ABSTRACT
Chest tube tracks may simulate normal structures or pathology. This article will help the radiologist to understand their formation and to recognize them as iatrogenic shadows.
Subject(s)
Intubation , Lung/diagnostic imaging , Pleura/diagnostic imaging , Thoracostomy , Humans , Tomography, X-Ray ComputedABSTRACT
The pathways of tumor spread through the lung are described and their significance for radiographic interpretation is illustrated. A key to understanding the spread of bronchogenic carcinoma is the realization that although the normal flow of lymph in the pulmonary lymphatics is centripetal, lymphatic obstruction can cause reversal of flow. As a result, tumor cells are commonly carried centrifugally to the periphery in lymphatics or the connective tissue around them, and remote pleural involvement, secondary parenchymal masses, or satellite nodules may develop. Failure to appreciate peripheral spread of tumor has negative consequences for tumor staging, surgery, and radiotherapy. In the absence of hilar node involvement causing obstruction, long line shadows more than 0.5 inch (1.25 cm) in length proximal to a peripheral mass very infrequently represent tumor.
Subject(s)
Carcinoma, Bronchogenic/diagnostic imaging , Lung Neoplasms/radiotherapy , Bronchi/pathology , Carcinoma, Bronchogenic/pathology , Carcinoma, Small Cell/pathology , Humans , Inflammation/pathology , Lung/pathology , Lung Neoplasms/pathology , Lymph/metabolism , Lymph Nodes/metabolism , Lymph Nodes/pathology , Lymphatic Metastasis , Neoplasm Invasiveness , Pleura/pathology , Pulmonary Atelectasis/diagnostic imaging , RadiographyABSTRACT
A review of the anatomy of the interlobar fissures is based on a detailed study of 100 fixed and inflated lung specimens (50 right and 50 left lungs). The upper part of the fissural surface of the right lower lobe almost always faces in a slightly lateral direction and is usually concave; the lower part typically faces laterally but is usually convex. The upper part of the left major fissure also almost always faces laterally and is concave; but unlike the right side, the lower part usually faces medially and is convex. The minor fissure is typically oriented so that the anterior part is lower than the posterior part and the lateral margin is lower than the medial margin. Incompleteness of the fissures (fusion between lobes) is common; this study revealed a 70% incidence of fusion across the upper right major fissure, 47% across the lower right major fissure, 40% across the upper left major fissure, 46% across the lower left major fissure, and 94% across the minor fissure. The fissural complex is a term used to describe the variable anatomic relation of the major and minor fissures. Some comments are offered concerning fissural anatomy relative to collateral air drift, the visualization and position of interlobar fissures on chest radiographs, and the appearance of inferior interlobar fluid on the lateral radiograph.
Subject(s)
Lung/diagnostic imaging , Humans , Lung/anatomy & histology , Pleura/diagnostic imaging , Pleural Effusion/diagnostic imaging , RadiographyABSTRACT
Lung density patterns in a group of randomly selected, normal individuals were determined by computed tomography, using two methods: one measuring the density of the peripheral lung (parenchyma), and the other determining the density of the whole lung field. The effects of body position and respiratory phase, as well as patient age were assessed. The potential use for this information in clinical settings and in physiological investigation is suggested.
