Front Cover
Endsheet 2
Problem Solving in Chest Imaging
Copyright Page
Dedication
Contributors
Preface
Table Of Contents
1 Anatomy
1 Normal Anatomy of the Lungs
Chapter Outline
■ Introduction
■ Surfaces
Hilum
Lobes
■ Bronchopulmonary Segments
■ Pulmonary Interstitium: Skeleton of the Lung
■ Blood Supply and Bronchovascular Anatomy
■ Pleura
■ Lung Fissures
■ Radiology
Normal Chest X-Ray
Computed Tomography
Computed Tomography of the Hilar Bronchi
■ Bronchial Anatomy
Right Bronchial Anatomy
Left Bronchial Anatomy
Computed Tomography of Hilar Vessels
Right Side
Left Side
Computed Tomography of the Hilar Lymph Nodes
■ Bronchoarterial Ratio and Bronchial Wall Thickness
■ Lung Attenuation
■ Secondary Pulmonary Lobule
■ Pleura–Chest Wall Interface
Bibliography
2 Mediastinum, Chest Wall, and Diaphragm
Chapter Outline
■ Introduction
■ Mediastinum
■ Chest Wall
Bony Structures
Musculature
Lymph Nodes
■ Diaphragm
■ Conclusion
Bibliography
3 Imaging Anatomy of the Heart and Thoracic Great Vessels
Chapter Outline
■ Introduction
Cardiac Anatomy on Conventional Radiography
Technical Factors for Cardiac Imaging and the Imaging Planes
Electrocardiographic Gated Scan
Cardiac Imaging Planes
Two-Chamber View (Paraseptal View)
Three-Chamber View
Four-Chamber View
Short-Axis Views
Aortic Valve: Short-Axis View
Right Ventricular Inflow-Outflow Plane
Bicaval View
Cardiac Chambers
Right Atrium
Right Ventricle
Left Atrium
Left Atrial Appendage
Pulmonary Veins
Left Ventricle
Cardiac Valves
Tricuspid Valve
Pulmonic Valve
Mitral Valve
Aortic Valve
Coronary Arteries
Left Coronary Artery
Right Coronary Artery
Coronary Dominance
Left Anterior Descending Artery
Left Circumflex Artery
Cardiac Veins
Pericardium
Thoracic Aorta
Arch Vessels
Pulmonary Arteries
Bronchial Arteries
Superior Vena Cava
Azygos, Hemiazygos, and Accessory Hemiazygos Systems
■ Conclusion
Bibliography
4 Step-by-Step Analysis of Cardiac Chambers in CT
Chapter Outline
■ Introduction
■ Standardized Cardiac Imaging Planes
Vertical Long-Axis and True Two-Chamber Views
Short-Axis View
Four-Chamber View
Three-Chamber View
■ Ventricular Morphology
■ Standardized Left Ventricular Myocardial Segmentation and Nomenclature
■ Atrial Morphology
■ Cardiac Chamber Quantification
Quantification of Left Ventricular Chamber Size
Quantification of Right Ventricular Chamber Size
Quantification of Left Atrial Chamber Size
Quantification of Right Atrial Chamber Size
Left Ventricular Wall Thickness
Evaluation of Global Left Ventricular Function and Regional Left Ventricular Wall Motion or Wall Thickening
■ Reference Values for the Cardiac Chambers on CT
■ Conclusion
Bibliography
2 Imaging Techniques
5 Radiographic Techniques
Chapter Outline
■ Conventional Chest X-Ray
Preliminary Considerations
Standard Views
Anteroposterior View
Lateral Decubitus View
Lordotic View
Expiratory Views
Rib Views
Use of Fluoroscopy
Field of View in Chest Radiography
■ Basics of Digital Chest X-Ray
Steps of Computed Radiography
Flat Panel Detector Technology
Processing of Digital Data
Displaying Digital Images
Computer-Aided Detection
Bibliography
6 Pulmonary CT
Chapter Outline
■ Introduction
■ CT Technology
Key Differences Between Multidetector-Row CT and Single-Detector Row CT Scanners for Chest Imaging
Key Features of Current State-of-the-Art Modern Multidetector CT Scanners
Better Detector Elements
Prepatient Dose Efficiency
■ Scan Factors
Factors That Affect In-Plane Spatial Resolution in CT Imaging
Factors Affecting Scan Time
■ Dual-Energy CT
Introduction
Role of CT in Pulmonary Imaging
■ Scan Protocols
Key Scan Parameters of CT Protocols
Stratifying Chest CT Protocols
Contrast Considerations When Designing Chest CT Protocols
Patient Factors
Weight.
Cardiac Output.
Age and Gender.
Site of Injection.
Hepatic and Renal Disorders.
Contrast Factors
Injection Duration.
Injection Rate.
Contrast Concentration.
Saline Flush.
Scan Direction and Duration.
■ Radiation Dose
Radiation Safety With CT
Parameters That Affect Radiation Dose in Chest CT
Setting the Tube Current
Selecting the Best Tube Voltage
Role of Iterative Reconstruction in Chest CT
■ Conclusion
Bibliography
7 Cardiovascular CT
Chapter Outline
■ Introduction
■ Basics of Cardiac CT
Electrocardiogram Gating
Image Reconstruction and Analysis
■ Common Indications for Imaging
Chest Pain
Sudden Cardiac Death
Coronary Artery Disease Risk Stratification
Contraindications to Cardiac Catheterization
Coronary Artery Bypass Patency
Presurgical Planning
■ Problem-Solving Issues
Causes of Acute Chest Pain
Determining if Coronary Atherosclerosis Is Present
Evaluation of Cardiac Function
Sudden Cardiac Death
Coronary Artery Anomaly
Hypertrophic Cardiomyopathy
Coronary Artery Bypass Grafts and Stents
Patency of a Bypass Graft
Patency of a Coronary Artery Stent
Presurgical Planning
Determining the Best Site for Revascularization
■ Pitfalls
Differentiating Ischemic From Nonischemic Myocardial Fat
Misinterpreting Stair Step Artifact as Coronary Artery Stenosis
Understanding Limits of Interpretation in Anatomy Adjacent to Calcium or Surgical Clips
■ Overcoming Technical Obstacles
Patient Is Unable to Hold Breath
Patient Has Metal in Chest
Patient Has Poor Renal Function
Patient Is Tachycardic
Patient Is Not in Sinus Rhythm
Bibliography
8 Pulmonary, Mediastinal, Vascular, and Chest Wall MRI
Chapter Outline
■ Introduction and Background: Considerations for Using MRI
Recent Technologic Advances That Make Chest MRI More Feasible
■ Lung MRI
Sequences Used to Evaluate the Lung Parenchyma and Lung Masses
When to Use MRI for Characterizing Lung Tumors
Solitary Pulmonary Nodules
Assessing Extrapulmonary Invasion
Assessing Metastases
Emerging Roles for Lung MRI in Diffuse Lung Diseases
■ Pulmonary MRA
Sequences Used to Evaluate the Pulmonary Arteries
When to Use MRA for the Evaluation of Pulmonary Embolism and Other Pulmonary Vascular Abnormalities
MRA for Pulmonary Embolism
MRA for Pulmonary Hypertension
MRA for Vasculitis
MRA for Congenital Abnormalities
Evidence Supporting the Use of MRA in These Indications
■ Mediastinal MRI
When to Use MRI for the Evaluation of Mediastinal Lesions
Sequences Used to Evaluate the Mediastinum
■ Chest Wall MRI
Sequences Used to Evaluate Chest Wall Lesions
When to Use MRI for the Evaluation of Chest Wall Pathology
Benign Chest Wall Disease
Malignant Chest Wall Masses
Chest Wall Infections
Evidence Supporting the Use of MRI in These Indications
Bibliography
Lung MRI
Pulmonary MRA
Mediastinal MRI
Chest Wall MRI
9 Cardiac MRI
Chapter Outline
■ Introduction
■ Basic Cardiac MRI
MRI Pulse Sequences
Imaging Planes
ECG and Respiratory Gating
■ Common Indications for Cardiac MRI
Ischemic Heart Disease
Cardiomyopathy
Congenital Heart Disease
Cardiac Mass
■ Problem-Solving Issues
Ischemic Heart Disease
Evaluating Viability of Myocardial Segments
Evaluating How Well the Heart Is Functioning
Cardiomyopathy
Evaluating a Patient for Suspected Hypertrophic Cardiomyopathy
Determining the Presence of Systolic Anterior Motion of the Mitral Valve Leaflet
Determining the Presence of Delayed Enhancement
Congenital Heart Disease
Evaluating the Function of the Heart
Determining the Presence of a Shunt
Determining the Presence of Postsurgical Complications
Cardiac Mass
Determining if the Mass Enhances
Determining if the Mass Has a Characteristic T1 or T2 Signal Property
Determining if Malignant Imaging Features Are Present
■ Pitfalls
Differentiation of Late Gadolinium Enhancement From Blood Pool Signal
Misinterpreting Hypokinesis in Patients With Irregular Cardiac Rhythm
Differentiation of Ischemic From Nonischemic Enhancement Patterns
Misinterpreting Subaortic Stenosis From Interventricular Thickening
Failure to Include Left Ventricle in Images When Evaluating a Cardiac Mass
Choosing the Correct Inversion Time in Amyloidosis
■ Overcoming Technical Obstacles
Patient Cannot Hold Breath
Patient Is in Irregular Cardiac Rhythm
Patient Has Poor Renal Function
Bibliography
10 Angiography and Interventions
Chapter Outline
■ Introduction
■ Pulmonary Angiography
Workup of a Patient for Pulmonary Angiography
Performing Pulmonary Arteriography
Complications of Pulmonary Arteriography
■ Pulmonary Arterial Interventions
Pulmonary Arteriovenous Malformations
Indications for Treatment
Performing Embolization
Results of Embolization Therapy
Pulmonary Embolism
Indications for Catheter-Directed Thrombolysis for a Pulmonary Embolism
Performing Percutaneous Pulmonary Embolectomy
Results of Catheter-Directed Thrombolysis for Pulmonary Embolism
Pulmonary Artery Aneurysms and Pseudoaneurysms
■ Arterial Interventions
Bronchial Artery Embolization
Indications for Bronchial Artery Embolization
Performing Bronchial Artery Embolization
Results of Bronchial Artery Embolization
Arterial Embolization of the Chest Wall
Thoracic Aortic Stent Grafts
Indications for a Thoracic Aortic Stent Graft
Complications of Thoracic Aortic Stent Grafting
■ Venous Interventions
Central Venous Catheters
Considerations Before Placing a Central Venous Catheter
Complications
Venous Revascularization
■ Lymphatic Interventions
Thoracic Duct Embolization
Indications for Thoracic Duct Embolization
Performing Thoracic Duct Embolization
Results of Thoracic Duct Embolization
■ Conclusion
Bibliography
11 Problem-Oriented Radionuclide Myocardial Perfusion Imaging
Chapter Outline
■ Introduction
■ Before the Test: Appropriate Patient Selection
Challenge: Patient Selection
Potential Solutions
■ Stress Test: Exercise and Pharmacologic Stress
Challenge: Rest Chest Pain
Potential Solutions
Exercise Stress Testing
Challenges During Exercise Stress Testing
Potential Solutions
Submaximal Heart Rate Response
Potential Solutions
Pharmacologic Stress Testing: Vasodilators and Dobutamine
Challenges During Pharmacologic Stress Testing
Potential Solutions
■ Imaging
Attenuation Artifacts
The Challenge
Identifying the Artifact
Potential Solutions
Gated SPECT
Repeat Imaging
Higher Radiotracer Dose Imaging
Software
Attenuation Correction
Patient Motion
The Challenge
Identifying Patient Motion
Traditional Anger SPECT Scanners
Cardiocentric SPECT Scanners and PET
Transmission Scans
Potential Solutions
Transmission and Emission Misregistration Artifacts
Identification of the Artifact
Potential Solutions
Subdiaphragmatic Activity
Identifying the Artifact
Potential Solutions
Image Acquisition and Reconstruction Artifacts
Potential Solutions
Other Artifacts
■ High-Risk Features
Exercise Findings
Myocardial Perfusion Imaging Findings
Perfusion Defects
Increased Lung Uptake
Increased Right Ventricular Tracer Uptake
Transient Ischemic Dilation Ratio of the Left Ventricle
Left and Right Ventricular Ejection Fraction
High-Risk Markers on PET Myocardial Perfusion Imaging
High-Risk CT Findings
Balanced Ischemia
Abnormal ECG With Normal Perfusion
Reporting Stress Test and Myocardial Perfusion Imaging Results: Appropriate Communication and Follow-Up
■ Summary
Bibliography
12 Thoracic Nuclear Imaging
Chapter Outline
■ Introduction
■ Part I: Principles of Pulmonary Scintigraphy
Radiopharmaceuticals
Ventilation
Xenon-133
Technetium-99m DTPA
Perfusion
Scan Techniques
Xenon-133 Ventilation Scanning
Technetium-99m DTPA Ventilation Scanning
Technetium-99m MAA Perfusion Scanning
Importance of Sequence of Imaging
Patient Preparation
Contraindications to Pulmonary Scintigraphy
Clinical Applications for Pulmonary Scintigraphy
Acute Pulmonary Embolism
Comparison of Diagnostic Performance of Pulmonary Scintigraphy to CT Angiography
Chronic Pulmonary Embolism
V/Q Scans
Quantitative V/Q Scan
Normal V/Q Scan
Approach to Interpreting the Abnormal V/Q Scan
Established Criteria for Interpreting V/Q Scans
Causes and Implications of Diffusely Heterogeneous Pulmonary Perfusion Pattern
Reverse Mismatch
The Stripe Sign
Interpreting the V/Q Scan in a Clinical Context
Important Incidental Imaging Findings
How to Recognize Technical Artifacts
Radiation Doses Associated With Pulmonary Scintigraphy
Radiation Risks During Pregnancy and Comparison of Dosimetry to CT Angiography
Strategies to Reduce Radiation Exposure
Guidelines for Breastfeeding Cessation
Role for SPECT in V/Q Scanning
■ Part II: Principles of FDG PET
Radiotracer
Patient Preparation
Imaging Protocol
Trajectory of PET Activity in Tumor Over Time
Common PET Artifacts
FDG Biodistribution in a Normal PET Scan
Hypermetabolic Brown Fat
Quantitation of PET Activity With Standardized Uptake Value
Clinical Applications
Oncology
Infection and Inflammation
Sarcoidosis
Evaluation of Vasculitides
Fever of Unknown Origin
Timing of Posttreatment PET After Surgery or Radiation
Safety Considerations Following FDG PET Imaging
Breastfeeding Cessation
Contraindications to FDG PET Imaging
Radiation Exposure
Bibliography
Part I: Principles of Pulmonary Scintigraphy
Part II: PrincipleS of FDG PET
3 Imaging Approach
13 Introduction to Terminology
Chapter Outline
■ Introduction
■ Thoracic Terminology
Lung Parenchyma
Interstitium
Nodule
Emphysema
Pulmonary Vasculature
Pleura
Airways
■ Vascular and Cardiac Terminology
Aorta
Pulmonary Artery
Pulmonary Vein
Cardiac Terms
Bibliography
14 Differential Diagnosis Based on Imaging Findings
Chapter Outline
■ Air Space Disease
Acute Consolidation
Chronic Consolidation
■ Pulmonary Nodules
Solitary Pulmonary Nodule
Multiple Pulmonary Nodules
Centrilobular Distribution
Perilymphatic Distribution
Random Distribution
Calcified Pulmonary Nodules
Cavitary Pulmonary Nodules
■ Pulmonary Masses
Anterior Mediastinal Masses
Middle Mediastinal Masses
Posterior Mediastinal Masses
Pleural Masses
Cardiophrenic Angle Masses
■ Thoracic Masses: Fat-Containing Masses
■ Lymphadenopathy
Calcified Lymphadenopathy
Low-Attenuation Lymphadenopathy
Bilateral Hilar Lymphadenopathy
■ Airways
Tracheal Narrowing
Tracheal Dilation
Bronchiectasis
■ Distribution of Disease
Upper Lung Distribution
Lower Lung Distribution
■ Miscellaneous Considerations
Unilateral Hyperlucent Hemithorax
Opacified Hemithorax
Cystic Lung Disease
Pneumomediastinum
Elevated Hemidiaphragm
Halo Sign
Reverse Halo Sign
Bibliography
4 Entities by Pathologic Category
15 Congenital and Developmental Diseases of the Lungs and Airways
Chapter Outline
■ Introduction
■ Imaging Modalities
Chest Radiography
Chest CT and CT Angiography
Thoracic MRI and MR Angiography
Catheter Angiography
■ Diseases
Bronchopulmonary Sequestration
Types of Sequestration
Imaging Appearance
Complications
Goals of Imaging
Differential Diagnosis
Treatment
Congenital Pulmonary Airway Malformation
Imaging Appearance
Complications
Differential Diagnosis
Congenital Lobar Overinflation
Imaging Appearance
Foregut Duplication Cysts: Bronchogenic and Esophageal Duplication Cysts
Imaging Appearance
Complications
Differential Diagnosis
Scimitar Syndrome
Characteristic Feature of Scimitar Syndrome on Imaging
Additional Disorders That Can Occur in Scimitar Syndrome
Imaging Appearance
Differential Diagnosis
Complications
Proximal Interruption of the Pulmonary Artery
Imaging Appearance
Complications
Differential Diagnosis
Pulmonary Arteriovenous Malformation
Types of Pulmonary Arteriovenous Malformations
Clinical Manifestations
Imaging Appearance
Differential Diagnosis
Bronchial Atresia
Imaging Appearance
Differential Diagnosis
Tracheal Bronchus
Clinical Significance
Accessory Cardiac Bronchus
Clinical Significance
■ Problem-Solving Issues
Differentiating Bronchopulmonary Sequestration From Other Congenital Lesions on Imaging
Determining Whether the Presence of a Systemic Artery Suggests a Bronchopulmonary Sequestration
When to Suspect Superimposed Infection
Distinction of a Congenital Mediastinal Cyst From a Solid Mass or Lymphadenopathy
Difficult to Categorize or Hybrid Lesions
Poland Syndrome
Imaging Appearance
Differential Diagnosis
■ Pitfalls of Imaging Congenital Lung Diseases
Bibliography
16 Infection
Chapter Outline
■ Introductory Considerations
Epidemiology
Symptoms
Pathogenesis
Diagnosis
Definitions
Community-Acquired Pneumonia
Hospital-Acquired Pneumonia
Health Care–Associated Pneumonia
Ventilator-Associated Pneumonia
■ Patterns of Infection
Lobar Pneumonia
Bronchopneumonia
Interstitial Pneumonia and Bronchiolitis
Tracheobronchitis
Hematogenous Spread of Infection
Patterns of Infection That Suggest a Specific Organism or Narrow the Differential Diagnosis
Cavitation
Nodules and Masses
CT Halo and Reverse Halo Signs
Lymphadenopathy
Tree-in-Bud Sign
Migratory Pulmonary Opacities
■ Complications of Infection
Lung Necrosis and Pulmonary Abscess
Parapneumonic Effusion and Empyema
Pseudoaneurysm and Bronchial Artery Dilation
Chest Wall or Diaphragm Invasion
■ Infections in Immunocompromised Hosts
HIV and AIDS
CD4+ Cell Count
CD4+ CELL COUNT >200 CELLS/mm3.
CD4+ CELL COUNT OF 100–200 CELLS/mm3.
CD4+ CELL COUNT <100 CELLS/mm3.
Bone Marrow Transplantation Infections
Preengraftment Period (0–30 Days)
Early Posttransplantation Period (31–100 Days)
Late Posttransplantation Period (>100 Days)
Solid Organ Transplantation
Bibliography
17 Neoplasms of the Lung and Airways
Chapter Outline
■ Introduction
■ Lung Neoplasms
Imaging of Lung Cancer
Malignant Neoplasms
Adenocarcinoma
Squamous Cell Carcinoma
Large Cell Lung Carcinoma
Small Cell Lung Carcinoma
Carcinoid
Lung Cancer Staging
VALSG and Modified VALSG Staging Systems
TNM System
Molecular Profiling
Benign Neoplasms
Hamartoma
■ Airway Neoplasms
Imaging of Airway Neoplasms
Malignant Airway Neoplasms
Squamous Cell Carcinoma
Adenoid Cystic Carcinoma
Mucoepidermoid Carcinoma
Carcinoid
Sarcomas and Lymphoma
Metastatic Disease
Benign Airway Neoplasms
Squamous Cell Papilloma and Tracheobronchial Papillomatosis
Hamartoma and Lipoma
Hemangioma
Glomus Tumor
Myofibroblastic Tumor
■ Conclusion
Bibliography
Questions
18 Smoking-Related Lung Diseases
Chapter Outline
■ Introduction
Determining Who Needs Imaging
Appropriate Modalities in These Disease Processes
■ Chronic Obstructive Pulmonary Disease
■ Emphysema
Different Types of Emphysema
Distinguishing the Types of Emphysema on Imaging
■ Smoking-Related Diffuse Lung Disease
Pulmonary Langerhans Cell Histiocytosis
Imaging Findings
Distinguishing Pulmonary Langerhans Cell Histiocytosis From Other Cystic and Nodular Diseases
Nodular-Only Lung Disease
Cystic Lung Disease
Respiratory Bronchiolitis and Respiratory Bronchiolitis–Interstitial Lung Disease
Imaging Findings
Distinguishing Respiratory Bronchiolitis–Interstitial Lung Disease From Other Causes of Centrilobular Nodules
Desquamative Interstitial Pneumonia
Definition
Imaging Findings
Fibrosing Interstitial Pneumonias
Usual Interstitial Pneumonia
Nonspecific Idiopathic Pneumonia
Combined Pulmonary Fibrosis and Emphysema
Acute Eosinophilic Pneumonia
■ Problem-Solving Issues
Distinguishing Emphysema From Cystic Lung Disease
Other Complications of Smoking
Infection
Hemorrhage
Pneumothorax
Lung Cancer
■ Pitfalls
Respiratory Motion Limits Evaluation for Nodules in the Setting of Smoking and Emphysema
Other Causes of Emphysema in Addition to Smoking
Emphysema Complicates Evaluation of Other Common Lung Diseases
Bibliography
19 Interstitial Lung Disease
Chapter Outline
■ Introduction
■ Appropriateness of Imaging Modalities
Appropriate Modalities in Suspected Interstitial Lung Disease
Standard CT Protocol for Interstitial Lung Disease Assessment
Rationale for Including Prone Images
Rationale for Including Expiratory Images
Ensuring That CT Images Were Acquired in Expiration
■ Usual Interstitial Pneumonia
Clinical Causes
Classification System on HRCT
Establishing Definite Diagnosis on HRCT
Importance of Honeycombing
HRCT Findings Suggestive of Alternative Diagnosis
Atypical Appearance on HRCT
HRCT Features and Diagnosis of Pulmonary Fibrosis
Differentiating Honeycombing From Traction Bronchiolectasis and Paraseptal Emphysema
Acute Exacerbation
Pitfalls
■ Nonspecific Interstitial Pneumonia
Clinical Causes
Appearance on HRCT
Differentiating NSIP From HP From UIP
Pitfalls
■ Organizing Pneumonia
Clinical Causes
Appearance on HRCT
Differentiating Cryptogenic Organizing Pneumonia From Chronic Eosinophilic Pneumonia
■ Acute Interstitial Pneumonia
Appearance on HRCT
■ Respiratory Bronchiolitis–Interstitial Lung Disease
Appearance on HRCT
Differentiating RB-ILD From Subacute HP
■ Desquamative Interstitial Pneumonia
Appearance on HRCT
■ Differentiating DIP From RB-ILD and NSIP
■ Rare Idiopathic Interstitial Pneumonias
Lymphoid Interstitial Pneumonia
Pleuroparenchymal Fibroelastosis
■ Genetics of Pulmonary Fibrosis
Familial Pulmonary Fibrosis
Link Between Genetics and Pulmonary Fibrosis
Bibliography
20 Occupational and Inhalational Lung Diseases
Chapter Outline
■ Introduction
■ Imaging Modalities
Patients Who Need Radiologic Screening
Determining Which Imaging Techniques and Protocols Are Best
International Labor Organization Classification of Radiographs
A and B Readers
Imaging Occupational and Environmental Lung Diseases
Role of PET/CT
Role of MRI
■ Imaging Approach
Role of the Radiologist
Consideration of Occupational and Environmental Lung Diseases
Asbestos-Related Disease
Relying on a Clinical History of Exposure
Length of the Latency Period for Asbestos-Related Pleural and Lung Diseases
■ Silicosis and Coal Workers’ Pneumoconiosis
Classifying Silicosis and Coal Workers’ Pneumoconiosis
Effect of Regulation of Workplace Air Quality on Silicosis and Coal Workers’ Pneumoconiosis
■ Chronic Beryllium Disease
Differentiating Chronic Beryllium Disease From Other Pneumoconioses
■ Hypersensitivity Pneumonitis
Excluding Hypersensitivity Pneumonitis if No Clear Exposure Is Identified
■ Less Common Occupational Exposures
Similarity of Imaging Patterns of Occupational and Environmental Lung Diseases
■ Pitfalls
Imaging Findings That Raise Concern of a Complicating Malignancy
How Smoking Affects the Workup of Occupational and Environmental Lung Diseases
A Normal Chest CT Does Not Exclude an Occupational or Environmental Lung Disease
■ Conclusion
Bibliography
21 Hypersensitivity Pneumonitis
Chapter Outline
■ Introduction
Causes of Hypersensitivity Pneumonitis
Clinical Manifestations
Clinical Characteristics That Suggest the Diagnosis
■ Imaging Findings
Conventional Radiographic Findings
High-Resolution CT Findings
Imaging Findings Regarding Acuity or Chronicity and Reversibility of the Disease
Imaging Findings Suggesting Hypersensitivity Pneumonitis
■ Differential Diagnosis
Narrowing the Differential Diagnosis
■ Treatment
Bibliography
22 Eosinophilic Lung Disease
Chapter Outline
■ Introduction
Approach to Diagnosis
Available Imaging Modalities to Evaluate Eosinophilic Lung Disease
■ Eosinophilic Lung Diseases
Diseases Without a Known Cause
Simple Eosinophilic Pneumonia
Chronic Eosinophilic Pneumonia
Acute Eosinophilic Pneumonia
Idiopathic Hypereosinophilic Syndrome
Diseases With a Known Cause
Allergic Bronchopulmonary Aspergillosis
Bronchocentric Granulomatous Inflammation
Churg-Strauss Syndrome
Drug Reaction–Associated Eosinophilic Lung Disease
Parasite Infection–Associated Eosinophilic Lung Disease
■ Some Problem-Solving Issues of Eosinophilic Lung Disease
Development of Eosinophilic Lung Disease in Patients Without a History of Asthma
Use of Bronchoalveolar Lavage as Appropriate Workup
Distinguishing Eosinophilic Lung Diseases From Disease Mimickers
Determining the Necessity of Biopsy to Establish a Diagnosis
■ Pitfalls in Diagnosing Pulmonary Eosinophilic Lung Diseases
Bibliography
23 Collagen Vascular Diseases and Vasculitis
Chapter Outline
■ Introduction
■ General Aspects of Collagen Vascular Diseases
Collagen Vascular Diseases That Usually Involve the Chest
Thoracic Manifestations With Greatest Clinical Impact in Patients With Collagen Vascular Disease
Best Imaging Techniques and Protocols for Assessing Patients With Collagen Vascular Disease
■ Interstitial Pulmonary Diseases in Patients With Collagen Vascular Disease
Most Common Interstitial Pattern
Accurate Detection of Pulmonary Interstitial Disease and Its Importance
Interstitial Pneumonia With Autoimmune Features and When This Diagnosis Should Be Considered
■ Pulmonary Hypertension
Collagen Vascular Diseases Usually Associated With Pulmonary Arterial Hypertension
CT Signs Indicating Pulmonary Arterial Hypertension
■ Collagen Vascular Diseases
Rheumatoid Arthritis
Main Thoracic Findings
Most Common Interstitial Findings
Other Thoracic Findings
Progressive Systemic Sclerosis
Main Thoracic Findings
Most Common Interstitial Findings
Other Thoracic Findings
Systemic Lupus Erythematosus
Main Thoracic Findings
Most Common Interstitial Findings
Other Thoracic Findings
Inflammatory Myopathies: Dermatomyositis and Polymyositis
Main Thoracic Findings
Other Thoracic Findings
Most Common Interstitial Findings
Mixed Connective Tissue Disease
Main Thoracic Findings
Most Common Interstitial Findings
Other Thoracic Findings
Sjögren Syndrome
Main Thoracic Findings
Most Common Interstitial Findings
Other Thoracic Findings
■ Vasculitides
Most Common Vasculitides That Usually Present With Pulmonary Involvement
Most Common Chest CT Findings Suggesting Vasculitis
Granulomatosis With Polyangiitis
Microscopic Polyangiitis
Eosinophilic Granulomatosis With Polyangiitis
Distinguishing Vasculitis and Other Diseases
Bibliography
24 Cystic Lung Disease
Chapter Outline
■ Introduction
■ Spectrum and Prevalence of Cystic Lung Disease
■ Demographics, Genetics, and Role of Other Causative Factors
Lymphangioleiomyomatosis
Pulmonary Langerhans Cell Histiocytosis and Desquamative Interstitial Pneumonia
Birt-Hogg-Dubé Syndrome
Lymphocytic Interstitial Pneumonia
Light Chain Deposition Disease
Amyloidosis
■ Appropriate Imaging Modalities for the Evaluation of Patients With Cystic Lung Disease
■ Importance of Ancillary Extrathoracic Findings
■ Pitfalls: How to Differentiate True Cystic Lung Disease From Mimics
■ Problem Solving and Case Scenarios
Diseases Associated With Numerous Cysts (Diffuse Cystic Lung Disease)
Clinical Presentation
Chest Radiographic and CT Findings
Lymphangioleiomyomatosis
Pulmonary Langerhans Cell Histiocytosis
Mimics and Imaging Pitfalls
Diseases Associated With Sparse Cysts (Focal or Multifocal Cystic Lung Disease)
Clinical Presentation
Birt-Hogg-Dubé
Lymphocytic Interstitial Pneumonitis
Light Chain Deposition Disease and Amyloidosis
Diseases Associated With a Combination of Cysts, Nodules, and Thick-Walled Cheerio Cysts
Clinical Presentation
Cheerio Sign on CT
Tumoral Cavitation
Thin-Walled Cystic Metastases
Necrobiotic Lung Nodules
Septic Emboli
Diseases Characterized by Cysts and Ancillary Findings on Chest CT (e.g., Ground-Glass Abnormalities)
Clinical Presentation
■ Conclusion
Bibliography
25 Radiation, Medication, and Illicit Drug–Related Lung Disease
Chapter Outline
■ Introduction and Background
■ Radiation-Related Lung Disease
Purpose of Radiation Treatment
Pathophysiology and Timeline of Radiation-Related Lung Disease
Radiation Pneumonitis
Radiation Fibrosis
Patterns of Radiation Treatment Seen in the Chest
Differentiating Radiation Pneumonitis and Fibrosis From Other Processes
Tumor Recurrence
Infection
Radiation-Induced Tumor
Long-Term Effects of Radiation
Non-Neoplastic Extrapulmonary Effects
Radiation-Induced Tumors
■ Medication-Related Lung Disease
When a Drug Reaction or Medication-Related Lung Disease Should Be Suspected
Different Patterns of Drug-Related Lung Disease
Diffuse Alveolar Damage
Organizing Pneumonia
Patterns of Usual Interstitial Pneumonitis and Nonspecific Interstitial Pneumonitis
Hypersensitivity Pneumonitis
Eosinophilic Pneumonia
Pulmonary Hemorrhage
Sarcoid-Like Reaction
Pulmonary Hypertension
Amiodarone Toxicity
Drug-Induced Pleural Disease
■ Illicit Drug–Related Diseases
Specific Illicit Drugs
Cocaine
Marijuana
Specific Effects of Illicit Drug Use
Barotrauma
Emphysema
Infective Endocarditis and Septic Emboli
Excipient Lung Disease
Talcosis
Bibliography
26 Diffuse Lung Disease With Calcification and Lipid
Chapter Outline
■ Introduction
■ Imaging Modalities Used to Assess Diffuse Lung Disease Involving High- or Low-Attenuation Lesions
■ Diffuse Lung Disease With Calcification or High Attenuation
■ Diseases Causing Calcified Pulmonary Nodules
Random Distribution
Healed Granulomatous Infections
Healed Varicella Pneumonia
Calcified Pulmonary Metastases
Perilymphatic Distribution
Pneumoconioses
Sarcoidosis
Amyloidosis
Centrilobular Distribution
Pulmonary Hemosiderosis
Metastatic Pulmonary Calcification
■ Diseases Causing Atypical Parenchymal Calcification
Diffuse Pulmonary Ossification
Pulmonary Alveolar Microlithiasis
■ Causes of Calcified Masses or Consolidation
Progressive Massive Fibrosis
Hyalinizing Granuloma
■ Causes of High-Attenuation Nodules, Masses, or Consolidation Without Calcification
Talcosis
Amiodarone Lung Toxicity
Pulmonary Alveolar Microlithiasis
■ Causes of Diffuse Lung Disease With Lipid
Lipoid Pneumonia
Pulmonary Alveolar Proteinosis
Fat-Containing Metastatic Disease
■ Problem-Solving Issues
Determining if Calcification Is Present at Imaging
Determining if Lipid Is Present at Imaging
Importance of Acuity of Symptoms in Providing a Rational Differential Diagnosis
Importance of Spatial Distributions of Disease in Providing a Differential Diagnosis
Importance of Nodule Distribution Patterns for Diagnosis
Importance of Imaging Patterns for Diagnosis of Diffuse Fat-Containing Pulmonary Disease
■ Pitfalls in Diagnosis
Bibliography
27 Pulmonary Vascular Diseases
Chapter Outline
■ Introduction
■ Pulmonary Vascular Anatomy
■ Imaging Modalities
Chest Radiography
Ventilation-Perfusion Scintigraphy
Multidetector CT
MRI/Magnetic Resonance Angiography
Invasive Pulmonary Angiography
■ Acute Pulmonary Embolism
Practical Approach to Interpreting CT Pulmonary Angiography for Pulmonary Embolism
Quality
Search Pattern
CT Pulmonary Angiography Findings of Acute Pulmonary Embolism
Artifacts
Respiratory Motion Artifact
Image Noise or Quantum Mottle
Mixing or Flow-Related Artifacts
Edge Enhancement Artifact
Low-Density Mucus Plugs
■ Prognosis and Treatment
Secondary Signs of Pulmonary Embolism on CT Pulmonary Angiography
Other Imaging Modalities for Pulmonary Embolism
Incidental Pulmonary Embolism, Isolated Subsegmental Pulmonary Embolism, and Overdiagnosis
Types of Embolisms
Chronic Pulmonary Embolism
Pulmonary Embolism: Beyond Bland Clot
Septic Embolism
Cement Embolism
Tumor Embolism
Amniotic Fluid Embolism
Fat Embolism
■ Other Pulmonary Vascular Findings
Pulmonary Artery Sarcoma
In situ Pulmonary Artery Thrombus
Pulmonary Hypertension
Pulmonary Artery Aneurysm
Traumatic Pseudoaneurysms
Infectious Pseudoaneurysms
Behçet Disease
Congenital Abnormalities
Arteriovenous Malformations
Partial Anomalous Pulmonary Venous Return
Bibliography
28 Congenital Heart and Vascular Disease
Chapter Outline
■ Introduction
■ Imaging Techniques
Electrocardiographic-Gated CT
Cardiac MRI
■ General Approach
■ Bicuspid Aortic Valve
■ Aortic Coarctation
Problem Solving
■ Atrial Septal Defects
Problem Solving
■ Ventricular Septal Defects
■ Coronary Anomalies
Problem Solving
■ Patent Ductus Arteriosus
■ Vascular Rings and Slings
Problem Solving
■ Tetralogy of Fallot
■ Transposition of the Great Arteries
Dextrotransposition of the Great Arteries
Levotransposition of the Great Arteries
■ Univentricular Conditions
Problem Solving
■ Conclusion
Bibliography
29 Acquired Diseases of the Aorta
Chapter Outline
■ Introduction
Determining Who Needs Imaging
■ Imaging Techniques
Radiography
Advantages of Radiography
Disadvantages and Limitations of Radiography
Problem Solving With Radiography
Computed Tomography
Advantages of CT
Disadvantages and Limitations of CT
Problem Solving With Noncontrast CT
Problem Solving With Contrast-Enhanced CT
Magnetic Resonance Imaging
Advantages of MRI
Disadvantages and Limitations of MRI
Problem Solving With Noncontrast MRI
Problem Solving With Contrast-Enhanced MRI
■ Aortic Anatomy
Normal Thoracic Aortic Anatomy
Normal Variants of Aortic Anatomy
Pitfalls in the Evaluation of Aortic Anatomy
Pseudocoarctation Versus Coarctation
■ Chronic Diseases of the Aorta
Atherosclerosis
Causes of Atherosclerosis
Appearance of Atherosclerosis
Thoracic Aortic Aneurysm
Normal Dimensions of the Aorta
Problem Solving: Measuring the Aorta
Appearance of a Thoracic Aortic Aneurysm
Clinical Significance of a Thoracic Aortic Aneurysm
■ Acute Aortic Syndromes
Intramural Hematoma
Causes of Intramural Hematoma
Appearance of Intramural Hematoma
Management of Intramural Hematoma
Problem Solving: How to Differentiate Intramural Hematoma From Vasculitis
Penetrating Aortic Ulcer
Causes of a Penetrating Aortic Ulcer
Appearance of a Penetrating Aortic Ulcer
Problem Solving: How to Differentiate a Penetrating Aortic Ulcer From Plaque
Aortic Dissection
Causes of Aortic Dissection
Appearance of a Dissection
Classification of Aortic Dissections
Complications of Aortic Dissection
Role of Imaging in Aortic Dissection
Problem Solving: Differentiating True Lumen Versus False Lumen
Pitfalls in the Evaluation of Acute Aortic Syndromes
Motion Artifacts
Inclusion of Noncontrast Images
■ Aortic Trauma
Imaging Modalities Useful in Trauma
Location of Acute Traumatic Aortic Injuries
Pseudoaneurysm
Appearance of a Pseudoaneurysm
Traumatic Aortic Dissection or Transection: Typical Imaging Appearance of Aortic Trauma
Pitfalls in the Imaging of Aortic Trauma
Motion
Normal Variants in Aortic Anatomy
Problem Solving: Aortic Spindle vs. Aortic Injury
Problem Solving: Pseudoaneurysm vs. Ductus Diverticulum
■ Conclusion
Bibliography
30 Ischemic Cardiac Disease
Chapter Outline
■ Introduction: Using Cardiovascular Imaging
Indications for Imaging
Determining the Appropriate Imaging Modality
X-Ray (Chest X-Ray, Invasive Coronary Angiography)
Computed Tomography (Coronary CT Angiography, CT Myocardial Perfusion Imaging)
Cardiac Magnetic Resonance
Nuclear Studies
■ CT Imaging Algorithms
Examining Patients With Suspected Coronary Artery Disease
Reporting the Findings
Reducing Radiation and Contrast Dose
■ Cardiac Magnetic Resonance Imaging Algorithms
Contraindications to the Use of Cardiac Magnetic Resonance
Examining Patients With Suspected Coronary Artery Disease
Administering a Gadolinium Agent
Reporting the Findings
■ Problem Solving
High or Arrhythmic Heart Rate
Obesity
High-Density Elements
In-Stent Lumen Assessment
Claustrophobia
Difficulty With Breath-Holding
■ Pearls and Pitfalls
CT Imaging
Cardiac Magnetic Resonance Imaging
■ Conclusion
Bibliography
31 Imaging of Cardiomyopathy and Myocarditis
Chapter Outline
■ Introduction
■ Imaging: What, Why, and How
Definition of a Cardiomyopathy
Reasons for Imaging Cardiomyopathy
Procedural Considerations
Problem Solving With Echocardiography
Problem Solving With Coronary CT Angiography
Problem Solving With Cardiac Magnetic Resonance Imaging
Assessing Myocardial Morphology
Assessing Myocardial Function
Characterizing Myocardial Tissue
Myocardial Edema.
Myocardial Iron Deposition.
Myocardial Fat.
Myocardial Fibrosis.
Assessing Myocardial Perfusion
Assessing for Blood Flow Acceleration
■ Primary Cardiomyopathies
Genetic Cardiomyopathies
Imaging Hypertrophic Cardiomyopathy
Imaging Arrhythmogenic Right Ventricular Cardiomyopathy
Imaging Left Ventricular Noncompaction
Acquired Cardiomyopathies
Imaging Myocarditis
Imaging Chagas Cardiomyopathy
Imaging Stress Cardiomyopathy
Imaging Peripartum Cardiomyopathy
Mixed Cardiomyopathies
Imaging Dilated Cardiomyopathy
Imaging Restrictive Cardiomyopathy
■ Secondary Cardiomyopathies
Imaging Endomyocardial Diseases
Imaging Cardiac Sarcoidosis
Imaging Amyloidosis
Imaging Cardiac Hemochromatosis and Siderotic Cardiomyopathy
Imaging Cardiac Involvement in Anderson-Fabry Disease
■ Conclusion
Bibliography
32 Cardiac and Vascular Tumors
Chapter Outline
■ Introduction
■ Benign Tumors of the Heart
Myxoma
Imaging
Lipoma
Description
Imaging
Fibroma
Description
Imaging
Rhabdomyoma
Description
Imaging
Hemangioma
Description
Imaging
Paraganglioma
Description
Papillary Fibroelastoma
Description
Imaging
■ Malignant Tumors of the Heart
Metastasis
Description
Imaging
Primary Malignancies of the Heart
Sarcomas
Description
Imaging
Lymphoma
Description
Imaging
■ Anatomic Variants and Mimics
Anatomic Variants
Thrombus
Caseous Mitral Annular Calcification
Hypertrophic Cardiomyopathy
Erdheim-Chester Disease
■ Pericardial Neoplasms
Pericardial Cysts
Description
Imaging
Pericardial Mesothelioma
Description
Imaging
Pericardial Metastasis
■ Vascular Neoplasms
Lymphangioma (Lymphatic Malformations)
Description
Imaging
Intravenous Leiomyomatosis
Intravenous Leiomyosarcoma
Bibliography
5 Entities by Anatomic Region
33 Diaphragm and Chest Wall
Chapter Outline
■ Diaphragm
Relevant Anatomy
Function
Imaging
Techniques That Best Image the Diaphragm
Normal Appearance of the Diaphragm on Imaging
Diagnostic Approach to an Elevated Diaphragm
Eventration
Diaphragmatic Paralysis
Diaphragmatic Paresis
Causes of Elevation of the Diaphragm That Mimic Primary Diaphragmatic Disease
Causes of Perceived Elevation of the Diaphragm
Causes of Flattening of the Diaphragm
Nontraumatic Defects
Features of Trauma
Masses That Can Occur in the Diaphragm
■ Chest Wall
Important Anatomy
Imaging
Techniques That Best Image the Chest Wall
Determining Chest Wall Invasion by Lung or Pleural Disease
Common Congenital and Developmental Anomalies
Important Measurements in Pectus Excavatum
Important Findings in the Setting of Trauma
Masses in the Chest Wall
Soft Tissue Masses
Lipomas and Liposarcomas
Hematomas
Peripheral Nerve Sheath Tumor
Other Tumors and Lesions
Osseous Masses
Benign Osseous Lesions
Malignant Osseous Lesions
Chest Wall Infections
Inflammatory Disorders That Can Result in Muscle Atrophy
Subcutaneous Emphysema
Bibliography
34 Problem Solving in the Mediastinum
Chapter Outline
■ Mediastinal Lesions
■ Problem Solving With Imaging
Chest Radiography
Contrast Esophagography
Chest CT
FDG-PET
Thoracic MRI
■ Mediastinal Lesions by Compartment
Prevascular or Anterior Mediastinal Compartment
Normal Anterior Mediastinal Structures
Pericardial Fat Pad Versus Pericardial Cyst
Normal Thymus
Nonneoplastic Anterior Mediastinal Masses
Thymic Hyperplasia Vs. Thymic Tumor (Pitfall: Nonsuppressing Normal Thymus)
Thymic Cyst: Discernment From Solid Thymic Lesion
Lymphangiomas and Hemangiomas
Prevascular or Anterior Mediastinal Neoplasms
Distinguishing Thymic Hyperplasia, Thymic Cysts, and Lymphoma From Thymoma
Thymic Hyperplasia.
Thymic Cysts.
Lymphoma.
Thymoma.
Distinguishing Low-Risk Thymoma From High-Risk Thymoma and Lymphoma.
Fatty Anterior Mediastinal Masses
Algorithm for Prevascular Mediastinal Mass Management
Visceral or Middle Mediastinal Compartment
Normal Middle Mediastinal Structures Sometimes Misinterpreted as Abnormal
Congenital Developmental Lesions of the Visceral Mediastinum
Posttraumatic, Postsurgical, and Inflammatory Lesions of the Visceral Mediastinum
Neoplasms in the Visceral or Middle Mediastinum
Paravertebral or Posterior Mediastinal Compartment
Previously Described Lesions Also Occurring in the Paravertebral Mediastinum
Neurogenic Tumors
■ Pitfalls and Remedies
■ Appropriate Diagnostic Imaging Examination Selection
Summary of Strengths and Weaknesses of Each Imaging Modality
■ Conclusion
Bibliography
35 The Pleura
Chapter Outline
■ Pleural Anatomy
Pleural Space and Its Normal Contents
Imaging the Pleura: Indications and Advantages of Different Modalities
Evaluation of Pleura
Indications for Plain Radiography
Indications for Ultrasound
Indications for Computed Tomography
Indications for Magnetic Resonance Imaging
Indications for Positron Emission Tomography
■ Pleural Effusion
Importance of the Size of Pleural Effusion
Characterization of Effusions on CT
■ Empyema
Imaging Features of Empyema
Effect of Multiloculation on Management
Significance of Air in an Empyema
■ Pneumothorax
Signs of Tension Pneumothorax
Importance of Apical Emphysema or Apical Bullae
■ Lipoma and Liposarcoma
Imaging Features Concerning for Liposarcoma
Usefulness of MRI
■ Asbestos-Related Pleural Disease
Types of Benign Asbestos-Related Pleural Disease
Holly Leaf Pattern of Pleural Calcification
■ Mesothelioma
Imaging Features Concerning for Malignant Mesothelioma
■ Problem-Solving Issues
Imaging Features That Help Distinguish a Subpulmonic Pleural Effusion From Low Lung Volumes
Imaging Features That Suggest the Presence of a Malignant Pleural Effusion
Imaging Features That Help Differentiate Empyema From a Lung Abscess
Distinguishing Talc Pleurodesis From Pleural Calcification
Imaging Features That Help Differentiate a Skin Fold From Pneumothorax
Imaging Features That Help Characterize and Differentiate Lesions as Parenchymal, Pleural, or Extrapleural
■ Pitfalls
Pleural Effusion Versus Ascites
Pneumonectomy
Bronchopleural Fistula
Esophagopleural Fistula
Empyema
Chylothorax
Pseudotumor (Interlobar Pleural Effusion)
Solitary (Localized) Fibrous Tumor of the Pleura
Fibrothorax
Bibliography
36 Trachea and Bronchi
Chapter Outline
■ Central Airway Anatomy and Physiology: Essentials for the Radiologist
Anatomy
Physiology
■ Appropriateness of Imaging Modalities: Determining Which Technique Should Be Used
Chest X-Ray
Computed Tomography
Potential Problem: How to Design and Review Appropriate CT Airway Imaging Protocols
Solution.
Magnetic Resonance Imaging
Potential Problem: How to Design and Review Appropriate Mr Airway Imaging Protocols
Solution.
Potential Problem: How to Prepare the Patient for Airway CT or MRI
Solution.
■ Pathology
Common Localized Central Airway Diseases
Iatrogenic Stenosis
Trauma
Neoplasm
Secondary Malignant Neoplasms
Primary Malignant Neoplasms
Benign Neoplasms
Focal Congenital Anomalies
Acquired Airway Diverticula
Broncholithiasis
Anthracofibrosis
Foreign Bodies
Infection
Diffuse Central Airway Diseases
Tracheobronchomalacia
Potential Problem: How and Where to Measure Central Airway Collapsibility
Solution.
Potential Problem: How to Differentiate Tracheobronchomalacia From Excessive Dynamic Airway Collapse
Solution.
Sarcoidosis
Granulomatosis With Polyangiitis (Wegener Granulomatosis)
Tracheobronchomegaly
Relapsing Polychondritis
Tracheobronchopathia Osteochondroplastica
Tracheobronchial Amyloidosis
Inflammatory Bowel Diseases and Other Inflammatory Diseases
■ Potential Pitfalls and Their Solutions
Differentiating Secretions From True Endobronchial Lesions
Assessing Very Short Areas of Stenosis
Defining the Right Threshold for Excessive Collapsibility of the Airways in Healthy Individuals
Distinguishing Excessive Thickening of Cartilaginous Rings From Pathologic Narrowing
■ Summary
Bibliography
37 Cardiac Valves
Chapter Outline
■ Introduction
■ Cardiac Valve Anatomy
Aortic Valve
Mitral Valve
Pulmonic Valve
Tricuspid Valve
■ Valvular Regurgitation
Mitral Valve Regurgitation
Aortic Valve Regurgitation
Pulmonic Valve Regurgitation
Tricuspid Valve Regurgitation
Quantification of Valve Regurgitation
■ Valvular Stenosis
Aortic Valve Stenosis
Mitral Valve Stenosis
Pulmonic Valve Stenosis
Quantification of Valve Stenosis
■ Valvular Vegetation
■ Valvular Tumors
Bibliography
38 Imaging of the Pericardium
Chapter Outline
■ Anatomy and Normal Appearance on Imaging
■ Congenital Anomalies of the Pericardium
Pericardial Cyst
Pericardial Defect
■ Acquired Pericardial Diseases
Pericardial Effusion
Pericardial Tamponade
■ Inflammation of the Pericardium
Acute Pericarditis
Fibrous Pericarditis
Constrictive Pericarditis
■ Pericardial Tumors
Bibliography
6 Special Situations
39 Intensive Care Imaging
Chapter Outline
■ Value of a Routine Daily Chest Radiograph in the Intensive Care Unit
Determining Who Needs Imaging
■ Respiratory
Location of Endotracheal and Tracheostomy Tubes
Positioning of Chest Tubes
Location of Enteric Tubes
■ Cardiovascular
Ideal Location for a Central Venous Catheter
Common Complications of Central Venous Catheter Insertion
■ Pacemakers and Implantable Cardioverter-Defibrillators
Situating Pacemaker Leads
Distinguishing Between an Implantable Cardioverter-Defibrillator and a Pacemaker
■ Pulmonary Catheters
Ideal Location of a Pulmonary Artery Catheter and Complications That Can Occur With Malposition
■ Aortic and Cardiac Support Catheters
Types and Location of Arterial Catheters in the Thorax
■ Pulmonary Disease
Atelectasis
Common Locations
Causes
Imaging Characteristics
Aspiration
Imaging Characteristics
Pneumonia
Common Causes and Patterns of Pneumonia
Pulmonary Edema
Common Imaging Manifestations
■ Acute Respiratory Distress Syndrome and Acute Lung Injury
Common Causes of Acute Respiratory Distress Syndrome
Imaging Manifestations in the ICU Patient
■ Pulmonary Embolism: Imaging Characteristics
■ Abnormal Air Collections
Considerations if Subcutaneous Emphysema Is Seen
Imaging Findings of Pneumothorax
Significance of Pulmonary Interstitial Emphysema
Radiographic Evaluation of Pneumomediastinum
Bibliography
40 Cardiac CT for the Evaluation of Acute Coronary Syndrome in the Emergency Department
Chapter Outline
■ Introduction
■ Standard Approach in Diagnosing Acute Coronary Syndrome
■ Patient Stratification in the Evaluation of Acute Coronary Syndrome
■ Role of Noninvasive Imaging in the Conventional Assessment of Acute Coronary Syndrome
Chest Radiography
Exercise Tolerance Test
Echocardiography
■ Radionuclide Myocardial Perfusion Imaging
Magnetic Resonance Imaging
Computed Tomography Calcium Scoring
Coronary Computed Tomography Angiography
■ Conclusion
Bibliography
41 Lung and Heart Transplantation
Chapter Outline
■ Lung Transplantation
Determining Who Gets a Lung Transplant
Selection Process
Problem Solving With CT and PET
How a Lung Transplantation Is Performed
Common Surgical Complications
Problem Solving With Chest X-Ray and CT
Typical Medical Therapy After Transplantation and Normal Surveillance Regimens
Problem Solving With Chest X-Ray and CT
Most Common Complications of Lung Transplantation and the Role of Imaging in Monitoring These Complications
Role of Imaging
Detection
Characterization
Assessing Response to Treatment
Primary Graft Dysfunction
Problem Solving With Chest X-Ray and CT
Infection
Problem Solving With Chest X-Ray and CT
Rejection
Antibody-Mediated and Hyperacute Rejection
Acute Cellular Rejection
Problem Solving With CT
Chronic Allograft Dysfunction
Problem Solving With CT
Other Complications
Bronchial Strictures
Problem Solving With CT
Recurrence of Primary Lung Disease
Complications in the Native Lung
Posttransplantation Lymphoproliferative Disorder
What to Look for on Post–Lung Transplantation Imaging
■ Heart Transplantation
Determining Who Gets a Heart Transplant
How the Procedure Is Performed
Most Common Complications
Primary Graft Failure
Problem Solving With Chest X-Ray and CT
Pericardial Effusion and Hematoma
Problem Solving With Chest X-Ray, CT, and MRI
Mediastinal Hematoma
Problem Solving With Chest Radiography, Chest CT, and MRI
Mediastinitis
Acute Cellular Rejection
Problem Solving With MRI
Coronary Allograft Vasculopathy
Problem Solving With CT
Malignancies
Commonly Encountered Abandoned Materials That Can Be Normal After Heart Transplantation
What to Look for on Post–Heart Transplantation Imaging
■ Heart-Lung Transplantation
Bibliography
42 Thoracic Interventions
Chapter Outline
■ Introduction
■ Lung and Mediastinal Needle Biopsy
Technical Principles
Indications and Contraindications for Lung and Mediastinal Biopsy
Determining Which Patients Would Benefit From Alternative Means of Obtaining Tissue Rather Than Lung Biopsy
How to Determine if Biopsy Is Technically Feasible
Preprocedure Checks Required for a Lung or Mediastinal Biopsy
How a Lung Biopsy Is Performed
Maximizing the Yield of Lung and Mediastinal Biopsy
Complications and Management of Lung and Mediastinal Biopsy
Decreasing the Risk of Complications
Optimal Postprocedure Patient Care
Special Considerations After Lung and Mediastinal Biopsy
■ Thoracentesis
Indications and Contraindications for Thoracentesis
Determining the Cause of Pleural Fluid
How Thoracentesis Is Performed
■ Pleural Drainage
Indications and Contraindications for Pleural Drainage
How Pleural Drainage Is Performed
Complications of Pleural Drainage
Management
Treatment of a Pleural Drain
Options if Pockets of Pleural Fluid Persist After Pleural Drain Placement
■ Drainage of Lung and Mediastinum
How Drainage of Lung and Mediastinum Is Performed
■ Lung Ablation
Indications and Contraindications for Lung Ablation
Indications
Absolute and Relative Contraindications
Considerations if the Patient Has a Pacemaker or Automatic Implanted Cardioverter-Defibrillator
How Lung Ablation Is Performed
Complications of Lung Ablation
Discharge and Follow-Up Instructions After Lung Ablation
Bibliography
43 Imaging of Thoracic Trauma
Chapter Outline
■ Introduction
■ Appropriateness of Imaging Modalities and Technique
When CT Should Be Performed
Appropriate Imaging Protocol
■ Abnormal Gas and Fluid Collections
Pneumothorax
Incidence of Pneumothorax in Trauma; Occult Pneumothorax
Pitfalls in Diagnosis
Determining if There Is Tension Physiology
Associated Injuries
Pneumomediastinum
Cause of Pneumomediastinum in the Traumatic Setting
Associated Injuries
Pneumopericardium
Importance of Pneumopericardium and Associated Injuries
Hemothorax
Signs of Hemothorax
Massive Hemothorax
Hemopericardium
Signs of Hemopericardium and Associated Injuries
Extrapleural Hematoma
Signs of Extrapleural Hematoma and Associated Injuries
Localizing Abnormal Gas Collections on Chest Radiography and CT
Determining Signs of Tamponade
■ Lung Parenchymal Injury
Contusion
Imaging Appearance of Pulmonary Contusion
Laceration
Imaging Appearance of Pulmonary Laceration
Distinguishing These Entities From Aspiration, Pneumonia, and Other Processes
■ Mediastinal Injury
Aortic and Great Vessel Injury
Direct and Indirect Signs of Vascular Injury
Minimal Aortic Injury
Most Common Great Vessel Injury
Finding Subtle Vascular Injury
Differentiating Artifact From Dissection Flaps and Other Signs of Injury; Decreasing Artifacts
Esophageal Injury
Sites of Esophageal Injury and Associated CT Findings
Tracheobronchial Injury
Suspecting Tracheobronchial Injury and Associated CT Findings
■ Cardiac Injury
Detecting Cardiac Injury
Suspecting and Detecting Coronary Artery Injury
■ Diaphragmatic Injury
Signs of Diaphragmatic Injury on Chest Radiography and CT
Differentiating Eventration From Diaphragmatic Injury
■ Conclusion
Bibliography
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Z
Endsheet 7