radiology, Okan

Universty
Demet DOĞAN
PA VİEW
• PA view

• On the PA chest-film it is important to examine all

the areas where the lung borders the diaphragm,
the heart and other mediastinal structures.
• At these borders lung-soft tissue interfaces are
seen resulting in a:
• Line or stripe - for instance the right para tracheal
stripe.
• Silhouette - for instance the normal silhouette of
the aortic knob or left ventricle
• These lines and silhouettes are useful
localizers of disease, because they
can be displaced or obscured with
loss of the normal silhouette. This is
called the silhouette sign, which we
will discuss later.
• The paraspinal line may be displaced
by a paravertebral abscess,
hemorrhage due to a fracture or
extravertebral extension of a
neoplasm.
• Widening of the paratracheal line (>
2-3mm) may be due to
lymphadenopathy, pleural
thickening, hemorrhage or fluid
overload and heart failure.

• Displacement of the para-aortic line

can be due to elongation of the aorta,
aneurysm, dissection and rupture.
• The anterior and posterior junction
lines are formed where the upper
lobes join anteriorly and posteriorly.
These are usely not well seen and
we will not discuss them.
• An important mediastinal-lung
interface to look for is the
azygoesophageal line or recess
(arrow).
Lateral view
• On a normal lateral view the
contours of the heart are visible and
the IVC is seen entering the right
atrium.
• The retrosternal space contains air
and should be radiolucent down to
the level where the right ventricle
borders the sternum (small black
arrow).
Any radiopacity in this upper
retrosternal area is suspective of a
process in the anterior mediastinum
or upper lobes of the lungs.
• As you go from superior to inferior
over the vertebral bodies they
should get darker, because usually
there will be less soft tissue and
more radiolucent lung tissue (white
arrow).

• If this area becomes more dense,

look carefully for pathology in the
lower lobes.
ULTRASONOGRAPHY

US indications;
Pleural fluid: It easily makes the differential
diagnosis of pleural fluid-sequelae adhesion in
patients with closed costodiaphragmatic sinus
on the graphy.
Septa indicates the presence of debris in the
pleural fluid.
• Diagnosis and characterization of
pleural-based masses and infections

• sampling and draining of pleural

fluid, biopsy of pleural-based masses
 CT
• HIGHER RESOLUTION
• NO SUPERPOSITION
• LESION FEATURES (Internal
structure, edge, etc.)
• NEIGHBORHOOD
• EXPANSION LYMPH GLANDS-
STAGING
• GUIDANCE IN ENTERPRISE
 CT

• MEDIASTEN WINDOW
• PARANKIM WINDOW
• HIGH RESOLUTION EXAMINATION
 HRCT
• It is a technique used to investigate
lung diseases with diffuse
involvement (e.g. emphysema,
bronchiectasis, interstitial
pneumonias, etc.)
 HRCT
•
Difference from normal CT:
intermittent sections are taken: it is
aimed for the patient to receive less
radiation dose. The inconsistency of
the sections may lead to skipping of
small nodules.
 HRCT
• bone is processed with kernel
software: pulmonary parenchymal
details are made clearer.
• Contrast is not given.
 MRI
• Its use in lung diseases is limited.
• Main indications: cystic mass
characterization, mediastinal and
chest wall invasion of lung cancer,
thymic mass characterization.
 MRI

• As the use of multislice computed

tomography enables multiplanar
high-quality images, the need for
MRI has decreased in most cases.
 MRI
• MEDIASTINAL LESIONS

• HEART AND LARGE VESSELS

• SPINAL CHANNEL

• MULTIPLANAR NEIGHBORHOOD
RELATIONSHIP
 CONSOLIDATION

Fluid accumulation (increased opacity) in the air-

containing structures of the lungs (alveoli and small
airways).
The reason cannot be told radiologically. The most
common causes are infection, infarction,
sarcoidosis, etc
Atelectasis

• Atelectasis is the volume reduction

due to collapse in the lung tissue
and is classified according to the
pathophysiological mechanism and
localizations.
• Pathophysiologically, it is divided
into two as obstructive and non-
obstructive.
• While obstructive atelectasis occurs
due to non-ventilated alveolar
blockage in the airways, non-
obstructive atelectasis occurs due to
loss of connection between the
visceral and parietal pleura,
parenchymal compression,
surfactant dysfunction, or
infiltrative diseases in the lung
 CAUSES OF ATELEKTASIA-COLLAPS
• Bronchial obstructions (intramural-
mural-extramural)
• Fibrosis-tbc-radiation
• Compression atelectasis-pleural
lesions
• ATELEKTASIA APPEARANCE-Opacity,
silhouette mark, displacement
 Ground glass

• In regions with an increase in lung

parenchyma density, if the vessel
and bronchial walls below the
density can be seen, it is said to have
a ground glass appearance, and if it
cannot be seen, it is consolidation.
• There is a blurring of the image as if
looking at the lung parenchyma
through a ground glass.
• Decreased aeration due to filling of
alveoli with fluid (transuda, exuda,
blood), cell (inflammatory,
malignant), substance (surfactant,
protein)
• Thickening of the interstitium due to
fluid, cell infiltration or fibrosis
• As a result of partial collapse of the
alveoli or a combination of these
 Air Bronchogram
• It is the name given to the
appearance of air-filled bronchi
with air-free lung parenchyma. This
appearance indicates that the
proximal airways are open and the
air in the alveoli has been resorbed
or replaced. The cause of resorption
is atelectasis, and the most common
cause of replacement is pneumonia
or pulmonary edema.
 CAUSES OF PNEUMONIA
BACTERIAL(Streptecoccus,staph.,
mycoplasma)
VIRAL(influenza,herpes)
MUSHROOMS
PROTOZOA
PARASITE (hydatid cyst)
CHEMICAL
RADIATION
 PULMONARY
NEOPLASMS
BENIGN TUMORS
Bronchial Adenoma
hamartoma
MALIGN PRIMARY TUMORS
Epidermoid tumor
Adenocarcinoma
small cell cancer
large cell cancer
METASTATIC TUMORS
 Pancoast tumours
It is a type of AK located in the apical (superior
pulmonary sulcus).
Most are squamous cell carcinomas
Rapidly invades the environment
Brachial plexus paralysis causes:

Horner's syndrome (miosis, ptosis, dry eye), shoulder-

arm pain
 SOLITER PULMONARY
NODULE (SPN)
• Single, less than 3 cm, well-
circumscribed nodule in the lung
parenchyma.
• It may be peripheral lung cancer,
granuloma, hamartoma, metastasis,
AVM.
• Tuberculosis granuloma is the most
common in our country.
• If there is fat and calcification inside
the nodule, it is benign; hamartoma.
• If 90% of the nodule is calcified, it is
benign if it has extensive central
calcification; granuloma or
hamartoma.
• Small or punctual peripheral
calcifications may also be seen in
cancer.
• Fat-free and non-densely calcified
SPNs are followed according to
clinical risk schemes: non-contrast,
low-dose CT protocols should be
used.
• Non-growing SPN that remains the
same for 2 years at follow-up is
benign.
MALIGNITY FEATURES IN SOLITER NODULE

• OVERAGE OF THE PATIENT

• NODULE 2 CM OR LARGER
• IRREGULAR AND SPICULAR EDGE
• CAVITY WITH THICK AND
IRREGULAR WALLS
• OPAQUE WITH CONTRAST
MATERIALS IN IT
 METASTATIC TUMORS IN
THE LUNG
• Usually multiple and peripheral

• Breast, kidney, testis, thyroid, testis,

colon,
• melanoma,sarcoma

• May show lymphangitic spread

 MEDIASTINAL MASSES
• ANTERIOR
• Thyroid, thymoma, teratogenic mass, lymphoma

MIDDLE
• LAP,central bronchial CA,cardiac aneurysm

• POSTERIOR
• Neurogenic tumor, vertebral and spinal lesions,
• hernia,aortic aeurysm
MEDIASTINAL LAP
RETROSTERNAL THYROID
TEŞEKKÜRLER