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Imaging of the Imaging of the respiratory system respiratory system

Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Page 1: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

Imaging of the respiratory Imaging of the respiratory systemsystem

Page 2: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Key PointsKey Points

Select of the imaging techniqueSelect of the imaging technique

Normal appearances of X-ray, CT and MR imaNormal appearances of X-ray, CT and MR imagesges

Imaging features of different pathological chanImaging features of different pathological changesges ：：– consolidaton, atelectasis, interstitial diseases, calcifconsolidaton, atelectasis, interstitial diseases, calcif

ication, node and mass, cavity, emphysema, effusiication, node and mass, cavity, emphysema, effusionon

Page 3: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Imaging modalities of respiratory Imaging modalities of respiratory systemsystem

[good natural contrast][good natural contrast]X-rayX-ray– basic, screeningbasic, screening

CTCT– routine routine

MRIMRI

Interventional Interventional

Page 4: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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X-rayX-ray

– FluoroscopyFluoroscopy

– FilmingFilmingPA, lateralPA, lateral

High kilovoltage radiographyHigh kilovoltage radiography

CR, DRCR, DR

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Some definitions of X-raySome definitions of X-ray

lung fieldlung field

mediastinummediastinum

hilumhilum

lung markingslung markings

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CTCT

– High spatial resolutionHigh spatial resolution

– High density resolutionHigh density resolution

– TomographyTomography

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Page 20: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

2020

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MRIMRI

– High tissue resolutionHigh tissue resolution

– Multi-directionMulti-direction

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InterventionIntervention

Pulmonary angiographyPulmonary angiography

Bronchial angiographyBronchial angiography

CT-guided biopsyCT-guided biopsy

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Page 31: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

consolidationconsolidation

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Early stage of lobar pneumonia caused by S. pneumoniae. The airspaces are filled with edema fluid, only occasional neutrophils are evident.

Page 33: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Advanced stage of lobar pneumonia. Neutrophils is predominate. The abundantfluid produced in the early stage of disease flows relatively easily from airspace to airspace, resulting in the homogeneous consolidation seen grossly. The alveolarsepta are intact in both stages of disease.

Page 34: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

3434Extensive consolidation of the right middle lobe.

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Page 39: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

3939Chest radiograph shows focal area of poorly defined consolidation and nodularityin the left upper lobe.

Page 40: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

4040HRCT images show multiple poorly defined nodular opacities and focal groundglass opacities in a predominantly peribronchial distribution in the upper lobe.

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Page 44: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

Interstitial changesInterstitial changes

Page 45: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Interstitial pneumonia. Photomicrographs show a moderate degree of alveolarinterstitial thickening that is predominantly the result of an infiltrate of lymphocytes.

Page 46: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Chest radiograph shows poorly defined nodular and reticular densities in both lungs and focal areas of consolidation in the lower lobes.

Page 47: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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HRCT image shows extensive bilateral ground-glass opacities and poorly-definedSmall nodules. Also note small right pleural effusion.

Page 48: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Page 54: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

nodulesnodules

Page 55: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Magnified view of a slice of lung shows numerous white nodules approximately 0.5 to 1mm in diameter distributed randomly throughout the parenchyma. Photo-micrograph of lung parenchyma also shows numerous nodules with a random distribution. View of one of the nodules shows the presence of granulomatous inflamation filling and obliterating several alveoli.

Page 56: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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HRCT image shows numerous nodules 1 to 3 mm in diameter distributedrandomly throughout both lungs.

Page 57: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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Adenocarcinoma. A sagittal slice of an upper lobe shows a subpleural white nodule approximately 2 cm in diameter. Normal lung structures are not evident within it, indicating that it is both invasive and destructive. The tumor is surrounded by a rim of tan-colored one to have a bronchioloalveolar pattern. HRCT image shows a nodular area of ground-glass opacity with central soft-tissue attenuation in right upper lobe. The margin is lobulated and spiculated.

Page 58: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

cavitycavity

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Cavitary tuberculosis. HRCT image shows a large, thin-walled cavity, a small cavity,linear opacities, and a few small nodules in right upper lobe. Magnified view of a sagittal slice of the excised specimen shows the cavity as well as several clacified an uncalcified granulomas.

Page 60: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

massmass

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Adenocarcinoma. HRCT image shows a 3-cm diameter node in the right upper lobe. It has lobulated and spiculated margins and is associated with a moderate degree of pleural puckering. A low magnification photomicrograph shows a adenocarcinoma adjacent to the pleura. The spicules are the result of subsegmental atelectasis, interlobular septal thickening by fibrous tissue and peribronchiolar thickening by tumor infiltration.

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Adenocarcinoma showing enhancement after administration of intravenous contrast medium. The attenuation value was 51HU.

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Bronchioloalveolar carcinoma. HRCT image shows a spiculated right upper lobe nodule with bubble lucencies.

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Bronchioalveolar carcinoma-air bronchogram. A magnified view of a well- demarcated tumor adjacent to the pleura. The latter is retracted. A patent airway is evident within the tumor. A view of another tumor shows a patent membranous bronchiole surrounded by lung parenchyma that is consolidated by neoplastic cells. Spread of such cells around but not into these airways is characteristic of bronchioloalveolar carcinoma and is responsible for the presence of an air bronchogram on CT.

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Page 66: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

chronic obstructive pneumonitischronic obstructive pneumonitis

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PA and lateral chest radiographs show left upper lobe atelectasis.

Page 68: Imaging of the respiratory system. 2 Key Points Select of the imaging technique Normal appearances of X-ray, CT and MR images Imaging features of different

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A sagittal slice of the left lung shows marked collapse of the upper lobe and obstructive of its bronchus by a 2-cm carcinoma. The upper lobe parenchyma has a gray and black appearance as a result of fibrosis and concentration of anthracotic pigment, respectively.

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Squamous cell carcinoma-obstructive pneumonitis. Low- and high-magnification views of the region show patchy chronic inflammation, alveolar interstitial fibrosis, and airspace filling by finely vacuolated macrophages. The vacuoles contain lipid that cannot be extruded from the alveoli via the mucociliary escalator because of the proximal airway obstruction.

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A chest radiograph shows a poorly defined mass and mild distal consolidation due to obstructive pneumonitis.

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abscessabscess

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Contrast-enhanced CT image shows airspace consolidation containing an area of low attenuation in the anterior segment of the right upper lobe. View of the excised specimen shows a cavity, the wall of which is composed partly of pinkish granulation tissue and partly of white fibrous tissue. The surrounding lung is consolidated.

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bronchiectasisbronchiectasis

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Bronchiectasis-gross appearance. Whole-mount slices of right and left lungs show pathy bronchiectasis in the lower and middle lobes on the right and the lingula on the left. On the right side, the disease can be classified as cystic in the superior segment of the lower lobe, varicose in the middle lobe, and cylindrical in the posterior basal portion of the lower lobe.

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CT image shows cystic and cylindrical bronchiectasis. A low magnification photomicrograph shows several dilated bronchi, the walls of which are thickened by fibrous tissue and inflammatory cell infiltrate. Abundant mucus is present in one airway.

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A coronal reformation image shows clusters of cysts in both lungs.

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calcificationcalcification

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CT image shows calcified lymph nodes in the aortopulmonary window. Obstruction of the anterior segmental bronchus of left upper lobe and partial atelectasis of corres- ponding segment are also evident. The resected left upper lobe shows bronchial wall fibrosis and luminal obstruction by an inflammatory exudate and granulation tissue. Calcified debris is evident in the airway lumen and peribroncial lymph node.

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PleuritisPleuritis

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pneumothoraxpneumothorax

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思考题思考题女性，女性， 2020 岁，发热（岁，发热（ 37.6℃)37.6℃) 、咳嗽，听诊双下肺呼吸、咳嗽，听诊双下肺呼吸音粗。采用何种影像检查方法？音粗。采用何种影像检查方法？女性，女性， 2020 岁，剧烈咳嗽后胸闷、憋气，听诊右肺呼吸音岁，剧烈咳嗽后胸闷、憋气，听诊右肺呼吸音消失。采用何种影像检查方法？消失。采用何种影像检查方法？女性，女性， 2020 岁，低热、咳嗽、盗汗，查体未见明显阳性体岁，低热、咳嗽、盗汗，查体未见明显阳性体征。结核菌素试验强阳性。采用何种影像检查方法？征。结核菌素试验强阳性。采用何种影像检查方法？女性，女性， 2020 岁，反复咳血，查体未见明显阳性体征。胸片岁，反复咳血，查体未见明显阳性体征。胸片未见明显异常。需要进一步检查吗？采用何种影像检查方未见明显异常。需要进一步检查吗？采用何种影像检查方法？法？


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