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Cystic Lung Disease

Introduction Cystic lung diseases present a considerable diagnostic challenge mainly because CT findings can be similar in many of these diseases. In addition, a number of pulmonary abnormalities can result in cystic patterns that mimic true lung cysts. However, the combination of characteristic imaging findings, clinical features, and genetic testing, where appropriate, often permits an accurate diagnosis. In this chapter, we review the unique CT features…

Collagen Vascular Diseases and Vasculitis

Introduction Collagen vascular diseases (CVDs) are a heterogeneous group of immunologically mediated inflammatory disorders that may involve various organs. They often affect the lungs, mediastinum, and pleura, but the frequency of pulmonary involvement varies according to the specific disease. Additionally, medical treatment may lead to lung infection or drug reaction. Thus imaging is essential in the management of patients with CVD, with early diagnosis and intervention…

Eosinophilic Lung Disease

Introduction Eosinophilic lung diseases are characterized by the presence of pulmonary opacities and peripheral blood eosinophilia, tissue eosinophilia, or both. Eosinophils are leukocytes that are involved in immune defense and various inflammatory processes. They decrease hypersensitivity reactions by reducing the activity of histamine and leukotriene complexes released by mast cells, as well as by phagocytizing mast cell granules and immune complexes. Eosinophils also release cytotoxic proteins…

Hypersensitivity Pneumonitis

Introduction Hypersensitivity pneumonitis is an immunologically mediated lung disease that occurs in susceptible sensitized individuals following inhalational exposure to antigenic organic dust. As such, the antigenic material must be small enough to deposit in the bronchioles and penetrate the alveoli, where it induces an inflammatory response. The vast majority, around 95%, of patients with hypersensitivity pneumonitis are nonsmokers. It is proposed that this may be due…

Occupational and Inhalational Lung Diseases

Introduction In many ways, the challenges related to occupational and environmental lung disease imaging reflect the challenges for all of radiology. The best imaging interpretation relies heavily on the appropriate imaging selection for the particular indication and access to patient history and clinical evaluation. The decision between ordering chest radiography, CT, MRI, or PET can absolutely make the difference for the correct diagnosis or treatment. Knowledge…

Interstitial Lung Disease

Introduction Interstitial lung disease (ILD) refers to a broad category of diffuse parenchymal lung diseases characterized by inflammation and/or fibrosis of the lungs. Patients invariably present with dyspnea of varying time course and severity. Patients are often hypoxemic, and pulmonary function tests typically demonstrate a restrictive pattern, with reduced diffusing capacity. The term interstitial lung disease is somewhat of a misnomer because many ILDs also involve…

Smoking-Related Lung Diseases

Introduction The deleterious effects of smoking tobacco have been established for decades and largely began with the 1964 Surgeon General's Report, which linked smoking to the development of bronchogenic carcinoma. Since then, smoking tobacco has been causally linked to diseases of nearly every organ system in the body. Specific pulmonary diseases linked to smoking include bronchogenic carcinoma, chronic bronchitis, and chronic obstructive pulmonary disease, as well…

Neoplasms of the Lung and Airways

▪ Introduction Primary lung cancer is the leading cause of cancer-related mortality worldwide and accounts for more deaths than the next three malignancies combined—pancreatic, colorectal, and pancreatic cancer in men; breast, colorectal, and pancreatic cancer in women. In 2017, it was estimated that 222,500 new cases would be diagnosed, with 155,870 deaths expected from the disease. Lung cancers are generally divided into two types, non–small cell…

Infection

▪ Introductory Considerations Diagnostic imaging is used in the detection of thoracic infections, identifying complications associated with infection, and differentiating noninfectious from infectious diseases. Chest radiography and computed tomography (CT) comprise the primary modalities used in diagnosis, with ultrasound, nuclear medicine, and magnetic resonance imaging (MRI) used in select cases. Suggesting a specific organism is generally not possible in the immunocompetent patient presenting with thoracic infection.…

Congenital and Developmental Diseases of the Lungs and Airways

▪ Introduction Congenital lung disease in the adult patient is rare. However, some congenital lung diseases can cause clinical symptoms for which patients undergo imaging, or these diseases may be incidentally discovered on imaging performed for other reasons. Although encountering congenital lung disease on imaging is very uncommon, the imaging appearance is often very characteristic, allowing the radiologist to make a specific diagnosis. Knowledge of the…

Differential Diagnosis Based on Imaging Findings

Air Space Disease Acute Consolidation Air space consolidation results when alveoli are filled with material that attenuates the x-ray beam more than the surrounding lung parenchyma. When encountered in the acute setting, air space consolidation on imaging has a differential diagnosis ( Table 14.1 ). TABLE 14.1 Differential Diagnosis of Acute Consolidation DIAGNOSIS COMMENTS Infectious pneumonia Alveoli are filled with pus or inflammatory fluid; fever and…

Introduction to Terminology

▪ Introduction The focus of this chapter is to define terms used in cardiovascular and thoracic imaging and provide a basic framework for pattern recognition for problem solving in the clinical practice. The thoracic terms used in this book incorporate the recommendations of the Nomenclature Committee of the Fleischner Society published in 1984, 1996, and 2008 for thoracic radiography and computed tomography (CT). A few terms…

Thoracic Nuclear Imaging

Introduction Historically, radionuclide lung imaging was used mainly for the diagnosis of pulmonary embolism (PE) and lung function. The advent of fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) scanning, with its integration of both functional and anatomic information into coregistered datasets, has heralded a new age of radionuclide imaging for lung cancer evaluation and staging. Expanded applications of FDG PET/CT now also include non-neoplasm…

Problem-Oriented Radionuclide Myocardial Perfusion Imaging

Introduction Radionuclide myocardial perfusion imaging (MPI) plays a key role in the diagnosis and management of individuals with known or suspected coronary artery disease (CAD). Recent breakthroughs in single-photon emission computed tomography (SPECT) technology and software, along with the increasing availability of positron emission tomography (PET) scanners, are rapidly changing the existing paradigm of MPI. Cardiac SPECT MPI is a versatile tool to diagnose obstructive CAD…

Angiography and Interventions

Introduction The bony thoracic cage and crowded vital organs in the thorax make open surgical access difficult and challenging. For these same reasons, the thorax is ideal for image-guided interventions. In addition to procedural skills, a thorough knowledge of the anatomy, physiology, pathology, imaging findings, and preprocedure and postprocedure care is required for successful practice of various interventional procedures. Thoracic interventions can be broadly divided into…

Cardiac MRI

■ Introduction Cardiac MRI is a study often used for the evaluation and diagnosis of a wide range of acquired and congenital cardiac abnormalities. Cardiac MRI offers excellent soft tissue contrast that is useful in evaluating cardiac masses and infiltrative diseases of the myocardium. Both ECG and respiratory gating improve temporal resolution, allowing for the detection of cardiac motion abnormalities and evaluation of small structures adjacent…

Pulmonary, Mediastinal, Vascular, and Chest Wall MRI

▪ Introduction and Background: Considerations for Using MRI Magnetic resonance imaging (MRI) is an important tool in imaging the mediastinum, chest wall, and chest vasculature, with a continuously expanding role. Excellent soft tissue contrast makes MRI a useful tool in the diagnosis, staging, surgical planning, and response to treatment evaluation in many cancers. MRI offers sensitivity to blood flow without ionizing radiation, which is particularly useful…

Cardiovascular CT

Introduction CT imaging of the heart plays an important role in anatomic and sometimes functional evaluation of the heart and coronary arteries. Coronary artery cardiac CT angiography (CTA) has substantially gained popularity, specifically for imaging acute chest pain in urgent care settings, allowing for a more rapid rule-out of acute coronary syndrome (ACS) and for imaging patients before and after coronary artery bypass graft (CABG) surgery.…

Pulmonary CT: The Scanner, the Protocol, and the Dose

Introduction CT has become an indispensable part of diagnostic imaging in recent times. With the help of the money that the Beatles’ records made for Electrical and Music Industries (EMI), Nobel Laureate Sir Godfrey Hounsfield invented CT in 1972, a technology that has evolved at a rapid pace since its introduction. The first CT scanner was an axial CT scanner, which took around 5 minutes for…

Radiographic Techniques

■ Conventional Chest X-Ray The chest radiograph is the most common radiographic procedure performed in the imaging department and is the initial imaging modality in a patient presenting with thoracic symptoms. The basic techniques of chest radiography have not changed significantly over the past 100 years. However, most centers are now using predominantly digital radiology as compared to the conventional screen-film technology. Preliminary Considerations W hy…