Download - Radiology of Chest 4
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RADIOLOGY OF CHEST
PLEURAL EFFUSION
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PLEURAL EFFUSION
This is the presence of fluid in pleural
cavity.
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TYPES OF PLEURAL FLUID:
Transudate.
Exudate.
Sanguinous. (Blood) Empyema.
Chylous.
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CAUSES OF PLEURAL
EFFUSION:
TRANSUDATE:
Heart failure
Renal failure
Hepatic failure
Hypoproteinemia
Meigs syndrome
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CAUSES OF PLEURAL
EFFUSION:
EXUDATE:
Inflammatory
Bacterial pneumonia
Viral
Tuberculosis
Pancreatitis
Neoplastic Pulmonary infraction
Subpherenic / liver abscess
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CAUSES OF PLEURAL
EFFUSION:
SANGUINOUS (Haemothorax)
Traumatic
Infection
Neoplastic
Bleeding disorders
Infarction
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CAUSES OF PLEURAL
EFFUSION:
EMPYEMA (Pyothorax).
Pneumonia
Liver/subpherenic/lung abscess
Tuberculosis
CHYLOUS (Chylothorax)Traumatic rupture/Obstruction of
thoracic duct
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RADIOLOGIC SIGNS OF
PLEURAL EFFUSION
FREE FLUID
Homogenous basal opacity in erect film
starting in costopherenic angle with miniscus,
curved upper margin extending along lateralchest wall, may extend into a fissure.
Change in appearance as posture changes
Transudate, exudate, Haemorrhagic or chylouseffusion requires aspiration for distinction.
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RADIOLOGIC SIGNS OF
PLEURAL EFFUSION
Exudates, haemorrhagic effusion or empyema can
lead to pleural thickening, altering diaphragmatic
contour. Can later calcify esp. in tuberculosis
Lateral decubitus view is needed for distinction
between small effusion and pleural thickening. But
ultrasound is more sensitive.
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RADIOLOGIC SIGNS OF
PLEURAL EFFUSION
More than 200 cc of fluid is needed to obscurelateral costophernic angle.
Massive effusion cause homogeneously opaquehemithorax with shifting of mediastinum towardsopposite side. Diaphragm can be depressed oreven inverted.
HYDROPNEUMOTHORAX provides air fluid
level.
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LOCAULATED PLEURAL
EFFUSION
IN-FISSURES: - In oblique or horizontal fissure
Ovoid in shape
Usually in heart failure Disappears as fluid state is corrected
(vanishing tumour).
SUBPULMONARY. LOCULATED EFFUSION ALONG
CHEST WALL.
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UprightMeniscus
SupineUnilateralincreased density
DecubitusEffusion
layered on downside
Pleural Effusion
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Pleural Effusion
Supine patient
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Pleural Effusion
Semiupright..Lung base opacityfades superiorly
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Pleural Effusion
63-year-old man recovering from
congestive heart failureEffusion
loculated in fissure
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Massive Pleural Effusion
or
Total Lung Atelectasis
Massive pleural effusion
Heart and
mediastinum
shifted away fromwhited out hemithorax
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Massive Pleural Effusion
or
Total
Lung Atelectasis
Total Atelectasis
Heart and mediastinum
shifted towardwhited out hemithorax
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PNEUMOTHORAX
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PNEUMOTHORAX
It is the air in the pleural space with
relaxation of lung tissue.
RADIOLOGICALLY
There is white line of lung margin and no
pulmonary marking beyond.
More obvious on expiratory film esp. whenit is small.
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TYPES OF PNEUMOTHORAX
Simple/Spontaneous pneumothorax.
Open pneumothorax. Tension pneumothorax.
Bronchopleural fistula.
Hydropneumothorax.
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CAUSES OF PNEUMOTHORAX
IDIOPATHIC
Most common type, usually in tall thin males
Rupture of small bleb/bulla
TRAUMATIC Rib fracture esp 1st or 2nd --- associated with haemothorax, surgical emphysema.
Surgical --- CVP line complication.
Accidental --- stab
Ventilator pressure
Pleural aspiration
Perforated oesophagus
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CAUSES OF PNEUMOTHORAX
MEDIASTINAL/SUBCUTANEUS EMPHYSEMA
Status-asthmaticus
Oesophageal tear.
RUPTURED BULLAE
In COPD
CONNECTIVE TISSUE DISORDER
Rheumatoid arthritis
NECROTIC TUMOUR
Ca. Bronchus
Metastasis esp. Osteosarcoma
HYALINE MEMBRANE DISEASE
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Trace the lung vascular
markings out to the border of
the rib cage. When the lung
markings stop short of the rib
cage and there is increased
radiolucency in the pleuralspace, the patient has a
pneumothorax.
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Tension Pneumothorax
PNEUMOTHORAX
**
Examine patient
* Look for deviated heart and
mediastinum, depressed
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Supine Patient
Medial
Pneumothorax
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Is there a pneumothorax or isnt there?
Order a Lateral Decubitus chest radiograph
With the side of the chest in question as the upside
Possible left pneumothorax get right lateral
decubitus chest
Look for displaced visceral pleura along upside
lateral chest wall
Order Upright Expiratory chest radiograph
Look for pneumothorax at lung apex
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Pneumopericardium
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