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Radiology of Respiratory System

Weizhong Cheng Dept. Radiology, Zhongshan Hospital Institute of Medical Imaging, Shanghai. Radiology of Respiratory System. Basics Best exam results Appreciate the role radiology plays ? Instill an interest in radiology. Aims. Textbook Reference book Literature Internet Apps

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Radiology of Respiratory System

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  1. Weizhong Cheng Dept. Radiology, Zhongshan Hospital Institute of Medical Imaging, Shanghai Radiology of Respiratory System

  2. Basics Best exam results Appreciate the role radiology plays ? Instill an interest in radiology Aims

  3. Textbook Reference book Literature Internet Apps Teacher & classmate Before Class: Histology and Embryology Anatomy Pathology Internal Medicine Surgery Gynecology Pediatrics Neurology 。。。 Everything。。。U need to know

  4. X-ray CT MR DSA US Nuclear Medicine PET/CT Radionuclide ventilation perfusion imaging methods

  5. PA （posteroanterior) & Lateral More information Two views Standardized Distance Pt needs to be stable Portable Quick Anywhere One shot No standardization X-ray Techniques

  6. Portable PA

  7. P-A (relation of x-ray beam to patient) Techniques - Projection

  8. A-P Supine/Erect Techniques - Projection (continued)

  9. Lateral Techniques - Projection (continued)

  10. Lateral Decubitus Techniques - Projection (continued) • Oblique

  11. Type Orientation Rotation Inspiration/expiration Penetration Technical Details

  12. Rotation

  13. Rotation (continued)

  14. Penetration

  15. Inspiration/Expiration

  16. 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

  17. 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 Densities

  18. Anatomy

  19. Anatomy

  20. Bronchopulmonary Anatomy

  21. Cross-sectional Anatomy of Lung Segments （CT）

  22. Right upper lobe: Lobes

  23. Right middle lobe: Lobes (continued)

  24. Right lower lobe: Lobes (continued)

  25. Left lower lobe: Lobes (continued)

  26. Left upper lobe with Lingula: Lobes (continued)

  27. Lingula: Lobes (continued)

  28. Left upper lobe - upper division: Lobes (continued)

  29. Right border: Edge of (r) Atrium 3. Left border: (l) Ventricle + Atrium 4. Posterior border: Reft Ventricle 5. Anterior border: Right Ventricle Heart

  30. Heart (continued 。。。。)

  31. IT’S NOT MINE…. Heart

  32. Made of: 1. Pulmonary Art.+Veins 2. The Bronchi Left Hilum higher (max 1-2,5 cm) Identical: size, shape, density Hilum

  33. Hilum

  34. Ribs

  35. Apices Behind the heart Costophrenic angle (CPA) Below the diaphragm Soft tissues ( breast, surgical emphysema) Ribs & clavicle Vertebrae Review areas:

  36. Abnormals

  37. Darker areas radiolucent Pneumothorax Cysts/bulla Air bronchograms Lighter areas Opacities Atelectasis “infiltrates” Blood Pus Water Nodules or mass Lung findings

  38. Opacities • Lobar or not…. • Pneumonia • Pulmonary Edema • “fluffy,” diffuse, “bat wing” distribution • Hemorrhage • Can’t tell by x-ray, need bronch

  39. RML pneumonia Opacities

  40. Opacities RLL pneumonia

  41. RUL pneumonia

  42. LLL pneumonia

  43. Consolidation on CT

  44. Causes:1. Adenopathies (neoplasia, infection)2. Primary Tumor3. Vascular4. Sarcoidosis The Enlarged Hila

  45. Mass

  46. HilarLymphadenopathy - BL

  47. Multiple Masses Metas

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