Diagnostic Imaging: Chest

Melissa L. Rosado-de-Christenson, MD, FACR, FAAWR, is Attending Radiologist at the Division of Cardiothoracic Imaging in the Department of Medical Imaging for Banner - University Medical Group Tucson,. She is also Professor of Medical Imaging at University of Arizona College of Medicine - Tucson, in Tucson, Arizona Dr. Santiago Martínez-Jiménez is with the Department of Radiology at Saint Luke's Hospital of Kansas City and is Professor of Radiology at the University of Missouri-Kansas City School of Medicine, in Kansas City, Missouri. He's a board-certified practicing radiologist who specializes in cardiothoracic radiology

Overview of Chest Imaging

Introduction and Overview

Approach to Chest Imaging

Illustrated Terminology

Approach to Illustrated Terminology

Acinar Nodules

Air Bronchogram

Air-Trapping

Airspace

Architectural Distortion

Bulla/Bleb

Cavity

Consolidation

Cyst

Ground-Glass Opacity

Honeycombing

Interlobular Septal Thickening

Intralobular Lines

Mass

Miliary Pattern

Mosaic Attenuation

Nodule

Pneumatocele

Reticular Pattern

Secondary Pulmonary Lobule

Traction Bronchiectasis

Tree-in-Bud Opacities

Centrilobular

Perilymphatic Distribution

Chest Radiographic and CT Signs

Approach to Chest Radiographic and CT Signs

Air Crescent Sign

Cervicothoracic Sign

Comet Tail Sign

CT Halo Sign

Deep Sulcus Sign

Fat Pad Sign

Finger-in-Glove Sign

Hilum Convergence Sign

Hilum Overlay Sign

Incomplete Border Sign

Luftsichel Sign

Reversed Halo Sign

Rigler and Cupola Signs

S-Sign of Golden

Signet Ring Sign

Silhouette Sign

Atelectasis and Volume Loss

Approach to Atelectasis and Volume Loss

Atelectasis

Relaxation and Compression Atelectasis

Cicatricial Atelectasis

Rounded Atelectasis

Developmental Abnormalities

Introduction and Overview

Approach to Developmental Abnormalities

Airways

Tracheal Bronchus and Other Anomalous Bronchi

Paratracheal Air Cyst

Bronchial Atresia

Tracheobronchomegaly

Lung

Extralobar Sequestration

Intralobar Sequestration

Diffuse Pulmonary Lymphangiomatosis

Apical Lung Hernia

Pulmonary Circulation

Congenital Interruption Pulmonary Artery

Aberrant Left Pulmonary Artery

Pulmonary Arteriovenous Malformation

Partial Anomalous Pulmonary Venous Return

Scimitar Syndrome

Pulmonary Varix

Meandering Pulmonary Vein

Systemic Circulation

Accessory Azygos Fissure

Azygos and Hemiazygos Continuation of the IVC

Persistent Left Superior Vena Cava

Aberrant Subclavian Artery

Right Aortic Arch

Double Aortic Arch

Aortic Coarctation

Cardiac, Pericardial, and Valvular Defects

Atrial Septal Defect

Ventricular Septal Defect

Bicuspid Aortic Valve

Pulmonic Stenosis

Heterotaxy

Absence of the Pericardium

Chest Wall and Diaphragm

Poland Syndrome

Pectus Deformity

Kyphoscoliosis

Morgagni Hernia

Bochdalek Hernia

Airway Diseases

Introduction and Overview

Approach to Airways Disease

Benign Neoplasms

Tracheobronchial Hamartoma

Tracheobronchial Papillomatosis

Malignant Neoplasms

Squamous Cell Carcinoma, Airways

Adenoid Cystic Carcinoma

Mucoepidermoid Carcinoma

Metastasis, Airways

Airway Narrowing and Wall Thickening

Saber-Sheath Trachea

Tracheal Stenosis

Tracheobronchomalacia

Middle Lobe Syndrome

Airway Granulomatosis With Polyangiitis

Tracheobronchial Amyloidosis

Tracheobronchopathia Osteochondroplastica

Relapsing Polychondritis

Rhinoscleroma

Bronchial Dilatation and Impaction

Bronchitis

Bronchiectasis

Cystic Fibrosis

Allergic Bronchopulmonary Aspergillosis

Primary Ciliary Dyskinesia

Mounier-Kuhn Syndrome

Williams-Campbell Syndrome

Broncholithiasis

Emphysema and Small Airway Diseases

Centrilobular Emphysema

Paraseptal Emphysema

Panlobular Emphysema

Infectious Bronchilitis

Constrictive Bronchiolitis

Swyer-James-Macleod Syndrome

Asthma

Infections

Introduction and Overview

Approach to Infections

General

Bronchopneumonia

Community-acquired Pneumonia

Healthcare-Associated Pneumonia

Nosocomial Pneumonia

Lung Abscess

Septic Emboli

Bacteria

Pneumococcal Pneumonia

Staphylococcal Pneumonia

Klebsiella Pneumonia

Pseudomonas

Legionella Pneumonia

Nocardiosis

Actinomycosis

Melioidosis

Tuberculosis

Nontuberculous Mycobacterial Infection

Mycoplasma Pneumonia

Viruses

Influenza Pneumonia

Cytomegalovirus Pneumonia

Coronavirus

COVID-19

Fungi

Histoplasmosis

Coccidioidomycosis

Blastomycosis

Cryptococcosis

Paracoccidioidomycosis

Aspergillosis

Zygomycosis

*Pneumocystis jirovecii* Pneumonia

Parasites

Approach to Parasites

Dirofilariasis

Hydatidosis

Strongyloidiasis

Amebiasis

Schistosomiasis

Pulmonary Neoplasms

Introduction and Overview

Approach to Pulmonary Neoplasms

Lung Cancer

Adenocarcinoma

Squamous Cell Carcinoma

Small Cell Carcinoma

Mutlifocal Lung Cancer

Uncommon Neoplasms

Pulmonary Hamartoma

Bronchial Carcinoid

Neuroendocrine Carcinoma

Kaposi Sarcoma

Lymphoma and Lymphoproliferative Disorders

Follicular Bronchiolitis

Lymphocytic Interstitial Pneumonia

Nodular Lymphoid Hyperplasia

Post-Transplant Lymphoproliferative Disease

Pulmonary Lymphoma

Metastatic Disease

Hematogenous Metastases

Lymphangitic Carcinomatosis

Tumor Emboli

Interstitial, Diffuse, and Inhalational Lung Disease

Introduction and Overview

Approach to Interstitial, Diffuse, and Inhalational Lung Disease

Idiopathic Interstitial Lung Diseases

Acute Respiratory Distress Syndrome (ARDS)

Acute Interstitial Pneumonia

Idiopathic Pulmonary Fibrosis

Nonspecific Interstitial Pneumonia

Organizing Pneumonia

Sarcoidosis

Pleuropulmonary Fibroelastosis

Smoking-Related Diseases

Respiratory Bronchiolitis and RBILD

Desquamative Interstitial Pneumonia

Pulmonary Langerhans Cell Histiocytosis

Combined Pulmonary Fibrosis and Emphysema

Pneumoconiosis

Asbestosis

Silicosis and Coal Worker's Pneumoconiosis

Hard Metal Pneumoconiosis

Beryliosis

Silo-Filler's Disease

Other Inhalational Disorders

Hypersensitivity Pneumonitis

Smoke Inhalation

?E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI)

Aspiration

Excipient Lung Disease

Eosinophilic Lung Disease

Acute Eosinophilic Pneumonia

Chronic Eosinophilic Pneumonia

Hypereosinophilic Syndrome

Metabolic Diseases and Miscellaneous Conditions

Alveolar Microlithiasis

Metastatic Pulmonary Calcification

Lymphangioleiomyomatosis

Pulmonary Amyloidosis

Pulmonary Alveolar Proteinosis

Lipoid Pneumonia

Dendriform Pulmonary Ossification

Connective Tissue Disorders, Immunological Diseases, and Vasculitis

Introduction and Overview

Approach to Connective Tissue Disorders, Immunological Diseases, and Vasculitis

Immunological and Connective Tissue Disorders

Rheumatoid Arthritis

Scleroderma

Mixed Connective Tissue Disease

Polymyositis/Dermatomyositis

Systemic Lupus Erythematosus

Sjögren Syndrome

Ankylosing Spondylitis

Inflammatory Bowel Disease

Erdheim Chester Disease

Thoracic Complications in Immunocompromised Patients

Hematopoietic Stem Cell Transplantation

Solid Organ Transplantation

HIV/AIDS

Neutropenia

Pulmonary Hemorrhage and Vasculitis

Idiopathic Pulmonary Hemorrhage

Goodpasture Syndrome

Pulmonary Granulomatosis and Polyangiitis

Eosinophilic Granulomatosis and Polyangiitis

Behcet Syndrome

Necrotizing Sarcoid Granulomatosis

Mediastinal Abnormalities

Introduction and Overview

Approach to Mediastinal Abnormalities

Primary Neoplasms

Thymoma

Thymic Neuroendocrine Neoplasm

Thymic Carcinoma

Thymolipoma

Mediastinal Teratoma

Mediastinal Seminoma

Nonseminomatous Malignant Germ Cell Neoplasm

Neurogenic Neoplasms of the Nerve Sheath

Neurogenic Neoplasms of the Sympathetic Ganglia

Neurofibromatosis

Lymphadenopathy

Metastatic Disease, Lymphadenopathy

Mediastinal Lymphoma

Mediastinal Fibrosis

Castleman Disease

Cysts

Bronchogenic Cyst

Esophageal Duplication Cyst

Pericardial Cyst

Thymic Cyst

Vascular Lesions

Mediastinal Vascular Masses

Coronary Artery Aneurysm

Paraesophageal Varices

Mediastinal Lymphangioma

Mediastinal Hemangioma

Glandular Enlargement

Thymic Hyperplasia

Goiter and Other Thyroid Masses

Diseases of the Esophagus

Achalasia

Esophageal Diverticuli

Esophageal Stricture

Esophageal Carcinoma

Miscellaneous Conditions

Mediastinal Lipomatosis

Mediastinitis

Mediastinal Fat Necrosis

Extramedullary Hematopoiesis

Hiatal and Paraesophageal Hernia

Cardiovascular Disorders

Introduction and Overview

Approach to Cardiovascular Disorders

Diseases of the Aorta and Great Vessels

Atherosclerosis

Aortic Aneurysm

Acute Aortic Syndromes

Marfan Syndrome

Takayasu Arteritis

Superior Vena Cava Obstruction

Pulmonary Edema

Pulmonary Edema

Pulmonary Hypertension and Thromboembolic Disease

Pulmonary Artery Hypertension

Pulmonary Venoocclusive Disease/Pulmonary Capillary Hemangiomatosis

Acute Pulmonary Thromboembolic Disease

Chronic Pulmonary Thromboembolic Disease

Sickle Cell Disease

Fat Embolism

Hepatopulmonary Syndrome

Illicit Drug Use, Pulmonary Manifestations

Diseases of the Heart and Pericardium

Valve and Annular Calcification

Aortic Valve Disease

Mitral Valve Disease

Left Atrial Calcification

Ventricular Calcification

Coronary Artery Calcification

Post Cardiac Injury Syndrome

Pericardial Effusion

Constrictive Pericarditis

Cardiovascular Neoplasms

Cardiac and Pericardial Metastases

Cardiac Myxoma

Cardiac Sarcoma

Pulmonary Artery Sarcoma

Aortic Sarcoma

Trauma

Introduction and Overview

Approach to Chest Trauma

Airways and Lung

Tracheobronchial Laceration

Trauma, Lung

Cardiovascular/Mediastinum

Pneumomediastinum

Traumatic Aortic Injury

Esophageal Rupture

Thoracic Duct Tear

Pleura, Chest Wall, and Diaphragm

Traumatic Pneumothorax

Traumatic Hemothorax

Thoracic Splenosis

Rib Fractures and Flail Chest

Spinal Fracture

Sternal Fracture

Diaphragmatic Rupture

Post-Treatment Chest

Introduction and Overview

Approach to Post-Treatment Chest

Life Support Devices

Endotracheal and Enteric Tubes

Vascular Catheters

Cardiac Conduction Devices

Thoracostomy Tubes and Mediastic Drains

Surgical Procedures and Complications

Pleurodesis

Sublobar Resection

Lung Volume Reduction Surgery

Lobectomy

Lobar Torsion

Pneumonectomy

Thoracoplasty and Apicolysis

Lung Herniation

Sternotomy

Cardiac Transplantation

Lung Transplantation

Esophageal Resection

Radiation, Chemotherapy, Ablation

Radiation-Induced Lung Disease

Drug Reaction, Intrathoracic

Ablation Procedures

Pleural Diseases

Introduction and Overview

Approach to Pleural Diseases

Effusion

Transudative Pleural Effusion

Exudative Pleural Effusion

Hemothorax

Chylothorax

Empyema

Pneumothorax

Iatrogenic Pneumothorax

Primary Spontaneous Pneumothorax

Secondary Spontaneous Pneumothorax

Pleural Thickening

Apical Cap

Pleural Plaques

Pleural Fibrosis and Fibrothorax

Neoplasia

Malignant Pleural Effusion

Solid Pleural Metastases

Malignant Pleural Mesothelioma

Localized Fibrous Tumor of the Pleura

Chest Wall and Diaphragm

Introduction and Overview

Approach to Chest Wall and Diaphragm

Chest Wall

Chest Wall Infections

Discitis

Chest Wall Lipoma

Elastofibroma and Fibromatosis

Chest Wall Metastases

Chondrosarcoma

Plasmacytoma and Multiple Myeloma

Diaphragm

Diaphragmatic Eventration

Diaphragmatic Paralysis