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Nontuberculous (Atypical) Mycobacterial Infection

A variety of nontuberculous mycobacteria (NTMB) can cause pulmonary infections, with important differences in epidemiology, microbiology, host response, and treatment options across the various species. The severity of an infection caused by NTMB is largely determined by the immune status of the individual and whether coexisting disease is present. More complex manifestations of NTMB are now recognized, such as the overlapping pathology of hypersensitivity pneumonitis and…

Pulmonary Tuberculosis

Overview Etiology, Prevalence, and Epidemiology Tuberculosis (TB) is a chronic recurrent contagious infection caused by Mycobacterium tuberculosis. M. tuberculosis is an aerobic, nonmotile, non–spore-forming rod that is highly resistant to drying, acid, and alcohol. It is transmitted person to person via droplet nuclei containing the organism and spread mainly by coughing. The contagiousness of a patient with TB increases with greater extent of disease, the presence…

Bacterial Pneumonia

Etiology, Prevalence, and Epidemiology Pneumonia and influenza represent the eighth leading cause of mortality in the United States, with an estimated 1.3 million hospital admissions yearly attributable to pneumonia in patients older than 65 years. Although pneumonia affects all ages, increased morbidity and mortality are seen at the extremes of age (very young and very old). Pneumonia is broadly divided into infection acquired in the community…

Congenital Malformations of the Pulmonary Vessels in Adults

Congenital malformations of the pulmonary vessels include absence or interruption, abnormal sizes, origins, or courses, and abnormal connections of the pulmonary arteries or veins. These abnormalities commonly accompany other congenital pulmonary or cardiac disorders but can occur in isolation. Although some malformations have no clinical significance and may be an incidental finding at imaging, others may have important consequences. For example, pulmonary hypertension may occur in…

Airway and Parenchymal Anomalies

Congenital lung disease remains a confusing topic owing to ever-changing histopathologic understanding of the various entities and frequent updates to antiquated clinical and pathologic classification schemes. Past classifications have been based on thoracic anatomic structures, dividing lesions into congenital malformations of the trachea, bronchi, lung, and pulmonary vasculature. Such divisions are controversial because the embryologic basis of these malformations is not clearly understood, as more recent…

Decreased Lung Density

Diseases that cause a decrease in lung density result in increased radiolucency (hyperlucency) on chest radiography and decreased attenuation on computed tomography (CT). Decreased lung density may result from obstructive overinflation without lung destruction (e.g., asthma, constrictive bronchiolitis), overinflation with lung destruction (e.g., emphysema), or a reduction in the quantity of blood and tissue in the absence of pulmonary overinflation (e.g., Swyer-James-McLeod syndrome, pulmonary thromboembolism). It…

Interstitial Patterns

Many diseases involve predominantly or exclusively the pulmonary interstitium. The differential diagnosis of the various entities on the chest radiograph and computed tomography (CT) is based on the pattern and distribution of abnormalities and on the presence of associated findings, such as lymph node enlargement or pleural effusion. Interstitial lung disease results in six distinct radiologic patterns of abnormality: septal, reticular, cystic, nodular, and ground-glass opacities…

Nodules and Masses *

Solitary Lung Nodule or Mass A pulmonary nodule is defined as any pulmonary lesion that is well-defined, discrete, approximately circular, and 3 cm or less in diameter. The term mass is used for lesions greater than 3 cm in diameter. The differential diagnosis of a nodule or mass detected on a radiograph or CT is very broad ( Table 4.1 ). However, more than 95% fall into one…

Atelectasis

Atelectasis is defined as less than normal inflation of all or part of the lung with a corresponding diminution in lung volume. Although the term collapse is often used synonymously with atelectasis, it should be reserved for complete atelectasis. Mechanisms of Atelectasis Mechanisms of atelectasis can be classified into five types: obstructive (resorptive), passive, compressive, adhesive, and cicatrization (scar). Obstructive Atelectasis Obstructive or resorptive atelectasis occurs…

Consolidation

Airspace consolidation is defined as replacement of gas within the airspaces by fluid, protein, cells, or other material. Consolidation is characterized on radiographs and computed tomography (CT) by the presence of one or more fairly homogeneous opacities associated with obscuration of the pulmonary vessels and little or no loss of volume. Homogeneous opacities that do not obscure the underlying pulmonary vessels are referred to as ground-glass…

Normal Chest Radiography and Computed Tomography

Radiography Technique Projections The standard radiographic views for evaluation of the chest are the posteroanterior (PA) and lateral projections with the patient standing; such projections provide the essential requirement for proper three-dimensional (3D) assessment ( Fig. 1.1 ). In patients who are unable to stand, anteroposterior (AP) upright or supine projections offer alternative but considerably less satisfactory views. The AP projection is of inferior quality because…

Ultrasound Contrast Agents in Vascular Disease

Introduction Sonography is often the first-line imaging technique for the evaluation of vascular disease, with the various aspects of this modality, including gray-scale, color or power Doppler, contributing to the success of the examination. The multiparametric nature of sonography has been expanded with the introduction of ultrasound contrast agents (UCAs). Non–contrast-enhanced ultrasound imaging has inherent limitations in the assessment of vascular diseases, such as the inadequate…

Correlative Imaging

Overview The current trends in vascular imaging are to increase the reliance on noninvasive approaches, to minimize complications linked to invasive imaging, and to reserve invasive techniques for therapeutic interventions. Arteriography, while still the gold standard for the evaluation of the arterial system, is performed with greater speed and lower complication rates than in previous decades. This has been achieved with the use of smaller catheters…

Ultrasound Screening for Vascular Disease

Introduction Medical screening is the process of using a diagnostic algorithm to detect a disease or the susceptibility to develop a disease. A screening process can consist of a medical history, a blood sample that measures a biochemical marker such as cholesterol, or medical imaging to detect a morphological or functional trait. The screening process is normally applied to a patient population with predefined characteristics. The…

Credentialing, Accreditation, and Quality in the Vascular Laboratory

Introduction Ensuring the quality of studies performed and interpreted in the vascular laboratory is a cornerstone of vascular laboratory management. This chapter will review the processes for credentialing of personnel and accreditation of facilities and the core components of a quality improvement (QI) program. In addition, examples of coordinated efforts to standardize the performance and interpretation of noninvasive vascular studies at the national level will be…

Evaluation of Organ Transplants

Introduction Organ transplantation has become the treatment of choice for end-stage renal and liver disease with the exception of cases with diffuse metastatic liver disease or with hepatocellular carcinoma that has extended beyond the liver. Advances in organ procurement and delivery, human leukocyte antigen (HLA) matching, surgical technique, and immunosuppression regimens have substantially improved both mortality and morbidity and the quality of life following organ transplantation.…

Duplex Ultrasound Evaluation of the Male Genitalia

Introduction This chapter has two components: the first reviews the ultrasound assessment of the scrotal contents, and the second describes the role played by ultrasound in the diagnosis of penile abnormalities, including erectile dysfunction and priapism. In both sections, emphasis is given to color Doppler imaging and Doppler spectral analysis. The Scrotum Anatomy and normal sonographic features The anatomy of the scrotum, testicles, and epididymis is…

Duplex Ultrasound Evaluation of the Uterus and Ovaries

Introduction Duplex and color Doppler imaging play an important role in the ultrasound evaluation of the female pelvis. Doppler is indispensable for the workup of many common problems. These techniques can be applied to both transabdominal and endovaginal examinations. The combination of Doppler ultrasound with endovaginal scanning is particularly valuable for gynecologic investigations because there is improved resolution and increased sensitivity to blood flow. The term…

Duplex Ultrasound of Native Renal Vasculature

Introduction Duplex and color Doppler ultrasound are utilized to evaluate a number of vascular diseases of the kidneys. The location of the renal vessels and the wide variation in the anatomy and physiology of the renal vessels can make the examination challenging and difficult to master. This chapter will provide a thorough review of all aspects of Doppler ultrasound in the assessment of the renal arteries…

Ultrasound Assessment of the Hepatic Vasculature

Introduction Because chronic liver disease and cirrhosis is the twelfth most common cause of death in the United States, evaluation of the liver and its vasculature is a very common indication for abdominal Doppler. The liver vessels are effectively imaged with ultrasound in a high percentage of patients. Therefore Doppler sonography is frequently the first modality used to evaluate patients with suspected hepatic vascular disorders. This…