Respiratory System Part II
Technique Chest
Radiography
Fluoroscopy
Esophagography
Sonography
Computed tomography
MRI
Chest Radiography
Standard AP + lateral
Decubitus views
Pleural effusion
Pneumothorax
Air trapping
Expiration views
Air trapping
Pneumothorax
Chest Fluoroscopy
Tracheo/bronchomalacia
Air trapping
Diaphragmatic motion
Esophagography
Vascular anomalies
Htype fistula recurrent infection
Bronchopulmonary foregut malformations
Chest Sonography
Chest wall
Peripheral lung masses
Pleural effusion/empyema
Diaphragmatic hernia/eventration
Computed Tomography of the Chest
Parenchymal disease
Masses
Adenopathy
Empyema/lung abscess
Metastatic survey
High Resolution Computed Tomography (HRCT) of the Chest
Diffuse lung disease
Bronchiectasis
Nodule characterization
MRI of the Chest
Vascular anomalies
Masses
Bronchopulmonary foregut cysts
Sequestration
Congenital heart disease
Tracheo/bronchomalacia
Neonatal Lung Disease
Transient tachypnea of the newborn
Hyaline membrane disease
Meconium aspiration
Neonatal pneumonia
Barotrauma
Transient Tachypnea of the Newborn
Wet lung disease
Retained fluid
Transient respiratory distress of the newborn
Transient Tachypnea of the Newborn Associations
Cesarean section
Prematurity
Maternal diabetes
Precipitous delivery
Transient Tachypnea of the Newborn Imaging
Edema pattern:
Poor vascular definition
Thickened fissures
Central predominant opacity
Small pleural effusions
Occasionally alveolar edema
Normal by 48-72 hours
Transient Tachypnea of the Newborn Differential Diagnosis
Sepsis
Congenital heart disease with edema
Amniotic fluid aspiration
Meconium aspiration
Hyaline Membrane Disease
Respiratory distress syndrome
Affects premature infants
Due to surfactant deficiency, increased surface tension, extensive microatalectasis
Hyaline membranes proteinaceous exudate + necrotic cells
Hyaline Membrane Disease Imaging
ÒGranularÓ or Òground glassÓ opacity extends to periphery
Air bronchograms
Small lung volume
Small patient
Hyaline Membrane Disease Complications
Iatrogenic
Tube malpositions
Barotrauma
Bronchopulmonary dysplasia-BPD
Patent ductus arteriosus
Barotrauma
Pulmonary interstitial emphysema
Pneumothorax
Pneumomediastinum
Pneumopericardium
Pneumoperitoneum
Meconium Aspiration
Inutero stress, defication, gasping
Bronchial obstruction
Chemical pneumonitis
Meconium Aspiration Imaging
Coarse, streaky, patchy opacity
Air trapping
Slow clearing
Neonatal Pneumonia
May be acquired:
In utero
During delivery
After birth
Respiratory distress
Neonatal Pneumonia Organisms
Bacteria
Hemolytic Strep
Staph aureus
E. coli
Proteus
Pseudomonas
Fungi
Viruses
Protozoans
Neonatal Pneumonia Imaging
Usually patchy/asymmetric opacity
Hemolytic strep may resemble hyaline membrane disease
Congenital Lung Abnormalities
Underdevelopment
Lobar emphysema
Sequestration
Cystic adenomatoid malformation
Pulmonary Underdevelopment
Agenesis complete absence of alveoli + bronchi
Aplasia rudimentary bronchus, but alveoli absent
Hypoplasia bronchus + alveoli present, but hypoplastic
Lobar underdevelopment always on right side
Scimitar Syndrome
Venolobar syndrome
Underdevelopment of one or more lobes on right
Partial anomalous pulmonary venous return from abnormal lung
Scimitar Syndrome
Absent or small pulmonary artery
Systemic arterial supply
Anomalies of the diaphragm
Segmentation anomalies
Congenital Lobar Emphysema
Progressive lobar hyperexpansion
Proposed etiologies
Bronchial dysplasia
Intrinsic or extrinsic narrowing
Luminal material
Mucosal redundancy
Increased number of alveoli
Often present in infancy
May be asymptomatic
LUL > RML > RUL > 2 lobes
DoesnÕt happen in lower lobes
Congenital Lobar Emphysema Imaging
Mass effect from hyperexpanded lobe
May be opaque early
Hyperlucent later
Air trapping may be progressive
Usual treatment = resection
Congenital Lobar Emphysema Differential Diagnosis
Aspirated foreign body
Endobronchial lesion
Vascular ring/sling
Pulmonary Sequestration
Congenital mass of aberrant pulmonary tissue with no normal connection to bronchial tree or pulmonary arteries
Often asymptomatic
Symptoms usually from infection
Usually posterior basal segments of lower lobe
Blood supply from one or more aortic branches, near diaphragm
Intralobar Sequestration
No separate pleural covering
Usually pulmonary venous drainage
May be aerated (collateral drift)
Some may be acquired
Extralobar Sequestration
Separate pleural covering
Usually systemic venous drainage
May be subdiaphragmatic
Congenital Cystic Adenomatoid Malformation (CCAM)
Intralobar mass of disorganized pulmonary tissue (hamartoma)
Failure of joining of mesenchymal and endodermal portions of developing lung
Some bronchial communication usually present
Blood supply usually from pulmonary circulation
Congenital Cystic Adenomatoid Malformation (CCAM)
Type 1 variable size large cysts (most common)
Type 2 uniform size 12cm cysts
Strong association with other anomalies
Type 3 microscopic cysts mass appears solid (least common)
Congenital Cystic Adenomatoid Malformation (CCAM)
Bimodal age presentation
At birth large lesions, respiratory distress
Later in childhood secondary infection
CCAM Differential Diagnosis
Sequestration
Congenital lobar emphysema
Diaphragmatic hernia
Pulmonary arteriovenous malformation
