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RADIOLOGYRADIOLOGY

OF THE RESPIRATORY SYSTEMOF THE RESPIRATORY SYSTEM

ADNAN MADNAN M

DEPART. OF RADIOLOGYDEPART. OF RADIOLOGY

MED. FAC. UNHASMED. FAC. UNHAS

LUTHFY ATTAMIMILUTHFY ATTAMIMI


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(= CHEST )

RADIOLOGY OF THE:

LUNG PARENCHYMA

PLEURA

DIAPHRAGMA

MEDIASTINUM (TUMORS)


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LUNG PARENCHYMA

PULMONARY LOBULE

PULMONARY ACINUS

Small Bronchiole

5 7 Terminal Bronchiole

Single Terminal Bronchiole

Respiratory Bronchioles

( air sacs in the walls )

ALVEOLI

Aveolar ducts


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ANATOMY


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INDIKASI PEMERISAAN FOTO TORAKS

BILA ADA KELAINAN / PENY. TRAKTUS RESP ;

A. BAWAAN, RADANG, TUMOR, TRAUMA

B. BATUK, BATUK DARAH, SESAK,SAKIT DADA,

d.


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RADIOLOGICAL METHODS OFRADIOLOGICAL METHODS OF

INVESTIGATION INVESTIGATION

!. PLAIN FILM / CHEST "#RAYSPLAIN FILM / CHEST "#RAYS

$.$. CT SCANCT SCAN

%.%. MRIMRI

&.&. ULTRASONOGRAPHY (USG)ULTRASONOGRAPHY (USG)'.'. NUCLEAR MEDICINENUCLEAR MEDICINE

.. ARTERIOGRAPHYARTERIOGRAPHY

.. MCS ( = MASS CHEST SURVEY )MCS ( = MASS CHEST SURVEY )*.*. TOMOGRAPHYTOMOGRAPHY

+.+. FLUOROSCOPYFLUOROSCOPY

!.!. BRONCHOGRAPHYBRONCHOGRAPHY


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C-0 1#234;5 67 68 0- 960 59:620370 d537605< 066

57 3>3057 :30570 ?50- :>967324 :26@9.

P-45


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CHEST "#RAYS VIEWS

POSTEROANTERIOR ( PA ) ROUTINE

LEFT / RIGHT LATERAL (LL/RL)

RIGHT / LEFT ANTERIOR OBLIUES (RAO/LAO)

RIGHT / LEFT LATERAL DECUBITUS (RLD/LLD)

TOP LORDOTIK


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POSTERO#ANTERIOR (PA) VIEW


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RIGHT / LEFT LATERAL DECUBITUS

RLD LLD

DBD/DHF


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TOP LORDOTIC VIEW


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MASS CHEST SURVEY (MCS)


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SYARAT#SYARAT FOTO THORA" PA @53 99>75737 ;

!. INSPIRASI CUKUP

D5382393 3737 0575 53.+ :602562

$. POSISI SIMETRIS

P2645 0>37 7 :-275


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ISTIA! "#$SITASISTIA! "#$SITAS

RADIOGRAFI

!. AIR DENSITY = HIPERLUSEN$. FAT DENSITY = RADIOLUSEN

%. WATER DENSITY = INTERMEDIATE

&. BONE DENSITY = RADIOPAK

'. METAL DENSITY = HIPERRADIOPAK


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>:57 AP (3702562:602562) :650567 0- 1#234 0>@ 5& 57


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is is a PA flm on the let compared with a AP supine flm on the right.

AP shows magnifcation o the heartand widening o the mediastinu

enever possible the patient should be imaged in an upright PA positio

AP views are less useul and should be reserved or very ill patients

who cannot stand erect.

PA ( POSTERO#ANTERIOR ) AP ( ANTERO#POSTERIOR )


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I7:5230567

T- :30570 -6>d @ 13957d 57 8> 57:5230567.

T- d53:-239 -6>d @ 86>7d 30 3@6>0 0-

68 0- *0- # !0- :602562 25@ 62 '0- # 0- 3702562 25@ 67 66d 57:5230567.


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A :30570 d 3d 46> 06 0- d53765 68 3 :65@ :7>96753.

H6?2, 0- :30570 -3d 037 3 :662 57:5230567.

O7 2:30 139 ?50- 59:26d 57:5230567, 0- 25-0 -320 @62d2 5 76293.


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76293 PA 859 0-30 5 >7d2:70230d 62:70230d PA 859

"#234 P70230567

Ad>30 :70230567 68 0- :30570 @4 23d5305675 36 2>52d 862 3 66d 859.


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NORMAL CHEST

PARENCHYME RADIOLUCENT

PLEURA INVISIBLE

HILAR LEFT RIGHT

DIAPHRAGM RIGHT LEFT

SINUS PHRENICOCOSTALIS


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T- 0- -3d6? 6255730 8269 0- -53 37d @2377 85d 32 76?7 3

>7 93257.

L>7 93257967324 32025 37d 57

3 ? 3 @237


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L>7 85d 3::32 d32 @ 68 352.

Ninety-nine percent of t he lung i !ir

T- :>967324 330>2 , 57020505>9 0 !J37d 5 0- 37 :30027.

H320, , 52 37d d53:-239 32 5>5d d7504.

V20@23, 027>9 37d 25@ 6@56>4


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NORMAL CHEST


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NORMAL CHEST LAT. VIEW


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M37585


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T-5 5 3 76293 PA 859 ?50-6>0 374 26030567.


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L6@ 37d F5>2

T- 80 593 -6? 0- 25-0 95762 85>2 ( A )37d

0- 5782562 @62d2 ( B )68 0- 9362 85>2@530234.

T- 25-0 593 -6? 0- >:2562 @62d2

68 0- 9362 85>2 (B) @530234.


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O7 0- 3023 5?, @60- >7 32 >:259:6d.

T-57 3@6>0 0-9 :32304,

0- 80 >7 -3 674 3 9362 85>2 3 -6?7.

T- 25-0 >7 ?5 -3 @60- 0- 9362 37d 95762 85>2.


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NORMAL CHEST RADIOGRAPHY

S%&T TISS'#

'$S

!#ART

SI$'S

!IA

#"IASTI$'

"IA&RAA * +#'RA

RIBS

E%AL&ATION :

N # INSPIRATION


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ADULT CHILD

N # INSPIRATION


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N # E"PIRATION


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NORMAL DD EMPHYSEMA THYMUS IN CHILD


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!.!. INFLAMMATORYINFLAMMATORY$.$. LUNG ABSCESSLUNG ABSCESS

%.%. ATELECTASISATELECTASIS

&.&. LUNG EDEMALUNG EDEMA

'.'. EMPHYSEMAEMPHYSEMA

.. CHRONIC BRONCHITISCHRONIC BRONCHITIS

.. BRONCHIECTASISBRONCHIECTASIS

*.*. RESPIRATORY DISTRESS OF THE NEW BORNRESPIRATORY DISTRESS OF THE NEW BORN(RDN)(RDN)

+. PNEUMOCONIOSIS+. PNEUMOCONIOSIS

!.!.LUNG TUMORSLUNG TUMORS

DISEASES OF THE LUNG PARENCHYMEDISEASES OF THE LUNG PARENCHYME


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TUBERCULOSIS (TBC)

A. PRIMARY TBCB. POST PRIMARY TBC

NON TBC / NON SPESIFIC

C. PNEUMONIA

D. BRONCHOPNEUMONIA

INFLAMMATORYINFLAMMATORY


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PRIMARY COMPLE" OF RANKE

'HE(T )-RAY( :

PRIMARY FOCUS ( = GHON )

LYMPHANGITIS

HILAR NODES OR CALCIFICATION

PRIMARY PULMONARY TBC


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PRIMARY PULMONARY TBC


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PRIMARY TBC


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GHON FOCUS RANKE COMPLE"


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PRIMARY TBC PNEUMONIA


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POSTPOST PRIMARY TBC

ACTIVE SIGNS

'HE(T )-RAY( :

PATCHIES

CONFLUENS OPACITIES

CLOUDY HAINESS

CAVITY CAVITIES


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POST PRIMARY TBC ( ADULT )

'A%ITY INHOMOGENEO&( O*A'ITY

TBC CAVITY AT LUL


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TBC CAVITY AT LUL

T>@265 L80 >::2 6@


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L80 >::2 6@ ::2 6@ @265


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L80 >::2 6@ @265

POST PRIMARY TBC


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POST PRIMARY TBC


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POST PRIMARY TBC UIESCENT

oFIBROSIS RETRACTION

oCALCIFICATIONS

INACTIVE (OLD) TBC


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INACTIVE (OLD) TBC

FIBROSIS CALCIFICATION


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OLD + INA'TI%E T,'

OLD + INA'TI%E T,'


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OLD + INA'TI%E T,'

*O(T *RIMARY T,' *NE&MONIA AT R&L


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*NE&MONIA AT R&L


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Pleural effusion

LUL cavity

Tuberculosis

TBC COMPLICATION MILIAR TBC


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M5324 T>@265


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I70205053 76d>

o U758629 5

o S-32:2 d

M5324 T>@265


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T>@265 S:57TBC COMPLICATION


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:

L6 68 570220@23 :3


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SPONDYLITIS TBC

PARA VERTEBRAL ABSCESS


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TB, T'A$ ,T S,A$ - TB,


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DESTROYED LUNG -27535


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RELATIVELY HOMOGENOUS CONSOLIDATION

CLOUDY , HAINESS LOBAR / SEGMENTALS .

SHARP BORDER

AIR BRONCHOGRAM SIGN (ABS / # )

SILHOUETE SIGN ( / # )

PNEUMONIAPNEUMONIA ( NON TB )

TENDENCY TO THE LOWER / MIDDLE LOBES

'ON(OLIDATION


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'ON(OLIDATION

C6765d30567 5 d857d 3 3 :26


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CONSOLIDATION OF THE LUNG PARENCHYME


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AIR BRONCHOGRAM SIGN ( ABS )

PNEUMONIA / HMD

LLL PNEUMONIA


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SILHOUETTE SIGN

LLL PNEUMONIA


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LLL PNEUMONIA


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D7504 57 0- :263 57 3023 5? A52 @2679

H357 57 0- 80 6?2 >7 85d

RUL PNEUMONIA


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R5-0 >::2 6@ 9

A52 @267


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D7504 57 25-0 >::2 >7 85dL6@32 d7504L6 68 300N6 -580 68 9d53057>9T2372 85>2 760 57585


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O7 25-0 760 0- 352 8269 365 32 2:3d30

2>057 57 5>5d d7504 06 RUL 57 C"R.

R6>7d P7>96753


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R6>7d d7504

S-6202 d6>@57 059

A52 @26773

$. T>@265

R6>7d P7>96753


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T-5 5 3


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PNEUMONIC ASPIRATION

RML PNEUMONIA


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RML PNEUMONIA

RIGHT PLEUROPNEUMONIA


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RIGHT PLEUROPNEUMONIA

PNEUMONIA

PLEURAL EFFUSION


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B26796753

P259324 388


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PATCHIES

IRREGULAR SCATTERED

BRONCHOPNEUMONIA


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C69:32567 68 @26796753 . 6@32 :7>96753

B26796753 L6@32 P7>96753


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L60 68 578


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LUNG ABSCESS

CAVITY WITH ONE CHAMBER

ORNODUL WITH

FLUID LEVEL,

THICK WALL

IRREGULAR BORDER

L>7 3@2305 (:> 862957)

57850230567 68 >7 0-30 32 >>34 d @4 S03:-,

37326@ 62 951d 578


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B53023

M>05:

F>5d

L>7 A@


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T-55d

LUNG ABSCESS


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LUNG ABSCESS

THI'. 0 IRREG&LAR 1ALL

LUNG ABSCESS


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LUNG ABSCESS

AIR FL&ID LE%EL


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LUL NODUL ABSCESS


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NOD&L 2 DAY( LATER

DD : 'AR' $'A%ITIE(


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*RIMARY (3&AMO&( 'ELL( 'AR'


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ATELECTASISATELECTASIS


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A00567 62 0>962.

I0 >3 04: 68 30


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6

'A&(ED ,Y :

ME'HANI(M( :

OBSTRUCTION / RESORPTION

COMPRESSION / PASSIVE / RELA"ATION

CONSTRICTION / CICATRIATION

ADHESIVE / MICROATELECTASIS

MECHANISME OF ATELECTASISMECHANISME OF ATELECTASIS


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DIRECT SIGN ATELECTASIS

DISPLACED SEPTA

LOSS OF AERATION / RADIOPACITY

ORLOCAL INCREASE IN DENSITY

VASCULAR BRONCHIAL SIGNS

CROWDING BRONCHIAL OR

VASCULAR MARKING


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INDIRECT SIGN ATELECTASIS

HEMIDIAPHRAGM ELEVATION

MEDIASTINUM DISPLACEMENT

HILAR DISPLACEMENT

COMPENSATORY OVERAERATION

NARROWING OF THE RIB CAGE


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+late li/e atelectasis

A0


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D7504 57 0- 25-0 >::2

>7 85d

T2372 85>2 :>d >:

R5-0 -5>9 :>d >:

S932 25-0 >7

S932 25-0 -950-6231

RUL ATELECTASIS

RUL ATELECTASIS


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RML A0


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V3> d7504 57 25-0 6?2 >7 85d (3960 3 76293 859).

D239305< RML 302

A0


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D7504 57 25-0 6?2 >7 85d

I7d505700 20357d

T2372 85>2 96d d6?7

R5-0 -5>9 96d d6?7


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LUL ATELECTASIS


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A07


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H69676> d7504

25-0 -950-6231

Md530573

-580 06 25-0

R5-0 -950-6231

932

R5-0 -320 37d

d53:-. 5-6>00

32 760 5d705853@

LEFT MASSIVE ATELECTASISHERNIA(I


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LEFT MASSIVE ATELECTASIS


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DD 6 AGENE(I( OF THE RIGHT 0 LEFT L&NG


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LUNG EDEMALUNG EDEMA


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CHEST "#RAYS

!. INTERSTITIAL

$. ALVEOLAR

KERLEYS A LINE

KERLEY B LINEPERIHILAR HAE

BATWING APPEARANCE

BUTTERFLY APPEARANCE

HAINESS

RAD$ OF THE INTER(TITIAL EDEMA


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KERLEYS B LINEKERLEY A LINE

EDEMA *AR& : RIGHT *ERIHILAR HA7E


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Diffuse alveolar infiltrates

Pulmonary edema


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Pulmonary edema

RA"I%%0 %& #"#A-

supine BUTTERFLY APPEARANCE


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p

,AR"I%#$I,

uremic lung

$%$ ,AR"I%#$I,


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CHEST "#RAYS EDEMA NODULES/HAINESSCHEST "#RAYS EDEMA NODULES/HAINESS

B 00 8 P 00


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B>00284 P30027

Indicative o1 2ilateral di11use alveolar disease

Also called 9d>324distri2ution

Also called B30 ?57 appearance

INFARK PARU COR PULMONALE VENOUS HYPERTENSION

( PULMONARY HT)


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LUNG EMPHYSEMALUNG EMPHYSEMA


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BONES # ANTERIOR BOWING OF THE STERNUM

# PROMINENT KYPHOSIS OF THE THORACIC SPINE

# INCREASED SPACING OF THE RIBS

DIAPHR # FLATTENING ( SIGN OF HYPERINFLATION)

LUNGS OVERINFLATION , OLIGEMIA , BULLAE

HEART TEAR DROP CONFIGURATIONQ

C"R ;


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NORMAL CHESTCOPD LUNG EMPHYSEMA


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COPDNORMAL DD EMPHYSEMA

E9:-493


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H4:2>7 85d

M>05: @@

P2695770 :>967324 32025

E9:-493


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H4:2>7 85d

AP d53902 5705: @@

R0260273 37d 57823


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LO'AL EM*HY(EMA

,&LLAE : AL%EOLAR EM*HY(EMA


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,&LLAE : AL%EOLAR EM*HY(EMA

GIANT ,&LLAE *NE&MATO'ELE


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LO,AR EM*HY(EMA


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PREOPERATIVE POST OPERATIVE

CHRONIC BRONCHITISCHRONIC BRONCHITIS

PROMINENT VASCULAR LUNGS MARKINGSPROMINENT VASCULAR LUNGS MARKINGS


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PROMINENT VASCULAR LUNGS MARKINGSPROMINENT VASCULAR LUNGS MARKINGS

( d5204


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6


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,RO'HIE'TA(I( : HONEY'OM, A**EARAN'E

B267


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ultiple 2ilateral 2asal

air 1luid levels

,ronchiect!i


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ultiple 2ilateral 2asal air 1luid levels


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HONEYCOMB LUNGS

Bronchiectasis

Cystic fibrosis


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Tram lines

Multiple cavities

,T S,A$ - BR%$,!I#,TASIS


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MILD DILATED ,RON'HI

M&LTI*LE AREA( of

'Y(TI' DILATATION ,RON'HI

RESPIRATORY DISTRESS OF THE NEW BORN (

R D N )


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o HMD HYALINE MEMBRANE DISEASESHMD HYALINE MEMBRANE DISEASES

o LACK OF SURFACTAN PRODUCTIONLACK OF SURFACTAN PRODUCTION

ALVEOLI COLLAPSALVEOLI COLLAPS

o PREMATUREPREMATURE HIPO"IAHIPO"IA

CAPILARYCAPILARY

BROKENBROKEN

HBHB MEMBRANE HYALINEMEMBRANE HYALINE

MUCOSE OF TBMUCOSE OF TB DUCTUS ALVEOLARDUCTUS ALVEOLAR

'HE(T )-RAY( : HMD


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AL%EOLI 'OLLA*( :AL%EOLI 'OLLA*( :

FINE GRANULAR HIPOAERATION

HI*ERAERATION T,HI*ERAERATION T, DA :DA :

AIR BRONCHOGRAM SIGN ( )

RDN HMD / IRDNRDN HMD / IRDN


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HIPOAERATION FINE GRANULARS

'HE(T )-RAY( : HMD


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AIR BRONCHOGRAM SIGN( = ABS )

HMD


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TRANSTIENT RESPIRATORY DISTRESSTRANSTIENT RESPIRATORY DISTRESS

OF THE NEW BORNOF THE NEW BORN


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TRDN

IMPAIRED

DELAYED

PROLONGED

FLUID CLEARANCE

EDEMA

'HE(T ) RAY( : TRDN


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'HE(T ) RAY( : TRDN

3TRDNTRDN EDEMAEDEMA

COARSEGRANULARNODULES

HYPOAERATION

PERIHILAR HAE

PLEURAL EFFUSION

'HE(T ) RAY( : TRDN


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T R D NT R D N


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T R D NT R D N

AGE ! HOUR

ALVEOLAR FLUID

PNEUMONIA

!$ HOURS LATER

CLEAR

PNEUMOCONIOSISPNEUMOCONIOSIS


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EGGSHELLS

A::3237


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SII,%SIS


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,T S,A$ - SII,%SIS


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,T S,A$ - SII,%SIS


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