chest surgical pathology &x rays

Surgical Pathology & X-rays Surgical Pathology & X-rays for Medical Studentsfor Medical Students

Chest SurgeryChest Surgery20082008

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•Normal Chest X-ray

•Pneumothorax

•Pleural Effusion

•Hydro-pnemothorax

•Complete Lung Collapse

•Opacified Hemithorax

•Bronchogenic Carcinoma

•Cavitary Lung Lesions

•Lung Abscess

•Fibro-caseous TB

•Pulmonary Metastasis

•Aortic Arch Aneurysm

Index

Normal Normal Chest Chest X rayX ray

Index

SVCSVC

RARA

PAPA

PAPA

LVLV

AAAA

CoPhSCoPhSIndex

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PneumothoraxPneumothorax

Index

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Lt. side pneumothoraxLt. side pneumothorax

Index

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Rt. side pneumothoraxRt. side pneumothorax

•Marked difference in X-ray transparency (density) between the left and right thoracic cavities. •Complete radio-translucency (manifest as greater film density or darker lung field on the image) of the Rt. thorax with absence of vascular markings

Normal for comparison

Index

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Lt. tension pneumothoraxLt. tension pneumothorax NoteNote:•The marked density difference between the left and right thoracic cavities. •The complete translucency on the left with absence of vascular markings•Shifting of the mediastinum

•What appears as a left hilar mass is in fact the collapsed left lung retracted into a small central density

NormalIndex

Lt. Tension pneumothorax

Index

Lt. side tension Lt. side tension pneumothoraxpneumothorax

Index

Basis of Diagnosis:

•Hyperresonance of affected hemithorax •Decreased or absence of breath sounds•Tracheal deviation to the other side of pneumothorax•Respiratory distress•Hypotension•Tachypnea•Hypoxia•Distended neck veins (unless the patient is hypovolemic)

Rt. side tension Rt. side tension pneumothorax pneumothorax

in an infantin an infant

Index

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Tension PneumothoraxTension Pneumothorax

Index

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Emergency treatment of tension pneumothoraxEmergency treatment of tension pneumothorax

Needle decompression (thoracostomy) with large-bore needle in the second intercostal space in the midclavicular line to convert the tension pneumothorax into a simple pneumothorax, then prepare for intercostal tube insertionThis simple procedure can save the patient’s life

Index

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Severe Rt. tension Severe Rt. tension pneumothoraxpneumothorax

Mechanism: The air enters to the pleural space and cannot escapeThe intrapleural pressure increases and the lung becomes collapsed with secondary shift of the mediastinal contents to the opposite side.

After treatment Index

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Pleural EffusionPleural Effusion

Index

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Rt. pleural effusionRt. pleural effusionoFlat opacified line at the right hemidiaphragm with obliteration of the costo-phrenic angle

oThe right middle lobe fissure is more sharply visible which tends to occur when (there is fluid in that fissure)

Index

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Lt. pleural effusionLt. pleural effusionoThe left base is showing a curved density in place of the normally convex diaphragm. oThat curvature is characteristic of a pleural effusion

Index

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Lt. pleural effusionLt. pleural effusion

Index

Lt. massive Lt. massive pleural effusionpleural effusion

Index

Massive effusions usually have an accompanying mediastinal shift to the

contralateral side

Normal

If a massive effusion does not shift the mediastinum, suspect malignant effusion

where the mediastinum is fixed.

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Massive Lt. pleural effusionMassive Lt. pleural effusion

Index

The right hemithorax is

opaqueThere is a shift of the heart and trachea away from the side of opacification

Massive Right Pleural EffusionMassive Right Pleural Effusion

Index

Rt. lung Rt. lung effusioneffusion

If an effusion (whatever the fluid is) fills the entire hemithorax It acts like a mass Pushing the heart and trachea away from the side of opacification

Index

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Hydro-Hydro-pneumothoraxpneumothorax

Index

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Rt. hydro-Rt. hydro-pneumothoraxpneumothorax

Hydropneumothorax in three different

views:

The PA, lateral, and right decubetus

reveal a horizontal air and fluid level.

PA Lateral

Rt. decubetus

Index

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Lt. Massive hydro-pneumothoraxLt. Massive hydro-pneumothorax

Index

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Lung CollapseLung Collapse

Index

Left Plural Tap was Left Plural Tap was NEGATIVENEGATIVE

Complete Lt. Lung CollapseComplete Lt. Lung Collapse

For comparison

Normal

Massive pleural effusion

Index

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Complete Lt. Lung CollapseComplete Lt. Lung Collapseo40-year-old woman with tuberculous bronchial stricture oChest radiograph shows complete collapse of left lung and deviation (arrows) of trachea to left lung

Index

There is a shift of heart and hemidiaphragm toward side of opacification(toward side of volume loss)

Lt. Lung Lt. Lung CollapseCollapse

IndexNormal

30

Compare

Rt. lung Rt. lung effusioneffusion

Lt. lung Lt. lung collapsecollapse

Index

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Compare

Lt. tension Lt. tension pnemothoraxpnemothorax

Lt. lung Lt. lung collapsecollapse

Index

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Compare

Rt. pleural effusionRt. pleural effusion Lt. lung collapseLt. lung collapse

Index

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Massive Massive PneumoniaPneumonia

Index

Lt. lung Lt. lung pneumoniapneumonia

The hemithorax is opaque and there is no shift of the heart

or trachea

Index

The left hemithorax is opaque

There is no shift of the heart or trachea

Pneumonia of the Pneumonia of the Left upper lobeLeft upper lobe

The opacified hemithorax contains air bronchograms

Index

Lt. lung collapse Rt. lung effusion

Lt. lung pneumonia Lt. neumonectomy

Causes of an

Opacified Hemithorax

Index

The arrow shows

mediastinal shift

No

Which is this?

Atelectasis

Pneumonia

Effusion

Index

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Bronchogenic Bronchogenic CarcinomaCarcinoma

Index

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Bronchogenic Bronchogenic CarcinomaCarcinoma

Fungating, hard solid white mass arising from the bronchial lining invading into the left bronchus and surrounding tissues.This is the lung of a 74-year-old man who first presents with cough, chest pain, wheezing, hemoptysis and progressive dyspnea

Can you relate his symptoms to the pathology seen?

Index

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Cough: infection distal to airway blocked by tumor.Hemoptysis: ulceration of tumor in bronchus.Dyspnoea: local extension of tumor.Chest pain: involvement of pleura and chest wall.Wheeze: narrowing of airway.

Index

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72-year-old man with bronchogenic carcinoma : Bone scintigraphy study shows multiple sites of increased uptake in left tibia, fibula and foot (metastasis)

Index

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oA large, well-defined mass in the right upper lobe

oExtensive emphysematous change

Lung CarcinomaLung Carcinoma

Index

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Squamous cell carcinomaA portion of the tumor demonstrates central cavitation, probably because the tumor outgrew its blood supply

Index

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Cavitary Lung LesionCavitary Lung LesionoThe air-fluid level indicates communication with the airway - hence sputum is likely to be helpful in diagnosis.oThe appearance of The appearance of the lesion could be a the lesion could be a carcinoma or an carcinoma or an abscess.abscess.o Sputum cytology was squamous cell bronchogenic carcinoma. oCavitation is a typical morphologic feature of this form of lung cancer.

Index

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Bronchogenic carcinoma

Cavitating staphylococcal pneumonia Note left lower lobe

consolidation with large cavity and air-fluid level

Cavitary Lung LesionsCavitary Lung Lesions

Fibro-caseous cavitary TB

Index

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Fibro-caseous TB of both superior Fibro-caseous TB of both superior lobes with cavitations on the Rt. sidelobes with cavitations on the Rt. side

Index

Multiple Multiple Pulmonary Pulmonary

secondariessecondaries

Index

The mediastinal shadow is dominated by the dilation of the aorta.

Better definition of the aortic anatomy is achieved with the CT scan Index

Thoracic aortic

aneurysm

Pulmonary T.B.

Index

chest surgical pathology &x rays

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