Radiographic Lung Patterns Systematic approach heart mediastinum - - PowerPoint PPT Presentation

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Radiographic Lung Patterns Systematic approach heart mediastinum - - PowerPoint PPT Presentation

Jul 31, 2023 424 likes •809 views

Radiographic Lung Patterns Systematic approach heart mediastinum vessels lungs pleural space thoracic wall diaphragm/abdomen Lung pathology Most cause Some cause INCREASED OPACITY DECREASED OPACITY patterns emphysema, air trapping

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SLIDE 1

Radiographic Lung Patterns

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Systematic approach

heart mediastinum vessels lungs pleural space thoracic wall diaphragm/abdomen

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Lung pathology

Most cause INCREASED OPACITY patterns INTERSTITIAL ALVEOLAR BRONCHIAL VASCULAR NODULAR Some cause DECREASED OPACITY emphysema, air trapping hypoperfusion PTE

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Approach

Is there increased opacity? What is the pattern(s)? What is the distribution?

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FOCAL/MULTIFOCAL DIFFUSE

PATTERN

NODULAR BRONCHIAL ALVEOLAR VASCULAR INTERSTITIAL

DISTRIBUTION

INTERSTITIAL

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VASCULAR

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Vascular pattern

What you will see... DIFFUSE increased opacity Due to: Multiple enlarged pulmonary vessels Veins Arteries BOTH

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SLIDE 8

Vascular pattern

Remember compare: cranial vessels to: caudal vessels to: Artery and vein should be: same size or smaller than rib similar size to each other

4th rib 9th rib

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Vascular

BIG VEINS BIG ARTERIES BIG VEINS normal ARTERIES BIG ARTERIES normal VEINS

Overcirculation Pulmonary hypertension Left heart failure

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BRONCHIAL

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What you will see... DIFFUSE increased opacity Due to... Prominent bronchial walls “RAILROAD TRACKS” “DONUTS”

  • ut to PERIPHERY

Bronchial pattern

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Bronchial pattern

Chronic bronchitis allergic, irritant Feline asthma Infectious bronchitis Lungworms Heartworm disease DIFFERENTIALS

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INTERSTITIAL

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Interstitial pattern

What you will see... DIFFUSE or FOCAL UNSTRUCTURED haziness BLURRING of vessel margins Due to: interstitial fluid or cells ARTIFACT

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Interstitial pattern

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Interstitial Differentials

Artifact - expiratory, obesity “old-dog” lungs Pneumonitis viral, parasitic, metabolic, toxic Alveolar disease in transition Pulmonary fibrosis ARDS Neoplasia - RARE (LSA, mets)

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Bronchial vs. Interstitial

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Bronchial vs. Interstitial

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DIFFUSE increased opacity

NO

hazy blurred vessels

YES

INTERSTITIAL BRONCHIAL vessels donuts RR tracks VASCULAR

Is opacity made up of STRUCTURES or MARKINGS?

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ALVEOLAR

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Alveolar pattern

What you will see... FOCAL or MULTIFOCAL distribution Uniform fluid opacity - fluffy to solid Due to: cells/fluid filling alveoli

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Alveolar pattern

continuum with INTERSTITIAL AIR BRONCHOGRAMS LOBAR SIGN SILHOUETTE SIGN

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Air Bronchogram

Branching BLACK airway WHITE background CAN’T see vessels

yes yes no no

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Lobar sign

Periphery of lobe affected Abrupt demarcation between diseased and normal lung DON’T confuse with PLEURAL FISSURES

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Silhouette sign

Adjacent to ST structure Effacement of margins cardiac silhouette pulmonary vessels diaphragm

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Alveolar pattern

BLOOD PUS WATER BIG 3 Differentials: hemorrhage, contusions edema pneumonia Other Differentials: Atelectasis Neoplasia Lung lobe torsion

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Cardiogenic pulmonary edema

Alveolar

CAUDODORSAL HILAR CRANIOVENTRAL

Non-cardiogenic pulmonary edema Pneumonia Location? Hemorrhage Hemorrhage Hemorrhage

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NODULAR

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Nodular Pattern

AKA = structured interstitial What you will see... FOCAL or MULTIFOCAL

  • pacities

Due to: nodules or masses MUST define characteristics

  • f nodule(s)!!
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Differentials for nodules

ematoma - trauma bscess - foreign body eoplasia - primary and metastatic ranuloma - fungal, parasitic ulla - air or fluid filled H A N G B

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Nodule characteristics

NUMBER - Single vs. Multiple SIZE - overall and relative nodule vs. mass (>3 cm) similar vs. variable MARGINATION well defined vs. ill defined

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Single Nodule/Mass

WELL-DEFINED margins NEOPLASIA!!

Primary vs. single metastatic nodule > 3 cm more likely PRIMARY tumor

BULLA, HEMATOMA ABSCESS GRANULOMA ILL-DEFINED margins

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Multiple Nodules/Masses

WELL-DEFINED

MARGINS

ILL-DEFINED

SIZE

VARIABLY SIMILARLY small, miliary

OTHER

LYMPHADENOPATHY SYMPTOMATIC Fungal Pneumonia Metastatic Neoplasia

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Margination

If you see both ILL and WELL DEFINED? ILL DEFINED won’ t look WELL DEFINED WELL DEFINED can look ILL DEFINED Due to: respiratory motion silhouetting associated hemorrhage or inflammation

BUT..

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Cavitated Nodules

Soft tissue and AIR WALL THICKNESS!! Differentials H A N G with necrosis thick irregular wall Bulla thin wall

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Nodular pattern

BEWARE OF IMPOSTORS... End on vessels Surface structures Pulmonary osteomas REMEMBER REAL NODULES! size > 5mm

  • n BOTH views

ST opacity

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SUMMARY

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NODULAR BRONCHIAL ALVEOLAR VASCULAR INTERSTITIAL

PATTERN

blurring of vessels air bronchogram silhouette sign lobar sign railroad tracks, donuts enlarged pulm vessels focal/multifocal nodules

SIGNS

d i f f u s e f

  • c

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