CHEST

ZHANG YAN( 张焱）

1st clinic teaching hospital of Zhengzhou
University
(Henan Medical University)
• RUL Br:right upper lobe
bronchus;
• LMBRr:left main
bronchus;
• AO:aorta
 Lung fields

1.Upper, middle and lower zones:

– Draw lines at the anterior lower level of 2nd and
4th ribs
2.Inner,middle and outer zones:
– Divide into three zones longitudinally averagely
 Examine the lungs
Hilar shadows
 Situatuated in the inner zone between 2nd
- 4th anterior intercostal space
 Consist of the shadow of the pulmonery
blood vessels(mainly), the large bronchi,
lymph nodes and the pleural reflections
18
 The left hilum is usually slightly higher in
position than the right
Check the position of the
mediastinum :
 Look at the mediastinum mainly
on lateral view
1.Three zones by the levels of T4 and
T8:
• Upper zone
• Middle zone
• Lower zone
2.Three division:
• Anterior:thymus,lymph nod,et al
• Middle:heart,aorta,trachea,hilar
• Poster:eso,nerves et al
• Subclavian artery
• Brachiocephalic vein(innominate vein)
• Brachiocephalic trunk (innominate artery)
• Common carotid artery
• Bronchi
• Bronchioles
• terminal Bronchioles
• Pectoralis major
• Subclavian artery
• Brachiocephalic vein(innominate vein)
• Brachiocephalic trunk (innominate artery)
• Common carotid artery
• Bronchi
• Bronchioles
• terminal Bronchioles
• Pectoralis major
• Radiological signs of lung disease
(1). Pulmonary consolidation :

Consolidation of a whole lobe or the

majority of a lobe is diagnostic of
bacterial pneumonia.
The diagnosis of lobar consolidation
requires the radiological anatomy of
the lobes (Fig.2.15) .
 Patchy consolidation
• one or more patches have ill-defined
shadowing (Fig.2.17), is usually due to:
1.pneumonia
2.infarction
3.immunological disorders.
 (2). Pulmonary collapse (atelectasis)

• The common causes of collapse (loss of

volume of a lobe or bung) are:
• ·bronchial obstruction;
• ·pneumothorax or pleural effusion.
 The signs of lobar collapse
1.displacement of structures;
2.the consolidation shadow of the
collapsed lobe
 The commoner causes of lobar
collapse are:

1. bronchial wall lesions

usually primary carcinoma;
rarely, other bronchial tumours such as
carcinoid( 类癌 );
rare , endobronchial tuberculoses.
2 .Intraluminal occlusion
mucus plugging, particularly in postoperative or
unconscious patients
inhaled foreign body.
3.Invasion or compression by an
adjacent mass
malignant tumour;
enlraged lymph nodes;
右肺上叶不张
Spherical shadows :
1.lung mass,
2.lung nodule
• The diagnosis of a solitary spherical shadow
in the lung (Fig. 2.29) is a common problem,
The usual causes of a solitary pulmonary
lesion:
1.bronchial carcinoma/bronchial carcinoid( 类
癌 );

2.benign tumour of the lung, hamartoma being

the most common;
3.infective granuloma, tuberculoma being the
most common in the UK; fungal granuloma
being the most frequent in the USA;
4.metastasis;
5.Lung abscess;
 (3). Calcification
Calcification is higher density,and it is a
common finding in hamartomas, tuberculomas
and fungal granulomas.
In hamartomas it is often of the ‘popcorn’ type
(Fig.2.30).
 CT is of great value in detecting
calcification and can help to confirm the
nature of the lesion.
Some calcification can be difficult to
recognize on plain chest radiography.
With CT, however, calcification can be
diagnosed easy (fig.2.31).
 ↗
→

左肺斑片状钙化
左肺爆玉米花样钙化
 (4).Cavitation

If the centre of the mass undergoes

necrosis and is coughed up, air is seen
within the mass.
An air-fluid level may be visible on erect
films.
These features, which may be difficult to
appreciate on plain films, are
particularly well seen at CT.
 Cavitation
thickness of the cavitation wall
1.Thick(exceed 3mm) ---acute lung
abscess;Ca
2.Thin (1-2mm) ---tuberculosis;Ca
3.Very thin ----caseous pneumonia
 Cavitation almost always indicates a
significant lesion.
It is very common in lung abscesses
(Fig.2.34), active TB,relatively common in

primary carcinomas (Fig.2.35) and

occasionally seen with metastases.
It does not occur in benign tumours
or inactive tuberculomas.
 The distinction between cavitating
neoplasms and lung abscesses can be very
difficult, a sometimes impossible,
particular if the walls are smooth.
If, however, either the inner or outer walls
are irregular the diagnosis of carcinoma is
highly likely.
 Size
A solitary mass over 4cm in diameter
which does not contain calcium is
nearly always either a primary
carcinoma or a lung abscess.
Lung abscesses of this size, however,
always show cavitation in fact.
TB
• Air containing space
含气囊肿
 (5).Mass
• Homogeneous in density ;
• Round oval or lobulated in shape;
• Some primary carcinoma may show
spiculation （毛刺） at the periphery,
Represent the growth of the mass;
• Multiple and widespread round opacities in
the middle and lower lung fields is metastases
周
围
性
肺
癌
Multiple pulmonary nodules
Multiple well-defined spherical
shadows in the lungs are virtually
diagnostic of metastases (p.97).
Occasionally, this pattern is seen
with abscesses or with
granulomas( 肉芽肿 ).
 (6).Free pleural fluid

Plain radiographic findings (Fig.2.43).

Free fluid is always fills in the
costophrenic angles, in the upright
position.
中量
 Pleural calcification
or thickening:
1.usually they are caused by old
tuberculous (Fig.2.52) or old
haemothorax.
2.X-ray plain film can find them and
CT can find them more clearly.
左侧胸膜肥厚钙化
 Pneumothorax (Fig.2.53)

The diagnosis of pneumothorax depends

on :
1.The line of pleura forming the lung edge
separated from the chest wall,
mediastinum or diaphragm by air;
• 2.the absence of vessel shadows
outside this line.
The end thanks!