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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…

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…