Radiological examination of the lung

I- INTRODUCTION :

Despite the development of new techniques, Chest radiographs remains with the clinical examination, the fundamental basis in pulmonary exploration.

II- ANATOMICAL RECALL :

right lung : 3 lobes
left lung : 2 lobes
Lobes séparés par des scissures :
– Great fissure in the right and left visible on profile
– Petite lobes Upton visible on the profiles and the face

pulmonary segments :

To the right :

3 the upper lobe level
2 means lobe
5 the lower lobe level

To the left :

5 the upper lobe level (3 the summit and 2 lingula)
5 at the lobe Less

III- TECHNICAL RESOURCES EXPLORATION :

RADIOGRAPHY STANDARD :

Chest film :

– In deep breath, standing, short exposure time
– -film distance : 1,5 at 2 m
– posteroanterior chest radiograph FACE
– other impacts : profile right, left, tangential shots and positional

intensifier :

Kinetics of the diaphragm under TV fluoroscopy (lower irradiation)

ULTRASOUND MODE B TRANS CHEST :

ultra sonographic further study :

Useful and inexpensive by transcutaneous thoracic first before all :
– effusion fluid, pleural mass with or without
– Syndrome solid mass or lung fluid
– Guided drainage or biopsy gesture

TOMODENSITOMETRY CHEST :

volume acquisition, axial section and multi-planar reconstructions without contrast injection and injection, she permits :
– Evaluate density and vascularity
– Appreciate reports of any mass syndrome with adjacent organs
– Make the assessment of the lesions

NUCLEAR MAGNETIC RESONANCE (MRI CHEST) :

Designed in-depth study of the presence of :
– Masses of clinic or juxta-apical diaphragmatique identifier for the module in altitude
– para-mediastinal masses to specify vascular reports

PET SCAN :

Injection of a radioactive tracer
– Assessment of extension
– scalable monitoring lung cancer

Pulmonary angiography :

Review to allow :
1/ Pressure measurements
2/ Embolization before
– abundant hemoptysis
– vascular malformation

SCINTIGRAPHY PULMONARY :

The embodiment is based on the cause of:

• Infusion if pulmonary embolism
• Ventilation if bronchial stenosis

fibroscopy BRONCHIAL :

It allows to make a gesture biopsy to determine the nature of any injury

IV- TECHNICAL AND NORMAL AND ABNORMAL SEMIOLOGY :

TELE-Chest-TECHNICAL ACHIEVEMENT :

Technical criteria of good quality chest incidence face :

Symmetry : inner ends clavicular line equidistant from the spinous
deep breath : 6^th costal arch projecting from the diaphragmatic
Blackening of the film : good visualization of the thoracic spine and heart vessels derrièreje
Standing position : visible air pocket under the diaphragmatic level image with

Contrast anatomical elements of the & rsquo; respirator :

Four main radiological densities and are : air, fat, water and metal
LUNG : Radio-transparent : contains the & rsquo; air (noir)

HOW TO ANALYZE THE CHEST CLICHE ?

INCIDENCE FACE :

CONTAINING :
– bone frame
– extra-thoracic soft parts :
+ Hollow supraclavicular
+ hollow axillary
+ lateral thoracic wall
+ breast shadows
– Floor under diaphragmatic

CONTENT :
– lungs, Ask scissure : analysis of both lung fields :
– pulmonary high transparency and down compared to the contralateral side
– Vasculatures starting from Hiles towards the periphery
– mediastinum (high voltage, identify vessels and mediastinal lines)
-Trachea, Diaphragm , Heart, Hiles
– fornix pleural

IMPACT PROFILE :

What background and How to recognize ?

– right profile :

Cupolas diaphragmatic right and left are parallel.

– left profile :

Cupolas diaphragmatic s & rsquo; intertwine.

– anatomical structures to be analyzed :
– bone frame (sternum, projection of the humeral heads, omoplate, rear wall, spine and rib arches, diaphragmatic)
– clear spaces : retro-sternal and reverse heart
– piecing

 

SEMIOLOGY ABNORMAL :

PATHOLOGICAL IMAGE AND HOW & rsquo; IDENTIFY ?

The chest radiograph is the summation of image data by the & rsquo; absorption of X-rays that pass through (posterior chest wall, pleura which adjoins, mediastinum, lung parenchyma, anterior chest wall pleura and)

L & rsquo; analysis of any pathological image must begin by determining the & rsquo; d & rsquo predominant involvement; one of parenchymal structures that are :
– ALVEOLES
– INTERSTITIUM
– VESSELS
– BRONCHI
– Their pathological changes distinguish syndromes : alveolar, interstitial, vascular and bronchial.
– The parenchymal syndrome includes different pictures cavitary, Emphysema and Bulle
– Reperage des scissures : capital time (Atélectasies, Emphysèmes obstructifs)

TYPE OF INJURY :
– OPACITE : of water tone or calcium
– HYPERCLARTE : localized (bubble) or diffuse : Unilateral clear picture (survey vessels : calibre, number and distribution)
– MIXED PICTURE : image cavitaire

LOCATION :
– WALL
– PLEURA
– MEDIASTINAL
– PARENCHYMA (alveoli, Interstitium, vessels , Bronchi)

RELATED INJURIES :

– Pleural effusion fluid or aeric associated lung lesion

– Image pulmonary and mediastinal lymph nodes

LIST THE IMAGE IDENTIFY ÉTIOLGIES

ESTABLISHING A RADIO CLINICAL CORRELATION

COMPARE THE CLICHE WITH RECENT & rsquo; OTHER PATIENT

PROPOSE A FURTHER REVIEW

BRIEF SEMIOLOGY DISEASE BY ACHIEVEMENT OF EACH FUND :

L & rsquo; analysis of the formation of pathological chest images is unique to each compartment, describes cell e marked on the lungs by I are following syndromes :
– Alveolar
– Interstitial
– bronchial
– Vascular
– parenchymal

SYNDROME ALVEOLAIRE :

Localized or diffuse alveolar filling liquid, cells results in air :

fuzzy opacities, confluent, contiguous with or bronchogram aivéoiogramme (bronchi and alveoli clear within the & rsquo; opacity)

Ex :OAP, PNEUMONIA

SYNDROME INTERSTITIAL :

It s & rsquo; d & rsquo acts; a water infiltration or cellular connective tissue

Net opacities contour, be streamed, no bronchogramme or aivéoiogramme, erase lescontours peri-bronchovasculaires, variable morphology can be reticular or nodular and honeycomb to the advanced form.

Ex : FIBROSIS, sarcoidosis, LYMPHANGITE CARCINOMATEUSE

SYNDROME CAVITAIRE :

It is characterized by a cavity image with some level of primitive alveolar damage, or interstitial lung that can lead to the destruction of the parenchyma and its excavation.

The cavity is formed from d & rsquo; alveolar exudate, d & rsquo; a tumor developed in & rsquo; interstitial or bronchial walls.

Ex : commonplace germs to abscess. tuberculous cavity, Cancers primary or secondary excavated

V- INDICATIONS :

They are broad front :

• pulmonary symptomatology : cough, dyspnea respiratory
• Hémoptysies
• Screening and diagnosis of neoplasia bronchopulmonary
• acute pulmonary vascular malformation -Œdème (OAP)
• Assessment of extension (lung metastases)
• trauma
• infectious pneumonitis, d’inhalation

WE- CONCLUSION :

L & rsquo; exploration of & rsquo; respirator relies initially on : plain radiography is the face and chest of the plate profile.

Radiological additional tests remain necessary for the diagnosis and scalable.

Courses Prof. FZ. LECHEHEB – Faculty of Constantine