Diagnostic Procedures In

Respiratory Diseases

Yadnyesh S. Patil
Group 9
 INTRODUCTION
1

Imaging Techniques
2

Agenda Medical techniques for

specimens
3

Case Presenatation
Introduction
The diagnostic modalities available for
assessing the patient with suspected or known
respiratory system disease include :-

• Imaging studies
• Techniques for acquiring biologic
specimens,
• Some of which involve direct visualization
of part of the respiratory system.

Methods to characterize the functional changes

developing as a result of disease, including
pulmonary function tests and measurements of
gas exchange

3
 Imaging Techniques
X-Rays:-An x-ray beam is generated by
passing an electron beam through a
vacuum between a cathode (-) and an anode
(+). The positively charged anode attracts the
rapidly moving, negatively charged
electrons.
X-rays Technical factors
 X-Rays

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 Ultrasound
Ultrasound (US) makes use of probes with an acoustical
frequency that is hundreds of times greater than humans can
hear, instead of using x-rays as both conventional radiography
and CT scans do.

On occasion, more detailed images can be obtained by

inserting the probe into the body, such as is done with
transvaginal, transrectal, and transesophageal sonography.

Safest way for Pregnant

patients

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Computed Tomography(CT Scan)
•T scan combines a series of X-ray images taken
from different angles around body.
• A CT scanner is connected to a computer that
processes the data though various algorithms to
produce images of diagnostic quality.
• A CT image is composed of a matrix of thousands
of tiny squares called pixels, each of which is
computer-assigned a CT number from −1000 to
+1000 measured in Hounsfield units (HUs),
1.Air is assigned a Hounsfield number of −1000
HU
2.Fat is −40 to −100 HU,
3.Water is 0
4.Soft tissue is 20 HU to 100 HU.
5.Bone about 400 HU to 1000 HU.
 CT Scans
Lung Windows Visual Planes
CT Scans
 Virtual Bronchoscopy
The three-dimensional (3D) image of the thorax obtained
by MDCT can be digitally stored, reanalyzed, and
displayed as 3D reconstructions of the airways

Virtual bronchoscopy has been proposed as an adjunct to

conventional bronchoscopy in several clinical situations:-
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• It can allow accurate assessment of the
extent and length of an airway stenosis, including the
airway distal to the narrowing;
• it can provide useful information about the
relationship of the airway abnormality to adjacent
mediastinal structures; and
• it allows preprocedure planning for
therapeutic bronchoscopy to help ensure the
appropriate equipment is available for the procedure.

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 MAGNETIC RESONANCE IMAGING

MRI USES A VERY STRONG MAGNETIC FIELD TO

MANIPULATE THE ELECTROMAGNETIC ACTIVITY OF
ATOMIC NUCLEI IN A WAY THAT RELEASES ENERGY IN
THE FORM OF RADIOFREQUENCY (RF) SIGNALS, WHICH
ARE RECORDED BY THE SCANNER’S RECEIVING COILS
AND THEN COMPUTER-PROCESSED TO FORM AN IMAGE.

THE MOST COMMON MRI SEQUENCES ARE T1-WEIGHTED

AND T2-WEIGHTED SCANS.

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 MRI SCANS
An advantage of MRI is
• the use of nonionizing electromagnetic radiation.
• Additionally, MR is well suited to distinguish
vascular from nonvascular structures without the
need for contrast.
• Blood vessels appear as hollow tubular structures
because flowing blood does not produce a signal
on MRI. Therefore, MR can be useful in
demonstrating pulmonary emboli, defining aortic
lesions such as aneurysms or dissection, or other
vascular abnormalities
• if radiation and IV contrast medium cannot be
used. Gadolinium can be used as an intravascular
contrast agent for MR angiography (MRA)

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 Limitations of MRI

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PULMONARY
ANGIOGRAPHY
The pulmonary arterial system can be visualized by
pulmonary angiography, in which radiopaque contrast
medium is injected through a catheter placed in the
pulmonary artery.

When performed in cases of pulmonary embolism,

pulmonary angiography demonstrates the consequences
of an intravascular thrombus—either a defect in the
lumen of a vessel (a filling defect) or an abrupt
termination (cutoff) of the vessel.

The risks associated with modern arteriography are small,

generally of greatest concern in patients with severe
pulmonary hypertension or chronic kidney disease.

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POSITRON EMISSION TOMOGRAPHIC
SCANING
Positron emission tomographic (PET) scanning is
commonly used to identify malignant lesions in the lung,
based on their increased uptake and metabolism of
glucose. The technique involves injection of a
radiolabeled glucose analogue, [18F]-fluoro-2-
deoxyglucose (FDG), which is taken up by metabolically
active malignant cells

Hybrid PET/CT scans provide images that help pinpoint

the abnormal metabolic activity to anatomical structures
seen on CT and provide more accurate diagnoses than
the two scans performed separately.

False-negative findings can occur in lesions with low

metabolic activity such as carcinoid tumors and
bronchioloalveolar cell carcinomas, , inflammatory
diseases like pneumonia and granulomatous diaseases.
 MEDICAL TECHNIQUES FOR OBTAINING BIOLOGIC SPECIMENS

COLLECTION OF SPUTUM PERCUTANEOUS NEEDLE THORACENTESIS

ASPIRATION (TRANSTHORACIC)

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Bronchoscopy
Bronchoscopy is the process of direct visualization of the tracheobronchial
tree.

The situations include the retrieval of a foreign body and the suctioning of a
massive hemorrhage, for which the small suction channel of the
bronchoscope may be insufficient

Types of bronchoscopy:-
1) Rigid Bronchoscopy:-The rigid bronchoscope, which is a hollow
stainless steel tube through which a rigid telescope is placed, provides
access to the central airways.

2) Flexible Bronchoscopy:- Flexible bronchoscopy is a procedure that

allows a clinician to examine the breathing passages (airways) of the
lungs
 MEDICAL THORACOSCOPY
Medical thoracoscopy (or pleuroscopy) focuses on the diagnosis of pleural-based problems. The
procedure is performed with a conventional rigid or a semi-rigid pleuroscope (similar in design to a
bronchoscope and enabling the operator to inspect the pleural surface, sample and/or drain pleural
fluid, or perform targeted biopsies of the parietal pleura). Medical thoracoscopy can be performed
in the endoscopy suite or operating room with the patient under conscious sedation and local
anesthesia. In contrast, video-assisted thoracoscopic surgery (VATS) requires general anesthesia and
is only performed in the operating room

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 Case Presentation

• A 74-year-old woman was admitted to the hospital with malaise, weight loss, cough and
dyspnea. Physical examination revealed an impaired general condition, and pulmonary
auscultation showed hypoventilation in the basal and middle fields. The rest of the clinical
examination was normal. The patient's blood pressure was 144/80 mm Hg, heart rate 90
bpm and oxygen saturation 95% on room air. She had type 2 diabetes and her medication
consisted of metformin 850 mg twice a day and insulin glargine 12 IU in the evening.

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 Investigations
The routine blood tests were normal, but chest
X-ray revealed massive left-sided pleural
effusion, collapse of the left lung and a nodule
near the right root of the lung. Thoracentesis
was performed and analysis revealed an
exudate.
Cytology of the fluid was negative for
malignancy. Thoracic CT scan showed massive
left-sided pleural effusion, which pushed the
mediastinum towards the right; a lung mass in
the left lower lobe (6.9×4.5×7.6 cm), which
suggested malignancy; complete collapse of the
left lower lobe and partial collapse of the left
upper lobe; multiple pulmonary nodules, within
both lungs, suggesting metastatic lesions; and
several lymph nodes within the mediastinum.
Thank you