Ct halo sign (part 2) hampton hump sign-westermark sign

1. CT halo sign (part 2)
2. Hampton hump sign
3. Westermark sign

1. Dr Mazen Qusaibaty MD, DIS Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health Email: [email protected] CT halo sign (part 2) Hampton hump sign Westermark sign

2. Topic Outline CT halo sign (part 2) Hampton hump sign Westermark sign 2

3. Useful links 3 http://bjr.birjournals.org http://radiographics.rsna.org http://radiology.rsna.org

4. CT halo sign (part 2)

5. Bronchiolitis Obliterans with Organizing Pneumonia An idiopathic disease that produces polypoid granulation tissue in: Bronchioles alveolar ducts 5 ColbyTV . Pathologic aspects of bronchiolitis obliterans organizing pneumonia.  Chest  1992;  102 (1 suppl ): 38S–43S.

6. Bronchiolitis Obliterans with Organizing Pneumonia Variable degrees of interstitial and airspace infiltration by mononuclear cells and foamy macrophages 6 ColbyTV . Pathologic aspects of bronchiolitis obliterans organizing pneumonia.  Chest  1992;  102 (1 suppl ): 38S–43S.

7. The most common CT finding in patients with BOOP Asymmetric bilateral ground-glass opacity with a predominantly peripheral distribution (arrows) 7 Courtesy of Paul Stark, MD.

8. The most common CT finding in patients with BOOP 8

9. The most common CT finding in patients with BOOP 9

10. The most common CT finding in patients with BOOP 10

11. The most common CT finding in patients with BOOP 11

12. The most common CT finding in patients with BOOP 12

13. The most common CT finding in patients with BOOP 13

14. BOOP Kim et al reported that CT images of 06 of 31 patients with BOOP showed nodular ground-glass opacity 14 KimSJ , Lee KS, Ryu YH, et al. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications.  AJR Am J Roentgenol  2003;  180 : 1251–1254.

15. BOOP A 46-year-old woman Axial CT image at the level of the aortic arch 15 KimSJ , Lee KS, Ryu YH, et al. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications.  AJR Am J Roentgenol  2003;  180 : 1251–1254.

16. BOOP A 46-year-old woman Shows multiple bilateral areas of ill-defined nodular ground-glass opacity , some of which contain solid components (arrows). 16 KimSJ , Lee KS, Ryu YH, et al. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications.  AJR Am J Roentgenol  2003;  180 : 1251–1254.

17. Case 48-year-old woman with an eight-week history of cough , dyspnea with exertion , fatigue , and slight weight loss . 17

18. Case/ High-resolution CT scan of this patient RLL reticular and hazy opacities that are subpleural 18 Courtesy of Talmadge E King Jr , MD

19. Quiz conti………….. This picture is look like: Idiopathic pulmonary fibrosis. Sarcoidosis stage IV TB BOOP All above 19

20. Quiz conti………….. This picture is look like: Idiopathic pulmonary fibrosis. Sarcoidosis stage IV TB BOOP All above 20

21. Reverse halo sign: BOOP CT of localized organizing pneumonia manifesting as a solitary nodule of the left lower lobe 21

22. Reverse halo sign: BOOP This pattern may be diagnosed as primary or metastatic lung tumor 22

23. Thoracic Endometriosis Catamenial syndrome 23

24. 24 AlifanoM , Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge.  Ann Thorac Surg  2006;  81 : 761

25. 25 AlifanoM , Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge.  Ann Thorac Surg  2006;  81 : 761

26. 26 AlifanoM , Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge.  Ann Thorac Surg  2006;  81 : 761

27. 27 AlifanoM , Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge.  Ann Thorac Surg  2006;  81 : 761

28. Catamenial syndrome This disease group includes four well-recognized clinical entities Catamenial pneumothorax Catamenial hemothorax Catamenial hemoptysis Lung nodules 28 AlifanoM , Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge.  Ann Thorac Surg  2006;  81 : 761

29. CPT Catamenial pneumothorax is a rare condition characterized by a reoccurrence of air in the pleural space coinciding with the onset of menses. 29 http://www.catamenial-pneumothorax.com/id15.htm

30. CPT CPT was first described in literature in 1958 30 http://www.catamenial-pneumothorax.com/id2.htm

31. CPT It is almost always right-sided 31 http://www.catamenial-pneumothorax.com/id2.htm

32. CPT Generally affects women in their thirties and forties 32 http://www.catamenial-pneumothorax.com/id2.htm

33. CPT Although the exact etiology of the condition is unknown Most physicians agree that endometriosis is involved. 33 http://www.catamenial-pneumothorax.com/id2.htm

34. CPT Documented case studies have described endometrial implants on the: Lung Pleura Diaphragmatic fenestrations (holes in the diaphragm) 34 http://www.catamenial-pneumothorax.com/id2.htm

35. CPT Case studies report women with CPT experiencing monthly Chest pain Shortness of breath Dizziness and fatigue 35 http://www.catamenial-pneumothorax.com/id2.htm

36. CPT Case studies report women with CPT experiencing monthly Some women have experienced multiple lung collapses over a period of several years. Many of these women have also been diagnosed with pelvic endometriosis. 36 http://www.catamenial-pneumothorax.com/id2.htm

37. Case 1 In a 42-year-old woman who presented with: Three episodes of spontaneous pneumothorax , each associated with the onset of menses . 37 http://radiographics.rsna.org/content/21/1/193/F43.expansion.html

38. Case 1 She had undergone a prior hysterectomy for endometriosis 38 http://radiographics.rsna.org/content/21/1/193/F43.expansion.html

39. Case 1 Had a 2-3-year history of: Episodic cough Hemoptysis Pleuritic chest pain 39 http://radiographics.rsna.org/content/21/1/193/F43.expansion.html

40. Posteroanterior chest radiograph Shows a right-sided pneumothorax A nodular opacity in the right lung base (arrow) 40 http://radiographics.rsna.org/content/21/1/193/F43.expansion.html

41. Case 2 Chest CT scan (lung windows) Shows a 2.5-cm solitary pulmonary nodule in the right lower lobe (arrow). 41 http://radiographics.rsna.org/content/21/1/193/F43.expansion.html

42. Parenchymal endometrioma in a 74-year-old woman The lesion was found on a routine preoperative chest radiograph obtained for cataract surgery. 42 http://radiographics.rsna.org/content/21/1/193/F43.expansion.html

43. Parenchymal endometrioma in a 74-year-old woman She had been receiving estrogen replacement therapy since undergoing hysterectomy She had no known history of endometriosis 43 http://radiographics.rsna.org/content/21/1/193/F43.expansion.html

44. Case 3 Catamenial hemoptysis syndrome in a 24-year-old woman with recurrent monthly hemoptysis during menstruation 44 http://radiographics.rsna.org/content/27/2/391/F29.expansion.html

45. Axial CT image at the level of the diaphragmatic dome Multiple areas of ill-defined nodular ground-glass opacity (arrows) 45 http://radiographics.rsna.org/content/27/2/391/F29.expansion.html

46. The patient underwent a bronchoscopic examination, and endometrial tissue was found at bronchial lavage 46 http://radiographics.rsna.org/content/27/2/391/F29.expansion.html

47. Focal Traumatic Lung Injury 47

48. Focal Traumatic Lung Injury Traumatic lung injury may be manifested as nodular ground-glass opacity at CT during subsequent disease progression 48

49. Focal Traumatic Lung Injury A transthoracic lung biopsy A transbronchial biopsy 49 KazerooniEA , Cascade PN, Gross BH. Transplanted lungs: nodules following transbronchial biopsy.  Radiology  1995;  194 : 209–212.

50. Pseudonodule in a 56-year-old woman who underwent a previous percutaneous lung biopsy Thin-section CT image obtained at the level of the aortic arch 50

51. Pseudonodule in a 56-year-old woman who underwent a previous percutaneous lung biopsy Shows a 9-mm well-defined nodular ground-glass opacity (arrow ) in the right upper lobe 51

52. Pseudonodule in a 56-year-old woman who underwent a previous percutaneous lung biopsy Axial image obtained during CT-guided percutaneous transthoracic biopsy with the patient in the supine position shows the biopsy needle (arrow), which has been inserted near the nodule 52

53. Pseudonodule in a 56-year-old woman who underwent a previous percutaneous lung biopsy Axial CT image, obtained after the biopsy, shows a poorly defined pseudonodule represented by ground-glass opacity (arrow) along the biopsy tract 53

54. Pseudonodule in a 56-year-old woman who underwent a previous percutaneous lung biopsy The pathologic diagnosis, obtained after a wedge resection, was focal interstitial fibrosis 54

55. Pulmonary Embolism Signs 55

56. Radiographic  sign s with a relatively high specificity but low sensitivity for PTE Pleura-based areas of increased opacity (Hampton  sign ) Decreased vascularity in the peripheral lung ( Westermarck   sign ) Enlargement of the central pulmonary artery (Fleischner  sign ) Hemidiaphragm elevation 56 Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study.   Radiology  1993;  189 :

57. Helical CT Findings in Acute PTE 57

58. Helical CT Findings in Acute PTE 58

59. Helical CT Findings in Acute PTE 59

60. Helical CT Findings in Acute PTE 60

61. Helical CT Findings in Acute PTE 61

62. Helical CT Findings in Acute PTE 62

63. Helical CT Findings in Acute PTE 63

64. Acute PE

65. Helical CT Findings in Chronic PTE 65

66. Pulmonary Embolism Acute PE Central intraluminal filling defects Parenchyma: rounded pleural-based densities, pleural effusion Subacute PE Convex mural filling defects Parenchyma: oval pleural-based densities, pleural effusion Chronic PE Concave mural filling defects, intraluminal “rope ladder” Irregular wall thickening, abnormal vascular tapering, variation in size of segmental vessels Parenchyma: translobular lines, mosaic perfusion, pleural effusion BC: Wacker_Gustav_19330609_BC_zentral/Akute LE: Sauer_Erna_DOB19211226_LE CTEPH: Prell/Sarkom: Jpn. J. Clin. Oncol. Uchida et al. 35 (7): 417

67. Chronic PE Concave mural filling defects 67

68. Chronic PE Intraluminal “rope ladder” 68

69. Hampton hump sign 69

70. Hampton hump sign A homogeneous wedge-shaped consolidation in the lung periphery

71. Hampton hump sign A base contiguous to a visceral pleural

72. Hampton hump sign A rounded convex apex directed toward the hilum

73. Hampton hump sign Associated with pulmonary infarct

74. Hampton hump sign Left intraluminal filling defects in left pulmonary artery Pulmonary infarction secondary to pulmonary embolism Bilateral pleural effusion 74

75. Computed tomography angiogram in a 53-year-old man with acute pulmonary embolism This image shows an intraluminal filling defect that occludes : The anterior basal segmental artery of the right lower lobe Acute Pulmonary Embolism (Helical CT): Imaging Contributor Information and Disclosures Updated: May Author:  Kavita Garg , MD,  Professor, Department of Radiology, University of Colorado Health Sciences Center- 14, 2008

76. Computed tomography angiogram in a 53-year-old man with acute pulmonary embolism An infraction of the corresponding lung, which is indicated by: A triangular, pleura-based consolidation (Hampton hump) Acute Pulmonary Embolism (Helical CT): Imaging Contributor Information and Disclosures Updated: May Author:  Kavita Garg , MD,  Professor, Department of Radiology, University of Colorado Health Sciences Center- 14, 2008

77. Case 3 A young man who experienced: Acute chest pain Shortness of breath after a transcontinental flight 77 Acute Pulmonary Embolism (Helical CT): Imaging Contributor Information and Disclosures Updated: May Author:  Kavita Garg , MD,  Professor, Department of Radiology, University of Colorado Health Sciences Center- 14, 2008

78. Case 3 Computed tomography angiography This image demonstrates a clot in : The anterior segmental artery in the left upper lung A clot in the anterior segmental artery in the right upper lung 78 Acute Pulmonary Embolism (Helical CT): Imaging Contributor Information and Disclosures Updated: May Author:  Kavita Garg , MD,  Professor, Department of Radiology, University of Colorado Health Sciences Center- 14, 2008

79. Westermark sign 79

80. Westermark sign Refers to an area of oligemia with minimal change in lung volume distal to a large PE

81. Westermark sign This regional oligemia is caused either by: Mechanical obstruction to blood flow by the clot Reflex vasoconstriction

82. Case 4 A 41-year-old woman presented to the emergency department complaining of a three-day history of left-sided chest pain . 82

83. Case 4 The pain was described as pressure-like, pleuritic, made worse with ambulation and when supine. 83

84. Case 4 The pain was constant, increasing in intensity and not associated with any alleviating factors, hence her request for evaluation 84

85. Case 4 Six weeks prior to the onset of her chest pain she had complained of: Right hip pain, radiating down the leg. This was diagnosed as radicular pain secondary to sciatica for which she had been under bed rest and analgesics 85

86. Case 4 Her past medical history was remarkable for: Depression Occasional migraine headaches Two cesarean sections Oral contraceptive 86

87. Case Physical examination was normal 87

88. Axial CT image of the chest A mass extending outside the vessel wall + a large filling defect involving the left main pulmonary artery and extending into all sub-branches. 88

89. Coronal reformatted CT image of the chest Demonstrating a mass extending outside the vessel wall 89

90. Sagittal reformatted CT image of the chest Demonstrating a mass extending outside the vessel wall 90

91. What diagnosis that do you expect? Left large cell carcinoma Bronchioloalveolar carcinoma Left small cell carcinoma Chronic left chronic pulmonary embolism Pulmonary angiosarcoma 91

92. What diagnosis that do you expect? Left large cell carcinoma Bronchioloalveolar carcinoma Left small cell carcinoma Chronic left chronic pulmonary embolism Pulmonary angiosarcoma 92

93. حاجه بقا داق خلقنا