Chest Pathologies

• Cyst:

  • round
  • well - defined margins
  • fluid filled (HU: 0 - 20)
  • do not invade nearby structures / organs
  • tend to be singular
• What is this an image of: cyst

  A) cyst

  
• Tumours:

  • irregular shape
  • ill - defined edges
  • dense on CT
  • invade nearby structures / organs
  • primary tend to be singular, but metastases tend to be multiple
• What is this an image of:

  A) tumour

  
• Pneumothorax: collapsed lung

  • symptoms: sudden chest pain, shortness of breath
  • treatment: decompression with a chest tube
• Tension pneumothorax:

  • displaces mediastinal structures + compromises cardiopulmonary function
• Atelectasis: complete or partial collapse of the lung that develops when alveoli within the lung become deflated

  Compressive atelectasis: form of atelectasis due to compression by a space occupying process (such as pleural effusion)

  • effusion exerts a mass effect upon the lung and causes it to collapse
• Identify the pathology:

  A) pneumothorax

  B) sign of golden

  
• Identify the pathology:

  A) pneumothorax

  B) left

  
• Lymph node:

  • mostly centered in anterior / posterior and right / left directions
  • only visible on a few slices before they disappear
• Vessels:

  • may track laterally or anterior / posterior when scrolling through the transverse slices
  • will persist through more than just a few transverse slices
• Node normal or abnormal:

  • if node > 1 cm in any dimension = considered abnormal
  • if node < 1 cm in all directions = considered normal
• Multiphase abdominal CT:

  • arterial phase: 15 - 20 seconds after injection
  • highly vascularized cortex vs medulla of kidney (mostly tubules)
  • portal venous phase: 35 - 40 seconds after injection
  • best evaluation of solid organs parenchyma
  • inferior vena cava
  • portal vein
  • delayed phase: 6 - 10 mins after injection
  • contrast in renal excreting phase (renal collecting system)
  • ureters
  • urinary bladder
• Pleural Effusion:

  • often caused by malignant processes
  • causes:
  • leakage from other organs
  • cancer
  • infections
  • autoimmune conditions
  • pulmonary embolism
  • symptoms:
  • shortness of breath
  • chest pain
  • fever
  • cough
  • treatment:
  • drain fluid (thoracentesis)
• Empyema (complicated pleural effusion):

  • pleural cavity is pus
  • can develop after: pneumonia, abscesses or injury to chest
• Hydropneumothorax:

  • pneumothorax + pleural effusion
  • pleural cavity contains: air and fluid
• Identifying pleural effusion on x-ray:

  • asymmetric differences in density of lungs (cavity will appear more dense than normal), fluid will fall to the bottom
  • silhouette sign (look at heart, abnormal objects of similar density will make it hard to see the border between the two objects
  • meniscus shadow
  • assess costophrenic angles → blunting
• Identify:

  • fluid accumulating in bottom of left lung → pleural effusion

  
• Identify:

  • silhouette sign - right lobe mass → pleural effusion

  
• Identify:

  • meniscus shadow in right lung → pleural effusion

  
• Identify:

  • abnormal costophrenic angle + silhouette sign → pleural effusion

  
• Identify:

  • pleural effusion on CT

  
• Consolidation of Lung: air in lung is replaced with

  • fluid (pus, blood, water) - inside the lung and does not change with patient position
  • solid (stomach contents - aspiration, cells)
  • appears as whitening of the lung on x ray
  • symptoms:
  • shortness of breath
  • hemoptysis
  • causes:
  • lung cancer
  • pneumonia
• Identify:

  • consolidated lung in upper left lobe

  
• Identify:

  • consolidated lung on CT

  
• COPD: chronic obstructive pulmonary disease (includes bronchitis and emphysema)

  • chronic bronchitis: airways become swollen, can be filled with mucus
  • emphysema: alveoli are damaged
  • seen as: barrel chest and hyper inflated lungs, diaphragm may look flatter and lower than normal
  • symptoms:
  • difficulty breathing
  • mucous production
  • tightness of chest
• Identify:

  • left sided pneumothorax with tension (trachea displaced to the right)
  • bi - lateral pleural effusion (blunting and meniscus on both sides)
  • left side hydropneumothorax

  A) pneumothorax

  B) tension

  C) meniscus

  D) blunting

  
• Identify:

  • COPD + hydropneumothorax

  
• Spiculated mass: lump of tissue with spikes or points on the surface

  • suggestive but not diagnostic of malignancy
  • use lung window to best see the mass
• Fractures:

  • non - displaced: bone is fractured, but still in perfect alignment
  • minimally displaced: slight shift in position, but usually not significant
  • displaced: bone has significantly shifted
  • angulated: angle of the bones are misaligned
  • shortening: surrounding muscles pull the bone ends together tightly - shortening the bone
• Pathologic fractures: bone weakens due to a disease that either displaces bone matter or interferes with the normal metabolism (remodelling) of a bone

  • osteopenia: body doesn't make new bone as quickly as it reabsorbs old bone → osteoporosis
  • cystic: formation of cysts (ex. bone cancer)
  • lesion: unspecified abnormality - may be caused by bone damage or past bone injury
• Identify:

  • fracture (minimally displaced)

  
• Identify:

  • CIED

  
• Identify:

  • esophageal stent (better visualized on lateral image)

  
• Identify:

  • G tube

  
• Identify:

  • N - G tube

  
• Identify:

  • metal rod