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Ischaemic Heart Disease

Introduction Ischaemic heart disease (IHD) is a complex, heterogeneous and incompletely understood disease that is usually caused by underlying coronary artery disease (CAD). Worldwide, it is the single most common cause of death and its frequency is increasing. Although the mortality associated with IHD has declined, due to therapeutic improvements and prevention campaigns reducing the incidence of fatal and non-fatal myocardial infarction, the prevalence of IHD…

Nonischaemic Acquired Heart Disease

Nonischaemic heart diseases (NIHDs) account for nearly half of the cardiac deaths. This group of diseases is extremely heterogeneous, including cardiomyopathies (CMPs), valvular problems, cardiac masses and pericardial disease. Modern noninvasive imaging techniques have increased diagnostic accuracy for all these diseases, with consequent decrease in the number of invasive procedures. Role of Imaging In the past, NIHD diagnosis was based on chest radiography and invasive angiography;…

Congenital Heart Disease: General Principles and Imaging

Introduction Although rare, with an incidence of 8 per 1000 births, congenital heart disease (CHD) has increased in prevalence due to the success of surgical and medical management in childhood. A significant proportion of patients with repaired CHD surviving to adulthood fall under the care of cardiologists outside tertiary centres for congenital cardiac care. Specialist cardiovascular and general radiologists require an understanding of the underlying morphological…

Cardiac Anatomy and Imaging Techniques

Knowledge of the cardiac anatomy is essential for identifying and understanding cardiovascular disease in patients and is therefore important in clinical practice. To date, various imaging techniques such as conventional chest radiography, cardiac magnetic resonance (CMR), computed tomography (CT) and echocardiography are all used to assess aspects of cardiac and vascular anatomy. This chapter contains an overview of the techniques used and provides examples of the…

Airspace Diseases

Introduction Diseases of the air spaces are remarkably common, yet, the radiological approach to diagnosis is often considered challenging. In part, this is because a pattern of airspace opacification is non-specific ( Table 11.1 ). However, at its simplest, this radiological pattern simply indicates that air has been displaced, to a greater or lesser degree, from the lung. In clinical practice, airspace opacification is most commonly…

Thoracic Trauma and Related Topics

Thoracic Trauma Introduction The thorax contains the organs most essential to basic life: namely, the heart, lungs and the largest and most important of the blood vessels. The alveoli of the lungs allow exchange of oxygen and carbon dioxide and the heart and great vessels circulate nutrients, oxygen and carbon dioxide to and from all organs and tissues. Traumatic injury to these structures, more than many…

High-Resolution Computed Tomography of Interstitial and Occupational Lung Disease

The pulmonary interstitium consists of the connective tissue fibres that support the lung. It includes the intralobular interstitium beneath the alveolar epithelium, the interlobular septa and the peribronchovascular interstitium. The term interstitial lung disease (ILD) is used to refer to a group of disorders that mainly affects these supporting structures. The predominant abnormality is usually thickening of the interstitium, which may be due to the accumulation…

Pulmonary Neoplasms

Histopathology All types of lung cancer are related to cigarette smoking, although around 15% of all lung cancers occur in never-smokers. The predominant cell types are small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC is divided into two main subtypes, squamous cell carcinoma and adenocarcinoma, although most patients are diagnosed on small biopsies and in around 10% the histological subtype is non-evaluable:…

Pulmonary Lobar Collapse: Essential Considerations

Collapse and atelectasis are terms which are often used synonymously and refer to loss of volume within the lung. In North America, the term collapse is often reserved to denote complete loss of volume within an entire lobe or lung. Atelectasis can be described according to extent (linear, plate-like or subsegmental atelectasis, sublobar and lobar atelectasis) or due to the underlying aetiology: compression or passive atelectasis…

Large Airway Disease and Chronic Airflow Obstruction

Introduction The purpose of this chapter is to review lesions involving the trachea and proximal bronchi, to describe the radiological signs of bronchiectasis and to discuss the role of imaging in obstructive lung disease, a group of diffuse lung diseases associated with chronic airflow obstruction that includes chronic obstructive pulmonary disease (COPD), asthma, and obliterative bronchiolitis. In obstructive lung disease, decreased expiratory flow may be related…

Pulmonary Infection in Adults

Respiratory infections are the most common illnesses occurring in humans and pneumonia is the leading cause of death due to infectious disease and the sixth most common cause of death in the United States. Pneumonia is an acute infection of the pulmonary parenchyma that is associated with at least some symptoms of acute infection, accompanied by the presence of an acute infiltrate on a chest radiograph.…

The Mediastinum, Including the Pericardium

The mediastinum is bounded laterally by the two lungs, anteriorly by the sternum, posteriorly by the vertebrae, superiorly by the thoracic inlet and inferiorly by the diaphragm. Mediastinal Diseases Mediastinal Masses Incidence The true prevalence of mediastinal masses is unknown as most surgical series are biased towards patients requiring surgery and do not include all aneurysms, intrathoracic goitres or lymph node masses in patients with established…

The Chest Wall, Pleura, Diaphragm and Intervention

The Chest Wall Although there are numerous tissues and structures that make up the chest wall, based on their radiographic presentation, its components can be grouped into two major parts: the soft tissues and the bony structures. Chest wall tumours can arise from either component; the approach to and differential of these lesions will be considered separately. Soft Tissues On the chest radiograph the soft tissues…

The Normal Chest

The Lungs Each lung is divided into lobes surrounded by pleura. There are normally two lobes on the left, the upper and lower, separated by the major (oblique) fissure, and three on the right, the upper, middle and lower lobes, separated by the major (oblique) and minor (horizontal) fissures. The fissures are frequently incomplete, particularly medially, containing localised defects which form an alveolar pathway for collateral…

Current Status of Thoracic Imaging

Chest radiography and computed tomography (CT) remain the stalwarts of thoracic imaging. The basic technique of chest radiography has remained largely unchanged since its inception, but continuing developments in image receptor technology have resulted in techniques which are simultaneously efficient and radiation dose-optimised. Radiographs are now mainly produced in digital format, thus facilitating their incorporation into picture archiving and communications systems (PACS). Evolving CT technology has…

Interventional Genitourinary Radiology

In the genitourinary system as in other organ systems, radiologically guided interventional procedures have grown in usage. Interventional genitourinary radiology procedures are used widely, so familiarity and experience with these procedures are necessary in most clinical settings. Growth in the use of these procedures is due to their minimally invasive nature. Advantages of these procedures include shortened hospital stay, diminished need for anesthesia, lower cost, and…

Imaging of the Adrenal Glands

Cross-sectional imaging plays a major role in the evaluation of adrenal gland disease. In many patients not only can adrenal gland pathology be identified, but also a specific diagnosis can be made. The appropriate selection and accurate interpretation of adrenal imaging and interventional studies are the subject of this chapter, which is divided into three sections. In the first section, the embryology, physiology, anatomy, and imaging…

The Male Genital Tract

The diagnosis and management of diseases of the male genital tract have changed significantly in recent years as a direct result of technologic advances in imaging and progress in therapeutics. The purpose of this chapter is to present current imaging of the male genital tract in the context of selected clinical problems. The first part of the chapter reviews the embryology, anatomy, and physiology of the…

The Female Genital Tract

Medical imaging has assumed an increasingly important role in the diagnostic evaluation of gynecologic disease. In part this is because sonography and magnetic resonance imaging (MRI) can allow for high-resolution and multiplanar imaging of the female reproductive tract without exposing the ovaries to ionizing radiation. In this chapter, gynecologic radiology is reviewed. The first section is an overview of the embryology, anatomy, and physiology of the…

The Lower Urinary Tract

The lower urinary tract consists of the bladder and the urethra. Diseases of the lower urinary tract are prevalent and can be potentially debilitating from a medical and a social point of view. The bladder is the most common site of urinary tract infection in women of reproductive age. Symptoms referable to bladder-outlet obstruction are among the most common reasons why elderly men are examined by…