영상의학과

• 꼭 알아야 할 흉부X선 소견

구 진 모

서울대학교병원

영상의학과

•

Normal chest radiograph

•

주의해서 봐야 할 부위, 놓치기 쉬운 부위

•

Normal chest radiograph

simulating diseases of the chest (false +)

•

Normal chest radiograph

with diseases of the chest (false -)

•

Basic pattern of lung disease

Contents

단순흉부촬영: normal anatomy

• lung

• heart

• mediastinum

• diaphragm

• bony thorax

• soft tissue

• upper abdomen

주의해서 봐야 할 부위

Right paratracheal area

AP window Hilum

Retrocardiac space Retrocardiac space Retrosternal space

Companion shadow

Right paratracheal stripe: <4 mm

1

Aorto-Pulmonary window

AP window bulging

놓치기 쉬운 부위

• 심장 후방

• 흉골후방

• 폐첨부

• 횡격막부위

심장 후방

Gibbs, J. M. et al. Radiographics 2007;27:33-48

azygoesophageal recess

Whitten, C. R. et al. Radiographics 2007;27:657-671

Bronchogenic cyst

Whitten, C. R. et al. Radiographics 2007;27:657-671

left paraspinal line

폐첨부

2001. 3. 15 2001. 5. 28

횡격막후방 폐

RULB LULB

PWBI:

3 mm 이하

Retrosternal space

Inferior hilar window

Inferior PV

Normal Chest Radiograph

Simulating Diseases of the Chest

•

Technical error

•

^Artifact

•

Extrathoracic lesion

•

Normal or normal variants

Expir Inpir

Diseases Manifesting as Normal Chest Radiographs

•

^{Miliary TB}

•

Pulmonary thromboembolism

•

Airway lesion

•

^{Early DILD}

•

Early stage of pneumonia

•

Small pleural effusion

Early

miliary TB

•

Obstructive atelectasis:

neoplasm, mucus plug, tuberculosis,.

•

Non-obstructive atelectasis:

embolism, radiation pneumonitis, ARDS, HMD,.

•

Compressive atelectasis

•

Cicatrizing atelectasis

Atelectasis

RUL

RML

LUL

LLL

Basic Patterns of Lung Diseases

•

Air space disease

•

Interstitial disease

•

Mass or nodule

•

Increased transradiancy

The Air Bronchogram

•

^Pneumonia

•

Pulmonary edema

•

^Pulmonary

hemorrhage

•

Hyaline membrane disease

•

Pulmonary lymphoma

•

Bronchioloalveolar carcinoma

Air Space Pattern

•

Lobar or segmental distribution

•

Poor margin

•

Tendency of the process to coalesce

•

Air bronchogram and air alveologram

•

Rapid change

Chest Radiograph

•

Linear pattern

•

Reticular pattern

•

Nodular pattern

•

Reticulonodular pattern

Interstitial Pattern

Diffuse Interstitial Lung Disease

•

Interstitial pulmonary edema

•

lymphangitic carcinomatosis

•

idiopathic pulmonary fibrosis

•

sarcoidosis

•

^silicosis

•

miliary tuberculosis

IPF

Silicosis

Pulmonary Mass / Nodule

•

^Nodule : a lesion up to 3 cm in diameter

Mass : a lesion greater than 3 cm in diameter

•

Primary or metastatic

malignant neoplasm, benign neoplasm, granuloma,

tuberculoma, abscess

Pulmonary Mass / Nodule

•

Calcification

•

A rate of growth

•

Size, Shape, Cavity

•

Serial change

Benign vs. Malignant SPN

Benign Malignant

Size <3cm >3cm

Calcification present absent

Doubling time no growth Short (1-18 mo)

Lobulation - +

Satellite lesion Air-

bronchogram

+

-

-

+

M/19, Osteosarcoma, s/p right arm amputation

Nodular Metastasis: Calcification

5 months before

Increased Transradiancy

•

Radiographic artifact

•

Thoracic wall and soft tissue abnormalities

•

Diminished vascular perfusion

•

Over-expansion of the lung

•

Mild generalized increased opacity of one lung

Emphysema

Chest wall defect

기흉

참고 문헌

• X-ray 흉부영상진단

대한흉부영상의학회