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THORAX:LUNGS AND

PLEURA

Chris Chris SistromSistrom, MD, MPH, MD, MPHAssistant Professor, Diagnostic RadiologyAssistant Professor, Diagnostic RadiologyUniversity of Florida College of MedicineUniversity of Florida College of Medicine

BREAST

MAMMOGRAM=BREAST XRAY• Use low energy X-RAYS• Very efficient film/screen>>low dose• Breast compression important for good

images• Two views of each breast

– Help to identify abnormalities– Help to localize abnormalities

MAMMOGRAMSMAMMOGRAMSMLO=MEDIO LATERAL OBLIQUEMLO=MEDIO LATERAL OBLIQUE

CASSETTE AND FILM

LOW ENERGY XRAYS

MAMMOGRAMSMAMMOGRAMSMLO=MEDIO LATERAL OBLIQUEMLO=MEDIO LATERAL OBLIQUE

MASS

PECTORALMUSCLES

LYMPHNODES

MAMMOGRAMSMAMMOGRAMSCC=CRANIO CAUDALCC=CRANIO CAUDAL

CASSETTE AND FILM

LOW ENERGY XRAYS

MAMMOGRAMSMAMMOGRAMSCC=CRANIO CAUDALCC=CRANIO CAUDAL

MASS

MAMMOGRAMMAMMOGRAMDENSE AND FATTY BREASTSDENSE AND FATTY BREASTS

MASS

PECTORALMUSCLES

MRI OF THE BREASTSMRI OF THE BREASTS

DIFFUSE EARLY CANCER ON THE RIGHT

BREAST ULTRASOUNDBREAST ULTRASOUND

BENIGNCYST

CANCER

CHEST XRAYCHEST XRAYPA=POSTERIORPA=POSTERIOR

ANTERIORANTERIOR

PA CHEST XRAY

CHEST XRAYCHEST XRAYPA CLOSE UPPA CLOSE UP

NOTE SHARPLY DEFINED

CLAVICLES (ALSO CLOSER

TOGETHER)

PA CHEST XRAYPA CHEST XRAY

CHEST XRAYCHEST XRAYLATERALLATERAL

CHEST XRAY LATERALCHEST XRAY LATERAL

PA vs AP CHEST XRAY

SAME PATIENT: NOTE DIFFERENCE IN HEART SIZE AND AORTIC ARCH

EXPIRATORY CHEST XRAY

INSPIRATORY CHEST XRAY

CHEST XRAY QUALITYGOOD BAD

• Dedicated chest unit• PA Posterior-Anterior• Inspiratory• Upright• Healthy patient

• Portable equipment• AP Anterior-Posterior• Expiratory• Supine• Sick patient

TYPICAL PORTABLE CHEST

PLEURA• Visceral-superficial lung surface• Parietal-inner chest wall surface• Slide against each other to allow breathing• Normally have a tiny amount of fluid in an

empty (potential) space• May fill with fluid in many disease processes

– Called PLEURAL EFFUSION

PLEURAL SPACE

LUNGVISCERALPARIETAL

PLEURAL SPACE (CAVITY)

PLEURA

PLEURAL ABNORMALITIES• Air

– Called PNEUMOTHORAX• Fluid

– Simple fluid called EFFUSION– Pus called PYOTHORAX

or EMPYEMA– Blood called HEMOTHORAX– Lymph called CYLOTHORAX

• Mass• Calcification

TENSION PNEUMOTHORAXPLEURAL AIR COLLAPSED LUNG

TENSION PNEUMOTHORAX

TINYPLEURALEFFUSION

ON MRI

PLEURAL FLUID (EFFUSION) ON CHEST XRAY

THIS ONE IS PRETTY SMALL ~200 cc

PLEURAL FLUID (EFFUSION) ON CHEST XRAY

THIS ONE IS PRETTY LARGE ~1000 cc

PLEURAL FLUID (EFFUSION)LATERAL DECUBITUS XRAY

FLUID HAS“LAYERED OUT”

PLEURAL FLUID (EFFUSION)LOCULATED INTO FISSURE

NOTE HOW THE TWO VIEWS OF THE CHESTHELP TO LOCALIZE THE FLUID

PLEURAL FLUIDON CHEST CT SCAN

TINY AMOUNTON THE RIGHT

PLEURAL MASSON CHEST CT SCAN

LUNGS• Bronchi (airway)

– Pathway for VENTILATION (air in and out)• Pulmonary Arteries (large)

– Blood into lungs for gas exchange• Pulmonary Veins (large)

– Blood out of lungs after gas exchange• Bronchial Arteries (small)

– Supply the bronchi• Lymphatic channels (tiny)

– Return lymph to the central circulation

TRIPLE BLOOD SUPPLY

BRONCHI (AIRWAYS)

LYMPHATIC DRAINAGE

AIRWAYS: BRONCHOGRAMSTHESE ARE NOT DONE

ANY MORE

AIR BRONCHOGRAMS

THIS IS WHAT FOLKS MEANBY BRONCHOGRAMS NOW

AIRWAYS CT CORONAL RECONSTRUCTION

TRACHEAR MAIN BRRUL BRBR INTRLL BR

L MAIN BRLUL BRLLL BR

SEGMENTS FRONTAL

SEGMENTS LATERAL

SEGMENTS RIGHT

SEGMENTS LEFT

RIGHT

RIGHT

RIGHTUPPER

BRONCHI

LOOKLIKE

A WHALE!

THIS IS THE MINORFISSURE AT THE TOPOF THE MIDDLE LOBE

RIGHT THIS IS THE BRONCHUS INTERMEDIUS

RIGHT

MIDDLE LOBE ANDSUPERIOR SEGMENT

OF LOWER LOBE BRONCHIAT ALMOST THE SAME LEVEL

RML

SS RLL

RIGHT

RIGHT BOTH RIGHT AND LEFTHAVE SAME BASILER SEGS

ANT, POST, MED, LAT

A

ML

P

A

M

L

P

LEFT

LEFT

LEFT

LEFT

LEFT

LEFT

LINGULAR ANDSUPERIOR SEGMENT

OF LOWER LOBE BRONCHIAT ALMOST THE SAME LEVEL

LING

SS LLL

LEFT

LEFT BOTH RIGHT AND LEFTHAVE SAME BASILER SEGS

ANT, POST, MED, LAT

A

M

L

P

A

ML

P

WAYS OF VIEWING CT SCANSLUNG SETTINGS

SOFT TISSUE SETTINGS

LEFT PULMONARY ARTERY

RIGHT PULMONARY ARTERY

RIGHT PULMONARY ARTERYEMBOLISM (BLOOD CLOT)

RIGHT PULMONARY ARTERYEMBOLISM (BLOOD CLOT)

PULMONARY VEINS

RIGHT PULMONARY ARTERIOGRAM

RIGHT PULMONARY VENOGRAM

LEFT PULMONARY ARTERIOGRAM

LEFT PULMONARY VENOGRAM