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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…

The Pleura, Diaphragm, and Chest Wall

Pleura Anatomy and Physiology The pleura is composed of two thin layers of mesothelium referred to as the visceral and parietal pleura. The visceral pleura covers the lung and fissural surfaces and the parietal pleura lines the mediastinum, ribs, and diaphragm. The visceral and parietal pleura differ in their arterial supply and their venous and lymphatic drainage. The visceral pleura is supplied by the pulmonary arterioles…

The Airways

Normal Anatomy Trachea The trachea is a tubular structure that extends from the cricoid cartilage superiorly to the carina inferiorly and is purely gas conducting. It is typically cylindrical in shape with slight flattening along its posterior aspect. The trachea measures approximately 11 cm in length and 2 to 2.5 cm in side-to-side diameter. Two specific segments can be identified, a shorter extrathoracic segment and a longer intrathoracic…

The Mediastinum

Introduction The mediastinum is bounded anteriorly by the sternum, posteriorly by the thoracic spine, laterally by the mediastinal pleura, superiorly by the thoracic inlet, and inferiorly by the diaphragm. It contains vital intrathoracic structures and organs, including the heart, aorta, great vessels, major lymphatic structures, trachea and mainstem bronchi, esophagus, thymus, and major nerves. The mediastinum can be affected by a wide variety of both focal…

PET-CT and PET-MRI: Technique, Pitfalls, and Findings

Introduction Positron emission tomography (PET) has become an important imaging tool in thoracic oncology over the past 10 to 20 years. It has proven its usefulness in the diagnosis of malignancies, initial staging, assessing response to treatment, and posttreatment monitoring for recurrence. Integration of PET with computed tomography (CT) initially and magnetic resonance (MR) lately has further improved its diagnostic accuracy, which has made it an…

Thoracic Magnetic Resonance Imaging: Technique and Approach to Diagnosis

Introduction Uses of Thoracic Magnetic Resonance Imaging Chest radiography (CXR) and chest tomography (CT) have been the mainstays of thoracic imaging for decades, and 18-fluorodeoxyglucose positron emission tomography (FDG-PET)–CT has more recently proven its value in staging lung cancer and metastatic disease within the thorax. Upon technical improvements that have addressed challenges related to cardiorespiratory motion, magnetic resonance imaging (MRI) has become appreciated for its capability…

Normal Anatomy and Atelectasis

Normal Anatomy Trachea and Main Bronchi The trachea is a midline cartilaginous and fibromuscular tubular structure that extends from the inferior aspect of the cricoid cartilage to the carina. The intrathoracic length of the trachea normally ranges from 6 to 9 cm. The wall contains 16 to 22 horseshoe-shaped cartilage rings that are connected longitudinally by annular ligaments containing fibrous and connective tissue. The posterior wall of…

Radiologic Techniques and Dose Reduction Strategies in Chest Imaging

Introduction This chapter reviews various x-ray–based techniques used in thoracic imaging, including radiography, fluoroscopy, digital tomosynthesis, and computed tomography (CT). Conventional, Computed, and Digital Radiography Merely 1 year after discovery of x-rays by Wilhelm Konrad Roentgen, calcium tungstate was chosen as the material for the first screen cassettes based on Thomas Edison's assessment of about 5000 chemicals for their light-producing capabilities upon exposure to x-rays. For…

Fetal Skeleton

Objectives On completion of this chapter , you should be able to: Describe in detail the embryology of the fetal skeleton Describe the variety of musculoskeletal anomalies that can occur in the fetus Differentiate sonographically among the most common skeletal dysplasias List limb abnormalities and the anomalies that are associated with and unique to specific defects Key Terms Achondrogenesis Achondroplasia Craniosynostosis Heterozygous achondroplasia Homozygous achondroplasia Hypophosphatasia…

Fetal Urogenital System

Objectives On completion of this chapter, you should be able to : Discuss the development of the urogenital and genital system Describe the sonographic appearance of the fetal kidneys and bladder Detail the complications of renal agenesis Describe the sonographic findings associated with abnormalities of the kidney Differentiate renal cystic disease Distinguish between different types of urinary obstruction Identify congenital malformations of the genital system Key…

The Fetal Abdomen

Objectives On completion of this chapter, you should be able to: Describe the development of the digestive system and list the unique features of the fetal abdomen Describe normal development of the stomach and the importance of its sonographic visualization Define abnormalities of the fetal gastrointestinal tract and hepatobiliary system and describe their sonographic findings Key Terms Anorectal atresia Asplenia Choledochal cyst Cholelithiasis Cystic fibrosis Duodenal…

The Fetal Anterior Abdominal Wall

Objectives On completion of this chapter, you should be able to: Describe the embryology of the abdominal wall Define and describe the anterior abdominal wall abnormalities discussed in this chapter List the sonographic findings for an omphalocele and for a gastroschisis Identify the fetal anomalies in pentalogy of Cantrell Explain the sonographic findings in a fetus with amniotic band syndrome Key Terms Amniotic band syndrome Beckwith-Wiedemann…

The Fetal Thorax

Objectives On completion of this chapter, you should be able to: Describe the development of the thoracic cavity List the normal sonographic features of the thorax and diaphragm Describe the development and consequences of pulmonary hypoplasia Differentiate between solid and cystic lesions of the lung Discuss the sonographic findings in a diaphragmatic hernia Key Terms Asphyxiating thoracic dystrophy Bronchogenic cyst Congenital bronchial atresia Congenital cystic adenomatoid…

Fetal Neural Axis

Objectives On completion of this chapter, you should be able to : Describe the embryology of the neural tube fetal brain development Discuss the anomalies that can occur in the fetal head and spine Recognize the sonographic appearance of fetal head and spine anomalies Key Terms Acrania Alobar holoprosencephaly Anencephaly Anomaly Cebocephaly Cyclopia Cystic hygroma Holoprosencephaly Hydranencephaly Hydrocephalus Macrocephaly Meningocele Meningomyelocele Myeloschisis Spina bifida Spina bifida…

Fetal Face and Neck

Objectives On completion of this chapter, you should be able to: Discuss basic embryology of the face Describe how to sonographically evaluate the fetal face and neck for normal features Define the most common face and neck congenital anomalies discovered sonographically in utero Key Terms Agnathia Anotia Anophthalmia Arhinia Beckwith-Wiedemann syndrome Branchial cleft cyst Cebocephaly Cephalocele Craniosynostosis Cyclopia Cystic hygroma (CH) Dacryocystocele Epignathus Encephalocele Ethmocephaly Exophthalmia…

Amniotic Fluid and Fetal Membranes

Objectives On completion of this chapter, you should be able to: Describe how amniotic fluid is derived Describe the production of amniotic fluid List the functions of amniotic fluid Describe methods for assessing amniotic fluid volume Determine abnormal volumes of amniotic fluid Understand the significance of ruptured membranes Describe the significance of amniotic band syndrome Differentiate amniotic band syndrome from amniotic sheets with sonography Distinguish between…

The Umbilical Cord

Objectives On completion of this chapter, you should be able to: Describe the development and normal anatomy of the umbilical cord Predict obstetric problems that may be associated with abnormal umbilical cord dimensions Discuss the umbilical cord disorders presented in this chapter, including causes and clinical significance Differentiate how the sonographer may distinguish tumors and cysts from a true knot in the umbilical cord Key Terms…