Professional Documents
Culture Documents
Spine
Ribs
Clavicle (collar bone)
Lung Lung
Heart
Heart
Cardiophrenic
Hila - with pulmonary artery angle
branches - blood vessels extending
from heart to lungs + lymph nodes
to fight infection.
Diaphragm Costophrenic
Diaphragm angle
(Muscle that helps
expand + contract lungs)
Thin plaq uing c an o ccur One side of plaque ill- S eldom ass o c iated with
Calcific ations seen in 10-15%
as an early marker of ex p osure. defined as it merges with the fun c tion al impairm ent un less
of chest x-rays, increasing with
Alt hough of ten bilateral, plaq ues c an normal pleural sur face. A sup erimp osed ver y num erous an d c alcified and/or enc as ing.
age and time from exp osure
b e unilalteral in 1/3 of pat ient s c arcinoma c an b e missed.
In - Profi l e, En - Face,
D iaph ragmatic Pa rave r te b ra l
Pe r i c a rd i a l Pl a q u i n g Per i c ard i a l , Pa raver teb ra l
Plaquin g Pl a q u i n g
+ D i ap hra g mati c Pl aq ui ng
M eso th elio ma
(Ch est Wall Tumo r) ( 1) Pl e u ra l E f f u s i o n s D i f f u s e Ch e s t Wa l l ( V i s cera l ) Fi s s ural ( V i s cera l)
with Pleural E ffusio n ( 2) Pl e u ra l Th i c k e n i ng Pl a qui ng
Fi s s u ra l
Th i c ke n i n g
In - Profile
Par ietal E n - Face
Plaquing Par ietal Pe ri c a rd i a l
Plaquing
Paraver tebral
D i a p h ra g m at i c I n - p ro f i l e a n d / o r
E n - f a ce p l e u ra l t h i c ke n i n g
a s s o c i ate d w i t h b l u nt i n g o f t h e co s to p h re n i c a n g l e s
Calcific ation
In - Profile
in Plaquing
Plaquing
E n - Face
Plaquing
1 2 3
D iffuse
Ex tent Pleural Ex tent Ex tent
Thickening
> 1 / 4 to 1 / 2 o f > 1 / 2 o f L ate ra l
Up to 1/4 of Ch e s t Wa l l
L ateral Chest Wall L ate ra l Ch e s t Wa l l
Parietal D iffuse
Pleural Visceral
Plaquing Pleural
Thickening
a b c
Thick ness Thick ness Thick ness
3 to 5mm > 5 to 1 0 m m >10mm
Sibson’s Fascia
(Suprapleural Membrane)-
part of Endothoracic Fascia
2. Mediastinal
Pleura
Pleural cavity Parts of
Parietal
Pleura
3. Costal Pleura
Lung Lung
Ribs
Visceral Pleura
4. Diaphragmatic
Pleura
Heart
Parietal Pleura
Front of B o d y
Heart Border
Pericardium-
lining covering
the heart,
deep to the
mediastinal
parietal pleura
Heart
Mediastinal
Lung Esophagus
Portion of the
Parietal Pleura
(tube leading from
mouth to stomach) Visceral
External Internal Pleura
Intercostal
Muscle
Intercostal
Muscle
Lung
Aorta
Physiologic
(main artery taking
Fluid between
Spine oxygenated
Visceral and
blood to body)
Rib Parietal Pleura
Endothoracic
Fascia
Parietal Pleura
covering chest wall
Rib
Spinal Cord
Visceral Pleura
covering lung
B ack of B o d y
The parietal pleura covers the thoracic cavity. It has 4 parts - the costal portion - covering the rib cage;
the cervical portion, also call the pleural cupola or dome of the pleura over the top of the lungs - the
apices, this extends through the superior thoracic aperature into the root of the neck; the mediastinal
portion, covering the tissues and organs located between the lungs and the diaphragmatic portion
The visceral pleura surrounds and covers the lung lobes and is inseparable from the lung tissue. It
The endothoracic fascia lies deep to the parietal pleura. It is called the phrenicopleural fascia over the
diaphragms and the suprapleural membrane or Sibson’s fascia at the lung apices.
Coalescence of Coalescence of
Centr ilobular Subpleural
No dules No dules
Pro g re s s i ve M assive Fibrosis Paracic atr icial Emphysema D istor tion and Volume Lo s s
W ith more time - usually over Emphysema develop es in the PMF or large opacities c an
10 years, the PMF c an migrate lower lung zones.This is usually of c avitate - central necrosis vs TB
towards the hila . Calcific ations c an a centilobular t yp e, but of ten coalesces and non - tub erculous mycobac ter ia
develop in the PMF. R arely r im into bullae and c an b e a major c ause of clinic al symptoms. or c ar inoma (esp ecially if unilateral).
c alcific ation c an also develop.
No dules only
1 - 3 mm small rounded
microno dules, b oth centr ilobular and
subpleural, with a p oster ior upp er and middle
lung zone predominance, thought to b e due to p o or Hilar adenopathy or enlargement,
lymphatic drainage in this par t of the lung. The no dules c an o ccur with or without No dules c an rarely centrally c alcify.
increase in size and profusion with advancing disease. egg-shell c alcific ations, pr ior to or af ter the
app earance of microno dules.
Coalescence of
Small R ounded Opacities Increased Cancer R isk
Coalescence of
pulmonar y no dules has visualized Increased c ancer r isk
magins to the no dules. PMF or large esp ecially if a smok er.
opacities are more homo geneous.
r/o c arcinoma
r/o tub erculoma
PMF= conglomerated
Large Opacities (> 1 cm) are PMF is asso ciated with elevated
centr ilobular no dules, matted
not always PMF. The pulmonar y hila and volume loss, p er ipheral
to gether, measur ing greater than 1 cm
macrophage, is damaged by the silic a, paracic atr icial emphysema along the lateral
in longest dimension. They have a p oster ior lo c ation,
mak ing that individual more susceptible edge of lesions and lower lung zone emphysema.
of ten flattened and lentifor m (as seen on lateral CXR),
to infec tion and TB. Always r/o TB, at ypic al I ts app earance is lik ened to “angle wings. ”
paralleling the lateral chest wall and of ten the major
mycobac ter ia, no dular sarcoid or lung c arcinoma. Per ipheral punc tate c alcific ations and rarely r im
fissure, asso ciated with lateral p er ipheral paracic atr ic al
Lo c ation, app earance, and volume loss c alcific ation c an develop in PMF.
emphysema and upp er lung zone volume loss.
is a clue, but not definitve for PMF.
Subpleural
The Subpleural No dules c an Pseudoplaques c an b e asso ciated
Interstitial Fibrosis coalesce and for m “pseudoplaques”, with the development of
develop es as microno dules. some of which c an c alcify. R ounded Atelec tasis.
Presentations of Silicosis
Ch ro n i c
Ac u te ( Si l i co p ro te i n o s i s ) Ac ce l e rate d 10-30 yrs
M edial upp er
We e k s to M o nt h s 4-10 yrs
lung zone alveolar
proteinaceous
exudative opacit y
pro gresses over D ense
months, asso ciated concentration.
with symmetr ic hilar Can have air
and mediastinal broncho grams.
adenopathy, volume
loss with pro gessive
fibros is, bullae and
distor ion of
mediastinal struc tures.
Pneumothorax,
recur rent pneumonia,
centr ilobular no dules
and patchy M ost common. M o derate to
consolidations high dust concentrations of ten for
may o ccur. Least common. R equires a severe, Ver y high dust exp osure with > 20 yrs. Can b e asymptomatic or have
intense inhalation usually within an onset of imaging findings in 4-10 yrs. chronic bronchitis and eventually develop non-smok ing
enclosed space such as with sandblasting. The patient is commonly shor t of breath. c aused emphysema - paracic atr icial and centr ilobular.
Can die in 1-3 years.
Diagram Teaching Files > Asbestos Disease > Emphysema > Silicosis and Coal Workers' Pneumoconiosis
Introduction
The teaching file consists of 3 parts. First, there are didactic articles. Second, there are visual diagrams,
which will help you conceptualize the anatomy of the chest and the findings associated with asbestos-caused
disease on chest x-rays, CT and HRCT scans. Many individuals learn better from visual observation of conceptual
ideas, which this presentation allows for. The individual images can be magnified twice, first doubled click with the
arrow over the picture set, and when viewing the magnified picture set, there is an option above, to view an even
larger online version by clicking that option, further enlarging the image information. Should the image information
be less than optimally readable, then a PDF version can be printed on your computer, which also may give sharper
detail and which could be used as a physical hardcopy reference. Third, actual chest x-rays, CT and HRCT
images of these findings are presented, along with stacked CT scans for you to review and test your skills.
Asbestos is a naturally occurring group of magnesium silicate minerals that are made up of tiny microscopic fibers
with very good insulating and heat-resistant properties. Asbestos fibers are divided into two basic groups: The
serpentine fibers, having long curly fibers, which include Chrysotile, and the amphibole fibers, having
straight, short, needle-like fibers, which include Crocidolite and Amosite. In general, the smaller and straighter
the fiber, the deeper it can be lodged into the lungs and the more harmful it is. The amphiboles
are more harmful than the serpentines. However, Chrysotile, a serpentine type fiber, was the most common
asbestos product used in the United States. Asbestos fibers, when breathed into the lung, can irritate the chest wall
and lung linings (the pleura) or the lung itself (the parenchyma). It can also be swallowed and can penetrate the
abdominal cavity irritating it as well as abdominal organs.
Disease caused by asbestos includes irritation to the lung lining with accumulation of fluid known as a pleural
effusion; scarring of the chest walls, diaphragms and mediastinum known as pleural (circumscribed)
plaquing; scarring of the lung lining or fusion of the lung lining to the chest wall often occurring after a pleural
effusion(s) called diffuse pleural thickening; which when associated with extension into and distortion of the
lung tissue is known as cicatricial scarring; and when infolding the lung into its scar mass is called rounded
atelectasis. Scarring of the lung tissue is known as interstitial or parenchymal fibrosis, which in its end
stage develops honeycombing. Cancers can occur to the chest wall lining known as a mesothelioma or to the
lung tissue known as a lung cancer or carcinoma.
On chest radiographs, there has been an attempt by various national and international organizations to standardize
readings of chest x-rays in workers having had occupational dust and fiber exposure and to classify them such that
they can be compared. This has evolved into the ILO system - the International Labor Organization
system of interpretation of chest radiographs. The ILO system rates the quality of the frontal chest x-ray,
describes the presence or absence of disease of the lung that can be caused by occupational dust or fiber
exposures, and rates lung scarring according to its size and shape, its location within the lung - upper, mid or lower
lung zones, and the concentration of visualized lung scarring per unit area of the disease process, also known as
the profusion. In addition, there is a discussion of the presence or absence of pleural plaquing - scarring of the
lining of the chest walls, diaphragms and mediastinum or diffuse pleural thickening - scarring of the lining of the
lung, as well as a description of "other findings" both presented as check boxes of specific symbols for specific
findings, or as an open-ended discussion entry. The below visuals are to help you understand what these findings
look like and how they are classified, both for plain radiographs, supine spiral CT and prone HRCT.
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Anatomy of
Frontal PA Chest X-Ray
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CT Scan of Chest;
Pleural plus Pericardial Coverings
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severe profusion.
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along the chest wall from those that are in the lung.
The mere presence of calcification associated with
a nodule does not guarantee that is a benign scar
or granuloma. If the calcium deposit is far on
the periphery, this is often a warning sign that
the nodule needs to be followed with
sequential images to exclude growth since
cancers can occur adjacent to a calcified area of
tissue abnormality.
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Emphysema is a lung condition whereby the respiratory unit of the lung is destroyed. It is a permanent
abnormal enlargement of air spaces distal to the terminal bronchiole accompanied by
destruction of their walls. Emphysema can have various presentations and be of various types, the four
main types being the centrilobular, paraseptal, panlobular, and paracicatricial types.
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Silicosis and coal workers’ pneumoconiosis ("CWP") are two forms of occupational dust disease that give similar
imaging appearances, but are caused by different pathologic changes to the lungs. Silicosis is
the more fibrotic of the two entities and can be an isolated disease process or overlap and be part of CWP.
Imaging changes begin with the simple type of the disease process in which the interstitial changes appear
as small rounded opacities (micronodules) primarily in the posterior upper greater than middle lung zones.
With progression, the patient develops the complicated type of the disease process, which involves
progressive massive fibrosis or large opacities due to a coalescence of the micronodules. The ILO
system has been applied to this disease process as well, and visual diagrams of such are shown below.
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Enseñanza Diagrama Archivos> Enfermedades asbesto > Enfisema > Silicosis y de Trabajadores del Carbón
Neumoconiosis
Introducción
El archivo de la enseñanza se compone de 3 partes. En primer lugar, hay artículos didácticos. En segundo lugar,
hay diagramas visuales, que le ayudará a conceptualizar la anatomía del pecho y los resultados asociados con el
amianto enfermedad causada en el pecho de rayos X, tomografías computarizadas y TCAR. Muchas personas
aprenden mejor a partir de la observación visual de las ideas conceptuales, que esta presentación permite. Las
imágenes individuales se pueden ampliar en dos ocasiones, primero doble clic con la flecha sobre el conjunto de
imagen, y al ver el conjunto imagen ampliada, hay una opción más arriba, para ver una versión aún más grande en
línea haciendo clic en esa opción, más la ampliación de la información de la imagen . Si la información de la imagen
será inferior a leer de manera óptima, a continuación, una versión en PDF se pueden imprimir en el equipo, que
también puede dar detalles más precisos y que puedan ser utilizados como referencia en papel físico. En tercer
lugar, el pecho real de rayos X, TC y TCAR imágenes de estos hallazgos se presentan, junto con la TC apilados
busca a revisar y poner a prueba sus habilidades.
El asbesto es un grupo natural de minerales de silicato de magnesio que se componen de pequeñas fibras
microscópicas, con muy buenas propiedades aislantes y resistentes al calor. Las fibras de asbesto se dividen en dos
grupos básicos: Las fibras de serpentina, con fibras largas de rizado, que incluye el crisotilo y las fibras de
anfíboles, de base recta, de aguja, como las fibras cortas-, que incluyen la crocidolita y amosita. En general, los
más pequeños y más rectos de fibra, la más profunda que puede presentarse en los pulmones y el más
dañino que es. Los anfíboles son más perjudiciales que las serpentinas. Sin embargo, el crisotilo, una fibra de tipo
serpentina, fue el producto de amianto más utilizado en los Estados Unidos. Las fibras de asbesto, al inhalarlo hacia
los pulmones, puede irritar el revestimiento de la pared torácica y el pulmón (pleura) o el pulmón en sí mismo
(parénquima). También se puede tragar y puede penetrar en la cavidad abdominal es irritante, así como los órganos
abdominales.
La enfermedad causada por el amianto incluye la irritación de la mucosa pulmonar con la acumulación de líquido
conocido como derrame pleural, la cicatrización de las paredes del pecho, el diafragma y el mediastino conocido
como pleural (circunscrita) plaquing; cicatrización de la mucosa pulmonar, o la fusión del revestimiento del pulmón
a la pared torácica a menudo ocurre después de un derrame pleural (s) llama engrosamiento pleural difusa, que
cuando se asocia con la extensión de la entrada ya la distorsión de los tejidos de los pulmones que se conoce como
cicatrices cicatricial, y cuando invaginación del pulmón en su masa cicatriz se llama atelectasia redonda. La
cicatrización del tejido pulmonar que se conoce como del parénquima o fibrosis intersticial, que en su etapa final
se desarrolla panal de abejas. Los cánceres pueden ocurrir en el revestimiento de la pared torácica conocido como
mesotelioma o el tejido pulmonar se conoce como cáncer de pulmón o carcinoma.
En las radiografías de tórax, ha habido un intento por parte de diversas organizaciones nacionales e internacionales
para normalizar las lecturas de las radiografías de tórax en los trabajadores que hayan tenido el polvo de trabajo y
exposición a las fibras y las clasifican de manera que puedan ser comparados. Esto se ha convertido en el sistema
de la OIT - el sistema de la Organización Internacional del Trabajo de la interpretación de radiografías de
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tórax. Los tipos de sistema de la OIT la calidad del tórax frontal de rayos X, se describe la presencia o ausencia de
enfermedad del pulmón que puede ser causada por el polvo o las exposiciones ocupacionales de fibra, y las tasas
de cicatrización pulmonar de acuerdo a su tamaño y forma, su ubicación dentro de la pulmonar - superior, media o
inferior del pulmón zonas, y la concentración de pulmón visualizar cicatrices por unidad de superficie de la
enfermedad, también conocida como la profusión. Además, hay un debate sobre la presencia o ausencia de
plaquing pleural - cicatrización de la mucosa de las paredes del pecho, el diafragma y el mediastino o engrosamiento
pleural difusa - cicatrización de la mucosa de los pulmones, así como una descripción de "otros hallazgos "ambos
presentados como casillas de verificación de los símbolos específicos de resultados específicos, o como un
elemento de debate de composición abierta. Las siguientes imágenes son para ayudarle a entender lo que estos
resultados se parecen y cómo se clasifican, tanto para las radiografías simples, TC helicoidal en posición supina y
TCAR en decúbito prono.
Anatomía de
Frontal de tórax de rayos X
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El enfisema es una enfermedad pulmonar por el que la unidad de cáncer de pulmón se destruye el sistema
respiratorio. Es un anormal ampliación permanente de los espacios aéreos distales a los bronquiolos
terminales acompañada de la destrucción de sus paredes. El enfisema puede tener varias presentaciones y ser
de varios tipos, los cuatro tipos principales son la, paraseptal, panlobulillar y paracicatricial tipos
centrolobulillar.
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TC / TCAR en el enfisema
[ parte superior de la
página ]
Silicosis y de trabajadores del carbón neumoconiosis (CWP ") son dos formas de la enfermedad de polvo
profesionales que dan imágenes de apariencia similar, pero son causados por cambios patológicos diferentes
a los pulmones. Silicosis es la fibrosis más de las dos entidades y puede ser una enfermedad aislada proceso o
se superponen y ser parte de CWP. cambios de imágenes comienzan con el tipo simple del proceso de la
enfermedad en la que los cambios intersticiales aparecen opacidades redondeadas pequeñas como
(micronódulos) principalmente en el mayor centro de pulmón zonas superior posterior. Con la progresión, el
paciente desarrolla el tipo complicado del proceso de la enfermedad, que consiste en la fibrosis masiva
progresiva o opacidades grandes debido a la coalescencia de las micronódulos. El sistema de la OIT se ha
aplicado a este proceso de la enfermedad así, y los esquemas visuales de tal se muestran a continuación.
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ILO Classific ation for Silicosis and CWP of the
Fro ntal (PA) Chest X-R ay Amount of Lung Sc arring: Profusion
Negative
M ild Profusion
M o derate Profusion
S evere Profusion
p q r
<1.5 mm 1 . 5 m m to 3 m m 3 mm - 10 mm
Small R o u n d e d O p a c i t i e s Cl a s s i c a l l y : Si l i co s i s / C W P
Upp er
Lung
ULZ Zone
Middle
Lu n g
Zo n e
MLZ
Lowe r
Lu n g
Zo n e
LLZ
Upp er 1/3 M i d d l e 1/3 Lowe r
L arge Opacities
a b c
>1 cm and <5 cm > 5 c m u p to RU L Zo n e > RU L Zo n e
An opacit y of a minimum Maximum length of a single or Maximum length of a single or
longest length exceeding 1cm mu l t i p l e o p a c i t i e s to t a l i n g g re ate r t h a n m u l t i p l e o p a c i t i e s to t a l i n g m o re t h a n
or multiple opacities, the sum of 5 c m a n d n o t to exce e d RU L Zo n e i n a re a t h e r i g ht u p p e r l u n g zo n e i n a re a
their longest dimensions, less than 5 cm
aa at ax
Co a l e s ce n ce o f
Atherosclerotic Aor ta Ap i c a l Pl e u ra l Th i c ke n i n g Sm a l l R o u n d e d O p a c i t i e s
Uncoiling of the aor ta with Us u a l l y s y m m e t r i c a n d n o n - s p e c i f i c o r Th e m a rg i n s o f t h e o p a c i t i e s
or without a c alcified arch. a g e - re l ate d, b u t i f a s y m m e t r i c r / o re m a i n v i s i b l e, w h e re a s a L a rg e O p a c i t y,
t u b e rc u l o s i s o r a Pa n co a s t t u m o r. a p p e a r s a s a h o m o g e n e o u s s o l i d m a s s.
bu ca cg
Ca l c i f i e d
G ra n u l o m a
Ca l c i f i e d Ca l c i f i e d
Pa rat ra c h e a l / H i l a r Ly m p h
Mediastinal No d e s
Ly m p h No d e s
Bulla(e) Ca l c i f i e d
Ca n ce r o f Lu n g G ra n u l o m ato u s D i s e a s e
H oles in lungs > 1cm
Th e m a s s m ay b e s m o o t h , Ca l c i f i e d h i l a r a n d / o r m e d i a s t i n al
Called when the margins of
the bullae identified. lobu l ate d, i r re g u l a r o r s p i c u l ate d. l y m p h n o d e s a n d / o r d i f f u s e l y c a l c i f i e d g ra n u l o m a s.
cn co cp
E n l a rg e m e nt
of hilar and
i nte r m e d i ate
s i ze l u n g
ve s s e l s
E n l a rg e d
Hy p e ra e rat i o n Heart
D i a m e te r
Fl at te n i n g
o r Co n c av i t y
o f D i a p h ra m s
Calcified No dules Ab n o rm a l i t y i n Ca rd i a c Co r Pu l m o n a l e
Punc tate central c alcific ations Si ze o r Sh a p e R i g ht - s i d e d h e a r t f a i l u re
M ost o f te n c a rd i a c e n l a rg e m e nt o f te n d u e to a dva n ce d CO P D. E n l a rg e m e nt o f ve s s e l s
in small pneumo coniotic opacities.
( Ca rd i o m e g a l y ) . i n a l l zo n e s g i ve s t h e a p p e a ra n ce o f p l e t h o ra .
cv di ef
Cancer Cavit y
Fungus
with Central
Cavit y
Necrosis
Fungus
Fluid B all
D i s to r te d Pl e u ra l Ef f u s i o n ( s )
Cavit y of ten asso ciated with
I nt ra - Th o ra c i c Co nte nt s O f te n s e co n d a r y to co n g e t i ve
fungal infec tion but, also c an
b e a centrally necrotic lung c ancer. s u c h a s h i l a r e l evat i o n f ro m h e a r t f a i l u re ( w i t h e n l a rg e d h e a r t ) ,
Pro g re s s i ve M a s s i ve Fi b ro s i s o r d i s to r t i o n b u t c a n b e d u e to t h e c a n ce r, k i d n ey f a i l u re o r
from oth e r c a u s e s o f p l e u ra l / p a re n c hy m a l s c a r r i n g. a s b e s to s - re l ate d d i s e a s e ( w i t h n o ra m l s i ze h e a r t ) .
px ra rp*
Co m e t - Ta i l Si g n
( i n fo l d i n g
and curving
o f Pu l m o n a r y
Ve s s e l s o r
B ro n c h i i nto
Ed g e o f Le s i o n )
Volume
Loss
tb tb OD
Ir regular
Apic al Pleural
Thick ening
Infiltrate/Sc ar r ing
or
Susp ec t
Ac tive Tub erculosis
(Apic al pleural thick ening Other Disease(s)
M i l i a r y Tu b e rc u l o s i s o r Si g n i f i c a nt Ab n o r m a l i t y ( i e s )
and parenchymal changes)
(D efinition also includes inac tive tb w i t h ex p l a n ato r y s t ate m e nt - e g. t hy roi d g o i te r
where findings go b eyond cg) o r l a rg e h i at a l h e r i n a w i t h a n a i r - f l u i d l eve l