Respiratory SystemRespiratory System

RT 91 RT 91

Chapter 3Chapter 3

Normal Two View CXR

MediastinumMediastinum

Anatomy – Heart, Hilar region, Anatomy – Heart, Hilar region, Thyroid &Thymus glands, Nervous & Thyroid &Thymus glands, Nervous & Lymphatic tissues.Lymphatic tissues.

Inspiration vs. Expiration

Elevated diaphram

Elevated diaphram

What do you think?

Dexatracardia

True or False?Mr. Parkers CXR?

Breast Implants

RadiographyRadiography

Correct exposure factors selection is Correct exposure factors selection is criticalcritical

Radiologists rely heavily on Radiologists rely heavily on consistent exposure factors for serial consistent exposure factors for serial portable radiographs portable radiographs Recording technique selectionRecording technique selection

RadiographyRadiography

For CXR maintaining kVp and For CXR maintaining kVp and changing the mAs is the general rulechanging the mAs is the general rule

AEC AEC A complete patient hx is very importantA complete patient hx is very important

CR/DRCR/DR High kVp High kVp

Technique ConsiderationsTechnique Considerations

PathologyPathology Overlapping StructuresOverlapping Structures

Prior ExaminationsPrior Examinations

Lungs/Bony Structures/Line Lungs/Bony Structures/Line PlacementPlacement

CR

Chest PositioningChest Positioning

PA/Lt LatPA/Lt Lat

APAP 72 inches72 inches Upright or Upright or

Supine Supine

AP or PA AP or PA DecubitusDecubitus

Oblique Oblique ProjectionsProjections

Lordotic Lordotic ProjectionsProjections

Incorrect line placement

Correct Line Placement

Reversed image (line placement)

Congenital Congenital DisordersDisorders

Cystic FibrosisCystic Fibrosis

An accumulation of excessively thick An accumulation of excessively thick mucous and abnormal secretion of mucous and abnormal secretion of sweat and salivasweat and saliva

Cystic Fibrosis

Cystic Fibrosisneonate

Hyaline Membrane Disease Hyaline Membrane Disease

RDS – Respiratory distress syndromeRDS – Respiratory distress syndrome Leading cause of infant deathLeading cause of infant death Premature birth before 26 weeksPremature birth before 26 weeks

““ground glass” look on the radiographground glass” look on the radiograph

RDS

Hyaline Membrane Disease

Sail SignSail Sign

Enlarged thymus in an Enlarged thymus in an infantinfant

Sail-like appearanceSail-like appearance

Sail Sign

Congenital hiatal hernia

Hiatal HerniaHiatal Hernia

Any structure through Any structure through the hiatus of the the hiatus of the

diaphramdiaphram

Cervical rib

Depressed sternum

ACUTE DISORDERSACUTE DISORDERS

CroupCroup

Soft tissue neckSoft tissue neck Croup is a syndrome that is produced Croup is a syndrome that is produced

by an acute infection of the lower air by an acute infection of the lower air passages and is usually seen in passages and is usually seen in children below age of 3 children below age of 3

Bark like coughBark like cough Thumb signThumb sign

Croup

Croup

CHFCHF

Enlarged heartEnlarged heart

PA chest – Distance?PA chest – Distance?

CHF

CHF

CHF

AtelectasisAtelectasis

Collapse of all or part of the lung due Collapse of all or part of the lung due to obstruction of bronchusto obstruction of bronchus Lung compression/consolidationLung compression/consolidation Air, fluid, tumors, enlarged lymph Air, fluid, tumors, enlarged lymph

nodes, ET tube below carinanodes, ET tube below carina

atelectasis

• caused by the obstructive effects of carcinoma of the bronchus supplying the upper lobe of the right lung.

atelectasis

Plate-like atelectasis

Plate-like atelectasis

Pleural EffusionPleural Effusion

Fluid within pleural spaceFluid within pleural space

Response to inflammationResponse to inflammation Infection, TraumaInfection, Trauma

bilateral pleural effusions

pleural effusions

pleural fluid layering

Lung Collapse

PneumoniaPneumonia

Acute infection of lung parenchymaAcute infection of lung parenchyma

Impairs air exchangeImpairs air exchange

pneumonia infiltrates

pneumonia infiltrates

streptococcal pneumonia

aspiration pneumonia

Aspiration of BaWhat else do we see?

Interlobular pneumonia

Pneumonia vs. Effusion

Pneumonia & Effusion

PneumothoraxPneumothorax

Collapse of lung, air in the chest Collapse of lung, air in the chest cavitycavity Change in interthoracic pressureChange in interthoracic pressure

Radiographical importanceRadiographical importance Order: 2V CXR Diag: Post Order: 2V CXR Diag: Post

BX/PneumoBX/Pneumo

Pneumothorax

Pneumothorax

Pneumothorax

Free air in the abdomen

Hemopneumothorax

Lobectomy

Thorocotomy for TB

Clavicle & Rib FX

Subcutaneous emphysema

Subcutaneous emphysema

Pulmonary Pulmonary Embolism/InfarctionEmbolism/Infarction

Acute onset of chest painAcute onset of chest pain

Lung Abscess/EmpyemaLung Abscess/Empyema

Pus formed in a cavityPus formed in a cavity

Disintegration of tissueDisintegration of tissue

Empyema

CHRONIC DISORDERSCHRONIC DISORDERS

COPDCOPD

A group of disorders that cause A group of disorders that cause chronic airway obstruction. chronic airway obstruction.

Chronic, inflammation process Chronic, inflammation process involving the lungsinvolving the lungs

Ex: Chronic bronchitis, emphysema, Ex: Chronic bronchitis, emphysema, asthma & bronchiectasis. asthma & bronchiectasis.

Asthma

Asthma

Asthma

pulmonary emphysema

• Blunting of the costophrenic angles.

• Barrel chest

• Trapped air

emphysema

bronchiectasis

bronchiectasis

Tuberculosis

TB

TB

Cavitatory Pulmonary TB

Lordotic projection for TB

Asbestosis Plaques

Asbestosis Plaques

PNEUMOCONIOSIS

PNEUMOCONIOSIS

Lung CancerLung Cancer

Bronchogenic Carcinoma is the most Bronchogenic Carcinoma is the most common fatal primary malignancy in common fatal primary malignancy in the United States.the United States.

Pulmonary metastases are much Pulmonary metastases are much more common than primary lung more common than primary lung neoplasm. neoplasm.

MediastinumMediastinum

Lymphoma Lymphoma

Anatomy – Heart, Hilar region, Anatomy – Heart, Hilar region, Thyroid &Thymus glands, Thyroid &Thymus glands, Nervous & Lymphatic tissues.Nervous & Lymphatic tissues.

Bronchogenic carcinoma right hilar mass

Mediastinum Adenopathy

Adenopathy

primary

primary

Pulmonary metastases

• uterine cancer

• “cotton ball” appearance

Mets

calcified nodes

Calcified Lymph nodes

Calcified hilar nodes

Lung cancer

Hiatal Hernia

Chest hernia

Coin in Esophagus

Marbles in Esoph.