呼吸系统放射影像学PPT课件.ppt

BasicsBest exam resultsAppreciate the role radiology plays?Instill an interest in radiologyTextbookReferencebookLiteratureInternetAppsTeacher&classmateHistology and EmbryologyAnatomyPathologyInternal MedicineSurgeryGynecologyPediatricsNeurology。Everything。U need to knowX-rayCTMRDSAUSNuclear Medicine PET/CT Radionuclide ventilation perfusion imagingPA（posteroanterior)&LateralMore informationTwo viewsStandardizedDistancePt needs to be stablePortableQuickAnywhereOne shotNo standardizationPA PortableLateralLateral DecubitusObliqueTypeOrientationRotation Inspiration/expirationPenetrationABCDEAirwaysTrachea,endotracheal tube,etcBonesClavicles,ribs,etcCardiacDiaphragm(Right hemidiaphragm slightly higher(1.5 cm)Everything else(tubes),effusions The big two densities are:(1)WHITE-Bone (2)BLACK-AirThe 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 Right upper lobe:Right middle lobe:Right lower lobe:Left lower lobe:Left upper lobe with Lingula:Lingula:Left upper lobe-upper division:Right border:Edge of(r)Atrium3.Left border:(l)Ventricle+Atrium4.Posterior border:Reft Ventricle5.Anterior border:Right VentricleITS NOT MINE.Made of:1.Pulmonary Art.+Veins2.The Bronchi Left Hilum higher(max 1-2,5 cm)Identical:size,shape,density Apices Behind the heart Costophrenic angle(CPA)Below the diaphragm Soft tissues(breast,surgical emphysema)Ribs&clavicle Vertebrae Darker areasradiolucentPneumothoraxCysts/bullaAir bronchogramsLighter areasOpacitiesAtelectasis“infiltrates”BloodPusWaterNodules or massLobar or not.PneumoniaPulmonary Edema“fluffy,”diffuse,“bat wing”distributionHemorrhageCant tell by x-ray,need bronchRML pneumoniaOpacitiesRLL pneumoniaOpacitiesRUL pneumonia LLL pneumoniaConsolidation on CTCauses:1.Adenopathies(neoplasia,infection)2.Primary Tumor3.Vascular4.SarcoidosisMass Hilar Lymphadenopathy-BL Multiple MassesMetasPleural EffusionPulmonary FibrosisHeart failure，Kerley A/B line（Interstitial lung hyperplasia edema）Heart failurePneumothoraxEmphysemaCavitating lesionThin-walled Cavitating lesionThick-walled Cavitating lesion 3mmBronchiectasisMiliary shadowingBenign Patterns of Calcification Within a Solitary Pulmonary NoduleChest Tube,NG Tube,Pulm.artery cathClinicalFactorsGrowthPatternSizeMargin(Border)CharacteristicsDensityContrast-EnhancedCTOtherfindingsairspace opacification air bronchogramsdense multifocal segmentalpneumonialung abscesslung abscesscavitationLobar/segmental consolidationPneumonia findinginfiltratesMiliary shadowingTuberculomaChronic fibro-cavitary TB Neoplastic:MalignantBronchogenic carcinomaSolitary metastasisLymphomaCarcinoid tumorNeoplastic:BenignHamartomaBenign connective tissue and neural tumors(e.g.,lipoma,fibroma,neurofibroma)InflammatoryGranulomaLung abscessRheumatoid noduleInflammatory pseudotumor(plasma cell granuloma)CongenitalArteriovenous malformationLung cystBronchial atresia with mucoid impactionMiscellaneousPulmonary infarctIntrapulmonary lymph nodeMucoid impactionHematomaAmyloidosisNormal confluence of pulmonary veinsMimics of SPNNipple shadowCutaneous lesion(e.g.,wart,mole)Rib fracture or other bone lesion loculated pleural effusionHamartomaBronchogenic carcinomaBronchogenic carcinomaGranulomachest 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 administrationMalignant SPNAge at diagnosis:55-60 years(range 40-80 years);M:F=1.4:1asymptomatic(10-50%)usually with peripheral tumorssymptoms of central tumors:cough(75%),wheezing,pneumoniahemoptysis(50%),dysphagia(2%)symptoms of peripheral tumors:pleuritic/local chest pain,dyspnea,coughPancoast syndrome,superior vena cava syndromehoarsenesssymptoms of metastatic disease(CNS,bone,liver,adrenal gland)paraneoplastic syndromes:cachexia of malignancyclubbing+hypertrophic osteoarthropathynonbacterial thrombotic endocarditismigratory thrombophlebitisectopic hormone production:hypercalcemia,syndrome of inappropriate secretion of antidiuretic hormone,Cushing syndrome,gynecomastia,acromegalyCigarette smoking(squamous cell carcinoma+small cell carcinoma)鈥搑elated to number of cigarettes smoked,depth of inhalation,age at which smoking began85%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 yearIndustrial exposure:asbestos,uranium,arsenic,chlormethyl etherConcomitant disease:chronic pulmonary scar+pulmonary fibrosisScar carcinoma45%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%)Adenocarcinoma(50%)Most common cell type seen in women+nonsmokersIntermediate 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 bullaesolitary peripheral subpleural mass(52%)/alveolar infiltrate/multiple nodulesmay invade pleura+grow circumferentially around lung mimicking malignant mesotheliomaupper 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 pleuraAdenocarcinoma Presenting as Solitary Pulmonary Nodule.A.Cone-down view of posteroanterior radiograph shows nodule in the right mid-lung(arrow).B.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 massSquamous cell carcinoma(30-35%)Strongly associated with cigarette smokingCentral location within main/lobar/segmental bronchus(2/3)large central mass&cavitationdistal atelectasis&bulging fissure(due to mass)postobstructive pneumoniaAll 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 wallSquamous cell carcinoma is the most common cell type to cause Pancoast tumorCentral lung cancerSquamous Cell Carcinoma.A.Posteroanterior chest film in a 58-year-old male smoker with hemoptysis shows a left hilar mass with left upper lobe atelectasis.B.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 CarcinomaSmall cell undifferentiated carcinoma(15%)Strongly associated with cigarette smokingRapid growth+high metastatic potential typically large hilar/perihilar mass often associated with mediastinal widening(from adenopathy)extensive necrosis+hemorrhagesmall lung lesion(rare)Large undifferentiated cell carcinoma(6 cm(50%)large area of necrosispleural involvementlarge bronchus involved in central lesion(50%)Large-cell bronchogenic carcinomasmall-cell bronchogenic carcinomathe 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 biopsyPure GGO（Ground-glass Opacity）Early stage98,6,1712*8mm,Lobular resection,8 yrs aliveLung cancer:solid nodules