Problem Solving in Chest Imaging (2019)

Description

Optimize diagnostic accuracy with Problem Solving in Chest Imaging, a new volume in the Problem Solving in Radiology series. This concise title offers quick, authoritative guidance from experienced radiologists who focus on the problematic conditions you’re likely to see―and how to reach an accurate diagnosis in an efficient manner. Addresses the practical aspects of chest imaging―perfect for practitioners, fellows, and senior level residents who may or may not specialize in chest radiology, but need to use and understand it. Helps you make optimal use of the latest imaging techniques and achieve confident diagnoses. Presents content by organ system and commonly encountered problems, with problem solving techniques integrated throughout. Features more than 1,500 high-quality images that provide a clear picture of what to look for when interpreting studies. Focuses on the core knowledge needed for successful results, covering anatomy, imaging techniques, imaging approach, entities by pathologic disease and anatomic region, and special situations. Key topics include Diffuse Lung Disease, Neoplasms of the Lung and Airways, Interstitial Lung Disease, Smoking-Related Lung Diseases, and Cardiovascular Disease. Shows how to avoid common problems that can lead to an incorrect diagnosis. Tables and boxes with tips, pitfalls, and other teaching points show you what to look for, while problem-solving advice helps you make sound clinical decisions.Expert Consult™ eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices. 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 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