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Strategies for Reducing Radiation Exposure From Multidetector Computed Tomography in the Acute Care Setting

Acknowledgments All figures and much of the text in this chapter have been reprinted with permission from: Sodickson A. Strategies for reducing radiation exposure in multi-detector row CT. Radiol Clin North Am . 2012;50(1):1-14; and Sodickson A. Strategies for reducing radiation exposure from multidetector computed tomography in the acute care setting. Can Assoc Radiol J . 2013;64(2):119-129. Synopsis Many tools and strategies exist to enable reduction…

Imaging of Thoracic Trauma

▪ Introduction Thoracic injury is a common sequela of acute trauma and is the third most common injury in trauma patients, after head and extremity injuries. The overall mortality rate approaches 25%, with acute aortic, tracheobronchial, and cardiac injuries often having an even worse prognosis. Given the high mortality rate and the impact on clinical management, rapid and accurate assessment of thoracic trauma imaging is imperative.…

Thoracic Interventions

▪ Introduction Thoracic interventions are performed for the diagnosis and treatment of focal lesions in the thorax. Image-guided percutaneous biopsy is used to obtain tissue for the diagnosis of benign and malignant conditions. Drainage of fluid or air from the pleural space or mediastinum can aid both diagnosis and therapy, and ablative therapies treat primary or secondary malignancy in lungs and chest wall. ▪ Lung and…

Lung and Heart Transplantation

■ Lung Transplantation Since the first lung transplantation was performed in 1963, there have been major improvements in the surgical technique and posttransplantation management of organ recipients. Lung transplantation represents the only effective therapeutic option for many patients with advanced lung disease. Although there continue to be advancements in the understanding of the posttransplantation care of these patients, improvements in long-term survival have been limited by…

Cardiac CT for the Evaluation of Acute Coronary Syndrome in the Emergency Department

■ Introduction More than 8 million Americans each year present to the emergency department (ED) with acute chest pain. This poses a diagnostic challenge to physicians, who must distinguish patients with life-threatening conditions, including acute coronary syndrome (ACS), aortic dissection, and pulmonary embolism, from those who have chest pain related to more benign causes. Most patients with chest pain are discharged with a diagnosis of noncardiac…

Intensive Care Imaging

■ Value of a Routine Daily Chest Radiograph in the Intensive Care Unit Determining Who Needs Imaging Imaging of an intensive care unit (ICU) patient can be a difficult task that relies on cooperation and teamwork among many members of the clinical care team and technologist. The complexity of these critically ill patients, many of whom have numerous support devices, has led to the practice of…

Imaging of the Pericardium

■ Anatomy and Normal Appearance on Imaging The pericardium is a fibrous sac that surrounds the heart and is composed of two distinct layers: the visceral pericardium and parietal pericardium. The visceral pericardium is the inner serous layer that consists of a very thin (<1 mm) layer of mesothelial cells. The visceral pericardium lines the epicardial surface of the heart and is separated from the cardiac…

Cardiac Valves

■ Introduction Echocardiography is the primary imaging modality used in the evaluation of cardiac valve morphology, function, and disease. This modality is broadly available and portable, and there is widespread clinical familiarity with the performance and interpretation of this modality. However, it is operator-dependent and is sometimes limited by suboptimal acoustic windows (e.g., patients affected by obesity). In certain patients, MRI may be used in the…

Trachea and Bronchi

■ Central Airway Anatomy and Physiology: Essentials for the Radiologist Anatomy The trachea is a cartilaginous and fibromuscular conduct extending from the lower border of the larynx (2 cm below the vocal cords, at the level of spinal C6) to the carina (at the level of spinal T5), where it bifurcates into the main stem bronchi. The trachea ranges from 10 to 12 cm in length, with an…

The Pleura

▪ Pleural Anatomy The pleura is a stroma supported by the mesothelial lining of the thoracic cavity. It is composed of two layers: an inner visceral pleura and an outer parietal pleura. The visceral pleura lines the lungs and their fissures. The visceral pleura is supplied by pulmonary arterioles, with drainage via the pulmonary veins. The parietal pleura lines the chest wall, diaphragm, and mediastinum. The…

Problem Solving in the Mediastinum

▪ Mediastinal Lesions Although it may not be difficult to identify a mediastinal mass on cross-sectional imaging, it can be challenging to determine its nature. Diagnostic specificity is critical to prevent unnecessary intervention and its associated morbidity and expenditure. The aim of this chapter is to serve as a guide toward maximizing the benefit of current diagnostic imaging tools for mediastinal lesions to improve diagnostic accuracy…

Diaphragm and Chest Wall

■ Diaphragm Relevant Anatomy The diaphragm is a dome-shaped muscle with a central noncontractile tendon. Anteriorly and laterally, the diaphragm attaches to the body wall (ribs, costal cartilages, inferior sternum, and xiphoid process) via muscular diaphragmatic slips ( Fig. 33.1A ). Posteriorly, musculotendinous crura attach the diaphragm to the posterior body wall (lower thoracic and lumbar vertebrae). The right crus is typically larger and longer than…

Cardiac and Vascular Tumors

▪ Introduction Cardiac tumors, benign and malignant types, are uncommon, with an incidence of 0.002% to 0.3% on autopsy series. However, even benign cardiac tumors may present with significant obstructive symptoms or be a substrate for arrhythmias. Tumors in the left side of the heart have the potential to cause systemic or neurologic embolic phenomena. The goals of imaging in cardiac masses are as follows: 1.…

Imaging of Cardiomyopathy and Myocarditis

▪ Introduction Cardiomyopathies and myocarditis are disorders frequently encountered in clinical practice, and imaging plays a major role in the diagnosis, management, and follow-up of these diseases. This chapter will describe imaging of the cardiomyopathies that have characteristic imaging features and that are most commonly imaged in clinical practice. ▪ Imaging: What, Why, and How Definition of a Cardiomyopathy Cardiomyopathies are diseases of the heart muscle…

Ischemic Cardiac Disease

■ Introduction: Using Cardiovascular Imaging Cardiovascular diseases remain one of the most common causes of death in industrialized nations. Over the last decade, substantial technical advances in cardiovascular imaging have been made and have helped mature such modalities from research techniques into clinical applications. Ischemic cardiac disease is defined as an efficiency loss of the myocardium due to inadequate oxygen supply, which is mostly caused by…

Acquired Diseases of the Aorta

■ Introduction The aorta is the largest artery in the body, arising from the left ventricular outflow tract and branching throughout the body. The spectrum of thoracic aortic disease is wide, with causes that may be chronic or acute, congenital or acquired, and symptomatic or asymptomatic. The clinical presentation of acquired thoracic aortic disease ranges from asymptomatic (as in the case of an ascending thoracic aortic…

Congenital Heart and Vascular Disease

▪ Introduction Congenital heart and vascular diseases are relatively uncommon malformations of the heart or great vessels that occur during embryologic development. With advances in medical and surgical treatments, most patients survive into adulthood, and it is imperative for the chest radiologist to be familiar with the imaging findings of common malformations and their postoperative appearance. Although echocardiography remains the first step in the assessment of…

Pulmonary Vascular Diseases

▪ Introduction CT pulmonary angiography (CTPA) to assess for pulmonary embolism (PE) makes up the lion's share of most radiologists’ exposure to the pulmonary vascular system and is the focus of this chapter. The pulmonary vascular anatomy is detailed because this can be the crucial determinant to differentiate embolism from artifact. Other modalities for pulmonary vascular assessment, including radiography, MRI, and catheter angiography, are briefly discussed.…

Diffuse Lung Disease With Calcification and Lipid

■ Introduction Certain diffuse lung diseases are associated with high- or low-attenuation lesions. High-attenuation lesions are most often due to calcium deposition from a variety of mechanisms, but can also be due to the accumulation of other radiopaque substances such as iodine (amiodarone lung toxicity) and talc (talcosis). Low-attenuation lesions are predominantly due to the deposition of lipid-containing substances. These diffuse lung diseases can encompass a…

Radiation, Medication, and Illicit Drug–Related Lung Disease

Introduction and Background Although different in appearances on imaging, radiation and drug-induced lung diseases share several similarities. Both entities may present with a variety of appearances, both in the acute and subacute or chronic settings, and require a high level of suspicion to make the correct diagnosis. Most importantly, these processes share a temporal relationship with the causal event. Furthermore, the two processes may coexist in…