Radiologe最新文献

Background: Many pathologies of the mediastinum can be diagnosed using standard radiographs. Correlation of radiographic findings with computed tomography (CT) is instructive for a better understanding and can help improve detection rates of mediastinal lesions.

Objectives: To identify the most common mediastinal lesions and to correlate their features in chest radiographs and CT.

Methods: The International Thymic Malignancy Interest Group (ITMIG) classification in the anterior, middle, and posterior mediastinum is based on anatomic landmarks. Used as a tool to characterize mediastinal lesions this classification is applied in this article.

Results: The most common lesions include mediastinal goiter, germ cell and thymic neoplasms in the anterior mediastinum, lymphadenopathy in the middle mediastinum, and neurogenic neoplasms in the posterior mediastinum. Other lesions of neoplastic or non-neoplastic origin can be distinguished in the three compartments and should be considered in the differential diagnosis.

Conclusions: Knowledge of the most common pathologies in the three mediastinal compartments can accelerate differential diagnosis. Understanding the normal mediastinal lines is key in anatomic localization and detection of many lesions in chest radiographs.

In the case of lesions of the pleura, the thoracic wall and the diaphragm, chest x‑ray is of great relevance in everyday clinical practice. In many clinical situations, it is already sufficient for the initial diagnosis or for monitoring the course of the disease; these include, for example, pleural effusion and pneumothorax. In some cases, however, supplementary cross-sectional imaging may be necessary, e.g., if there is a possible pleural empyema or if the soft tissues of the mediastinum and pleural wall are also affected. Further diagnostic workup is also necessary for more advanced questions such as staging or surgical planning. This article is intended to provide an overview of the most common diseases of the pleura, thoracic wall, and diaphragm with their typical appearances on radiographs and, at the same time, to demonstrate the importance and limitations of conventional diagnostics.

Due to the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) asymptomatic incidental findings of the gastrointestinal (GI) tract are increasingly being recognized. Incidental findings are frequently not part of the primary inquiry from referring physicians but it is obligatory to make a diagnosis and to stipulate the need for further clarification. A multitude of incidental findings in the intestinal lumen, in the intestinal wall and in the adjacent mesentery or subperitoneal space are shown in CT and MRI of the GI tract. The last part of the two-part review addresses the gastrointestinal incidental findings in the intestinal wall and the adjacent sections. Extramural incidental findings occur as mesenteric inflammation, tumors and cysts. Many of the findings can be classified as benign and as "leave me alone lesions" do not necessitate any further clarification but in contrast others need a definitive clarification. The most important incidental findings in the GI tract are systematically classified, illustrated and evaluated with respect to the clinical relevance, depending on the localization (e.g. stomach, small and large intestines).

Clinical issue: Chest X‑ray is the most commonly performed X‑ray examination in children and adolescents. The aim of this review is to present the benefit of this radiologic modality, but also its limitations.

Methods: Compared with older children, most X‑ray examinations of the chest were performed in newborns. After the neonatal period, this review focusses on the diagnosis of inflammatory pulmonary changes, foreign body aspiration, detection of pulmonary nodules, and cystic fibrosis.

Methodological innovations: The radiation exposure of X‑ray examinations is continuously decreasing due to technical innovations. However, other imaging modalities were also continuously being optimized; therefore, alternatives without radiation exposure, i.e., magnetic resonance imaging [MRI] and ultrasound, should be considered in case of specific clinical indications.

Practical recommendation: Even if the diagnostic performance of chest X‑ray examinations is often minor compared to computed tomography or MRI, chest X‑ray still has a high value in children and adolescents, due to its ubiquitous availability and the relatively simple acquisition.

Clinical issue: Diffuse parenchymal lung diseases include a heterogeneous group of diseases of the lung parenchyma, the alveolar spaces, the vessels and the airways, which can be triggered by various pathomechanisms, such as inflammation and fibrotic changes. Since the therapeutic approaches and prognoses differ significantly between the diseases, the correct diagnosis is of fundamental importance. In routine clinical practice, next to the patients' history, the clinical presentation, the laboratory findings and the bronchoscopy, imaging plays a central role in establishing a diagnosis.

Practical recommendations: The diagnosis of diffuse parenchymal lung diseases is an enormous challenge for clinicians, radiologists as well as pathologists and should therefore preferably be carried out in a multidisciplinary setting. Since patients often present with unspecific, respiratory symptoms, chest radiographs are the first imaging method used. Many patterns of diffuse parenchymal lung diseases (e.g., ground-glass opacities and consolidations), their distribution (e.g., cranial-caudal) and the presence of additional findings (e.g., mediastinal lymphadenopathy) are often already detectable on chest X‑rays. However, the imaging reference standard and thus, an integral part of the assessment of diffuse parenchymal lung disease, is the chest HR-CT. In some cases, the pattern of the HR-CT is pathognomonic, in others it is unspecific for a disease, so that further diagnostic steps are necessary.

Background: Increases in pressure in the pulmonary arteries or pulmonary veins may be the result of a variety of underlying diseases. Noninvasive imaging plays a crucial role not only for identification, but also for differential diagnosis.

Objectives: This article provides a comparative review of the signs of increased pulmonary arterial and pulmonary venous pressure in chest X‑ray and computed tomography (CT).

Radiological procedures: Typical signs of a pulmonary arterial or pulmonary venous pressure increase in chest X‑ray and CT facilitate diagnosis of pulmonary hypertension (e.g., enlargement of central pulmonary arteries) and interstitial or alveolar pulmonary edema (e.g., Kerley lines/thickened interlobular septae or butterfly edema). A basic understanding of imaging findings and underlying pathophysiology helps in establishing the differential diagnosis.

Conclusions: Chest X‑ray and CT are essential for diagnosis of patients with suspected increased pulmonary arterial or pulmonary venous pressure.