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Imaging pattern of respiratory disease. Liu Lin Xiang 刘林祥 Radiology school 6222136, lxliu@tsmc.edu.cn. Obstructive change of bronchiel emphysema Atelectasis Pleural abnormalities Pleural effusion pneumothorax Pleural thickening. Lung disease Consolidation Fibrosis Calcification
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Imaging pattern of respiratory disease Liu Lin Xiang 刘林祥 Radiology school 6222136, lxliu@tsmc.edu.cn
Obstructive change of bronchiel emphysema Atelectasis Pleural abnormalities Pleural effusion pneumothorax Pleural thickening Lung disease Consolidation Fibrosis Calcification Nodule and mass Cavity and Interstitial changes Imaging pattern
Chronic diffuse obstructive emphysema • Increased translucency of both lungs • Lung marking scattered, thined • normal domed diagphragms are flattened • Retrosternal space is increased on the lateral film • Heart tends to be elongated, narrow and central in position
CT findings of emphysema • Centrilobular emphysema • Panlobular emphysema • Paraseptal emphysema
Centrilobular emphysema • Result from cigarette smoking • Mainly involves the upper lung zones • Predominantly affects the central portion of acini (centriacinar emphysema) • Multiple, small areas of emphysema scattered throughout the lung • More severe, areas of destruction confluent
Panlobular emphysema • Involves all the components of the acinus uniformly, entire lobule • On HRCT, widespread areas of abnormally low attenuation expressing the uniform destruction of the pulmonary lobule • Pulmonary vessels appear fewer and smaller than normal • Severe in the lower lobes • Mild and moderately severe emphysema can be subtle and difficult to detect radiologically
Paraseptal emphysema • Often marginated by interlobular septa and is more striking in a subpleural location • HRCT, areas of low attenuation visible in the subpleural areas, along the peripheral or mediastinal pleura, mainly in the upper lobe, and along the fissures • Often have very thin but visible walls corresponding to interlobular septa thickened by associated fibrosis • CT may early detect the apical subpleural emphysematous spaces in spontaneous pneumothorax • Subpleural bullae are frequently associated
Obstructive atelectasis • Involve one or more lobes or segments • Air within the collapsed or atelectatic lung parenchyma can be entirely resorbed and partially replaced by fluid or fibrosis • Appears radiologically as an opacification • Mostly bronchiel obstruction • Also called lobar collapse • Loss of lung volume with reduced inflation of a segment or a lobe
Lobar atelectasis • Opacity of the lobe, loss of volume of the lobe • Direct signs of loss of volume: displacement of fissures, pulmonary blood vessels and major bronchi, and shift of other structures to compensate for the loss of volume • Tumor mass in parahilar produce a bulge in the contour of the collapsed lobe (golden S sign) • Compensatory overinflation of the adjacent lobe results in spreading out of the vessels within that lobe • Mediastinal shift accompanying lobar atelectasis • Displacement of the anterior mediastinal fat, and trachea • Hemidiaphragm elevation is another sign of compensatory shift • Inward displacement of the chest wall causing narrowing of the spaces between the affected ribs, seen in severe atelectatic lobe
Right upper lobe atelectasis • Right hilum be elevated • Minor fissures are displaced upwards and rotated towards the mediastinum • Collapsed lobe packs against mediastinum and apex • Compensatory overinflation of the right lower lobe, especially superior segment
Right upper lobe atelectasis • Right hilum be elevated • minor fissures are displaced upwards • Collapsed lobe packs against mediastinum and apex • Compensatory overinflation of the right lower lobe
Right middle lobe atelectasis • The collapsed lobe is easily and reliably recognized on the lateral chest radiograph • The major and minor fissures move towards one another and the collapsed lobe resembles a curved, elongated wedge • The right hilum is not displaced • The right hemidiaphragm and mediastinum are in a normal position
Right lower lobe atelectasis • The atelectatic lobe is seen as a triangular retrocardiac opacity limited laterally by the displaced major fissure • Right hilum is displaced downwards • The vascular pedicle visible in the normal location for the hilum corresponds to the anterior trunk of the right pulmonary artery
Combined right lower and middle lobe colapse • Obstruction to the intermediate bronchus • Major and minor fissures are both displaced downward and backward creating an opacity that obliterates the dome of the right hemidiaphragm • Right hilum, mainstem bronchus and upper lobar bronchus are displaced downward • Anterior mediastinal fat is markedly shifted to the right side
Left upper lobe atelectasis • Hilum is displaced upwards and the major fissure forwards • Lobe retains much of its original contact with the anterior chest wall • Displacement of the anterior mediastinum fat and displacement of the trachea towards the left are commonly present • Left hemidiaphragm is moderately elevated
Left lower lobe atelectasis • Major fissures are displaced downward and backward creating an opacity that obliterates the dome of the right hemidiaphragm • left hilum are displaced downward behide the shadow the heart • Mediastinum is markedly shifted to left side
Consolidation • Replacement of alveolar air by fluid, cells, tissue, or other material • Homogeneous increase in lung attenuation with obscuration of underlying pulmonary vessels • Air bronchogram may be seen
