Pub Date : 2019-07-01DOI: 10.1093/med/9780199858064.003.0030
Christopher M Walker
Empyema discusses the clinical features, evolution, differential diagnosis, complications, and imaging manifestations of this disease process. There are three distinct stages in the evolution of empyema: exudative stage, fibropurulent stage, and organizing stage. The majority of patients with empyema are symptomatic and present with cough, fever, chest pain, and dyspnea. A simple parapneumonic effusion manifests as a free small to moderate pleural effusion of variable size and is usually associated with adjacent consolidation. Empyema manifests as a loculated pleural effusion which may or may not be associated with adjacent consolidation. Empyema typically exhibits smooth parietal pleural thickening and enhancement indicative of an exudative pleural effusion. Approximately 50% exhibit the split pleural sign with thickening and enhancement of the visceral and parietal pleura. Complications of empyema include bronchopleural fistula, empyema necessitans, “trapped” lung, and malignant transformation. The treatment of empyema is drainage via thoracostomy tubes or surgical decortication in complicated cases.
{"title":"Empyema","authors":"Christopher M Walker","doi":"10.1093/med/9780199858064.003.0030","DOIUrl":"https://doi.org/10.1093/med/9780199858064.003.0030","url":null,"abstract":"Empyema discusses the clinical features, evolution, differential diagnosis, complications, and imaging manifestations of this disease process. There are three distinct stages in the evolution of empyema: exudative stage, fibropurulent stage, and organizing stage. The majority of patients with empyema are symptomatic and present with cough, fever, chest pain, and dyspnea. A simple parapneumonic effusion manifests as a free small to moderate pleural effusion of variable size and is usually associated with adjacent consolidation. Empyema manifests as a loculated pleural effusion which may or may not be associated with adjacent consolidation. Empyema typically exhibits smooth parietal pleural thickening and enhancement indicative of an exudative pleural effusion. Approximately 50% exhibit the split pleural sign with thickening and enhancement of the visceral and parietal pleura. Complications of empyema include bronchopleural fistula, empyema necessitans, “trapped” lung, and malignant transformation. The treatment of empyema is drainage via thoracostomy tubes or surgical decortication in complicated cases.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115223556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.7326/0003-4819-63-1-157_1
C. Raptis
Pulmonary emboli (PE) range from asymptomatic to life-threatening and are a common source of clinical concern in patients presenting with chest pain and dyspnea. CT using a PE protocol has become the standard for the evaluation of this condition. CT findings include intraluminal filling defects, parenchymal changes of infarction and potentially signs of right heart strain. These must be distinguished from well-known artifacts, most notably bolus-related and motion artifacts. Signs of acute PE must also be distinguished from those related to chronic PE, septic emboli, tumor emboli, chemical emboli and intraarterial thrombi. MR and nuclear studies may be useful in certain patients (e.g, young and those with allergies to iodinated contrast) and in those with certain suspected conditions (such as primary pulmonary arterial tumors or macroscopic tumor emboli).
{"title":"Pulmonary Embolic Disease","authors":"C. Raptis","doi":"10.7326/0003-4819-63-1-157_1","DOIUrl":"https://doi.org/10.7326/0003-4819-63-1-157_1","url":null,"abstract":"Pulmonary emboli (PE) range from asymptomatic to life-threatening and are a common source of clinical concern in patients presenting with chest pain and dyspnea. CT using a PE protocol has become the standard for the evaluation of this condition. CT findings include intraluminal filling defects, parenchymal changes of infarction and potentially signs of right heart strain. These must be distinguished from well-known artifacts, most notably bolus-related and motion artifacts. Signs of acute PE must also be distinguished from those related to chronic PE, septic emboli, tumor emboli, chemical emboli and intraarterial thrombi. MR and nuclear studies may be useful in certain patients (e.g, young and those with allergies to iodinated contrast) and in those with certain suspected conditions (such as primary pulmonary arterial tumors or macroscopic tumor emboli).","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125271152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0003
M. Rosado-de-Christenson
Overview of normal thoracic imaging anatomy provides a review of the normal anatomic markings of the thorax with emphasis on radiographic and CT anatomy. Chest radiography allows visualization and evaluation of various anatomic structures in the thorax including the lungs, airways, hila, thoracic vessels (including pulmonary and systemic), mediastinum, pleura and chest wall (including soft tissues and skeletal structures). The various mediastinal interfaces are also discussed including the anterior and posterior junction lines, the right paratracheal stripe, the azygoesophageal recess and the paravertebral stripes. The anatomy of the hila on lateral chest radiography is also presented. These anatomic landmarks are illustrated using a series of normal radiographic and computed tomographic (CT) images. Knowledge of normal imaging anatomy allows identification of anatomic alterations as manifestations of thoracic disease.
{"title":"Overview of Normal Thoracic Imaging Anatomy","authors":"M. Rosado-de-Christenson","doi":"10.1093/MED/9780199858064.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0003","url":null,"abstract":"Overview of normal thoracic imaging anatomy provides a review of the normal anatomic markings of the thorax with emphasis on radiographic and CT anatomy. Chest radiography allows visualization and evaluation of various anatomic structures in the thorax including the lungs, airways, hila, thoracic vessels (including pulmonary and systemic), mediastinum, pleura and chest wall (including soft tissues and skeletal structures). The various mediastinal interfaces are also discussed including the anterior and posterior junction lines, the right paratracheal stripe, the azygoesophageal recess and the paravertebral stripes. The anatomy of the hila on lateral chest radiography is also presented. These anatomic landmarks are illustrated using a series of normal radiographic and computed tomographic (CT) images. Knowledge of normal imaging anatomy allows identification of anatomic alterations as manifestations of thoracic disease.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116926352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0027
Christopher M Walker
The chapter titled introduction to pleural disease discusses the imaging and clinical features of diseases of the pleura. The pleural space is a potential space located between the visceral and parietal pleural surfaces. Pleural effusion and pneumothorax are the most common manifestations of pleural disease and are caused by a wide variety of disease processes. Pleural thickening may be related to benign or malignant processes. Bilateral discontinuous nodular pleural thickening is characteristic of pleural plaques. Pleural thickening with calcification may also be seen in fibrothorax. Malignant pleural disease may manifest with pleural effusion, pleural nodules or masses, or a combination of the two. There are several CT features suggestive of malignant pleural thickening including circumferential pleural thickening, pleural nodules or masses, involvement of the mediastinal pleural surface, and pleural thickening measuring greater than 1 cm in thickness. Metastatic disease is the most common pleural neoplasm. Mesothelioma is uncommon but remains the most common primary pleural malignancy and is almost always seen in patients with previous asbestos exposure. Pleural abnormalities must be differentiated from pulmonary processes. Pleural masses may exhibit obtuse angles with the adjacent pleural surfaces, displace rather than engulf adjacent pulmonary vasculature, and may exhibit the incomplete border sign.
{"title":"Introduction to Pleural Disease","authors":"Christopher M Walker","doi":"10.1093/MED/9780199858064.003.0027","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0027","url":null,"abstract":"The chapter titled introduction to pleural disease discusses the imaging and clinical features of diseases of the pleura. The pleural space is a potential space located between the visceral and parietal pleural surfaces. Pleural effusion and pneumothorax are the most common manifestations of pleural disease and are caused by a wide variety of disease processes. Pleural thickening may be related to benign or malignant processes. Bilateral discontinuous nodular pleural thickening is characteristic of pleural plaques. Pleural thickening with calcification may also be seen in fibrothorax. Malignant pleural disease may manifest with pleural effusion, pleural nodules or masses, or a combination of the two. There are several CT features suggestive of malignant pleural thickening including circumferential pleural thickening, pleural nodules or masses, involvement of the mediastinal pleural surface, and pleural thickening measuring greater than 1 cm in thickness. Metastatic disease is the most common pleural neoplasm. Mesothelioma is uncommon but remains the most common primary pleural malignancy and is almost always seen in patients with previous asbestos exposure. Pleural abnormalities must be differentiated from pulmonary processes. Pleural masses may exhibit obtuse angles with the adjacent pleural surfaces, displace rather than engulf adjacent pulmonary vasculature, and may exhibit the incomplete border sign.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115187754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0094
K. Cummings
Shunts, intracardiac and intrapulmonary, are vascular communications that allow mixture of deoxygenated and oxygenated blood within the cardiovascular system. The most common intracardiac shunts encountered in adults allow left (oxygenated) to right (deoxygenated) directional shunting which over time can lead to pulmonary circulation volume overload and pulmonary hypertension. In this chapter, the most common adult intracardiac shunts (atrial septal defects, patent foramen ovale and ventricular septal defects) are discussed. Shunting can also occur at the level of the lung parenchyma with one of the most common examples being a pulmonary arteriovenous malformation (pAVM). PAVMs are very frequently inherited conditions, and their identification has implications both for the patient and immediate family members. The imaging appearances of these intracardiac and intrapulmonary lesions will be discussed.
{"title":"Shunts, Intracardiac and Intrapulmonary","authors":"K. Cummings","doi":"10.1093/MED/9780199858064.003.0094","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0094","url":null,"abstract":"Shunts, intracardiac and intrapulmonary, are vascular communications that allow mixture of deoxygenated and oxygenated blood within the cardiovascular system. The most common intracardiac shunts encountered in adults allow left (oxygenated) to right (deoxygenated) directional shunting which over time can lead to pulmonary circulation volume overload and pulmonary hypertension. In this chapter, the most common adult intracardiac shunts (atrial septal defects, patent foramen ovale and ventricular septal defects) are discussed. Shunting can also occur at the level of the lung parenchyma with one of the most common examples being a pulmonary arteriovenous malformation (pAVM). PAVMs are very frequently inherited conditions, and their identification has implications both for the patient and immediate family members. The imaging appearances of these intracardiac and intrapulmonary lesions will be discussed.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123711539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780199858064.003.0066
J. Azok
Asbestosis is a fibrotic pneumoconiosis resulting from the inhalation of asbestos fibers, most commonly from occupational exposure. Chest radiographs and high-resolution chest CT can detect asbestos-related disease. Pleural abnormalities include pleural plaques, pleural effusions, pleural thickening, and mesothelioma. Pleural plaques serve as a marker of asbestos exposure and are the most common imaging abnormality found in patients exposed to asbestos. Parenchymal-induced lung disease includes pulmonary fibrosis, known as asbestosis, rounded atelectasis, and lung cancer. Asbestos exposure leads to an increased risk of both lung cancer and especially mesothelioma, which is rare in the absence of asbestos exposure.
{"title":"Asbestosis","authors":"J. Azok","doi":"10.1093/med/9780199858064.003.0066","DOIUrl":"https://doi.org/10.1093/med/9780199858064.003.0066","url":null,"abstract":"Asbestosis is a fibrotic pneumoconiosis resulting from the inhalation of asbestos fibers, most commonly from occupational exposure. Chest radiographs and high-resolution chest CT can detect asbestos-related disease. Pleural abnormalities include pleural plaques, pleural effusions, pleural thickening, and mesothelioma. Pleural plaques serve as a marker of asbestos exposure and are the most common imaging abnormality found in patients exposed to asbestos. Parenchymal-induced lung disease includes pulmonary fibrosis, known as asbestosis, rounded atelectasis, and lung cancer. Asbestos exposure leads to an increased risk of both lung cancer and especially mesothelioma, which is rare in the absence of asbestos exposure.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128563647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0069
T. Henry, B. Little
Radiation pneumonitis represents an acute or subacute process following radiotherapy that may be reversible. Fibrosis is a more chronic process that may continue to evolve up to 2 years after treatment. To avoid confusion with other parenchymal opacities that may be encountered post-radiation, one must understand the technique used for radiotherapy in the thorax including: traditional, three-dimensional conformal radiation therapy (3D-CRT), and stereotactic beam radiation therapy (SBRT). The goal of this chapter is to review these different techniques so that expected findings can be distinguished from more significant imaging abnormalities.
{"title":"Radiation Pneumonitis and Fibrosis","authors":"T. Henry, B. Little","doi":"10.1093/MED/9780199858064.003.0069","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0069","url":null,"abstract":"Radiation pneumonitis represents an acute or subacute process following radiotherapy that may be reversible. Fibrosis is a more chronic process that may continue to evolve up to 2 years after treatment. To avoid confusion with other parenchymal opacities that may be encountered post-radiation, one must understand the technique used for radiotherapy in the thorax including: traditional, three-dimensional conformal radiation therapy (3D-CRT), and stereotactic beam radiation therapy (SBRT). The goal of this chapter is to review these different techniques so that expected findings can be distinguished from more significant imaging abnormalities.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"51 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125927102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0001
M. Rosado-de-Christenson
Introduction to chest radiology provides a general overview of thoracic imaging. Chest radiography is an important part of the imaging evaluation of patients who present with thoracic complaints and is frequently ordered in patients undergoing physical examinations, hospital admission and surgery. Portable chest radiographs are also commonly obtained in patients in the intensive care unit. Chest computed tomography (CT) is characteristically employed for further evaluation of suspected pulmonary, vascular, pleural, mediastinal and chest wall abnormalities. Magnetic resonance imaging (MRI) is often employed as a problem solving tool to further evaluate abnormalities found on radiography or CT. Radiologists should work with radiologic technologists to continuously assess and improve radiologic technique and image quality. Right and left markers must be noted on all radiographs in order to diagnose situs abnormalities. Radiologists should also strive to have optimal working conditions with regards to their reading rooms and viewing equipment. Accurate interpretation of thoracic imaging studies relies on a systematic evaluation of all thoracic structures on radiography, CT and MRI. Radiologists should produce clear radiologic reports and should include recommendations for further imaging and/or management when appropriate. Critical and unexpected imaging findings should be promptly communicated to the clinical team, and such communications should be documented on the radiologic report.
{"title":"Introduction to Chest Radiology","authors":"M. Rosado-de-Christenson","doi":"10.1093/MED/9780199858064.003.0001","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0001","url":null,"abstract":"Introduction to chest radiology provides a general overview of thoracic imaging. Chest radiography is an important part of the imaging evaluation of patients who present with thoracic complaints and is frequently ordered in patients undergoing physical examinations, hospital admission and surgery. Portable chest radiographs are also commonly obtained in patients in the intensive care unit. Chest computed tomography (CT) is characteristically employed for further evaluation of suspected pulmonary, vascular, pleural, mediastinal and chest wall abnormalities. Magnetic resonance imaging (MRI) is often employed as a problem solving tool to further evaluate abnormalities found on radiography or CT. Radiologists should work with radiologic technologists to continuously assess and improve radiologic technique and image quality. Right and left markers must be noted on all radiographs in order to diagnose situs abnormalities. Radiologists should also strive to have optimal working conditions with regards to their reading rooms and viewing equipment. Accurate interpretation of thoracic imaging studies relies on a systematic evaluation of all thoracic structures on radiography, CT and MRI. Radiologists should produce clear radiologic reports and should include recommendations for further imaging and/or management when appropriate. Critical and unexpected imaging findings should be promptly communicated to the clinical team, and such communications should be documented on the radiologic report.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122280556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0095
S. Bhalla
The chapter titled chest wall and diaphragm discusses a variety of thoracic abnormalities. Chest wall conditions can be divided into masses, fluid-like processes and congenital variants. The variety of masses encountered in the chest wall is reflective of the tissue of origin. The approach to the chest wall lesion is be guided by three main considerations: the patient’s age, the acuity of the process and the tissue of origin. The desmoid tumor, for example, is a lesion characteristically seen in young adults. Presenting symptoms can also be helpful as infection, hematoma and malignant lesions are more often associated with chest pain. The diaphragm also has a variety of conditions that may manifest on thoracic imaging including masses, defects and anomalies of function. When the innervation is paralyzed, the entire hemidiaphragm may be elevated. Focal defects results in characteristic hernias.
{"title":"Diseases of the Chest Wall and Diaphragm","authors":"S. Bhalla","doi":"10.1093/MED/9780199858064.003.0095","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0095","url":null,"abstract":"The chapter titled chest wall and diaphragm discusses a variety of thoracic abnormalities. Chest wall conditions can be divided into masses, fluid-like processes and congenital variants. The variety of masses encountered in the chest wall is reflective of the tissue of origin. The approach to the chest wall lesion is be guided by three main considerations: the patient’s age, the acuity of the process and the tissue of origin. The desmoid tumor, for example, is a lesion characteristically seen in young adults. Presenting symptoms can also be helpful as infection, hematoma and malignant lesions are more often associated with chest pain. The diaphragm also has a variety of conditions that may manifest on thoracic imaging including masses, defects and anomalies of function. When the innervation is paralyzed, the entire hemidiaphragm may be elevated. Focal defects results in characteristic hernias.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"1197 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133819479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0013
B. Little, T. Henry
Atelectasis and pneumonia are commonly encountered in the inpatient setting, particularly in the intensive care units (ICUs) where patients are intubated and seriously ill, and often subject to variety of co-morbidities. The two entities are often confused as they have overlapping imaging appearances and may coexist. Atelectasis represents incomplete expansion of the lung parenchyma, with associated loss of volume –whereas pneumonia is an infection of the parenchyma and not typically associated with volume loss. Recognition of the characteristic imaging findings of these diseases allows a confident diagnosis to be made in many cases, and a helpful differential diagnosis to be offered in others. Clues to lobar or total lung atelectasis include volume loss, mediastinal shift, fissural and hilar displacement, and a homogeneous opacity with straight borders obscuring adjacent structures (e.g., hemidiaphragm or heart border). Pneumonia may manifest with many different patterns – often nonspecific for a given organism; however, the pattern may help to narrow the differential diagnostic considerations. Aspiration most commonly manifests with dependent centrilobular nodules and/or consolidation. Chest radiographs may change rapidly in patients affected by aspiration or the more severe forms of atelectasis (i.e. lobar or whole lung) and the patient’s symptoms typically change just as rapidly, frequently developing hypoxemia and respiratory distress. While atelectasis in the inpatient setting is a common finding, outpatients who present with lobar atelectasis should be suspected to have an obstructing tumor until proven otherwise (except for patients with CF or asthma).
{"title":"Atelectasis, Pneumonia, and Aspiration","authors":"B. Little, T. Henry","doi":"10.1093/MED/9780199858064.003.0013","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0013","url":null,"abstract":"Atelectasis and pneumonia are commonly encountered in the inpatient setting, particularly in the intensive care units (ICUs) where patients are intubated and seriously ill, and often subject to variety of co-morbidities. The two entities are often confused as they have overlapping imaging appearances and may coexist. Atelectasis represents incomplete expansion of the lung parenchyma, with associated loss of volume –whereas pneumonia is an infection of the parenchyma and not typically associated with volume loss. Recognition of the characteristic imaging findings of these diseases allows a confident diagnosis to be made in many cases, and a helpful differential diagnosis to be offered in others. Clues to lobar or total lung atelectasis include volume loss, mediastinal shift, fissural and hilar displacement, and a homogeneous opacity with straight borders obscuring adjacent structures (e.g., hemidiaphragm or heart border). Pneumonia may manifest with many different patterns – often nonspecific for a given organism; however, the pattern may help to narrow the differential diagnostic considerations. Aspiration most commonly manifests with dependent centrilobular nodules and/or consolidation. Chest radiographs may change rapidly in patients affected by aspiration or the more severe forms of atelectasis (i.e. lobar or whole lung) and the patient’s symptoms typically change just as rapidly, frequently developing hypoxemia and respiratory distress. While atelectasis in the inpatient setting is a common finding, outpatients who present with lobar atelectasis should be suspected to have an obstructing tumor until proven otherwise (except for patients with CF or asthma).","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134300175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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