Radiology: Cardiopulmonary Module

Radiology CardioPulmonary Module Dr. Mary G. Cormier Professor of Radiology Georgetown Medical School

Outline • Historical perspective • Making images • Basic anatomy – CXR – CT • Examples of disease – lung – pleura – heart/pericardium

HISTORICAL PERSPECTIVE Wilhelm Konrad Roentgen Radiology officially traces its beginning to Wilhelm Konrad Roentgen’s discovery (and naming) of xrays, 1895

HISTORICAL PERSPECTIVE • physics professor at University of Wurzburg, in Germany • discovered “a new kind of ray” accidentally while experimenting with Crooke electrical tubes • “x” was the mathematical symbol for an unknown

WILHELM KONRAD ROENTGEN

Making X-RAYS • Electrons from (-)anode are accelerated to (+)cathode in vacuum tube • Electrons’ direction altered by the (+)nucleus • X-RAYs are thereby emitted in all directions • X-RAYS escape through a filtered window

X-rays

MAKING IMAGES

X-RAYS • Electromagnetic radiation of a short wavelength (high energy) • Penetrate materials to a certain degree • Conventional radiology is based on – irradiating the measured object – measuring the intensity of the X-rays which have been attenuated by the object

Making a chest radiograph

Creating a PA CXR

Creating a lateral CXR

Making a CT image

Making a CT image

Multiplanar capability

Multiplanar CT images

axial

coronal

sagittal

Normal Anatomy CXR CT Chest

Normal CXR

frontal view

side view

Normal frontal CXR trachea

Pulmonary arteries

heart

diaphragm

Pleura l angle

Normal bones clavicle

Spinous process

Coracoid process

ribs

vertebrae

Normal “moguls”

Aortic arch

Pulmonary trunk Right atrium

Left atrium/ appendage Left ventricle

Normal Lateral CXR scapulae sternum

trachea

Vertebrae

heart

diaphragm

Axial slice

Normal axial CT anatomy

Normal axial CT anatomy

1

8

9

15

16

14

2

7

10

6 13 3

4

5

11

12

Normal axial CT anatomy

Normal axial CT anatomy

1

16

71

18

15

9 6 10

12

141

5 13

14

111

12

13

Normal axial CT anatomy

Normal cardiac valves (axial CT)

•aortic valve with right (R), left (L), and noncoronary (N) cusps •pulmonary valve with right (R), left (L), and anterior (A) cusps

Normal coronary arteries (axial CT)

Left main (LM) coronary artery at the level of the ostium, arises from the left Valsalva sinus, courses posterior to the right ventricular outflow tract (RVOT), and bifurcates into the left anterior descending (LAD) and the left circumflex (LCX) branches Middle segment of the right coronary artery (RCA) and distal segments of the left anterior descending and left circumflex branches. The latter is seen in the left atrioventricular groove, in close proximity to the great cardiac vein (GCV).

Normal azygos vein

right paratracheal prominence caused by the azygos vein (arrow) widening is due to the azygos vein (arrow)

azygos vein arches forward to join the SVC (arrow)

azygos vein (arrow)

Examples of disease

• Lung –pneumonia –tumor –pulmonary embolism

pneumonia

pneumonia

baseline

RUL pneumonia

baseline

RUL pneumonia

RUL pneumonia

baseline

RUL pneumonia

tuberculosis (cavitary)

tumor

lung carcinoma

lung carcinoma

PET scan

uterus cancer, spread to lungs

2007

2008

colon cancer, spread to lungs

2006

2008

possible early neoplasm

pulmonary embolism

Pulmonary embolism Axial: clot in right and left pulmonary arteries (arrows)

Coronal: clot in right pulmonary artery extending into upper and lower branches (arrow)

Normal Pleura

normal pleura

Pleural outlines Minor fissure

Major fissures

Pleural fissures (LEFT)

LUL

LLL

Pleural fissures (RIGHT)

RUL

RML

RLL

Normal pleura

Examples of disease • Pleura –pneumothorax –pleural effusion –pleural infection (empyema) –other

pneumothorax

pneumothorax

Complete L pneumothorax

L apical pneumothorax

Pleural effusion

Large pleural effusion

Layering pleural effusion

Layering pleural effusion

Pleural infection (empyema)

empyema

empyema

Chest tube drainage

Pleural micronodules (sarcoidosis)

CT scan demonstrates small nodules in the lungs and along the minor (arrowhead) and major (arrow) fissures representing sarcoidosis

Normal pleura

Examples of disease • Heart/Pericardium – Enlarged cardiac silhouette – Pulmonary edema – Pericardial effusion

enlarged “cardiac silhouette”

Normal heart size Enlarged cardiac

pulmonary edema

alveolar edema

pulmonary edema

baseline

1 day later

pulmonary edema

0000 hrs

0800 hrs

pericardial effusion

pericardial effusion

Review • Historical perspective • Making images • Basic anatomy – CXR – CT • Examples of disease – lung – pleura – heart/pericardium

The End