Chest Wall and Lung Trauma Chest Wall and Lung Trauma Rib fractures More than 50% of acute fractures are missed on the initial CXR ▸ additional lateral or oblique views are inappropriate in an acute trauma patient – the main priority is to detect complications such as a pneumothorax, haemothorax or a pulmonary contusion Fractures of the 1 st to 3 rd ribs imply a severe…
HRCT Patterns of Diffuse Lung Disease HRCT Technique Thin collimation (1-2 mm) with a high spatial frequency algorithm reconstruction ▸ interspaced versus volumetric acquisition (dose considerations) Reducing slice thickness < 1 mm will not increase spatial resolution but increase image noise A sharp reconstruction algorithm reduces images smoothing making structures visibly sharper (at the cost of increased image noise) IV contrast should be avoided if possible as it…
Evaluation of the Solitary Pulmonary Nodule Evaluation of the Solitary Pulmonary Nodule Definition This is defined as a solitary circumscribed pulmonary opacity with no associated pulmonary, pleural, or mediastinal abnormality ▸ it measures < 3 cm in diameter Many are discovered incidentally (but up to 40% may be malignant) <10% are due to a solitary pulmonary metastasis Benign intrapulmonary lymph nodes: nodules <15 mm from the pleural surface…
Mechanisms and Radiographic Appearances Mechanisms and Causes of Lobar Collapse Lobar collapse: this is divided into those causes due to an endobronchial obstruction (intrinsic or extrinsic) or those causes without obstruction ▪ A segment of atelectatic lung pivots around the central hilum via its attaching bronchovascular structures – any fissures will also influence the direction of collapse Common causes differ between adults and children: ▪ Adults:…
Tracheal Disorders Post-Traumatic Strictures Definition These are usually secondary to damage from external neck trauma or from a cuffed endotracheal or tracheostomy tube CXR/CT A focus of circumferential or eccentric tracheal narrowing associated with a segment of increased soft tissue Postintubation stenosis: this extends for several cm ▸ it typically involves the trachea above the level of the thoracic inlet Post-tracheostomy stenosis: this typically begins 1–1.5 cm…
Lobar Pneumonia Lobar Pneumonia Definition An infection developing within the distal airspaces (and adjacent to the visceral pleura) ▸ it spreads via collateral air drift (pores of Kohn), producing homogeneous opacification of partial or complete lung segments (and occasionally an entire lobe) ▸ any lung opacification is limited by the fissures and is usually unifocal As the airways are not primarily involved and remain patent there…
Mediastinitis Acute Mediastinitis Definition Acute infection of the mediastinum ▸ this is rare It is most commonly due to an oesophageal perforation (e.g. following endoscopy or from a swallowed object) – the alimentary contents serve as an infective source Other causes Boerhaave's syndrome (forceful vomiting that tears the oesophagus) with the tear almost invariably just above the gastro-oesophageal junction ▸ leakage through a necrotic neoplasm ▸…
Chest Wall: Bony and Soft Tissue Lesions Rib Lesions Benign Congenital abnormalities The upper ribs are commonly bifid, splayed, fused, or hypoplastic ▸ they are occasionally associated with syndromes (e.g. basal cell naevus syndrome) or other anomalies (e.g. Sprengel's deformity) Cervical rib: this arises from C7 (affecting 1–2% of the population) and consists of an initially downward sloping rib just lateral to the spine (cf. an…
Introduction Image-guided interventional procedures in the spine and the appendicular skeleton are used in the diagnosis and treatment of various medical conditions of benign or malignant origin. The procedures that are described in the present chapter should be performed by appropriately trained interventional radiologists, who work within a wider multidisciplinary team of clinical specialists that may include neurosurgeons, orthopaedic surgeons, oncologists and pain physicians. Interventional radiologists…
Introduction The number of venous interventions performed by interventional radiology (IR) is increasing. These increasing demands can be broadly divided into those for venous access, and those relating to the management of deep vein thromboses (DVTs). The latter includes the insertion and removal of inferior vena cava (IVC) filters to prevent pulmonary emboli from peripheral DVTs, catheter-directed thrombolysis and primary stenting in acute proximal limb DVTs,…
Introduction The genitourinary (GU) tract is especially prone to anatomical and morphological variations, and successful intervention relies on careful anatomical appreciation and planning. This chapter describes the various interventional procedures currently used in the GU tract but commences with a review of the anatomy relevant to renal access, as this is the cornerstone of most GU interventions. Percutaneous Renal Access—Important Anatomical Factors Renal Position The kidneys…
Kidney Renal Artery Stenosis Background Stenosis of the renal artery, which is usually focal, can cause a cascade of ischaemic-driven events in the kidney, in addition to other potential insults such as cholesterol embolisation. This can lead to clinical consequences such as secondary hypertension, impaired renal function and fluid retention (flash pulmonary oedema). Much interest has focused on correcting the anatomical abnormality, initially with angioplasty and…
Management of Biliary Obstruction Introduction Biliary intervention is not as prevalent as it was 30 years ago because of the advent of endoscopic retrograde cholangiopancreatography (ERCP). Skilled endoscopists can treat the vast majority of patients with biliary obstruction with stents, stone removal and/or sphincterotomy. Furthermore, with the advent of magnetic resonance cholangiopancreatography (MRCP) and multidetector computed tomography (CT), a diagnostic percutaneous transhepatic cholangiogram (PTC) is currently…
Image-guided drainage is an established technique with a multitude of applications. However, the indications, techniques and management of image-guided catheter drainage continue to evolve. Percutaneous drainage is now the technique of choice for the drainage of abscesses in most locations. Abscesses in challenging locations, which were previously managed by surgical intervention, are now often drained percutaneously. Ninety-seven per cent of intra-abdominal abscesses are currently drained percutaneously.…
Image-Guided Biopsy Introduction There is an increasing role for imaging in the planning and performance of biopsy procedures. It is generally deemed unacceptable in modern practice to perform ‘blind’ biopsies on anything other than the most superficial lesions when imaging can provide real-time monitoring of biopsy needle position. Image-guided biopsies improve diagnostic accuracy and reduce complication rates. Ongoing technological advances are providing us with new and…
Since the first edition of this textbook, vascular radiology has changed beyond recognition. It was only 30 years ago that the role of radiology in the vascular system was mainly to provide diagnostic images using invasive angiography. Since the development of interventional techniques in the late 1980s, interventional radiologists have assumed a major role not only in the diagnosis of vascular disorders but also in their…
Introduction Open surgery for the treatment of aortic pathologies is technically demanding for surgeons and invasive for the patient. It is a major physiological insult often resulting in significant morbidity and mortality. Mortality rates from elective surgery of open thoracic and abdominal aneurysms are in the region of 8% and 5%, respectively. Additionally, the cohort of patients requiring aortic intervention commonly have a significant number of…
Introduction It was Dos Santos who performed the first diagnostic angiogram in 1929 in Lisbon. With the introduction of the Seldinger technique in 1953, the procedure became much safer and was rapidly popularised ( Fig. 78.1 ). Diagnostic angiography was developed for the diagnosis of many diseases; and hospitals in the 1960s and 1970s often had many angiosuites. With the introduction of the computed tomography (CT)…
Introduction Noninvasive cross-sectional imaging with computed tomography angiography (CTA) and magnetic resonance angiography (MRA) plays a crucial role in the diagnosis and preintervention assessment of patients with vascular disease. Because imaging of vascular disease imposes stringent requirements in terms of high spatial and temporal resolution, many of the developments in computed tomography (CT) and MR have been spurred by the demands that cardiovascular imaging places in…
Normal Brain Maturation Brain maturation is assessed by observing tissue characteristics related to myelination, as well as variations in morphology. Most of the changes associated with myelination occur in the first 2 years of life, and gyral and sulcal development mainly occurs in utero or in the premature brain, while other morphological changes are observable later in life. Normal Myelination Myelination is the process by which…