- •Chest Imaging
- •Foreword
- •Preface
- •Educational Support and Funding
- •Acknowledgments
- •Contents
- •Fundamentals > Chest Primer Presentation
- •Chest X-Ray Interpretation Self-Study Instructions
- •Using the RoboChest Website
- •Decision Tree Algorithms to Help Solidify Concepts
- •References
- •Comprehensive Review of Search Patterns
- •Search Pattern Mnemonic
- •Interpretive Approach to CXR
- •Applying the Mnemonic to the Search Pattern
- •Chest Primer Presentation
- •References
- •Introduction and Terminology
- •Chest Imaging Terminology
- •Mach Effect on CXR
- •Trachea and Lungs on CXR
- •Mediastinal Anatomy on CXR
- •The Hilum (Plural: Hila)
- •Pulmonary Arteries and Veins
- •Normal Lung Markings
- •Vessel Size
- •Quiz Yourself: Mediastinum Lines, Edges
- •Shoulder Anatomy
- •Reference
- •Abnormal Lung Parenchyma
- •Mass
- •Mass Considerations
- •Size
- •Mass Characteristics
- •Malignancy
- •Case 4.1
- •Metastatic
- •Case 4.2
- •Bronchial Carcinoid
- •Radiological Signs
- •Case 4.3
- •Granulomatous Disease
- •Infectious Granulomatous Disease
- •Case 4.4
- •Non-infectious Granulomatous Disease
- •Benign Neoplasm
- •Hamartoma
- •Case 4.6
- •Congenital Abnormality
- •Pulmonary Arteriovenous Malformations
- •Case 4.7
- •Consolidation
- •Consolidative Radiological Findings/Distribution
- •Consolidative Model
- •Blood (Hemorrhage)
- •Case 4.8
- •Pus (Exudate)
- •Case 4.9
- •Case 4.10
- •Water (Transudate)
- •Pulmonary Edema
- •Case 4.11
- •Case 4.12
- •Protein (Secretions)
- •Case 4.13 (see Figs. 4.38 and 4.39)
- •Cells (Malignancy)
- •Interstitial
- •Radiological Signs
- •Linear Form: Lines
- •Case 4.14
- •Nodular Form: Dots
- •Case 4.15
- •Reticulo-Nodular Form
- •Pneumoconiosis
- •Case 4.16
- •Case 4.17
- •Destructive Fibrotic Lung
- •Case 4.18
- •Langerhans Cell Histiocytosis
- •Case 4.19
- •Vascular Pattern
- •Normal Pulmonary Vascular Anatomic Review
- •Radiological Signs in the Vascular Pattern
- •Mechanism
- •Vascular Examples
- •Pulmonary Arterial Hypertension (PAH)
- •Case 4.20
- •Pulmonary Venous Congestion
- •Pulmonary Venous Congestion: Edema
- •Emphysema
- •Airway (Bronchial) Patterns
- •Complete Obstruction
- •Lobar Atelectasis (Collapse)
- •Signs
- •Lobar Atelectasis Patterns
- •Complete Obstruction: Case Study
- •Partial Obstruction
- •Radiological Signs
- •Bronchial Wall Thickening
- •Bronchial Wall Thickening Causes
- •Bronchial Wall Thickening Model
- •Bronchiolar
- •Case 4.21
- •References
- •Pleural Effusion
- •Case 5.1
- •Technique and Positioning Revisited
- •Case 5.2
- •Comparison of Effusions over Time
- •Loculated Fluid/Pseudotumor
- •Case 5.3
- •Case 5.4
- •Thickening
- •Pneumothorax
- •Fluid and Air
- •Analogous Model
- •References
- •Anterior Mediastinal Mass
- •Case 6.1
- •Middle Mediastinal Mass
- •Posterior Mediastinal Mass
- •Case 6.2
- •Mediastinal Enlargement
- •Case 6.3
- •Reference
- •Case 7.1
- •Lines and Tubes
- •References
- •Appendix
- •Appendix 1: Glossary and Abbreviations
- •Appendix 2: Sources and Additional References
- •Text Sources
- •Image Sources
- •Additional References
- •Chest Imaging References
- •Chest Imaging Online References
- •Index
Airway (Bronchial) Patterns |
93 |
Fig. 4.70 Drawings depict the patterns of atelectasis (by Sofia Echelmeyer)
tion of the right lower lobe with obliteration of the right hemidiaphragm and the right costophrenic angle. Also, the right heart border is becoming obscured. The CXR taken several hours later displays complete collapse of the right lung.
Pattern: Airway, complete obstruction.
Differential Diagnosis: RLL atelectasis from obstruction from blood, bullet fragments, or tooth (blood most likely since metal or calcification is not seen in the area of the bronchus). A blood clot was discovered and removed at urgent bronchoscopy.
Aspiration, potentially developing into pneumonia; however, post bronchoscopy CXR shows clearing after removal of blood.
Partial Obstruction
A good example of partial airway obstruction is bronchiolitis obliterans (BO) where air-trapping can be seen on expiration CT. This condition is uncommon; however, this can be seen post infection, especially in children, or post transplant. See Fig. 4.72 for inspiration/expiration HRCT demonstrating air-trapping in the expiration.
94
Fig. 4.71a CT scout of head, neck, and chest showing a GSW to the mandible with the bullet in the trachea. Note developing RLL atelectasis
4 Abnormal Lung Patterns
Mandible Fx
Frag
RLL
Atelectasis
Fig. 4.71b CXR obtained 1 h after GSW showing
decreased visualization of the right hemidiaphragm with associated increasing density RLL
Airway (Bronchial) Patterns |
95 |
Fig. 4.71c CXR obtained in ICU 3 h after wound showing complete whiteout of right hemithorax with truncation of right mainstem bronchus. Note also shift in the trachea to the right. This is compatible with right lung collapse due to right mainstem bronchus obstruction
Fig. 4.71d CXR post bronchoscopy/removal of blood clot. Note the return of aeration to the right lung
Radiological Signs
Can also have increased lung volume (chronic air-trapping) overall.
Findings: Generalized hyperaeration, with additional localized air collections. Pattern: Airway, partial obstruction.
Differential Diagnosis
•Bronchiolitis obliterans
•COPD
•Centrilobular emphysema
•Pneumatoceles