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’respiratory :

Four main radiological densities and are : air, fat, water and metal
LUNG : Radio-transparent : contains the’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’interweave.

– 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’IDENTIFIER ?

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

L’analysis of any pathological image must begin by determining the’predominant involvement of’a 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’OTHER PATIENT

PROPOSE A FURTHER REVIEW

BRIEF SEMIOLOGY DISEASE BY ACHIEVEMENT OF EACH FUND :

L’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’opacity)

Ex :OAP, PNEUMONIA

SYNDROME INTERSTITIAL :

it s’acts of’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’alveolar exudate, d’a tumor developed in’interstitium 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)
• balance sheet’extension (lung metastases)
• trauma
• infectious pneumonitis, d’inhalation

WE- CONCLUSION :

L’exploration of’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