Radiography of the Upper Airways - univet.hu OKTATASI ANYAGOK/oktatas 2010_1… · Radiography of...

Radiography of the Thorax

Attila Arany-Toth 1

Radiography of the Upper Airways

Radiography of the Upper Airways

Attila ARANY-TÓTH

Radiography of the Upper AirwaysGeneral considerations


• Usually in association with thoracic

radiography

• Lateral view

• Usually in association with thoracic

radiography

• Lateral view



• Usually in association with thoracic radiographs

• Lateral view

• Easy to identify

• Important parameters:

– diameter

– position

• Usually in association with thoracic radiographs

• Lateral view

• Easy to identify

• Important parameters:

– diameter

– position

Anatomy of the LarynxAnatomy of the LarynxAnatomy of the LarynxAnatomy of the Larynx

Anatomy of the LarynxAnatomy of the LarynxAnatomy of the LarynxAnatomy of the Larynx

pyriform recess

basihyoideum

hyoid bones

Radiography of the Upper AirwaysRadiography of the TracheaRadiography of the Upper AirwaysRadiography of the Trachea

• Visible structures: lumen, cartilages (when calcified)

• Diameter• Line: acute angle with line of thoracic spine

• Visible structures: lumen, cartilages (when calcified)

• Diameter• Line: acute angle with line of thoracic spine


Attila Arany-Toth 2

Radiography of the Upper AirwaysTracheal collapse


• toy breeds, middle/old aged dogs• coughing



inspirationinspiration

exspirationexspiration

Radiography: suspicionEndoscopy: confirmation

Radiography of the Upper AirwaysBrachycephalic syndrome


1. Stenotic nares1. Stenotic nares

- congenital malformation(narrowing) of different portions of the upper airways- in brachycephalic dog (bulldog, boxer, pekinese,pug etc)- restricted respiratory capacity, highersusceptibility to respiratory infections



1. Stenotic nares

2. Elongated soft palate

1. Stenotic nares




1. Stenotic nares


3. Laryngeal hypoplasia

4. Eventrated laryngeal

saccule

1. Stenotic nares




saccule



1. Stenotic nares




saccule

5. Tracheal hypoplasia

!!!

1. Stenotic nares




saccule

5. Tracheal hypoplasia

!!!


Attila Arany-Toth 3

Hypoplasia of the tracheaHypoplasia of the tracheaHypoplasia of the tracheaHypoplasia of the trachea

-- congenital malformationcongenital malformation-- congenital malformationcongenital malformation-- the entire trachea is affectedthe entire trachea is affected-- the entire trachea is affectedthe entire trachea is affected

-- brachycephalic dogs !! brachycephalic dogs !! (boxer, bulldog, mastiff etc.) (boxer, bulldog, mastiff etc.) -- brachycephalic dogs !! brachycephalic dogs !! (boxer, bulldog, mastiff etc.) (boxer, bulldog, mastiff etc.)

Diameter of the tracheaDiameter of the trachea

Tracheal diameter (TD)Thoracic inlet (TI)

Tracheal diameter (TD)Thoracic inlet (TI)

NonNon--brachycephalic: brachycephalic: >>20%20%

Brachycephalic: Brachycephalic: >>16%16%

Bulldogs: Bulldogs: >>12%12%

Radiography of the Upper AirwaysForeign body in upper airways







General considerationsRadiography of the Thorax

General considerations

• frequently indicated

• assessment of vital organs

• monitoring progression of diseases

• high kV, low mAs

• grid

• frequently indicated

• assessment of vital organs

• monitoring progression of diseases

• high kV, low mAs

• grid


Attila Arany-Toth 4


General considerationsRadiography of the Thorax

General considerations

• The quality of thoracic radiograph is

influenced by:

– left / right recumbency

– movement blur

– respiratory phase (expiration - inspiration)

• The quality of thoracic radiograph is

influenced by:

– left / right recumbency

– movement blur

– respiratory phase (expiration - inspiration)

Radiography of the ThoraxProjections


Left lateralLeft lateral



Right lateralRight lateral



VentrodorsalVentrodorsal



DorsoventralDorsoventral

Radiography of the ThoraxGross radiographic anatomy


Lateral viewLateral view


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heart

lung



Dorsoventral viewDorsoventral view



Precise positioning !Precise positioning !

Radiography of the ThoraxRadiographic anatomy of the lungs


Composite shadow of:

- alveoli

- interstitium

- vasculature

- brochi and broncheoli

- (thoracic wall)

Composite shadow of:

- alveoli

- interstitium

- vasculature

- brochi and broncheoli

- (thoracic wall)



Alveoli and interstitiumAlveoli and interstitium


Attila Arany-Toth 6



Bronchi and broncheoliBronchi and broncheoli

Radiography of the ThoraxLung patterns


Normal lung pattern Normal lung pattern



Alveolar pattern Alveolar pattern

air bronchogramair bronchogram

Fluid (cells) in the lumen of the alveoli.Fluid (cells) in the lumen of the alveoli.



Alveolar pattern Alveolar pattern

air bronchogramair bronchogram

Causes:- pnemonia (asp.)- haemorrage- atelectasis

Causes:- pnemonia (asp.)- haemorrage- atelectasis

- homogenous soft tissue opacity- air bronchogram

- homogenous soft tissue opacity- air bronchogram



Interstitial pattern Interstitial pattern Causes:Cell or fluid accumulation in the interstitium( oedema, haemorrage, fibrosis, neoplasia etc.)

Causes:Cell or fluid accumulation in the interstitium( oedema, haemorrage, fibrosis, neoplasia etc.)

1. Structured interstitial pattern (=nodular)2. Non-structured interstitial pattern1. Structured interstitial pattern (=nodular)2. Non-structured interstitial pattern

- general increased radiopacity - diffuse haziness- increased non-branching linear densities

- general increased radiopacity - diffuse haziness- increased non-branching linear densities


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Interstitial pattern Interstitial pattern Causes:Cell or fluid accumulation in the interstitium of any origin ( oedema, haemorrage, fibrosis, neoplasia, pneumonia etc.)

Causes:Cell or fluid accumulation in the interstitium of any origin ( oedema, haemorrage, fibrosis, neoplasia, pneumonia etc.)



Interstitial pattern Interstitial pattern



Nodular pattern – A. MicronodularNodular pattern – A. Micronodular

- metastases- PIE (pulmonary infiltrates with eosinophilia)

- metastases- PIE (pulmonary infiltrates with eosinophilia)



Nodular pattern – A. MacronodularNodular pattern – A. Macronodular

- pulmonary metastases


Radiography of the ThoraxLung patternsBronchial pattern Bronchial pattern

Peribronchial- inflammation- proliferation- calcification

- parallel lines- end-on view

(„donut sign”)

Peribronchial- inflammation- proliferation- calcification

- parallel lines- end-on view

(„donut sign”)


Radiography of the ThoraxLung patternsMixed pattern (interst.-alveol.)Mixed pattern (interst.-alveol.)


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Radiography of the ThoraxLung patternsMixed pattern (interst.- bronch.)Mixed pattern (interst.- bronch.)


Radiography of the ThoraxLung patternsBullous pattern (bullae)Bullous pattern (bullae)


Radiography of the ThoraxLung patternsHypovascularisationHypovascularisation

Radiography of the ThoraxExtrapulmonary anomalies


PneumothoraxPneumothorax- air in the pleural space- displacement of the heart - retraction of the lung lobes

- air in the pleural space- displacement of the heart - retraction of the lung lobes



Pleural effusionPleural effusion

- homogenous opacities with sharp margins- homogenous opacities with sharp margins

- interlobar- interlobar



Flail chestFlail chest


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Radiography of the HeartRadiography of the Heart

1. Shape2. Size3. Secondary changes (vessels, lung)

1. Shape2. Size3. Secondary changes (vessels, lung)

Pericardium, muscles, chambers, blood, valves etc. are not seen separately!

Pericardium, muscles, chambers, blood, valves etc. are not seen separately!

Cardiologic diagnosis: never only on the basis of the radiograph !Cardiologic diagnosis: never only on the basis of the radiograph !

Radiographic anatomy of the heartRadiographic anatomy of the heart1. Shape



Radiographic anatomy of the heartRadiographic anatomy of the heart1. Size

• height: max. 2/3 of the thorax• width: max. 3 intercostal space• height: max. 2/3 of the thorax• width: max. 3 intercostal space

Radiographic anatomy of the heartRadiographic anatomy of the heart1. Size

• height: max. 2/3 of the thorax• width: max. 3 intercostal space•Vertebral Heart Scale (VHS)

• height: max. 2/3 of the thorax• width: max. 3 intercostal space•Vertebral Heart Scale (VHS)

Th4

5.55.5

6.56.5

VHS=5.5+6.5=12VHS=5.5+6.5=12

Normal range: 8.5-10.5


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Cardiac enlargementCardiac enlargement

•Left heart•Right heart•Both (generalized cardiomegaly)

Left heart enlargement


normal

•• straight/concave caudal marginstraight/concave caudal margin•• elevated tracheaelevated trachea•• secunder pulmonary oedemasecunder pulmonary oedema




normal





•• straight/concave caudal marginstraight/concave caudal margin•• elevated tracheaelevated trachea•• secsecoondndaarryy pulmonary pulmonary oedemaoedema(e.g. mitral (e.g. mitral insufficiency)insufficiency)

•• straight/concave caudal marginstraight/concave caudal margin•• elevated tracheaelevated trachea•• secsecoondndaarryy pulmonary pulmonary oedemaoedema(e.g. mitral (e.g. mitral insufficiency)insufficiency)

normal


Right heart enlargement

•• rounded cranial marginrounded cranial margin•• longer strernal contactlonger strernal contact•• rounded cranial marginrounded cranial margin•• longer strernal contactlonger strernal contact

normal


Generalized enlargement

normal

•e.g. cardomyopathies




Generalized enlargementGeneralized enlargementGeneralized enlargementGeneralized enlargement

normal

Note: pericardial disease (effusion, hernia) !!

Note: pericardial disease (effusion, hernia) !!

Radiography of the ThoraxRadiography of the Mediastinum


Radiography of the MediastinumRadiography of the Mediastinum•• craniodorsal: soft tissue opacity (vena cava, esophagus, a. craniodorsal: soft tissue opacity (vena cava, esophagus, a. subclavia, nerves, thymus etc.)subclavia, nerves, thymus etc.)•• cranioventralcranioventral

Radiography of the MediastinumRadiography of the MediastinumEsophagusEsophagus

cat: herring-bone pattern

dog: longitudinal mucosal folds

Radiography of the MediastinumRadiography of the MediastinumEsophagusEsophagus

Radiography of the MediastinumRadiography of the Mediastinum

Esophageal disordersEsophageal disorders

Dilatation:Dilatation:

- partial (e.g. PRAA)- partial (e.g. PRAA) - total (megaoesophagus)- total (megaoesophagus)

SURVEYSURVEYSURVEYSURVEY



Radiography of the MediastinumRadiography of the Mediastinum

Esophageal disordersEsophageal disorders

Dilatation:Dilatation:

- partial (e.g. PRAA)- partial (e.g. PRAA) - total (megaoesophagus)- total (megaoesophagus)

CONTRASTCONTRAST



Esophageal Foreign Body



PneumomediastinumPneumomediastinum

•• injury of the trachea/esophagus or skin on the neckinjury of the trachea/esophagus or skin on the neck•• the tracheal wall is separated from the the tracheal wall is separated from the mediastinummediastinum

Radiography of the DiaphragmRadiography of the Diaphragm

Radiography of the DiaphragmRadiography of the Diaphragm Radiography of the DiaphragmRadiography of the Diaphragm



Radiography of the DiaphragmRadiography of the Diaphragm

Diaphragmatic herniaDiaphragmatic hernia• abdominal organs in the thorax• abnormal abdominal anatomy

Radiography of the Upper Airways - univet.hu OKTATASI ANYAGOK/oktatas 2010_1… · Radiography of...

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