CHEST RADIOLOGY

PULMONARY DISEASES

PULMONARY DISEASES

According to predominant involvement of pulmonary tissues, altered density in pulmonary area of chest x-ray could represent:
  

Alveolar processes Interstitial processes Mixed alveolar and interstitial processes

ALVEOLAR PROCESSES
 Also

sometimes called CONSOLIDATION  These result in increased lung radio density by filling the alveoli and in some cases, the smaller bronchi with material other than air, usually fluid.

BRONCHOPULMONARY SEGMENTS
 10

on right and 9 on left side

ALVEOLI & PULMONARY LOBULES
 Bronchi

divide between 6-20 times before becoming bronchioles  Terminal bronchioles are 0.2mm in diameter  Each terminal bronchiole receives 2-3 respiratory bronchioles, which connect between 2 and 11 alveolar ducts.  Each alveolar duct in turn receives 2-6 alveolar sacs, which are connected to Alveoli.

ALVEOLI & PULMONARY LOBULES
 ACINUS

is the functioning lung unit arising from terminal bronchiole. It casts 5-6 mm shadow when filled with water.  Pores of KOHN, 3-13 µ m, connect alveoli  Canals of LAMBERT, 30 µ m, connect bronchioles and alveoli.  PRIMARY LOBULE arises from last respiratory bronchiole  SECONDARY LOBULE 1-2.5 cm in size surrounded by connective tissue septa.

ALVEOLAR PROCESSES
 Differential
 Bacterial

Diagnosis:

pneumonias  Pulmonary edema  Tuberculosis  Lung contusion/bleeding  Adult respiratory distress syndrome  Viral and fungal pneumonias  Aspiration  Carcinomas  Pulmonary embolism

RADIOLOGY SIGNS OF ALVEOLAR PROCESSES
 SPECIFIC

SIGNS:

 Silhouette

sign  Air bronchogram  Inhomogenous alveolar infiltrates  Lung abscess  Pneumetoceles

RADIOLOGY SIGNS OF ALVEOLAR PROCESSES
 NON-SPECIFIC
 Fluffy

SIGNS: -

margins  Lobar distribution  Segmental distribution  Central fluffy pattern

INTERSTITIAL PROCESSES
 These

processes are those that add to the radio density of structures in the interstitium of lung.

INTERSTITIAL PROCESSES
 Abnormal

structures sought are:

 Thickened

bronchial walls  Thickened interlobular septa  Engorged lymphatic channels  Nodules  Thick bands of fibrosis

INTERSTITIAL PROCESSES

 RADIOLOGICALLY
 Lines  Nodules

THEY APPEAR AS: -

and  Ring shadows

THICKENED BRONCHIAL WALLS
 Common
 Chronic  Asthma  Bronchiectasis  Cystic

Differential Diagnosis are:
bronchitis

fibrosis  Heart failure  Tumor engorgement of lymphatic Channels

LINEAR INTERSTITIAL PATTERNS
 Common
 Fibrosis  Viral

Differential Diagnosis include:
pulmonary edema

 Interstitial

pneumonia  Granulomatous tissue disease  Metastatic tumors

NODULAR (MILLIARY) PATTERN
 Granulomatous
 Tuberculosis  Sarcoidosis  Histoplasmosis  Metastasis

disease like

HONEY COMBING
 Is

seen commonly in
lung

 Rheumatoid  Sarcoidosis

 Pneumoconiosis  Bronchiectasis  Scleroderma

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