呼吸系统放射影像学.ppt

,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,Aims,Basics,Best exam results,Appreciate the role radiology plays,?,Instill,an interest in radiology,Before Class:,Textbook,Reference book,Literature,Internet,Apps,Teacher&classmate,Histology and Embryology,Anatomy,Pathology,Internal Medicine,Surgery,Gynecology,Pediatrics,Neurology,。,Everything,。,U need to know,methods,X-ray,CT,MR,DSA,US,Nuclear Medicine,PET/CT,Radionuclide ventilation perfusion imaging,Techniques-Projection,P-A (relation of x-ray beam to patient),Techniques-Projection,(continued),A-P Supine/Erect,Techniques-Projection,(continued),Lateral,Techniques-Projection,(continued),Lateral Decubitus,Oblique,Technical Details,Type,Orientation,Rotation,Inspiration/expiration,Penetration,Rotation,Rotation,(continued),Penetration,Inspiration/Expiration,Things to see,ABCDE,Airways,Trachea,endotracheal tube,etc,Bones,Clavicles,ribs,etc,Cardiac,Diaphragm(Right hemidiaphragm slightly higher,(1.5 cm),Everything else(tubes),effusions,Densities,The big two densities are:,(1)WHITE-Bone,(2)BLACK-Air,The others are:,(3)DARK GREY-Fat,(4)GREY-Soft tissue/water,And if anything Man-made is on the film,it is:,(5)BRIGHT WHITE-Man-made,Anatomy,Anatomy,Bronchopulmonary Anatomy,Cross-sectional Anatomy of Lung Segments,（,CT,）,Lobes,Right upper lobe:,Lobes,(continued),Right middle lobe:,Lobes,(continued),Right lower lobe:,Lobes,(continued),Left lower lobe:,Lobes,(continued),Left upper lobe with Lingula:,Lobes,(continued),Lingula:,Lobes,(continued),Left upper lobe-upper division:,Heart,Right border:Edge of(r)Atrium,3.Left border:(l)Ventricle+Atrium,4.Posterior border:Reft Ventricle,5.Anterior border:Right Ventricle,Heart,(continued,。,),Heart,ITS NOT MINE.,Hilum,Made of:,1.Pulmonary Art.+Veins,2.The Bronchi,Left Hilum higher(max 1-2,5 cm),Identical:size,shape,density,Hilum,Ribs,Review areas:,Apices,Behind the heart,Costophrenic angle(CPA),Below the diaphragm,Soft tissues(breast,surgical emphysema),Ribs&clavicle,Vertebrae,Abnormals,Lung findings,Darker areas,radiolucent,Pneumothorax,Cysts/bulla,Air bronchograms,Lighter areas,Opacities,Atelectasis,“infiltrates”,Blood,Pus,Water,Nodules or mass,Opacities,Lobar or not.,Pneumonia,Pulmonary Edema,“fluffy,”diffuse,“bat wing”distribution,Hemorrhage,Cant tell by x-ray,need bronch,RML pneumonia,Opacities,RLL pneumonia,Opacities,RUL pneumonia,LLL pneumonia,Consolidation on CT,The Enlarged Hila,Causes,:1.Adenopathies(neoplasia,infection)2.Primary Tumor3.Vascular4.Sarcoidosis,Mass,Hilar Lymphadenopathy-BL,Multiple Masses,Metas,Pleural Effusion,Pulmonary Fibrosis,Heart failure,，,Kerley A/B line,（,Interstitial lung hyperplasia edema,）,Heart failure,Pneumothorax,Emphysema,Cavitating lesion,Thin-walled,Cavitating lesion,Thick-walled,Cavitating lesion,3mm,Bronchiectasis,Miliary shadowing,Calcification,Benign Patterns of Calcification Within a Solitary Pulmonary Nodule,Chest Tube,NG Tube,Pulm.artery cath,CT Indications,Key,Clinical Factors,Growth Pattern,Size,Margin(Border)Characteristics,Density,Contrast-Enhanced CT,Other findings,Pulmonary Infection,airspace opacification,air bronchograms,dense multifocal segmental,pneumonia,lung abscess,cavitation,Lobar/segmental consolidation,Pneumonia finding,Tuberculosis,infiltrates,Miliary shadowing,Tuberculoma,Chronic fibro-cavitary TB,CAUSES OF SOLITARY PULMONARY NODULES,（,SPN,）,Neoplastic:Malignant,Bronchogenic carcinomaSolitary metastasisLymphomaCarcinoid tumor,Neoplastic:Benign,HamartomaBenign connective tissue and neural tumors(e.g.,lipoma,fibroma,neurofibroma),Inflammatory,GranulomaLung abscessRheumatoid noduleInflammatory pseudotumor(plasma cell granuloma),Congenital,Arteriovenous malformationLung cystBronchial atresia with mucoid impaction,Miscellaneous,Pulmonary infarctIntrapulmonary lymph nodeMucoid impactionHematomaAmyloidosisNormal confluence of pulmonary veins,Mimics of SPN,Nipple shadowCutaneous lesion(e.g.,wart,mole)Rib fracture or other bone lesion,loculated pleural effusion,Neoplastic:Benign,Hamartoma,Neoplastic:Malignant,Bronchogenic carcinoma,Neoplastic:Malignant,Bronchogenic carcinoma,Inflammatory,Granuloma,chest radiograph shows a small,well-circumscribed,round opacity at the right lung base(arrows).,Lateral view shows that the opacity is within the lung on two views(posterior segment of the right lower lobe)and thus represents a pulmonary nodule(arrow).,Contrast CT in Malignant Solitary Pulmonary Nodule.Thin-collimation(3-mm)CT scans through left upper lobe nodule in a 62-year-old woman with biopsy-proven lung cancer shows a lobulated contour with positive enhancement of 50 H after contrast administration,Malignant SPN,Bronchogenic Carcinoma,（,Clinical,）,Age at diagnosis,:,55-60 years(range 40-80 years);M:F=1.4:1,asymptomatic(10-50%)usually with peripheral tumors,symptoms of central tumors,:,cough(75%),wheezing,pneumonia,hemoptysis(50%),dysphagia(2%),symptoms of peripheral tumors,:,pleuritic/local chest pain,dyspnea,cough,Pancoast syndrome,superior vena cava syndrome,hoarseness,symptoms of metastatic disease,(CNS,bone,liver,adrenal gland),paraneoplastic syndromes,:,cachexia of malignancy,clubbing+hypertrophic osteoarthropathy,nonbacterial thrombotic endocarditis,migratory thrombophlebitis,ectopic hormone production:hypercalcemia,syndrome of inappropriate secretion of antidiuretic hormone,Cushing syndrome,gynecomastia,acromegaly,Risk factors,Cigarette smoking,(squamous cell carcinoma+small cell carcinoma),鈥搑,elated to number of cigarettes smoked,depth of inhalation,age at which smoking began,85%of lung cancer deaths are attributable to cigarette smoking!,Passive smoking may account for 25%of lung cancers in nonsmokers!,Radon gas,:may be the 2nd leading cause for lung cancer with up to 20,000 deaths per year,Industrial exposure,:asbestos,uranium,arsenic,chlormethyl ether,Concomitant disease,:,chronic pulmonary scar+pulmonary fibrosis,Scar carcinoma,45%of all peripheral cancers originate in scars!,Incidence:,7%of lung tumors;1%of autopsies,Origin:,related to infarcts(50%),tuberculosis scar(25%),Histo:,adenocarcinoma(72%),squamous cell carcinoma(18%),Location:,upper lobes(75%),Types:,Adenocarcinoma(50%),Most common cell type seen in women+nonsmokers,Intermediate malignant potential(slow growth,high incidence of early metastases),almost invariably develops in periphery;frequently found in scars(tuberculosis,infarction,scleroderma,bronchiectasis)+in close relation to preexisting bullae,solitary peripheral subpleural mass(52%)/alveolar infiltrate/multiple nodules,may invade pleura+grow circumferentially around lung mimicking malignant mesothelioma,upper lobe distribution(69%),air broncho-/bronchiologram on HRCT(65%),calcification in periphery of mass(1%),smooth margin/spiculated margin due to desmoplastic reaction with retraction of pleura,Adenocarcinoma Presenting as Solitary Pulmonary Nodule.,Cone-down view of posteroanterior radiograph shows nodule in the right mid-lung(arrow).,Thin-section CT shows 12-mm nodule with spiculated margins(arrow)in the superior segment of the right lower lobe.Transthoracic needle biopsy revealed adenocarcinoma.,solitary peripheral mass,Squamous cell carcinoma(30-35%),Strongly associated with cigarette smoking,Central location within main/lobar/segmental bronchus(2/3),large central mass,&cavitation,distal atelectasis&,bulging fissure(due to mass),postobstructive pneumonia,All cases of pneumonia in adults should be followed to complete radiologic resolution!,airway obstruction with atelectasis(37%),Solitary peripheral nodule(1/3),characteristic cavitation(in 7-10%),Squamous cell carcinoma is the most common cell type to cavitate!,invasion of chest wall,Squamous cell carcinoma is the most common cell type to cause Pancoast tumor,Central lung cancer,Squamous Cell Carcinoma.,Posteroanterior chest film in a 58-year-old male smoker with hemoptysis shows a left hilar mass with left upper lobe atelectasis.,Enhanced CT scan shows the left hilar mass occluding the left upper lobe bronchus with an endobronchial component(straight arrow).Note the presence of mucus bronchograms within the atelectatic lung(curved arrow),Squamous Cell Carcinoma,Small cell undifferentiated carcinoma(15%),Strongly associated with cigarette smoking,Rapid growth+high metastatic potential,typically large hilar/perihilar mass often associated with mediastinal widening(from adenopathy),extensive necrosis+hemorrhage,small lung lesion(rare),Large undifferentiated cell carcinoma(6 cm(50%),large area of necrosis,pleural involvement,large bronchus involved in central lesion(50%),Large-cell bronchogenic carcinoma,small-cell bronchogenic carcinoma,Ground-glass Opacity,the pattern was shown to be caused by predominantly interstitial diseases in 54%of cases,equal involvement of the interstitium and airspaces in 32%,and predominantly airspace disease in 14%,GGO is an important finding.In certain clinical circumstances,it can suggest a specific diagnosis,indicate a potentially treatable disease,and guide a bronchoscopist or surgeon to an appropriate area for biopsy,Pure GGO,（,Ground-glass Opacity,）,Early stage,98,6,17,12*8mm,Lobular resection,8 yrs alive,Lung cancer:solid nodules,Self test,？,MR Indications,Never stop looking,carry on with your systematic approach!,