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Question 1. What do the organs of the chest cavity look like on x-rays in a direct projection? How many lobes and segments are there in the right and left lung?
Answer – Roentgenography (X-Ray) is mainly used for radial diagnostics. All the roentgenography of the Thorax – cavity organs always start from the making of the Image in forwarding direct projection. But it’s also compulsory to make also on right and left sides.
- Posterior – Anterior (PA) – most common and preferred X-Ray. It will help for getting a clear Image or Picture of the heart and lungs.
- Anterior-posterior (AP) – Less Preferred due to less clear image of heart and mediastinum. This type of X-Ray helps to get an image of the presence of free fluid, the air inside the lung, airway obstruction, etc.
- side-view (lateral) – This Type of Image is mainly used for localizing of lesion Which together with a frontal image allows 3-D analysis. In this Image, we can find the slant directed ribs, the bodies of the thoracal vertebra – behind, the breast bone – in the front. Back departments of the ribs are visible in the form of the small arches going slantwise downwards and to the front, crossing the bodies of the underlying vertebra ( the fourth rib crosses the body of the fifth vertebra, etc.).
Lobes and Fissure of the lungs: –
If we talk about the Left lung, it having 2 types of lobes, known as Superior and Inferior Lobes divided by Oblique Fissure which is More Posterior on the Lower lobe and more anterior at the upper and middle lobe, which is allowed for more expansion of the whole lung. And this oblique thickness will give cuts into all thicknesses of the lungs (Except – Hilum).
And If we talk about the Right lung, it having 3 types of lobes, known as Superior, Medial and Inferior Lobes divided by Oblique and Horizontal Fissure. If we talk about Horizontal fissure is mainly helps to make the superior lobe and middle lobe and Oblique fissure, it helps to make the middle lobe and posterior lobe. The horizontal fissure is passed from the anterior border to the oblique fissure (Meets the oblique fissure by the backward running of the Horizontal fissure in the midaxillary line).
Segments of the Lungs –
Apex – it present at medial of supraclavicular fossa or Just above medial 1/3 of the clavicle at the level of 1st RIB (At anterior Side) And having a length of only 2.5 cm.
Base – this is a semilunar and concave shaped lobe that is present (Resting) on the diaphragm. The right side (dome) will be higher than the left in this segment.
Lungs having 3 types of Borders and 2 types of surface: –
- Anterior (Margo Anterior) border – in the left lung, having a cardiac notch (touch shaped projection) which is present at below of 4th costal cartilage known as Lingula. (correspond to the middle lobe of the right lung) and uncovered by pericardium and heart. This is a thin border and corresponds to a costo-mediastinal line of pleura reflection.
- Posterior (Margo Posterior) border – This is a medial margin of heads of ribs (C7-T10). And this is the thick border of the lung.
- Inferior (Margo Inferior) border – This border is sharp and thin which is the mainly separate base from the coastal and medical surface.
There are having two types of surfaces: –
- Costal (Fascies Costalis) Surface – This surface having a large and convex surface which is present within the contact with costal pleura. This is an overlapping thoracic wall.
- Medial (Fascies Mediastinal) surface – it’s having two parts – Vertebra or posterior part and Mediastinal or Anterior part. On this surface, having a cardiac impression known as Hilum.
Segments of lungs are known as: –
In right lung –
- Right upper lobe
- Apical segment
- Posterior segment
- Anterior segment
- Right middle lobe
- Medial segment
- Lateral segment
- Right lower lobe
- superior segment
- basal medial segment
- basal anterior segment
- basal lateral segment
- basal posterior segment
In Left lung –
- left upper lobe
- apicoposterior segment
- anterior segment
- superior lingular segment
- inferior lingular segment
- left lower lobe
- superior segment
- basal anteromedial segment
- basal lateral segment
- basal posterior segment
Question 2. what is the algorithm for using radiation methods for diagnosing respiratory diseases and what are the goals of the study?
The patient’s position during his diagnostics!
As a rule, the X-ray thoracal cavity organs diagnostics is carried out in the vertical position of the patient. The direct feature is a gas bubble of the stomach with the horizontal liquid level located to the left under the diaphragm down. To the indirect signs concern:
- The most slanting position of the front ribs pieces is protective the angle between the front and back pieces of the ribs > (more) than 90* ( ninety degrees) applying of claves on the lungs apexes. The liquid level when the patient is in the horizontal position is not defined, the angle between the front and the back ribs pieces is sharper and the clavicles are outside of the thorax in the neck bottom departments fields.
- The symmetrical position of the patient is the main criterion for the well-done roentgenogram.
- If the patient is lying symmetrically it is usually used the following method:
To compare the distance from the chest clavicle’s extremity or the place where the osteal part of the ribs is in the cartilaginous one from both sides to the median line where the line is going through the thoracal vertebra bodies acanthus. If the patient is being correctly their distances must be equal. The distance augmentation from one side means that the patient has turned to that side.
Precisely profile image: – The main criterion if the patient is lying correctly is the precise profile image of the breast bone serves in the lateral projection on the roentgenogram.
For the left lungs share definition in the lateral projection of topography it is necessary to part mentally the done on two parts and to make the line to the fourth thoracal vertebra. The projection of a horizontal interlobar cleft passes at the level of 4th pair ribs.
Question 3. Advantages and disadvantages of radiography, fluorography?
Question 4. Advantages and disadvantages of computed tomography, MRI?
|Computed Tomography (CT) scan||
|Magnetic resonance imaging (MRI)||
Question 5 advantages and disadvantages of ultrasonography, scintigraphy?
Question 6 What do you know about contrast methods of lung research? How are they conducted?
The vessel artificial contrasting is for the detailed analysis of the lung’s vascular system. It is carried out by the ulnar fold vein or the femoral vein, through which the catheter is entered into the right auricle and further into the pulmonary trunk, which is an agent filled with contrast.
It is important to define such factors as the sharpness, and the contrast of the picture the packing symmetry for the well-done roentgenogram. It is important to note the following for making a roentgenogram of the thoracal cavity organs. The sharpness criterion is the ribs front pieces contours are clear.
The roentgenoscopy: – For knowing the vessel’s pulsation, systole heart function, the diaphragm movement.
Photoroentgenography: – It is used as the screening – method which allows discovering the risk group from the great number of the examined ones.
Linear X-ray tomography: – For profound studying of the structure of lungs use level-by-level pictures – a tomography technique.
Computer tomography: – Standard research includes performance of consecutive cross-section tomograms from apexes of lungs to back is a costal-phrenic sine.
Bronchography: – For the detailed research tracheobronchial tree, including the subsegmental bronchus, apply a special radiological method of research – a bronchography. Iodolipolum is used for the artificial contrast.
Now the bronchography using has been reduced because of the CT.
The lungs vessel angiography: – The vessel artificial contrasting is for the detailed analysis of the lungs vascular system. It is carried out by the ulnar fold vein or the femoral vein, through which the catheter is entered into the right auricle and further into the pulmonary trunk, which is an agent filled with contrast.
Question 7 – What are the main radiological pathologic syndromes of the respiratory system you know?
- Phrenic hernia
- Lung cirrhosis
- Pneumonic infiltration
- Tubercular infiltration
- Limited interlobar paracostal pleuritis
- Lung cystic disease
- Peripheric cancer
- Cystic bronchiectasis
- Bronchopulmonary lymphadenopathy
Question 8. What are the main types of pneumonia, and what changes on the x-ray are with pneumonia?
Mediastinum organs are not displaced – it is more often characteristic of pneumonia, mainly acute. when pathological process amazes not all lung, but only it’s part: a share, a segment. Its anatomic substrate is the pulmonary tissue infiltration (pneumonia, tuberculosis)
Mainly there are two types of Pneumonia: – Atypical Pneumonia and Typical Pneumonia
Upper, middle, and lower lobe pneumonia: – X-rays play an important role in distinguishing between these types: the term lobar pneumonia is used if an entire lung lobe is visibly inflamed. Depending on which lung lobe is affected, the pneumonia is referred to as upper, middle, or lower lobe pneumonia.
If there are several multi-lobe focal inflammations in the lungs, the term focal pneumonia is used. Some people use the term bronchopneumonia if the focal inflammations started in inflamed airways (bronchi).
Sometimes, it’s the air sacs that are more inflamed (alveolar pneumonia), and sometimes it’s the tissue between the sacs (interstitial pneumonia).
For the pneumonic infiltration roughness, the contours illegibility of the average intensity a shade are characteristic. The bronchus’s lumens can be visible in this background.
The pneumosclerosis site is characterized by the zones alternating inspissation and the rising of the pulmonary tissue lightness, that is heterogeneity
The military pneumonia is localized mainly in the bottom departments, the infiltration centers of the pulmonary tissue tend to merge, with the average intensity, and the indistinct contours.
At the pneumoconiosis (occupational disease) – the centers extend diffusively against emphysema.
The middle focal shades have a 5-8 mm diameter, meet at pneumonia, metastasizes of the malignant tumors. These centers have the roundish form with accurate and equal contours, “coin-shaped shades of different sizes.
The macro focal shades with the 9-15 mm diameter take place at macro focal pneumonia, the tumors and their metastasizes, not emptied cavitary formations (the cyst, the abscess).
Question 9. What are the main types of tuberculosis, and what changes on the x-ray are in tuberculosis?
Tuberculosis encompasses an enormously wide disease spectrum affecting multiple organs and body systems predominantly caused by the organism Mycobacterium tuberculosis. A small proportion can also be caused by Mycobacterium Bovis.
Types of Tuberculosis: –
There are having two types of TB: TB disease and latent TB infection. But, if their TB germs become active, they can develop.
- Consolidation or Infiltrate TB – airspaces in the lung parenchyma. Consolidation can be patchy or dense & irregular or hazy borders.
- Any cavitary lesion: – a darkened area within the lung parenchyma, nodular or fibrotic (reticular) densities, the lucent area can be thick or thin, area of airspace infiltrates.
- Nodule with poorly defined margins: – Round density within the lung parenchyma
- Pleural effusion – Presence of fluid within the pleural space.
- Hilar or mediastinal lymphadenopathy: – Enlargement of lymph nodes
To expose the early pulmonary tuberculosis forms and lung cancer, there is a need to carry out preventive fluorographic diagnostics.
As cavernous tuberculosis concerns the tuberculosis secondary forms except for the cavern on the roentgenogram, it is possible to see one of the primary form’s signs.
Distinguish the milliary shades with 1-2 mm diameter, the small focal shades with 3-4 mm diameter which are observed at the millinery, and disseminative tuberculosis accordingly.
Question 10. What are the main types of Central cancer and what changes on the x-ray are there?
- Adenocarcinomas – arise in the outer, or peripheral, areas of the lungs.
- Squamous cell carcinomas – arise most frequently in the central chest area in the bronchi.
- Large cell carcinomas – undifferentiated carcinomas
- Mixtures – different types of non-small cell lung cancers
Bronchial carcinoids –
Annular shade. An anatomic basis of occurrence of such symptom can be an abscess of the lung and a tubercular cavern in the evacuation, a peripheric cancer of easy in the disintegration stage, the single air cyst, the bullous an inflation, and the lung cystic disease.
The disintegration of the lung peripheric cancer is accompanied by hyperadenosis of the lung root.
The history and physical examination – the presence of symptoms or signs that are suspicious for lung cancer.
The chest X-ray
CT (computerized tomography)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Task 1. of Radial Diagnostics of Respiratory System
Name the research method: – Radiography (X-Ray)
The main pathological syndrome: – Tuberculosis (TB)
Possible pathology: – total shading of the left lung with a displacement of the mediastinal organs
Task2 of Radial Diagnostics of Respiratory System
Name the research method: – X-Ray
The main pathological syndrome: – Lobar or pulmonary segment or Segment Pneumonia
Possible pathology: – Surface is rough and dry due to Fibrinous exudate on the pleura and the right lung was heavier than normal. alveolar fluid rich
Task 3 of Radial Diagnostics of Respiratory System
Name the research method: – Radiography, linear tomography, CT
The main pathological syndrome: – Acute abscess of the right lung
Possible pathology: – a rounded cavity containing fluid and often sequesters
Task 4 of Radial Diagnostics of Respiratory System
Name the research method: – a) X-ray in direct projection & b) computed tomogram
The main pathological syndrome: – Primary tuberculosis complex – Hematogenous metastases of malignant tumors in the lungs
Possible pathology: – multiple bilateral or (much less often) single round shadows
Task 5 of Radial Diagnostics of Respiratory System
Name the research method: – Radiograph indirect projection.
The main pathological syndrome: – Chronic disseminated pulmonary tuberculosis
Possible pathology: – bilateral dissemination with the predominant localization of varied in size, merging foci in the upper lobes of the lungs against the background of an enhanced and deformed (as a result of fibrosis) pulmonary pattern
Task 6 of Radial Diagnostics of Respiratory System
Name the research method: – Radiograph indirect projection.
The main pathological syndrome: – Left-sided exudative pleurisy (middle)
Possible pathology: – small amount of fluid – only the area of the lateral costal-diaphragmatic sinus; at average – to the angle of the scapula and the contour of the heart; with large – with subtotal shading of the pulmonary field; with total – the entire pulmonary field. Encapsulated pleurisy, regardless of the position of the patient, is displayed in the form of limited uniform shading with clear convex contours, located paracostally or along the interlobar cracks
Task 7 of Radial Diagnostics of Respiratory System
Name the research method: – X-ray of the chest in the vertical
The main pathological syndrome: – Hemopneumothorax
Possible pathology: – in an upright position, the horizontal level of the liquid is determined. total hemothorax causes uniform shading of the entire pulmonary field.