Common Radiological Abnormalities in Diseases of Respiratory system …
Consolidation, collapse, fibrosis, pleural effusion, pneumothorax, cavities and Opacities in the lungs are all common radiological abnormalities. What are their significance?
The presence of homogenous opacities with well defined margins indicates pulmonary consolidation, since there is no change in the volume of the lung the trachea and mediastinum are not shifted.
Pulmonary collapse throws a homogenous opacity with clear-cut concave margins. The trachea, mediastinum, and interlobar fissure are shifted towards the area of collapse. The dome of the diaphragm on the affected side is elevated. The unaffected portions of the lung show hyper-translucency due to compensatory emphysema.
Presence of streaky linear or reticular shadows with shift of trachea and mediastinum to the same side and compensatory emphysema of the unaffected regions is suggestive of fibrosis.
The presence of small quantities of fluid (less than 300ml) in the pleura causes only obliteration of the costophrenic angle. As the quantity of fluid increases, more extensive homogenous opacity appears with obliteration of the costophrenic and cardiophrenic angles. The upper margin tends to be concave with its higher level towards the axilla and the lower level towards the mediastinum. Midline structures are shifted to the opposite side. The presence of fluid and air (hydropneumothorax) is diagnosed by the presence of a horizontal level of fluid below, with hypertranslucency (due to air) above. The lung markings are not visible since the lung is collapsed towards the helium.
Presence of air in the pleura leads to hyperlucency and absence of lungs markings on the affected side. The margin of the collapsed lung is seen towards the hilum. The midline structures are pushed to the opposite side.
Cavities are seen as areas of central translucency within areas of consolidation or fibrosis. Morphology of the cavities vary with different lesions. Tuberculous cavities are thin-walled and empty. Thick-walled cavities containing fluid and air suggest the possibility of lung abscess or neoplasm.
Opacities in the lung
Opacities may be single or multiple. Depending on their size and uniformity of distribution, multiple opacities are grouped as military mottling (1-2 mm size), nodularity (1cm or above) and cannon balls. Their size, density, distribution, and number give clues to their pathological nature.
The lungs are hypertranslucent in emphysema and less translucent in conditions such as interstitial fibrosis or pulmonary edema. Lesions in the apices of the lungs are brought out better by taking lordotic views or penetrated views. By this method, parts concealed behind ribs are visualized. The exact spatial location of any lesion can be obtained by taking the PA and lateral views. Oblique views may be required for further localization. Radiographs taken in the lateral decubitus are necessary to detect conditions such as infrapulmonary effusions. Special procedures which give a contrast picture are partial penumothorax and artificial pneumoperitoneum, which are required when pulmonary lesions have to be distinguished from those in the pleura or the upper part of the liver.
This procedure helps in assessing the respiratory movements and the movements of mediastinal structures. Screening in different positions helps in delineating lesions better. Fluroscopy has a disadvantage in that small lesions are likely to be missed. Moreover unless special machines are used, the dose of radiation received by the patient and the observer can be harmful. Proper dark adaptation of the observer’s eye is an essential requirement for fluoroscopy. Use of television screens obviates this disadvantage.
Tomograms are serial radiographs taken at different depths. Tomography helps in studying the lesions throughout their entire thickness. Solid lesions. Cavities, cysts, calcification, and satellites around primary lesions can all be identified.
The technique of visualizing the bronchial tree using a radio-opaque dye (Dionosil) is called bronchiography. This is the only reliable method to assess the total extent and type of bronchiectasis.
It is performed to study the pattern and distribution of the pulmonary arteries and their branches. Arteriography is the method of choice to demonstrate pulmonary embolism and arteriovenous malformations.
It is a valuable non-invasive investigation to detect intrathoracic lesions such as tumors, fluid collections, mediastinal and vascular structures, and cardiac abnormalities.
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