WMUH

Teaching
Program

CT Chest

Dr Chieh-Yin Huang: F2
Dr Gemma Sheehan-Dare: F2
Dr Ashkan Sadighi: AMU Consultant
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Outline Program

• CT Chest – principles and indications

• A few pathologies
• Practice cases for audience
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Principle Program

Type Dose (mSv) Natural Background

CXR 0.04 3 Days
AXR 1.0 6 Months
Annual UK Average 2.4 1 Year
CT Head 2,5 14 Months
CT Chest 8.0 3.6 Years
CT Abdo/Pelvis 10-20 5-10 Years
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Common Indications Program

• Standard (5mm per slice)

• High Resolution CT (0.625 – 1.25mm per slice)

• Various protocols exist to detecting different pathologies

• Emergency
• Chest Trauma
• Pulmonary Embolism (PE)
• Aortic dissection/transection
• Complex pleural collections

• Non-Emergency
• Nodules, masses and malignancy staging
• Interstitial lung disease (ILD)
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Program

Hx
• LOC + Collapse
• Chest tightness
• SoB
• Recent air travel
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Saddle PE Program

• IV Contrast study

• Saddle PE

• Extension to main PA
and lobar branches
bilaterally

• Presence of filling
defects

• PA enlarged with
straightening of
septum in keeping
with right heart strain
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Program

Hx
• Central chest pain
• Widened mediastinum
on CXR
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Aortic Dissection Program

• Type A dissection
• Without aortic arch vessel involvement
• Requires urgent surgical input
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Program

Hx
• SoB ?PE
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• Incidental finding:
Aortic Aneurysm (Thoracic) saccular Aneurysm
Program

(4.3cm diameter)

• Involves mid
descending thoracic
aorta with eccentric
thrombus

• Large heart
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Program
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Pulmonary fibrosis Program

Honeycombing
Reticular changes
with ground glass
opacities
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Program
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Malignancy Program
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Basic Tips to Interpretation Program

• Type of scan – where is the contrast?

• Different windows and different protocols

• A systematic approach that works for you

• Knowing what is normal

• Knowing what pathology you are looking for…

• But don’t stop looking after finding it!

• Satisfaction of search
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Program

Cases to try on PACS

• Case 1: Haemoptysis & SoB

• Case 2: Chest pain, palpitation & SoB

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Case 1 Program

Large mass at the right hilum encasing the pulmonary arteries and invading the left atrium.
There is narrowing of the main bronchial branches on this side.

Left-sided pulmonary embolus with filling defects seen in the proximal main branches.
Some ill-defined nodules are noted in the right middle lobe which may represent metastases.
Emphysematous changes are noted with some lymphangitis suspected around the large left-sided hilar
mass.

Conclusion: Large mass at right hilum with small pulmonary emboli seen on the left.
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Program

Cases to try on PACS

• Case 1: Haemoptysis & SoB

• Case 2: Chest pain, palpitation & SoB

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Case 2 Program

Fluid noted along root of aorta.

There is some contrast leakage on right postero-
lateral aspect of aortic root, which could
represent active bleed.

Dense fluid noted in pericardium. Its density is

+30 HU, which is likely to be fresh blood. It
measures about 27 mm in thickness.

Heart is likely to be compressed, and due to its

size, it is likely to cause cardiac tamponade.

No aortic dissection noted.

No other abnormality noted in chest and upper

abdomen, within limitations of this arterial phase
scan.
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References Program

• Radiopaedia.org

• Images for CT principles - Wikipaedia.org

• National Cancer Institute (US) – www.cancer.gov

• Clinical Manual and Review of Transesophageal

Echocardiography. 2nd ed. Figure 16-4. via
www.accessanesthesiology.com

Thanks for listening!

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Teaching
Program
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Teaching
Program