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Fetal Aneuploidies

Introduction * Acknowledgement: This study was supported by a grant from the Fetal Medicine Foundation (Charity No: 1037116). Aneuploidies are major causes of perinatal death and childhood disability. Consequently, the detection of chromosomal disorders constitutes the most frequent indication for invasive prenatal diagnosis. However, invasive testing, by amniocentesis or chorionic villus sampling (CVS), is associated with a risk of miscarriage and therefore these tests are carried…

First-Trimester Detection of Fetal Anomalies

Introduction The first trimester of pregnancy is generally considered to be the first 13 completed weeks. In the past, first-trimester ultrasound has mainly been used to confirm fetal viability, establish pregnancy location, count the number of fetuses and assess gestational age by measurement of fetal crown rump length (CRL). A major breakthrough in screening for fetal abnormalities was the finding that fetal nuchal translucency is increased…

Interventional Techniques

Introduction The most common interventional procedures in thoracic radiology are drainage of air or fluid collections followed by percutaneous transthoracic needle biopsy (PTNB) of lung and mediastinal lesions. Other procedures are placement of localization markers in lung parenchyma to facilitate resection or radiation and thermal ablation to treat primary and secondary neoplasms. Biopsy of Lung and Mediastinum Indications and Contraindications Percutaneous transthoracic needle biopsy is commonly…

Lung Cancer Staging

Introduction A standardized staging system is fundamental in delivering evidence-based treatment tailored to an individual patient. To determine the extent of a tumor and choose treatment strategies, an accurate staging system is essential. The stage of the tumor is the single most important factor in determining prognosis in patients with lung cancer. The American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC)…

Lung Cancer Screening

Lung cancer is suitable for screening because of identifiable risk factors that allow targeted screening of high-risk individuals, its significant prevalence, the existence of a preclinical phase, its high morbidity and mortality, and evidence that treatment in early-stage disease is potentially curative. Why Screen? Lung cancer is the third most common cancer in the United States but has the highest mortality rate among cancers. The 5-year…

Incidental Pulmonary Nodule

Introduction A pulmonary nodule is defined as a rounded or irregular opacity measuring up to 3 cm in diameter. There are many etiologies, both benign and malignant, of lung nodules ( Table 22.1 ). Some opacities can resemble a nodule but are truly nodule mimics and can be identified as such in cross-sectional imaging. Lung nodules are extremely common, with some studies indicating that more than 50%…

Pulmonary Tumors and Lymphoproliferative Disorders

Lung cancer is the leading cause of cancer mortality in the United States, accounting for more than 150,000 deaths each year. In addition to lung cancer, the chapter reviews primary malignant and benign pulmonary tumors more commonly encountered in clinical practice based on the latest 2015 World Health Organization (WHO) Classification of Lung Tumors ( Box 21.1 ). Pulmonary lymphoproliferative disorders and benign entities that mimic…

Obstructive Lung Diseases

Introduction Obstructive lung diseases consist of a heterogeneous group of chronic respiratory illnesses characterized by airway obstruction and air trapping ( Box 20.1 ). The most common causes include chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, followed by asthma and bronchiectasis. Bronchiectasis is discussed in Chapter 6 . Constrictive or obliterative bronchiolitis is a less common cause of obstructive lung disease. Patients…

Pneumoconioses

Introduction Industrial and technological advancements have made occupational lung diseases a major cause of work-related illness. The pneumoconioses are a set of lung diseases caused by the repeated inhalation and retention of small particles within the lung. The resultant lung injury depends on many factors, including particle size, cumulative dose, clearance rate, and inherent toxicity of the substance. The fact that only a proportion of similarly…

Diffuse Lung Diseases

Introduction There are innumerable causes of chronic diffuse lung disease. This chapter reviews the common causes of diffuse lung disease, including the idiopathic interstitial pneumonias (IIPs), connective tissue disease (CTD), hypersensitivity pneumonitis (HP), sarcoidosis, cystic lung disease, eosinophilic lung disease, collagen vascular diseases, and drug reaction. Idiopathic Interstitial Pneumonias The IIPs are a group of diffuse lung diseases that present similarly. The classification system of IIPs…

Approach to Diffuse Lung Disease: Anatomic Basis and High-Resolution Computed Tomography

Introduction Diffuse lung diseases are often detected and initially evaluated on chest radiographs (CXR). A CXR can provide valuable clues regarding pulmonary pathology such as the lung volume, distribution, and characterization of abnormalities. Radiographs assess lung volumes and distribution of disease. Whereas low volumes suggest the presence of a restrictive defect such as pulmonary fibrosis, large lung volumes suggest hyperinflation or obstructive lung disease. Ancillary findings…

Mycobacterial Infection

Introduction The genus Mycobacterium contains numerous acid-fast staining aerobic bacilli that result in a variety of infections in human hosts. Pulmonary infections by Mycobacterium spp. are characterized as tuberculous (TB) mycobacterial infection and nontuberculous mycobacterial (NTM) infection . Tuberculous Mycobacterial Infection Tuberculosis is an infection caused by the inhalation of the aerosolized aerobic bacillus Mycobacterium tuberculosis . According to the World Health Organization (WHO) 2015 annual…

Pulmonary Disease in the Immunocompromised Patient

Introduction Infection with the human immunodeficiency virus (HIV) that causes the acquired immunodeficiency syndrome (AIDS) has been and continues to be a serious health threat around the globe. Despite great advances in the treatment of HIV/AIDS, such as the aggressive use of prophylactic antimicrobial therapies and the introduction of highly effective antiretroviral therapies, it remains a major cause of morbidity and mortality in populations with limited…

Community-Acquired Pneumonia

Introduction Pneumonia is an important cause of morbidity and mortality, with tremendous variability in its clinical and imaging manifestations, treatment, and outcomes. Many individuals with mild pneumonias never come to medical attention, but other patients ultimately succumb to infections that cause extensive local and systemic damage. Likewise, pneumonia on imaging studies may manifest with minimal findings or demonstrate extensive tissue necrosis. This heterogeneity poses a challenge…

Thoracic Trauma

Introduction In the United States, 25% of trauma-related deaths are secondary to thoracic injuries, which can result from either penetrating trauma or blunt trauma. Penetrating chest trauma is less frequent but deadlier than blunt chest trauma and commonly results from gunshot and stabbing. Surgery is more frequently required for penetrating thoracic injury than blunt injury. The most common causes of blunt trauma are motor vehicle collisions…

The Postoperative Chest

Introduction For optimal interpretation of imaging studies done after thoracic surgery, it is essential to understand the surgical techniques and the possible complications. The common surgical procedures that are performed in the lung, pleura, mediastinum, and chest wall are discussed in this chapter. Lung Surgeries Open and Minimally Invasive Almost all thoracic surgical procedures in the past have been performed via open lung approach, requiring either…

Pulmonary Embolus and Pulmonary Vascular Diseases

Pulmonary Embolus Pulmonary embolus (PE) is a common clinical problem with an annual incidence of 4 to 21 per 10,000 people per year, rising significantly to 1 in 100 patients after 80 years of age. Autopsy studies have shown that PE is the second leading cause of sudden, unexpected, nontraumatic death in outpatients, and it is not diagnosed premortem in most cases. The all-cause, 30-day mortality…

Acute Thoracic Conditions in the Intensive Care Unit

Introduction Thoracic imaging plays a vital role in the management of intensive care unit (ICU) patients. The chest radiograph provides critical information regarding placement of life support devices, complications such as barotrauma, intravascular volume status, and a wide spectrum of underlying diseases. A systematic review of the life-support devices, lungs, pleura, mediastinum, bones, and extrathoracic soft tissues ensures that all important observations are made. To ensure…

Thoracic Lines and Tubes

Introduction Chest radiography serves a vital role in the management of critical care patients. Most patients in the intensive care unit (ICU) have at least one and frequently more than one device for central venous access, mechanical ventilation, hemodynamic monitoring, hemodynamic support, pleural drainage, or nutrition. The chest radiograph is an essential tool to assess these devices for proper position, to ensure proper function, and to…

Congenital Thoracic Malformations

Introduction Several congenital abnormalities of the thorax have been described, but most are rare. Classification of these anomalies is difficult because the embryologic basis often is not clearly understood. A classification based on anatomic structures uses the categories of trachea, bronchi, lung, and pulmonary vasculature. Although often described as separate entities, bronchopulmonary malformations are frequently interrelated, and features of different imaging and pathologic entities may coexist…