Pneumothorax is the presence of air between the parietal and visceral pleura in the pleural cavity. It is caused most frequently by trauma or blunt or penetrating injury, which may be accidental or iatrogenic. If it is not caused by trauma, it is referred to as spontaneous; this may be primary (not associated with an underlying cause) or secondary to preexisting significant pulmonary disease. Pneumothorax may…
Lung Transplantation Complications Lung transplantation can prolong life in a variety of diseases that cause progressive respiratory failure. As of 2015, more than 55,000 adult lung transplantations and almost 4000 heart-lung transplantations had been performed worldwide, more than 3500 a year. The most common indications for lung transplantation in adults have been chronic obstructive pulmonary disease (COPD), pulmonary fibrosis and other interstitial lung diseases (ILDs), and…
Chest radiography is the primary imaging modality used in the intensive care unit (ICU), given its portability, rapid image acquisition, and immediate bedside return of information on the preview screen. Of consequence, it is of utmost importance that both radiologists and intensivists are adept in reading these studies. Portable ICU radiographs are obtained in an anteroposterior (AP) view in which the x-ray beam traverses the patient…
A spectrum of cardiopulmonary diseases can be treated surgically. Surgical procedures in the thorax include lung resection, lung transplantation, cardiovascular and mediastinal surgery, as well as pleural and cavitary space reduction procedures. This chapter reviews the surgical procedures, indications, and imaging findings in the postoperative setting, both expected and unexpected, including potential complications. In the intensive care unit, postoperative findings, such as malposition of support lines…
Blunt thoracic trauma is a common indication for hospital admission, with the predominant cause of trauma being motor vehicle collisions. The thorax is the fourth most injured area in unrestrained passengers, but it is the most commonly injured area in individuals who are restrained by a seat belt. Other common causes of blunt thoracic trauma include falls from heights of greater than 10 feet and motor…
Radiation therapy is an important modality in the management of patients with intrathoracic malignant neoplasms and primary and secondary chest wall neoplasms. Radiation therapy for these tumors usually results in radiation of the adjacent lung, and radiation-induced lung injury has been reported in association with treatment of lung, breast, esophageal, and thymic neoplasms and in lymphoma and pleural mesothelioma. Adverse effects of radiation therapy on the…
Etiology The number of drugs recognized to cause an adverse pulmonary reaction of one kind or another is reported to be more than 600 and continues to rise yearly with the advent of new medications. Pharmacologic groups associated with pulmonary toxicity include chemotherapeutic agents, antimicrobials, antiinflammatory agents, cardiovascular drugs, and illicit drugs. Drug reactions are usually the result of either direct (toxic and idiosyncratic reactions) or…
Aspiration refers to the misdirection of contents of the oral or upper gastrointestinal tract that have passed through the trachea and larynx and entered the lung. The diagnosis rests mostly on the history of presenting illness, medical history, vital signs, and chest radiograph. Aspiration includes a spectrum of clinical and radiologic manifestations secondary to chemical pneumonitis or bacterial pneumonia that range from asymptomatic focal inflammatory reactions…
The most common pneumoconioses are silicosis, coal workers' pneumoconiosis, and asbestosis (see Chapters 61 and 62 ). There are numerous rare pneumoconioses related to variable occupational dust exposures. Hard metal lung disease, aluminum pneumoconiosis, talc pneumoconiosis, welders' pneumoconiosis, and chronic beryllium disease are discussed here. The high-resolution computed tomography (HRCT) findings of these uncommon pneumoconioses vary and are relatively nonspecific; however, there are predominant and characteristic…
Etiology Silicosis and coal workers' pneumoconiosis (CWP) are occupational lung diseases; silicosis is caused by continued exposure to excessive amounts of respirable silica, and CWP is caused by exposure to carbonaceous material (anthracosis). Respirable crystalline silicate and coal dust embed in the lungs, causing granulomatous and fibrotic changes that lead to radiographic and pathologic abnormalities. Silica is a naturally occurring mineral that is mainly composed of…
Etiology Asbestos is the general term given to a group of magnesium silicate minerals that have in common a tendency to separate into fibers. The fibers are resistant to heat and acid, thus the name asbestos, which is derived from the Greek meaning inextinguishable ( a-, “not,” and sbestos, “extinguishable”). Because asbestos is not combustible, has great tensile strength, and is durable, it has been widely…
Definition and Etiology Emphysema is defined as a “condition of the lung characterized by abnormal, permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of their walls.” Because emphysema decreases the elastic recoil force that drives air out of the lung and thereby reduces maximal expiratory airflow, the disease is clinically classified as one of the chronic obstructive pulmonary diseases (COPDs). In…
Bronchiolitis refers to a wide variety of inflammatory and fibrotic disease processes affecting the small airways. Bronchiolitis is common and may be the primary manifestation in various clinical settings (e.g., infections, connective tissue diseases (CTDs), inhalational injuries, cigarette smoking, drug reactions, and transplantation). Bronchiolitis, however, frequently occurs in association with large airway disease and in association with parenchymal and interstitial lung disease ( Table 59.1 ).…
Asthma is an inflammatory disease characterized by increased airway reactivity and by airflow obstruction that is at least partially reversible and results in recurrent episodes of wheezing, breathlessness, and cough. Etiology Asthma can be divided into two main categories: extrinsic and intrinsic. Extrinsic asthma occurs in patients who are atopic, a term used to refer to the genetic predisposition to respond to antigenic challenge with excessive…
Bronchiectasis Etiology Diseases of the airways are surprisingly common in clinical practice, and imaging tests have a central role in the evaluation of the patient. Bronchiectasis is an important yet, in historic terms, a surprisingly neglected disorder characterized pathologically by abnormal permanent dilatation of the bronchi, leading to significant morbidity and mortality. The causes and associations of bronchiectasis are diverse and summarized in Box 57.1 .…
The wide variety of tracheal diseases includes both benign and malignant conditions that may manifest as tracheal masses, focal or diffuse tracheal thickening, or tracheal calcification. Tracheal tumors, inflammatory conditions involving the trachea, infections, and posttraumatic or iatrogenic injuries are among the variety of tracheal pathologies that can be characterized at imaging. Structural abnormalities of the trachea include acquired or congenital tracheal stenosis, tracheomalacia, and tracheomegaly.…
Etiology Pulmonary edema is defined as an excess of fluid in the extravascular compartment of the lung and is classified into four categories based on pathophysiology: hydrostatic edema, permeability edema with diffuse alveolar damage, permeability edema without diffuse alveolar damage, and mixed edema resulting from hydrostatic and permeability edema. Permeability pulmonary edema is almost always a manifestation of capillary endothelial injury or alveolar epithelial damage with…
Etiology Pulmonary edema is defined as an abnormal accumulation of fluid in the extravascular compartments (interstitial and airspace) of the lung. Traditionally, pulmonary edema has been divided into hydrostatic edema and permeability edema based on the presumed mechanism. Hydrostatic edema is caused by an elevation in pulmonary capillary pressure, and permeability edema is caused by disruption of the capillary endothelium, resulting in protein leakage into the…
Pulmonary arterial hypertension (PAH) is defined as a mean pulmonary arterial pressure of greater than 25 mm Hg at rest or 30 mm Hg with exercise, with an elevated pulmonary vascular resistance (PVR) greater than 3 Wood units. Although pulmonary pressures may be elevated in many conditions, PAH fundamentally requires changes in the pulmonary vasculature. Mean pressures of 26 to 40 mm Hg are considered mild; 41 to 55 mm…
Fat Embolism Etiology, Prevalence, and Epidemiology The term fat embolism refers to the presence of globules of free fat within the pulmonary vasculature. Fat embolism is common among trauma patients, especially those with long bone or pelvic fractures. In the context of trauma, fat embolism is also common after extensive injury to subcutaneous fat, such as occurs in severe beatings or liposuction. Fat embolism must be…