3B2010 Subject: Radiology Topic: Chest Radiology
Date: June 13, 2008 Lecturer: Dra. Irene Bandong
CHEST RADIOLOGY
 The cornerstone of radiologic diagnosis
is the CHEST RADIOGRAPH.
 The most satisfactory basic or routine
radiographic views evaluation of the
chest are:
o Posterioranterior and
o Left lateral projections
 The optimal chest radiograph is
obtained
o In the posterior-anterior (AP) view
o At a target-to-film distance of 72
inches
o With the patient in the upright
position
o At maximum inspiration
 ADEQUATE PENETRATION BY
RADIATION
o Thoracic spine should be barely
seen thru the heart
o Bronchovascular structures can
usually be seen thru the heart
o Spine appears to be darker
caudally. This is due to more air
in lung in the lower lobes and
less chest wall
o Sternum should be seen edge on
o Posteriorly there should be two
sets of ribs
Non-standard chest radiography
 Lordotic Projection
It is advocated in 3 situations:
1. For improving visibility of the lung
apices, superior mediastinum and
thoracic outlet
2. For locating a lesion by parallax
3. For identifying the minor fissure in
these suspected cases of atelectasis of
the right middle lobe
 Lateral Decubitus
-particularly helpful for the
identification of small pleural effusions
-useful to demonstrate a change in
position of an air fluid level in a cavity
-to ascertain whether a structure that
forms part of a cavity represents a
freely mowing intracavitary loose body
(fungus ball)
 Oblique Projection
-useful in locating a disease process
(pleural plaque)
Trans Group: Riz, Alphe, AM
Special Radiographic Techniques:
1. Inspiratory-Expiratory radiography
-main indication is the investigation of
air trapping either general or local
 General air trapping- exemplified
by asthma or emphysema
 Local air trapping- there is
bronchial obstruction, or lobar
emphysema
nd
-2 indication= when pneumothorax is
suspected and the visceral pleural
pleural line is not visible
2. Valsalva and Muller maneuvers
-may aid in determining the vascular or
solid nature of intrathoracic mass
3. Bedside radiography
-in patients who are too ill to stand,
anteroposterior (AP) upright or supine
projections offer an alternative
COMPUTED TOMOGRAPHY
Most common indication for the use of
CT scan
1. Evaluation of suspected mediastinal
abnormalities identified on standard
chest radiograph
2. Search for occult thymic lesions
3. Determination of the presence and
extent of neoplastic
4. Search for diffuse or central calcification
in a pulmonary nodule
Miscellaneous indications:
1. Assisting in the percutaneous biopsy of
a lesion such as mediastinal, pleural or
pulmonary masses
2. Localization of loculated collections of
fluid within the pleural space
3. Assessment of the size and
configuration of the thoracic aorta
Main indication for the use of HRCT
1. Diagnosis of bronchiectasis
2. Detection of parenchymal lung disease
ATELECTASIS
-state of incomplete expansion of lung or any
portion of it
-loss of lung volume
Causes of Collapse
  Intrinsic mass
-primary or metastatic neoplasms or
eroding lymph nodes
 Intrinsic stenosis
-TB, inflammatory processes, fracture of
a bronchus
 Extrinsic pressure
-enlarged LN, mediastinal tumor, aortic
aneurysm, cardiac enlargement
 Bronchial plugging
-FB or mucus accumulation

Types
1. Resorption/ obstructive atelectasis
-occurs when communication between
the trachea and alveoli is obstructed
-may be intrinsic, caused by a tumor,
foreign body, inflammatory disease,
heavy secretions
-extrinsic pressure on bronchi caused
by tumor or enlarged nodes or bronchial
constriction secondary to inflammatory
disease

2. Passive atelectasis
-intrapleural abnormalities
-caused by space occupying process
that can compress the lung
-pneumothorax, pleural fluid,
diaphragmatic elevation, herniation of
the abnormalities viscera into the
thorax, large intrathoracic tumors

3. Compressive atelectasis
-intrapulmonary abnormalities
-is a secondary effect of compression of
normal lung by a primary, space-
occupying abnormality
-bullous emphysema, lobar emphysema

4. Adhesive atelectasis
-occurs when the luminal surfaces of
the alveolar walls stick together
-hyaline membrane disease, pulmonary
embolism, acute radiation pneumonitis,
uremia

5. Cicatrization atelectasis
-is primarily the result of fibrosis and
scar tissue formation in the
interalveolar space
-classic cause: TB