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CT Applications in Chest Pathology
CT Applications in Chest Pathology
Basics of CT
Lung window
Bone window
Conventional CT
High resolution CT
Conventional CT Vs HRCT
Indications of Chest CT
Pulmonary embolism
Haemoptysis
Applications of CT
1. Detection of Lung Tumours
2. Diagnosis
3. Anatomic extent of disease -Intra and/or extra thoracic disease extent , TNM
descriptors
4. Decision of therapeutic strategy -Surgery -vs- Chemotherapy -vs- Palliative
Care Resectability / Irresectability
5. Image guided biopsies
Lung tumours
Benign tumours
Harmatoma
Fat in 50%
Rarely multiple
Bronchial Adenoma
Pathological types
Squamous (30-35%)
Adenocarcinoma (30-35%)
Large Cell Undifferentiated (15-20%)
Small Cell (20-25%): systemic disease
Stage I
Stage II
Adds hilar lymph node involvement (IIA) or resectable chest
wall/mediastinal
involvement (IIB)
Stage III
lobar bronchi
T2>3cm diameter; involves main bronchus but 2cm distal to carina; invades
visceral pleura; associated with atelectasis or obstructive pneumonitis extending to
hila but not involving entire lung
T3Tumour of any size but with invasion of: chest wall,diaphragm, mediastinal pleura,
parietal pleura, parietal pericardium, or tumour in main bronchus <2cm from carina
but not involving carina; or atelectasis / obstructive pneumonitis of entire lung
T4Tumour of any size but with invasion of: heart, great vessels, trachea,
oesophagus, vertebral
body, carina; tumour with malignant pleural / pericardial
effusion; or with satellite tumour nodule(s) in ipsilateral primary-tumour lobe
T
1
The CT Staging of Lung Cancer: T1 / T2 lesions
T2
T3
NO
None
N1
Ipsilateral hilar
N2
N3
Cavitating Carcinoma
Liver
33-39%
Adrenals
20-33%
Brain
16-26%
Bone
15-21%
Key point
CT remains the mainstay in the non-invasive staging of lung cancer;
Mediastinal masses
ANTERIOR MEDIASTINUM
THYMOMA
TERATOMA
INTRATHORACIC THYROID ENLARGEMENT
LYMPHOMA (3 Ts and an L)
OTHER
- LYMPHANGIOMA
ANEURYSM OF ASCENDING AORTA
Lymphadenopathy
Bronchogenic cyst
Aortic aneurysm
Neurogenic tumour
Extramedullary haemopoeisis
Reticulosis, myeloma
Paravertebral abscess
Aortic aneurysm
Hiatus hernia
Thymoma CT
Retrosternal goiter
Malignant mesothelioma
Lung Abscess
Aortic aneurysm
Pulmonary embolism
Lines
Nodules
Consolidation
Ground-glass Opacity
Cysts
Linear abnormalities
a) thickened interlobular septa
b) bronchovascular interstitial thickening
c) reticular change
e.g Fibrosing alveolitis Lymphangitic tumours
Fibrosing alveolitis
Lymphangitic tumour
Nodules
Nodules Infective
A hazy opacity that does not obscure the associated pulmonary vessels. This
appearance results from parenchymal abnormalities that are below the spatial
resolution of HRCT.
E.g. alveolar wall inflammation or thickening, with partial air-space filling, or with
some combination of the two.
Cysts
Rounded structure that is filled with air and usually has a thin wall.
E.g.Cystic bronchiectasis
Chronic interstitial fibrosis (subpleural honeycombing)
Langerhans cell Histiocytosis
Lymphangioleiomyomatosis
Cystic Bronchiectasis
Consolidation