Pattern of Calcification in Pulmonary Nodules

Pattern of Calcification in Pulmonary Nodules on Radiological Findings :

Carotid Echocardiogram (right carotid artery plaque)

Patient is having a plaque in his right carotid artery 

Cor-pulmonale

Cor-pulmonale is a term for right-sided heart failure most commonly due to pulmonary disease. Signs of right-sided heart failure include

• JVD
• right sided S3
• right ventricular heave
• hepatomegaly
• Ascites 
• Dependent edema

Multinodular Goiter

Multinodular Goiter - Euthyroid Patient : 

Non-Tender-thyroid nodule.

USG: 

Case: Left Renal Calculus (Renal Stones)

H/O left pyelolithiasis 17 year

H/O Right Nephrectomy 14 year with Tubular Pyonephrosis

B.P 140/85

USG :

shows Mild dilatation of all Calyces of Left Kidney with 1.1 cm echogenic shadow -> Lower calyx.

Liver, Gallbladder, Bile ducts, Spleen and Urinary Bladder are normal .

Right Kidney is absent .

Case 1 :Mild Hydronephrosis with Proximal hydroureter

CT SCAN OF HEAD

          

                 

1.Interhemispheric fissure - Centered on the midline

2.Cortical  sulcation  Of cerebrum and cerebellum 

3.Cerebral cortex  width, Density (no calcifications or hemorrhages), No separation from the calvarium, No abnormal fluid collection (convex or concave) between the cerebral cortex and calvarium

4.Ventricles – Shape, Size, Symmetry (no unilateral or circumscribed enlargement), No signs of increased intracranial pressure (e.g. effaced sulci, narrowing or unilateral expansion of ventricles)

5.White matter Density (homogeneous, especially at periventricular sites)- No hypodensities (circumscribed, lacunar, or diffuse), No hyperdense changes (calcification, hemorrhage), Normal width in relation to cortex

6. Basal ganglia- Position, internal and external capsule,  Delineation

7. Thalamus – Density

8. Brain stem – Shape, Density (homogeneous), No focal abnormalities

9. Cerebellum- General form (symmetry), Cortex (width, sulcation), White matter (homogeneous density)

10. Intracranial vessels- No abnormal dilatation, No vascular malformations

• Contusions occur at the inferior and polar surfaces of the frontal and temporal lobes secondary to contact with bony surfaces during deceleration or due to depressed skull fractures. 
• Produced by damage to parenchymal blood vessels leading to petechial haemorrhage and oedema.

• Contusions develop in surface grey matter tapering into white matter.
• Contusions are seen as multiple focal areas of low or mixed attenuation intermixed with tiny areas of increased density representing petechial haemorrhage.

• The CT appearance of fresh blood (acute hemorrhage) is that of a white (hyperdense) area in comparison to the grey colored brain. 
• After a week, blood starts to appear grey like the brain or slightly darker than the brain. At this point, it is called a subacute hemorrhage (isodense or slightly hypodense).
• After several weeks, blood appears much darker than the grey brain, and it is then called a chronic hemorrhage (hypodense). 
• Bleeding may occur in four areas within the skull, as intraparenchymal, subarachnoid, subdural or epidural hemorrhages

              

INTRAVENTRICULAR HEMORRHAGE 

RING ENHANCING LESION SUGGESTIVE OF BRAIN ABSCESS( IN THIS CASE ), METASTASIS AND GLIOMA

SUMMARY

• Symmetry—Compare left and right sides of the cranium

• Midline—Look for midline shift
• Cross-sectional anatomy—Review anatomical landmarks for each slice
• Brain tissue—Gray matter, white matter, intracerebral lesions
• CSF spaces—Ventricles, basal cisterns, cortical sulci, and fissures
• Skull and soft tissues—Scalp swelling, fractures, sinuses, orbits
• Subdural windows—Look for blood collections adjacent to the skull
• Bone windows—Skull, orbits and sinuses, intracranial air
• Targeted Approach to CT Interpretation
• Trauma—Blood (extra-axial, intraparenchymal), cerebral edema, fractures, pneumocephalus, scalp swelling, coup, and contra-coup injuries

• Headache—Blood in the basilar cisterns (SAH), masses, hydrocephalus, cerebral venous sinuses thrombosis, paranasal sinusitis
• Stroke—Examine region of neurological deficit for blood, edema.

Chest radiograph of different conditions

• Pink Puffer

– Pa02 70 – 75 

– Mild C02 retention 40 – 50 torr

• Blue Bloater

– Pa02 < 70 

– Mod – Severe C02 retention

– Polycythemia

Bronchiectasis:

• Permanent dilatation of bronchi.
• Cough, copious purulent sputum.
• Lower lobes common
• Complications; 
• Pneumonia, empyema, septicemia, meningitis.
• Types:
• Cylindrical, Saccular, Fusiform (no significance)

Cardiomegaly

Causes

Numerous causes such as hypertension, renal failure, valvular lesions, cardiomyopathy,

severe anemia, thyroid disorders, hemochromatosis, and amyloidosis.

CXR Findings

Measure from the most lateral borders of the heart and compare this width to the inner border of the widest part of the inner rib; if this ratio exceeds 50%, the diagnosis can be made.

Heart size and shape

A normal Heart shadow in CXR PA view

Left atrial enlargement

Rheumatic mitral stenosis. This frontal film shows marked

enlargement of the left atrial appendage (arrow).

Penetrated chest film in the same patient double right heart border and splaying of the carina is seen

Right atrial enlargement

Right atrial enlargement. Right atrial enlargement is often difficult to detect with only subtle enlargement of the right heart border present on the PA view.

Left ventricular enlargement

Selective left ventricular enlargement in aortic incompetence. (A) Frontal view shows that the left ventricle has enlarged along its long axis, taking the apex of the heart to the left and downward (white arrow).

(B) Lateral view shows the left ventricle extending behind the line of the barium-filled oesophagus (arrow).

Congestive Heart Failure (CHF)

STAGE I CHF (PROGRESSIVE CEPHALIZATION) (Can only use this sign on an upright chest x-ray, not supine, since blood flow will redistribute.)

CAUSE

Increased mean capillary wedge pressure 10–20 mm Hg

CHEST X-RAY FINDINGS

Progressive cephalization, which means increased blood fl ow toward the top of the lung

CXR showing cardiomegaly with cephalization in a patient with pulmonary venous hypertension.

STAGE 2 CHF  (INTERSTITIAL EDEMA)

CAUSE

Increased mean capillary wedge pressure 20–25 mm Hg

CHEST X-RAY FINDINGS

Thin white lines due to interstitial edema, known as Kerley B lines (Horizontal white lines at the lung bases extending from the periphery of the lung). 

Kerley-B lines

STAGE 3 CHF (ALVEOLAR EDEMA)

CAUSE

Wedge pressure greater than 25 mm Hg

CHEST X-RAY FINDINGS

Increased opacity around the hilum in a butterfly pattern referred to as “bat wings” appearance. 

STAGE 4 CHF (CHRONIC PULMONARY VENOUS HYPERTENSION) 

CAUSE

Increased wedge pressure greater than 30 mm Hg

CHEST X-RAY FINDINGS

Bilateral interstitial infi ltrates and bilateral pleural effusions.

Note- If the patient doesn’t have cardiomegaly, consider noncardiogenic causes of CHF such as head injury or drug overdose.

CXR depicting cardiomegaly with bilateral interstitial infiltrates and bilateral pleural effusions, consistent with advanced CHF.

Enlargement of the ascending aorta can be found with Marfan's disease, aortic insufficiency, post-stenotic dilation and aortic aneurysms. 

The prominence of central pulmonary artery caused by pulmonary hypertension.