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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
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BREAST
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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
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MAMMOGRAMSMAMMOGRAMSMLO=MEDIO LATERAL OBLIQUEMLO=MEDIO LATERAL OBLIQUE
CASSETTE AND FILM
LOW ENERGY XRAYS
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MAMMOGRAMSMAMMOGRAMSMLO=MEDIO LATERAL OBLIQUEMLO=MEDIO LATERAL OBLIQUE
MASS
PECTORALMUSCLES
LYMPHNODES
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MAMMOGRAMSMAMMOGRAMSCC=CRANIO CAUDALCC=CRANIO CAUDAL
CASSETTE AND FILM
LOW ENERGY XRAYS
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MAMMOGRAMSMAMMOGRAMSCC=CRANIO CAUDALCC=CRANIO CAUDAL
MASS
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MAMMOGRAMMAMMOGRAMDENSE AND FATTY BREASTSDENSE AND FATTY BREASTS
MASS
PECTORALMUSCLES
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MRI OF THE BREASTSMRI OF THE BREASTS
DIFFUSE EARLY CANCER ON THE RIGHT
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BREAST ULTRASOUNDBREAST ULTRASOUND
BENIGNCYST
CANCER
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CHEST XRAYCHEST XRAYPA=POSTERIORPA=POSTERIOR
ANTERIORANTERIOR
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PA CHEST XRAY
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CHEST XRAYCHEST XRAYPA CLOSE UPPA CLOSE UP
NOTE SHARPLY DEFINED
CLAVICLES (ALSO CLOSER
TOGETHER)
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PA CHEST XRAYPA CHEST XRAY
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CHEST XRAYCHEST XRAYLATERALLATERAL
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CHEST XRAY LATERALCHEST XRAY LATERAL
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PA vs AP CHEST XRAY
SAME PATIENT: NOTE DIFFERENCE IN HEART SIZE AND AORTIC ARCH
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EXPIRATORY CHEST XRAY
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INSPIRATORY CHEST XRAY
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CHEST XRAY QUALITYGOOD BAD
• Dedicated chest unit• PA Posterior-Anterior• Inspiratory• Upright• Healthy patient
• Portable equipment• AP Anterior-Posterior• Expiratory• Supine• Sick patient
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TYPICAL PORTABLE CHEST
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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
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PLEURAL SPACE
LUNGVISCERALPARIETAL
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PLEURAL SPACE (CAVITY)
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PLEURA
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PLEURAL ABNORMALITIES• Air
– Called PNEUMOTHORAX• Fluid
– Simple fluid called EFFUSION– Pus called PYOTHORAX
or EMPYEMA– Blood called HEMOTHORAX– Lymph called CYLOTHORAX
• Mass• Calcification
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TENSION PNEUMOTHORAXPLEURAL AIR COLLAPSED LUNG
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TENSION PNEUMOTHORAX
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TINYPLEURALEFFUSION
ON MRI
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PLEURAL FLUID (EFFUSION) ON CHEST XRAY
THIS ONE IS PRETTY SMALL ~200 cc
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PLEURAL FLUID (EFFUSION) ON CHEST XRAY
THIS ONE IS PRETTY LARGE ~1000 cc
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PLEURAL FLUID (EFFUSION)LATERAL DECUBITUS XRAY
FLUID HAS“LAYERED OUT”
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PLEURAL FLUID (EFFUSION)LOCULATED INTO FISSURE
NOTE HOW THE TWO VIEWS OF THE CHESTHELP TO LOCALIZE THE FLUID
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PLEURAL FLUIDON CHEST CT SCAN
TINY AMOUNTON THE RIGHT
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PLEURAL MASSON CHEST CT SCAN
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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
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TRIPLE BLOOD SUPPLY
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BRONCHI (AIRWAYS)
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LYMPHATIC DRAINAGE
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AIRWAYS: BRONCHOGRAMSTHESE ARE NOT DONE
ANY MORE
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AIR BRONCHOGRAMS
THIS IS WHAT FOLKS MEANBY BRONCHOGRAMS NOW
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AIRWAYS CT CORONAL RECONSTRUCTION
TRACHEAR MAIN BRRUL BRBR INTRLL BR
L MAIN BRLUL BRLLL BR
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SEGMENTS FRONTAL
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SEGMENTS LATERAL
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SEGMENTS RIGHT
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SEGMENTS LEFT
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RIGHT
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RIGHT
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RIGHTUPPER
BRONCHI
LOOKLIKE
A WHALE!
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THIS IS THE MINORFISSURE AT THE TOPOF THE MIDDLE LOBE
RIGHT THIS IS THE BRONCHUS INTERMEDIUS
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RIGHT
MIDDLE LOBE ANDSUPERIOR SEGMENT
OF LOWER LOBE BRONCHIAT ALMOST THE SAME LEVEL
RML
SS RLL
![Page 54: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/54.jpg)
RIGHT
![Page 55: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/55.jpg)
RIGHT BOTH RIGHT AND LEFTHAVE SAME BASILER SEGS
ANT, POST, MED, LAT
A
ML
P
A
M
L
P
![Page 56: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/56.jpg)
LEFT
![Page 57: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/57.jpg)
LEFT
![Page 58: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/58.jpg)
LEFT
![Page 59: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/59.jpg)
LEFT
![Page 60: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/60.jpg)
LEFT
![Page 61: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/61.jpg)
LEFT
LINGULAR ANDSUPERIOR SEGMENT
OF LOWER LOBE BRONCHIAT ALMOST THE SAME LEVEL
LING
SS LLL
![Page 62: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/62.jpg)
LEFT
![Page 63: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/63.jpg)
LEFT BOTH RIGHT AND LEFTHAVE SAME BASILER SEGS
ANT, POST, MED, LAT
A
M
L
P
A
ML
P
![Page 64: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/64.jpg)
WAYS OF VIEWING CT SCANSLUNG SETTINGS
SOFT TISSUE SETTINGS
![Page 65: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/65.jpg)
LEFT PULMONARY ARTERY
![Page 66: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/66.jpg)
RIGHT PULMONARY ARTERY
![Page 67: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/67.jpg)
RIGHT PULMONARY ARTERYEMBOLISM (BLOOD CLOT)
![Page 68: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/68.jpg)
RIGHT PULMONARY ARTERYEMBOLISM (BLOOD CLOT)
![Page 69: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/69.jpg)
PULMONARY VEINS
![Page 70: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/70.jpg)
RIGHT PULMONARY ARTERIOGRAM
![Page 71: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/71.jpg)
RIGHT PULMONARY VENOGRAM
![Page 72: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/72.jpg)
LEFT PULMONARY ARTERIOGRAM
![Page 73: THORAX: LUNGS AND PLEURAedoc.weebly.com/uploads/1/9/3/9/193932/lecture_4_slides.pdf · THORAX: LUNGS AND PLEURA Chris Sistrom, MD, MPH Assistant Professor, Diagnostic Radiology University](https://reader030.vdocuments.net/reader030/viewer/2022040209/5e3c0490e71514081e43e00c/html5/thumbnails/73.jpg)
LEFT PULMONARY VENOGRAM