Comparative Interpretation of CT and Standard Radiography of the Chest (eBook)

Medical Radiology Diagnostic Imaging 1
Copyright page 4
Foreword 5
Preface 6
Acknowledgements 7
Contents 8
Part I Introduction 10
1: Chest Radiography Today and Its Remaining Indications 11
1.1 Introduction 12
1.2 Main Indications of Chest Radiography 17
1.2.1 Pneumonia 17
1.2.1.1 Community-Acquired Pneumonia 17
1.2.1.2 Pneumonia in the Immunocompromised patient 17
1.2.2 The Patient in Intensive Care Unit 19
1.2.3 Position of Catheters and Thoracic Devices 22
1.2.4 The Patient in the Emergency Room 24
1.2.5 The Patient’s Follow-Up 29
1.2.6 Clinical Situations in Which Chest Radiography Has Been Abandoned or Its Role Discussed 29
1.2.6.1 Lung Cancer Screening 29
1.2.6.2 Preoperative Patients 31
1.2.6.3 Daily Routine Chest Radiography 31
1.3 Conclusions 32
References 33
2: Difficulties in the Interpretation of Chest Radiography 35
2.1 Introduction 35
2.2 Technique 36
2.2.1 Exposure 36
2.2.2 Positioning and Inspiration 36
2.2.2.1 Frontal View Posteroanterior Erect View 37
2.2.2.2 Lateral View 38
2.2.2.3 Other 38
2.2.3 Image Processing and Post-Processing 38
2.3 Interpretation 39
2.3.1 Knowledge of Anatomy and Physiology 39
2.3.2 Basic Principles of a Chest X-Ray 40
2.3.2.1 Three Basic Principles 40
2.3.2.2 Threshold Visibility 41
2.3.3 Analyzing the Radiograph Through a Fixed Pattern 41
2.3.4 Evolution Over Time 49
2.3.5 Knowledge of Clinical Presentation, History, and Correlation to Other Diagnostic Results 54
2.4 Errors and Perception 55
2.4.1 Perceptual and Cognitive 55
2.4.2 Observer Errors 55
2.5 Radiologic Report 56
References 57
Part II Technical and Practical Aspects for CTReconstruction and Image Comparison 58
3: The Use of Isotropic Imaging and Computed Tomography Reconstructions 59
3.1 Introduction 59
3.2 MSCT Spiral Acquisition and Reconstruction 61
3.2.1 MSCT Spiral Acquisition 61
3.2.2 MSCT Image Reconstruction 61
3.2.2.1 Slice Thickness, Reconstruction Increment 61
3.2.2.2 The Reconstruction Filter 63
3.2.2.3 Isotropic Imaging 67
3.2.2.4 The Reconstruction Matrix 68
3.2.3 Postprocessing 70
3.3 Dosimetric Aspects of MSCT 73
3.3.1 Chest CT: A High-Dose Examination? 73
3.3.2 Dose Modulation 75
3.4 Future Perspectives 75
References 79
4: PACS – Tips and Tricks for Imaging Comparison 80
4.1 Introduction 80
4.2 RIS and PACS 81
4.2.1 RIS 82
4.2.2 PACS 82
4.2.2.1 Basic Elements of PACS 82
4.3 Workstations 83
4.3.1 Fundamental Functions 84
4.3.1.1 Navigation and Image Manipulation 84
4.3.2 Advanced Functions 84
4.3.2.1 MPR 85
4.3.2.2 MIP 85
4.3.2.3 MinIP 85
4.3.2.4 Averaging 86
4.3.2.5 SSD 86
4.3.2.6 VRT 86
4.3.2.7 VE 87
4.3.2.8 CAD 87
4.3.3 Applications (MPR, MIP, MinIP, VRT, and Averaging) 87
References 94
Part III Semeiology of Normal Variantsand Diseased Chest 96
5: Semeiology of the Mediastinum 97
5.1 Introduction 98
5.2 Mediastinal Compartments and Contents 100
5.2.1 Anterior Mediastinum 100
5.2.2 Middle Mediastinum 100
5.2.3 Posterior Mediastinum 100
5.3 The Anterior Mediastinal Compartment 101
5.3.1 Anterior Junction Line 101
5.3.2 Retrosternal Line or Stripe and Space 103
5.4 The Middle Mediastinal Compartment 106
5.4.1 Aortopulmonary Window on Frontal Films, the Aortopulmonary Stripe 106
5.4.2 Aortopulmonary Window on Lateral Films 107
5.4.3 Right Paratracheal Line or Stripe 113
5.4.4 Left Paratracheal Line 113
5.4.5 Retrotracheal Line or Stripe 115
5.4.6 Posterior Wall of the Bronchus Intermedius 117
5.5 The Posterior Mediastinal Compartment 120
5.5.1 Azygoesophageal Line 120
5.5.2 Azygoesophageal Recess 120
5.5.3 Posterior Junction Line or Stripe 124
5.5.4 Para-aortic Line 126
5.5.5 Preaortic Line and Recess 128
5.5.6 Paraspinal Lines 128
References 133
6: Correlation of Chest Radiograph and CT of the Heart 134
6.1 Introduction 134
6.2 Anatomy Revisited 135
6.2.1 Review of Basic Anatomy Radiographs/CT Correlation 135
6.2.2 Imaging Anatomy of the Left Ventricle 141
6.3 Heart Chamber Evaluation 142
6.3.1 General Characteristics 142
6.3.2 Evaluation of Pathology with Normal Chamber Dimensions 143
6.3.3 Left Heart Imaging 144
6.3.4 Right Heart Imaging 148
6.4 Other Pathology 151
6.4.1 Calcifications 151
6.4.2 Pericardial Effusion and Pneumopericardium 153
6.4.3 Tumors of the Heart and Pericardium 156
6.5 The Postoperative Heart 159
6.5.1 Cardiac Pacemakers and Implantable Cardioverter Defibrillators 160
6.5.2 Devices for Cardiopulmonary Support 160
6.5.3 Coronary Artery Bypass Grafts 160
6.6 Conclusion 163
References 166
7: Imaging of Hila and Pulmonary Vessels 167
7.1 Introduction 167
7.2 Normal Anatomy 168
7.2.1 The Hila 168
7.2.1.1 Frontal View 168
Right Hilum 168
Left Hilum 169
Tips and Tricks 169
7.2.1.2 Lateral View 170
Right Hilum 170
Left Hilum 170
Inferior Hilar Window 171
7.2.2 Pulmonary Veins 173
7.2.3 Intrapulmonary Vessels 173
7.3 Pulmonary Vascular Diseases 173
7.3.1 Congenital Diseases 173
7.3.1.1 Absence of a Pulmonary Artery 173
7.3.1.2 Left Pulmonary Artery Sling 175
7.3.1.3 Idiopathic Dilation of the Main Pulmonary Artery 178
7.3.1.4 Pulmonary Arteriovenous Malformations 178
7.3.1.5 Anomalies of Pulmonary Veins 181
Anomalous Drainage 181
Anomalous Drainage Without Anomalous Course 181
Anomalous Drainage with Anomalous Course 181
Anomalous Course Without Anomalous Drainage 182
Anomalous Caliber 183
7.3.2 Acquired Diseases 185
7.3.2.1 Pulmonary Aneurysm 185
Pulmonary Pseudoaneurysm 185
7.3.2.2 Pulmonary Valve Stenosis 186
7.3.2.3 Vasculitis 188
Behçet Disease 188
Hughes–Stovin Disease 188
Takayasu Disease 188
Giant Cell Arteritis 188
7.3.2.4 Tumor 189
Primary Tumor 189
Intravascular Metastasis 192
7.3.2.5 Fibrosing Mediastinitis 193
7.3.2.6 Postablation Stenosis of Pulmonary Veins 194
7.4 Conclusion 194
References 194
8: Interstitial Lung Disease 197
8.1 Introduction 197
8.2 Anatomy 198
8.3 Patterns of Interstitial Lung Disease 198
8.3.1 Linear and Reticular Pattern 199
8.3.1.1 Linear Pattern 199
Chest Radiograph 199
HRCT 200
Smooth Septal Thickening 200
Nodular Septal Thickening 200
Irregular Septal Thickening 204
8.3.1.2 Reticular Pattern 204
Chest Radiograph 204
HRCT 204
8.3.2 Nodular Pattern 205
Chest Radiograph 205
HRCT 205
Perilymphatic Distribution 205
8.3.2.1 Random Distribution 206
8.3.2.2 Centrilobular Distribution 207
8.3.3 Decreased Lung Attentuation 210
8.3.3.1 Alteration of Pulmonary Volume 211
Pulmonary Emphysema 211
Cystic Lung Disease 213
Overinflation 213
8.3.3.2 Alteration in Pulmonary Vasculature 213
8.3.4 Increased Lung Attenuation 216
8.4 Some Examples of Diseases 219
8.4.1 Cardiogenic Pulmonary Edema 219
8.4.2 Idiopathic Pulmonary Fibrosis 220
8.4.3 Complicated Silicosis 220
8.4.4 Sarcoidosis 220
References 221
9: The Lung Parenchyma: Radiological Presentation of Alveolar Pattern 223
9.1 Introduction 224
9.2 Basic Features of Alveolar Pattern 224
9.2.1 Morphology 224
9.2.1.1 The Silhouette Sign 224
9.2.1.2 Pulmonary Consolidation 224
9.2.1.3 Air Bronchogram 227
9.2.1.4 Ground-Glass Opacities 227
9.2.1.5 Nodules 228
9.2.1.6 Specific Signs Only Seen on CT 229
CT Angiogram 229
Crazy Paving 230
9.2.2 Distribution 230
9.2.3 Evolutive Changes 231
9.3 Most Relevant Conditions that Present with an Alveolar Pattern 233
9.3.1 Acute Alveolar Pattern 233
9.3.1.1 Pulmonary Edema 233
9.3.1.2 Infectious Pneumonia 233
9.3.1.3 Pulmonary Hemorrhage 234
9.3.1.4 Acute Respiratory Distress Syndrome 236
9.3.1.5 Drug-Induced Lung Disease 237
9.3.2 Chronic Alveolar Pattern 238
9.3.2.1 Organizing Pneumonia 238
9.3.2.2 Pulmonary Alveolar Proteinosis 240
9.3.2.3 Bronchioloalveolar Cell Carcinoma 241
9.3.2.4 Lymphoma 242
9.3.2.5 Chronic Eosinophilic Pneumonia 242
9.3.2.6 Radiation Pneumonitis 244
References 245
10: The Respiratory Tract 248
10.1 Anatomy of the Large Airways 249
10.1.1 Normal Anatomy 249
10.1.2 Anatomical Variations and Abnormalities 249
10.1.2.1 Tracheal Bronchus 249
10.1.2.2 Accessory Cardiac Bronchus 249
10.1.2.3 Bronchial Agenesis 251
10.2 Evaluation of Trachea and Bronchial Structures 251
10.2.1 Evaluation of the Trachea 251
10.2.2 Evaluation of the Carina 253
10.2.3 Evaluation of the Bronchi 254
10.2.3.1 Evaluation of the Diameter 254
Bronchoarterial Ratio 254
Lack of Bronchial Tapering 254
Visibility of Peripheral Airways 255
10.2.3.2 Evaluation of the Wall Thickness 255
10.3 Diseases of Trachea and Bronchial Structures 255
10.3.1 Bronchiectasis 255
10.3.2 Focal Diseases 257
10.3.2.1 Tracheal Stricture 257
10.3.2.2 Neoplastic Lesions 260
10.3.3 Diffuse Diseases 261
10.3.3.1 Tracheobronchomegaly 261
10.3.3.2 Infectious Tracheobronchitis 262
10.3.3.3 Saber-Sheath Trachea 262
10.3.3.4 Relapsing Polychondritis 263
10.3.3.5 Amyloidosis 263
10.3.3.6 Sarcoidosis 266
10.3.3.7 Wegener’s Granulomatosis 267
10.3.3.8 Tracheopathia Osteochondroplastica 267
References 268
11: Pleura 270
11.1 Introduction 271
11.2 Anatomy 271
11.3 Basic Imaging Principles 271
11.4 Pleural Effusion 271
11.4.1 Distribution of Pleural Effusion in the Erect Patient 272
11.4.2 Distribution of Pleural Effusion in the Supine Patient 276
11.4.3 Atypical Distribution and Loculation of Pleural Fluid 277
11.5 Empyema 280
11.6 Pneumothorax 280
11.6.1 Pneumothorax in the Erect Patient 281
11.6.2 Pneumothorax in the Supine Patient 282
11.7 Pleural Fibrosis 282
11.7.1 Focal Pleural Fibrosis 282
11.7.1.1 Healed Pleuritis 282
11.7.1.2 Apical Cap 282
11.7.1.3 Pleural Plaques 285
11.7.2 Diffuse Pleural Fibrosis 287
11.7.2.1 Asbestosis-Related Diffuse Pleural Thickening 287
11.7.2.2 Non–Asbestosis-Related Pleural Thickening 289
11.8 Pleural Neoplasms 291
11.8.1 Localized Pleural Tumors 291
11.8.1.1 Localized Fibrous Tumor of the Pleura 291
11.8.1.2 Pleural Lipoma and Liposarcoma 291
11.8.1.3 Pleural Extension of Bronchogenic Carcinoma 291
11.8.2 Malignant Mesothelioma 291
11.8.3 Other Tumors of the Pleura 295
11.8.4 Pleural Metastases 296
References 298
12: The Diaphragm 299
12.1 Introduction 300
12.2 The Normal Diaphragm 300
12.3 Pathology of the Diaphragm 302
12.3.1 Change in Diaphragmatic Contour 302
12.3.2 Elevation of the Diaphragm 302
12.3.2.1 Unilateral and Bilateral Symmetrical Elevation of the Diaphragm 302
12.3.2.2 Focal Elevation of the Diaphragm Presenting as a Bulge on the Contour of the Diaphragm 306
Focal Diaphragmatic Dysfunction 309
Eventration 309
Diaphragmatic Hernias 311
Bochdalek Hernia 311
Morgagni Hernia 312
Esophageal Hiatus Hernia 312
Hernia through Traumatic Tear of the Diaphragm 313
Tumors of the Diaphragm 315
12.3.3 Depression of the Diaphragm 316
References 318
13: Chest Wall 320
13.1 Normal Variants, Congenital Disorders, and Thoracic Wall Deformities 321
13.1.1 Rib Variants and Deformities 321
13.1.2 Sternal Deformities 323
13.1.3 Sternal Defect 325
13.1.4 Poland Syndrome 325
13.2 Traumatic Lesions of the Chest Wall 325
13.3 Inflammatory and Infectious Diseases of the Chest Wall 326
13.4 Chest Wall Tumors 327
13.4.1 Benign Tumors of the Chest Wall 327
13.4.2 Malignant Tumors of the Chest Wall 328
13.4.2.1 Bone Metastases 328
13.4.2.2 Cancers of the Hematopoietic System 329
13.4.2.3 Chondrosarcoma 330
13.4.2.4 Ewing’s Sarcoma and Primitive Neuroectodermal Tumor 330
References 331
Part IV Selected Diseases with Peculiar Aspecton Chest Radiography 332
14: Chronic Obstructive Pulmonary Disease: Comparison Between Conventional Radiography and Computed Tomography 333
14.1 Definitions 334
14.2 Radiography in Emphysema 335
14.3 CT in Emphysema 342
14.3.1 Objective CT Quantification of Emphysema 345
14.3.2 Tissue Characterization 352
14.3.3 Factors Influencing CT Densitometry 355
14.3.4 Spiral and Multidetector CT – New Challenges 358
14.3.4.1 Density Thresholds 358
14.3.4.2 Radiation Dose Exposure 360
14.3.4.3 Potential Role of Expiratory CT 360
14.4 Airway Analysis in COPD 360
14.4.1 Quantitative CT Assessment of Airway Wall Dimensions 363
14.4.2 Clinical Applications and Limitations of Quantitative CT Assessment of Airway Wall Dimension and Three-Dimensional Air 363
14.5 Conclusion 365
References 365
15: Missed Lung Lesions 368
15.1 Introduction 368
15.2 Reasons for Missed Lung Lesions 369
15.3 Specific Problems 370
15.4 Missed Nodules 370
15.4.1 Nodular Lesions – Tumors 370
15.4.2 Nodular Lesions – Infections 375
15.4.3 Nodular Lesions – Miscellaneous 376
15.5 Missed Consolidation 378
15.5.1 Airspace Disease 378
15.6 Missed Interstitial Lung Disease 381
15.6.1 Diffuse (Interstitial or Mixed Alveolar Interstitial) Lung Disease 381
15.7 Take Home Messages 382
References 383
16: Atelectasis 385
16.1 Mechanisms 385
16.1.1 Obstructive or resorptive atelectasis 386
16.1.2 Adhesive atelectasis 386
16.1.3 Passive Atelectasis 386
16.1.4 Compressive Atelectasis 387
16.1.5 Cicatrization Atelectasis 387
16.2 Basic Concepts 387
16.2.1 Direct Signs 387
16.2.2 Indirect Signs 387
16.3 Patterns of Atelectasis 388
16.3.1 Right Upper Lobe Atelectasis 388
16.3.2 Right Middle Lobe Atelectasis 390
16.3.3 Left Upper Lobe Atelectasis 390
16.3.4 Right Lower Lobe Atelectasis 392
16.3.5 Left Lower Lobe Atelectasis 392
16.3.6 Combined Middle Lobe and Right Lower Lobe Atelectasis 397
16.3.7 Combined Middle and Right Upper Lobe Atelectasis 399
16.3.8 Combined Right Upper and Lower Lobe Atelectasis 399
16.3.9 Whole Lung Atelectasis 399
16.3.10 Subsegmental Atelectasis 401
16.3.11 Platelike atelectasis 401
16.3.12 Round atelectasis 401
References 403
17: Lung Cancer 404
17.1 Introduction 404
17.2 Clinical Presentations 405
17.2.1 Symptomatic Presentation 405
17.2.2 Asymptomatic Presentation 406
17.3 Radiographic Manifestations of Lung Carcinoma 406
17.3.1 Factors That Affect Visualization of Lung Carcinoma on CXR 406
17.3.2 Location 406
17.3.3 Central Tumors 407
17.3.3.1 Obstructive Pneumonitis 407
17.3.3.2 Unilateral Hilar Enlargement 407
17.3.3.3 Alteration of Regional Lung Volume 407
17.3.3.4 Bronchial Wall Thickening 413
17.3.3.5 Mediastinal Involvement 414
17.3.4 Peripheral Tumors 419
17.3.4.1 Pulmonary Nodules and Masses 420
Shape and Margin 420
Calcifications 420
Cavitation 423
Air Bronchogram and Bubble-Like Lucencies 423
Pure or Mixed Nodular Ground Glass Opacification 423
17.3.4.2 Chronic Air-Space Consolidation (Pneumonia-Like Appearances) 423
17.3.4.3 Diffuse Interstitial Disease 425
17.3.5 Pleural Effusion and Pleural Thickening 427
17.3.6 Chest Wall Involvement 427
17.3.7 Apical Tumors 427
17.4 Conclusion 429
References 429
18: Pulmonary Embolism and Pulmonary Hypertension 431
18.1 Pulmonary Embolism 431
18.1.1 Acute Pulmonary Embolism 432
18.1.1.1 Etiopathogenesis 432
18.1.1.2 Investigation 432
18.1.1.3 Radiographic Features 432
Pulmonary Vascular Abnormalities 432
Focal Parenchymal Opacities 432
Pleural and Diaphragmatic Abnormalities 434
18.1.2 Chronic Pulmonary Thromboembolism 435
18.1.2.1 Etiopathogenesis 435
18.1.2.2 Radiographic Features 436
18.1.3 Nonthrombotic Pulmonary Embolism 437
18.2 Pulmonary Hypertension 438
18.2.1 Pathophysiology 438
18.2.2 Classification 439
18.2.3 Pulmonary Arterial Hypertension 439
18.2.3.1 Radiographic Signs 439
Vascular signs 439
Lung Parenchymal Signs 439
Mediastinal and Cardiac Signs 442
18.2.4 Pulmonary Venous Hypertension 442
18.2.4.1 Etiopathogenesis 442
18.2.4.2 Radiographic Features 443
References 445
19: Chest Trauma 447
19.1 Introduction 447
19.2 Chest Radiographs and MDCT 448
19.2.1 Aortic Injury 448
19.2.2 Diaphragmatic Injury 449
19.2.3 Tracheobronchial Injury 452
19.2.4 Pulmonary Contusion 452
19.2.5 Pneumothorax 455
19.2.6 Hemothorax 455
19.2.7 Rib Fractures 456
19.2.8 Scapulothoracic Dissociation 458
19.3 Conclusion 458
References 459
Index 462