RADIOLOGICAL ASPECT OF

ABNORMAL
RESPIRATORY SYSTEM
 Abnormality of the lung
Increase of density / opacity

• Consolidation - pathologic
process, alveoli consist of
fluid, pus, blood, cell
• Atelectasis - lung
collapsà decreasing of
alveolar air à loss of
volume à increased
density.
• Nodule or mass - SOL,
soliter/multiple
• Interstitial - abnormality
of supporting tissue of
lung parenchymà fine
/coarse reticular opacities
/small nodules.
 Water Pus Blood Cells

Heart failure BAC

Content of Trauma
ARDS Organizing pneum.
Pneumonia Goodpasture
the alveoli Low albumin
Henoch-Schonlein
Chronic
Volume overload eosinophilic
SLE
Renal failure Sarcoidosis

Diffuse Lobar Multiple ill-defined

Bronchopneumonia
Edema - Staphylococcus
- Heart failure Lobar pneumonia - Legionella
- Volume overload - Streptococ. pneum. - Gram negative
1. CONSOLIDATION Pattern - Low albumin - Klebsiella - Streptococ. pneum.
- Renal failure - Aspiration - Klebsiella
- ARDS - Pseudomonas
- Transfusion reaction Hemorrhage - Anaerobe
- Contusion - PCP
Bronchopneumonia - Infarction - TB
- Staph aureus
- Gram-negative Others Vascular
- PCP - BAC - Septic emboli
- Viral-fungal - Lymphoma - Wegener’s
- Organizing pneum.
Hemorrhage - Eosinophilic pneum. Neoplasm
Acute Chronic - SLE - Sarcoidosis - BAC
- Henoch-Schonlein - Lymphoma
- Metastases
BAC - Wegener
- Goodpasture Batwing Reversed Batwing
Lymphoma
Pneumonia Organizing pneum.
Aspiration Eosinoph. BAC Broncho-alv. carcinoma
Edema
Infarction Pneumonia Lymphoma Organizing pneum (BOOP)
Bact pneumonia
Edema Alveolar Organizing pneum. Eosinophilic pneumonia
PCP
proteinosis Eosinophilic pneum. Sarcoidosis
Viral pneumonia
Sarcoidosis Hypersensitivity pneum. Radiation
KEY FINDINGS OF
CONSOLIDATION
• Homogenous opacity covering of vessel
• Silhouette sign: disappear of lung edge/ soft tissue interface
• Air-bronchogram
• Expansive to pleural / fissure but not cross
• No volume loss
CONSOLIDATION
Atelectasis Resorption

Mucus
Tumor
2. Foreign body
ATELECTASIS
Relaxation

Pleural effusion
Pneumothorax
Round atelectasis
RADIOLOGICAL SIGNS OF
COLLAPSE
Direct signs of Indirect signs of
collapse collapse
• Displacement of • Elevation of the
interlobar fissures hemidiaphragm
• Loss of aeration • Mediastinal
• Vascular and displacement
bronchial sign • Hilar displacement
(crowded)
 Complete collapse of the left lung : a left hilar tumour

A. - Deviation of the trachea and shift B. Herniation of both the retrosternal

of the mediastinum to the left. lung and the azygo-oesophageal
- Herniation of the right lung across reflection.
the midline . the oesophagus contains a small
amount of air.
Right middle lobe collapse.
(A) PA film shows loss of definition of the
right heart border indicating loss of
aeration of the middle lobe.
(B) A lateral film shows partial collapse of
the middle lobe evident as a wedge-
shaped opacity (arrows).
NODULE-
MASS Nodule < 3 cm Mass > 3 cm

Granuloma
- Fungal Lung Ca
- TB
Granuloma
Lung Ca
Metastasis Hamartoma
3. NODULE- Hamartoma
MASS

Multiple massess

Infection: Metastasis
BAC
- TB
Sarcoidosis
- Histoplasmosis
Wegener
- Fungi
RA
- Sept. emboli
Rendu-Osler
Squamous cell ca
Adenocarcinoma
Metastatic Lung Disease
INTERSTITI
AL Reticular
Smooth septal

Pulmonary edema
Irregular septal

Lymphangitis ca
Fibrosis
UIP
- IPF
Honeycombing

Drugs
Lymphangitis ca Sarcoid
Amyloidosis - Coll. Vascular
Amyloidosis Hypersens. pneu
Asbestosis - RA

Perilymphatic Centrilobular Random

Sarcoid Endobronchial infection

- TB Metastases
Lymphangitis ca
- Mac Miliary TB
4. Nodular Silicosis
Hypersens. pneum Fungi
INTERSTITIAL Pneumoconiosis Pulmonary edema Sarcoidosis
LIP-Amyloidosis Vasculitis

Emphysema Cystic disease

Langerhans CH
Low attenuation Centrilobular
LAM
Panlobular
Pneumatoceles
Paraseptal
LIP

Acute ground glass Chronic ground glass

Fibrosis
Pulm. edema
- UIP-NSIP
Hemorrhage
High attenuation PCP
Hypersens. pneumonitis
BAC
Early fibrosis
Alveolar proteinosis
Hypersens. pneumonitis
Sarcoidosis
Interstitial
• Pulmonary edema • Lymphangitis
carcinomatous
Dark / luscent lesion
Luscent lesion
 CHEST
COMPLAINTS

COUGH
AND
DYSPNEU

NON
CARDIA
CARDIA
C C

Parenchymal air way Pleura

 PNEUMONI
A
• Infective Agent • Setting Of Infection
• Bacterial • Community Acquired
• Fungal Pneumonia
• Mycobacterial • (CAP)
Hospital Aquired
• Viral Pneumonia (HAP)
• Ventilator Associated
• Coronavirus
Pneumonia (VAP)
• Covid 19
• Healthcare Acquired
• MERS
Pneumonia (HCAP)
• SARS

• Aspiration Pneumonia
METHODE OF
SPREAD
Bronchopneumonia
(Lobular Pneumonia)
• Multifocal process which
commences in the terminal and
respiratory bronchioles
• Spreads segmentally
• Produces patchy consolidation
Lobar Pneumonia
• Localized infection of terminal air
spaces
• Spreads to adjacent lung via the
terminal airways and pores Kohn
causes Uniform consolidation of
all or part of lobe
• X ray appearance :
- Homogenous opacification limited
by fissures
- Affected lobes retain normal
volume
- Often show air bronchogram
BRONCHOPNEUMO
NIA
LOBAR
PNEUMONIA
A 56 yo woman, Covid -
19
 CLINICAL
• Most usefulPRACTICE
classification is according to causative
organism
• It is not possible to diagnose the organism from
radiology alone
• Radiology is important to confirming :
- The presence and location of pneumonia
- Following the pneumonia
- Indicate complication :
○ Pleural effusion
○ Emphyema
○ Atelectasis
○ Abscess
○ Scarring
 LUNG
ABSCESS
• Cavitating lesion secondary to infection by pyogenic bacteria
• Radiographycally an abscess
- may or may not surrounded by consolidation
- appearance air fluid level indicates that the communication
with the airways has developed
- The wall may be thick at the first
- Becomes thinner with further necrosis & coughing up of
infected material
Lung abscess
continue…..
a. Lung abscess b. Several weeks later a thin walled
pneumatocele remains
Mrs X 40 yo,
fever

Abscess
Fungal Pneumonia;
 Bacterial
RESUM
Aetiology Non Bacterial
E
Viral

Acute CAP
Inflammation pneumonia Setting of
disease of the lung infection
HAP

Broncho
pneumonia
Method of
spread
Lobar
pneumonia
 PRIMARY PULMONARY
TUBERCULOSIS
Immune
response

positive negative

consolidation, enlarged nodes,

Healing
cavitation, caseating nodes

rupture Pulmonary
Hematogenous Spread
collaps

Pneumothorax, pleural effusion, empyema,

Miliary TB air trapping
erotion of pulmonary vessels
PRIMARY PULMONARY
TUBERCULOSIS
Post Primary
Tuberculosis

Sub apical upper lobes/ segment of the

lower lobes

Typically of the Cavity : a large cavity with

several smaller satellite cavities, often bilateral

Large cavities à secondary

Small cavities that
infection or fungal
heal à fibrotic
colonisation
 Nonspecific Healing
affect small or an entire often complete without
CONSOLIDATION lobe any sequele
IN
INFECTION
PRIMARY Tuberculoma Unilateral
A nodule / nodules lymphadenophaty hilus
Air bronchogram and mediastinum

Appears in the apex of an

upper or lower lobe Healing : fibrotic
contraction à trachea
Tuberculoma
CONSOLIDATIO
pulled away from the
N Patchy and nodular, midline, elevation of the
IN POST bilateral. hila & distortion of the
PRIMARY lung parenchyma
INFECTION Fluid level in cavity,
bronchiectasis, Lymphadenophaty is rare
emfisema,
• Ranke complex (in 'healed' primary Pulmonary
TB)
a Ghon
It consists of lesion that has undergone calcification
two components:
an ipsilateral calcified mediastinal node
Miliary
Tuberculosis
BRONCHIECTA
SIS
• Bronchiectasis is defined as an irreversible
abnormal dilatation of the bronchial tree.
• It has a variety of underlying causes, with a
common etiology of chronic inflammation.
Bronchiectasis continue…..
• Morphologically
Cylindrcal Varicose Cystic
Paralel walls, Walls are irre- The airways
Ireguler,bron- gular,resemble terminal are
chi fail to taper Varicose veins round cyst,
iregular, Filled
purulent fluid
 Mrs SJ 63
yo

• Infected bronchiectasis
Bronchiectasis
Cilindrical bronciectasis,bronchi fail Cystic bronchiectasis,a CT images
to taper and have a irreguler thickened demonstrates multiple ring
walls shadows
PLEURAL
SPACE
 PLEURAL
FLUID
1. Microvascular pressure ↑ 1. Transudate
2. Permeability microvascular ↑ 2. Eksudate
3. Plasma oncotic pressure Ô 3. Pus
4. Lymphatic drainage Ô 4. Blood
5. Defects in the diaphragm à 5. Chyle
peritoneal fluid in pleural
space
 Effusions / Extrathoracic soft tissue
• Obtuse angle of costophrenic angle à plural
effusion
• Lateral decubitus is more sensitive than erect to
detect pleural effusion
Ny P, 50 tahun

• Massive of right pleural

effusion
• Minimally of left pleural
effusion
• Heart ’s size
measurement is not
valid
Pneumothorax

ØIs the presence of the air in the pleural cavity

ØAetiology :
a. spontaneous pneumothorax
b. traumatic pneumothorax
c. artificial pneumothorax
Pneumothorax
Mr MIS 19
yo
• Right
Hydropneumothorax
Pneumomediastinum
• Spontaneous • Non spontaneous
• Asthma • Perforation or rupture
• Prolonged of the oesophagus
coughing/vomiting • Iatrogenic
• excercise • Rupture of trachea or
main bronchus
• pneumoperitoneum
 Radiologic appearance:

Pneumomediastinum. 12-year-old boy with asthma.

PA (A) and lateral (B) films show air in the mediastinum with displacement of the pleura
and demonstration of the thymus gland
PLEURAL
THICKENING
• Bilateral • Unilateral

• Simetrical • Asimetrical
• Fairly common • Associated with pain
• Erderly patient • Pancoast tumor
• aetiology uncertain
Tn S, 45 thn

• TB Pulmo lama aktif

dengan schwarte pleura
dextra
BILATERAL APICAL PLEURAL
THICKENING
Pleural tumor
• Primary neoplasm of the pelura are rare
• Benign neoplasm:
• Fibrous-lipoma
• Malignant neoplasm
• Mesothelioma
• Exposure to asbestosis dust
Fibrous tumor and Mesothelioma
RESUM
E
PLEURA
PLEURAL
L
THICKENING
TUMOUR
S
Bilateral apical
pleural Benign
thickening

Unilateral
apical pleural Malignant
thickening
 Diaphragm

• Right is higher than left • Paralysis

• Flattening of bilateral • Hernia
diaphragms
• Chronic asthmatic and
emphysematous
• Flattening of unilateral
diaphragm
• Tension Pneumothorax
• Foreign Body aspiration
• Under diaphragm: free air
Tn HS 71
tahun
• Paralysis of left
diaphragm
• Normal lung
• Normal heart
• Suggestion : Thoracic
CT
TERIMA KASIH
DAN
MOHON ASUPAN

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