Comprehensive Textbook of Clinical Radiology Volume III: Chest and Cardiovascular System

1st Edition - April 24, 2023
Editors: C Amarnath, Aparna Irodi, Priya Jagia, Hemant Patel, R Rajeshkannan, Chander Mohan, Vimal Someshwar, Pankaj Sharma
Language: English
Hardback ISBN:
9 7 8 - 8 1 - 3 1 2 - 6 3 6 1 - 7
eBook ISBN:
9 7 8 - 8 1 - 3 1 2 - 6 3 6 2 - 4

Comprehensive textbook of Clinical Radiology is a fully integrated illustrated textbook of radiology to cater for residents and practising radiologists. It is a one-stop solution… Read more

Comprehensive Textbook of Clinical Radiology Volume III: Chest and Cardiovascular System

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Comprehensive textbook of Clinical Radiology is a fully integrated illustrated textbook of radiology to cater for residents and practising radiologists. It is a one-stop solution for all academic needs in radiology. It helps radiologists as a single reference book to gain complete knowledge instead of referring to multiple resources. More than 500 remarkable authors, who are recognized experts in their subspeciality, have contributed to this book. To meet the expectations of clinical radiologists, thorough clinical expertise and familiarity with all the imaging modalities appropriate to address their clinical questions are necessary, regardless of one’s favoured subspeciality. To keep the content relevant to them, we have tried to stay upgraded to their level. This book comprises six volumes, which gives information on Radiological Anatomy, Embryology, Nomogram, Normal Variants, Physics, Imaging Techniques, and all the aspects of Diagnostic Radiology including Neuroradiology, Head and Neck, Chest and CVS, Abdomen, Obstetrics and Gynaecology, Breast, Musculoskeletal and Multisystem Disorders & related Interventional techniques. It will serve as a primary reference for residents and subspeciality trainees and fellows to facilitate their learning in preparation for their examination, and also the consultant radiologists in their daily clinical practice.

This volume is subdivided into two sections. Section 5 deals with the diagnosis and interventions involving the chest and its contents. The pleura, mediastinum, lungs, chest wall and bony thoracic cage are discussed in detail. The initial section deals with the anatomy, development, paediatric abnormalities of the chest and approach to lung lesions. Section 6 is further subdivided into three subparts. The initial section deals with paediatric cardiac imaging. It begins with normal development of paediatric heart, approach to paediatric cardiac X-rays and describes all paediatric cardiac pathologies. The second part deals with the adult cardiac imaging involving all the pathologies of the heart, pericardium, pulmonary vasculature and the coronary arteries. The third part educates the reader with the peripheral vascular imaging and interventions.

Cover image
Title page
Table of Contents
Copyright
Foreword
Foreword
Foreword
Preface
Contributors
List of Illustrations
List of Tables
SECTION 5. Chest
Introduction
Key features
5.1. Radiological techniques: Thorax
5.1.1. CHEST RADIOGRAPHY
Introduction
Radiographic techniques
Image evaluation
Radiography
Conclusion
5.1.2. THE ADULT CHEST RADIOGRAPH: AN INSIGHT
Introduction
Radiographic views
Overview of localization strategies
Mediastinum
Conclusion
5.1.3. CHEST FLUOROSCOPY
Introduction
Fluoroscopy
Dysfunctions of the diaphragm
Imaging the diaphragm
Fluoroscopic evaluation of the diaphragm
Conclusion
5.1.4. ULTRASOUND THORAX
Introduction
Basics of lung sonography
Basic anatomy of lung ultrasound
Normal lung findings on chest ultrasound
Lung pathologies on USG
Point-of-care (PoCUS) ultrasound
Conclusion
5.1.5. COMPUTED TOMOGRAPHY
Introduction
Reconstruction and reformation techniques
Radiation dose and image noise
Thoracic CT protocols
Conclusion
5.1.6. MRI THORAX
Abbreviations
MRI lung
MRI mediastinum
MRI pleura
MRI chest wall
MR pulmonary angiogram
Cine MRI
5.1.7. NUCLEAR MEDICINE PROCEDURES IN LUNG IMAGING
Ventilation–perfusion studies: Introduction
Indications
Contraindications
Radiopharmaceuticals used (Tables 5.1.7.1–5.1.7.3)
Patient preparation
Tests to be performed before V/Q scan
Technique
Instruments and types of equipment used
Positioning
Planning and protocols
Methods of acquisition
Normal appearance in ventilation–perfusion imaging
Pathological appearance
Advantage
Pitfalls
Differential diagnosis
Image analysis
Interpretation criteria for pulmonary embolus diagnosis
Conclusion
5.1.8. INTERVENTIONAL RADIOLOGY IN CHEST: OVERVIEW
Introduction
Preprocedure imaging workup
Preprocedure laboratory workup
Imaging modalities for guidance
Indications, techniques and complications
Conclusion
5.2. Normal anatomy of thorax
5.2.1. NORMAL ANATOMY ON CHEST RADIOGRAPH
Trachea, carina and main bronchi
Tracheobronchial divisions: Lobar and segmental bronchi
Lungs: Lobes, fissures and zones
Bronchopulmonary segments
Hilum and pulmonary vasculature
Pleura
Mediastinum
Mediastinal lines, stripes and interfaces
Cardiac silhouette
Diaphragm
Costophrenic and cardiophrenic angles
Hidden areas
Chest wall and soft tissues
Bones
5.2.2. NORMAL ANATOMY ON CHEST ULTRASOUND
Technique and equipment
Sonographic anatomy
5.2.3. NORMAL ANATOMY ON CHEST CT
Mediastinal compartments
Mediastinal anatomy
Mediastinal spaces
Pulmonary hila
Hilar vessels
Lymphatics
Lungs
Bronchopulmonary segments
Diaphragm
Lymph nodes
5.2.4. NORMAL ANATOMY ON CHEST MRI
Lung: Pulmonary parenchyma and fissures
Hila and pulmonary vessels
Pleura
Mediastinum
Diaphragm
Chest wall
Conclusion
5.2.5. NORMAL VARIANTS IN LUNG FISSURES, LOBES AND SEGMENTS
Introduction
Major fissure
Minor fissure
Variations of fissures
Lobe and segmental variations
Conclusion
5.2.6. NORMAL VARIANTS OF TRACHEOBRONCHIAL TREE
Introduction
Normal tracheobronchial anatomy
Tracheobronchial variation
Conclusion
5.2.7. NORMAL VARIANTS OF LUNG VASCULATURE
Introduction
Pulmonary artery variation
Pulmonary vein variation
Bronchial artery variation
Conclusion
5.2.8. NORMAL VARIATION OF CHEST WALL AND DIAPHRAGM
Introduction
Sternal variations
Sternal shape affecting anterior chest wall
Suprasternal or episternal ossicle or suprasternal bone (Fig. 5.2.8.2)
Ribs
Diaphragm
Conclusion
5.3. Nomograms
5.4. Imaging approaches in thorax
5.4.1. TERMINOLOGY IN CHEST RADIOLOGY
Introduction
Anatomical terms
Descriptive terms for pathological lesions
Distribution of disease
Distribution of disease in emphysema
Named patterns of parenchymal/airway involvement in disease
Special signs
5.4.2. GENERAL APPROACH TO A CHEST RADIOGRAPH
Introduction
Views in chest radiography
Technical adequacy of a PA chest radiograph
Assessing the PA chest radiograph
Assessment on the lateral chest radiograph
Conclusion
5.4.3. GENERAL APPROACH TO HRCT THORAX
Technical considerations
HRCT anatomy
HRCT patterns
5.4.4. SOLITARY PULMONARY NODULE
Introduction
Assessment of the risk of malignancy
Knowledge about quantitative predictive models for SPN
Pragmatic approach in evaluation of SPN
Radiographic evaluation
Computed tomography
Role of magnetic resonance imaging (MRI)
Positron emission tomography
Biopsy of nodule
Management and follow-up of SPN
Conclusion
5.4.5. APPROACH TO HYPERLUCENT LUNG IN ADULTS
Introduction
Differential diagnoses of unilateral lung hyperlucencies
Diagnostic approach for unilateral hyperlucent lung
Differential diagnoses of bilateral lung hyperlucencies
Diagnostic approach for bilateral hyperlucent lung
5.4.6. APPROACH TO DENSE HEMITHORAX IN ADULTS
Introduction
Differential diagnoses of a dense hemithorax
Diagnostic approach in a case of dense hemithorax
5.4.7. APPROACH TO A PATIENT WITH HAEMOPTYSIS
Definition of haemoptysis
Classification of severity of haemoptysis
Causes of haemoptysis
Haemoptysis in children
Pathophysiology of haemoptysis
Pathophysiology of large vessel haemoptysis
Diagnostic approach to haemoptysis
Multidetector CT
Bronchoscopy
Digital subtraction angiography (+bronchial artery embolization)
Conventional pulmonary arteriography
5.4.8. APPROACH TO AN ADULT PATIENT WITH ACUTE BREATHLESSNESS
Introduction
Pathophysiology
Causes of dyspnoea
Diagnostic approach
5.4.9. APPROACH TO PLEURA
Approach to pleural-based and extrapleural lesions
Approach to pleural thickening and plaques
Approach to pleural effusion
Approach to pneumothorax
Approach to pleural calcification
Differentiate ascites versus pleural effusion on CT
5.4.10. DIFFUSE CYSTIC LUNG DISEASE
Introduction
Differentiating cysts from cyst-like lesions
Diffuse cystic lung disease without other findings
Diffuse cystic lung disease with other findings
5.5. Signs in chest imaging
5.5.1. FELSON SIGNS ON CHEST RADIOGRAPH
Introduction
The signs
Conclusion
Acknowledgements
5.5.2. OTHER SIGNS IN CHEST IMAGING
Air crescent sign
Air trapping sign
Anterior bronchus sign
Antler sign
Atoll sign/reverse halo sign
Batwing sign/butterfly sign
Buffalo chest sign
Bronchiectasis
Collar sign/cottage loaf sign
Crazy paving sign
CT angiogram sign
Dark bronchus sign
Deep sulcus sign
Dependent viscera sign
Dense hilum sign
Double artery sign
Double diaphragm sign
Eggshell calcification sign
Flat waist sign
Fluid bronchogram sign/water bronchogram/mucus bronchogram
Four corners sign
Finger-in-glove sign
Feeding vessel sign
Frozen mediastinum sign
S sign of gloden
Head cheese sign
High-density consolidation
Holly leaf sign
Honeycombing sign
Hydatid cyst signs
Incomplete border sign
Juxtaphrenic peak sign/diaphragmatic tenting/kattan sign
Leafless tree sign
Luftsichel sign
Medial breast margin sign
Miliary nodules
Monod sign
Peribronchial cuffing
Plankton sign (USG)
Pneumomediastinum signs
Popcorn calcification
Pulmonary embolism signs
Pseudocavitation sign
Reverse batwing pulmonary opacities/photographic negative of pulmonary oedema
Sabre sheath trachea (X-ray/CT) in a patient with COPD
Sarcoidosis
Lung point sign and absent sliding pleura sign
Split pleura sign
Straight edge sign/absent straight edge sign
Thymic sail sign
Tree-in-bud sign
Interstitial infiltration
5.6. Embryology of chest: Airway, lungs, pleura, diaphragm and chest wall
Development of larynx, trachea and airway
Development of the lungs
Pleura and pleural cavity
Diaphragm
Chest wall
5.7. Imaging modalities in paediatric chest
5.7.1. PAEDIATRIC CHEST RADIOGRAPHY
Introduction
Role of chest radiograph
Radiographic views
Adequacy of chest radiograph
Normal appearances
Potential sources of errors in paediatric chest radiograph
Radiographic artefacts
Tubes and catheters on chest radiograph
Conclusion
5.7.2. NORMAL DEVELOPMENTAL VARIANTS OF THE PAEDIATRIC THORAX
Introduction
Thymus and variants
Tracheobronchial variants
Lung parenchymal variants
Bony variants
Conclusion
5.8. Respiratory distress in infancy
Introduction
Medical conditions
Surgical conditions
5.9. Pulmonary infections
Viruses
Bacteria
Fungi
Atypical pneumonia
Fungi
5.10. Imaging of paediatric chest tuberculosis
Introduction
Aetiopathogenesis
Imaging modalities
Imaging features
Special situations
Complications/sequelae
Summary
5.11. Paediatric interstitial lung disease: Unravelling the alphabet soup
Introduction
Approach to initial workup and diagnosis
Age-related presentation of paediatric ILDs in different stages of life
A review of pulmonary embryology
Initial investigations for patients suspected to have ILD
Introduction to high-resolution chest CT
Various types of paediatric ILDs
Disorders masquerading as interstitial disease
Two special entities: Vaping-related lung injury and COVID-19-related lung infection
Conclusion
5.12. Bronchial obstruction
Introduction
Imaging modalities
Intrinsic causes of bronchial obstruction
Extrinsic causes of bronchial obstruction
Conclusion
5.13. Paediatric pulmonary, pleural and chest wall masses
Introduction
Imaging modalities
Imaging features
Pulmonary masses
Benign pulmonary neoplasms
Malignant pulmonary neoplasms
Pleural masses
Benign tumours
Malignant tumours
Chest wall masses
Conclusion
5.14. Mediastinal masses in children
Introduction
Mediastinal compartments and their boundaries
Approach to mediastinal masses
Role of imaging
Spectrum of imaging findings
Conclusion
5.15. Lines and tubes in paediatric chest
Introduction
PICC line
ET tube and tracheostomy tube
Enteric tubes
Umbilical venous catheter
Umbilical arterial catheter
Chest drains
Extracorporeal membrane oxygenator (ECMO)
Conclusion
5.16. Infections
5.16.1. COMMUNITY-ACQUIRED PNEUMONIA AND HOSPITAL-ACQUIRED PNEUMONIA
Imaging approach
Pathophysiology
Ventilator-associated pneumonia
Hospital-acquired pneumonias
Health care–associated pneumonias
Complications of pneumonias
Differential diagnosis
Follow-up
Role of lung ultrasound
Role of MDCT
Acknowledgement
5.16.2. VIRAL PNEUMONIAS
Pathophysiology behind the radiological findings
Radiological patterns of viral pneumonias
Hand drawing for examinations: Viral pneumonia
Specific imaging appearances
Rationale for not using chest CT as screening test
Radiological findings
5.16.3. IMAGING IN PULMONARY BACTERIAL INFECTIONS
Introduction
Pathogenesis and mechanisms of infection
Host and environmental factors
Role of imaging
Classification of pulmonary bacterial infection
Radiological patterns of bacterial infections
Specific infections
Anaerobic pneumonia
Childhood infections
Complications of pneumonia
Conclusion
5.16.4. RADIOLOGY OF PULMONARY TUBERCULOSIS
Introduction
Epidemiology
Aetiopathogenesis
Diagnostic approach to tuberculosis
Conclusion
5.16.5. FUNGAL INFECTIONS OF LUNG
Introduction
Approach to fungal infections of the lung
Conclusion
5.16.6. PARASITIC INFECTIONS OF THE CHEST
Protozoa
Nematodes
Cestodes
Trematodes
Conclusion
5.16.7. CHEST INFECTION IN IMMUNOCOMPROMISED PATIENTS
Infections in post-transplant recipients
Primary immunodeficiency conditions
Secondary immunodeficiency conditions
Approach to chest imaging in patients living with HIV
Chest infections in chronic diseases
Infections related to treatment
5.17. Lung neoplasms
5.17.1. BENIGN NEOPLASMS AND MASS-LIKE LESIONS IN LUNGS
Introduction
Classification
Conclusion
5.17.2. IMAGING IN LUNG CANCER
Epidemiology, aetiology and prevention
Lung cancer pathology, biology and genomic landscape of lung cancer
Lung cancer screening: Patient selection and implementation in indian scenario
Lung cancer diagnosis and percutaneous image-guided needle biopsies
Multidisciplinary clinics in management of lung cancer
Alternatives to surgery in early stage non-small-cell lung cancer: Thermal ablation
Imaging of therapy-related pulmonary complications in lung cancer
Post–radiation therapy changes
5.18. Diffuse parenchymal lung diseases
5.18.1. APPROACH TO INTERSTITIAL LUNG DISEASE
Comprehensive clinical evaluation
Comprehensive radiological evaluation
Approach to ILD
5.18.2. IDIOPATHIC INTERSTITIAL PNEUMONIAS
Chronic fibrosing interstitial pneumonias
Smoking-related IIPs
IIPs with acute or subacute presentations
5.18.3. CONNECTIVE TISSUE DISORDER–RELATED INTERSTITIAL LUNG DISEASES
Imaging modalities
Pathophysiology
Clinical features
Specific connective tissue disorders
Conclusion
Acknowledgement
5.18.4. EXPOSURE-RELATED LUNG DISEASES: Suspect to Prospect Pneumoconiosis
Introduction
Epidemiology
Clinical features
Investigations
Role of imaging modalities
Radiology reporting
Spectrum of ER-ILD
Pneumoconiosis
Distribution in different pneumoconiosis
MCQ
5.18.5. ALLERGIC DISORDERS
5.18.6. THORACIC SARCOIDOSIS
Introduction
Epidemiology
Pathogenesis
Pathology
Clinical features and disease course
Diagnosis of sarcoidosis
Imaging features of thoracic sarcoidosis
Imaging pearls and pitfalls
Imaging differential diagnosis
Is it tuberculosis or sarcoidosis?
Imaging recommendations and scan technique in sarcoidosis
5.18.7. EXPOSURE-RELATED LUNG DISEASES: Including Hypersensitivity Pneumonitis
Hypersensitivity pneumonitis
Organic dust toxic syndrome
Chemical pneumonitis
Biomass fuel exposure-related respiratory diseases
New or emerging ERLD
Exposure-related lung cancer
Patterned radiological approach
Conclusion
MCQ
5.18.8. DRUG-RELATED LUNG DISEASE
Introduction
Drug-related lung disease
Illicit drugs
Clinical dilemma
Acknowledgements
5.18.9. RADIATION-INDUCED LUNG INJURY
Introduction
Types of radiation therapy in thoracic malignancies
Basics of radiation physics
Effects of radiation at molecular level
Pathophysiology of radiation-induced lung injury
Clinical manifestations
Risk factors
Pathological findings
Radiological appearances: According to the timeline
Other thoracic complications induced by radiation: Other than RP and RPF
Differential diagnoses
Clinical assessment and severity scales
Treatment of RILI
New frontiers in the management of RILI
Conclusion
Salient points to remember
CT reporting format/template for RILI
5.18.10. PULMONARY ALVEOLAR PROTEINOSIS
Differential diagnoses
5.18.11. PULMONARY ALVEOLAR MICROLITHIASIS
5.18.12. PULMONARY HISTIOCYTOSIS
Pulmonary langerhans cell histiocytosis
Lymphangioleiomyomatosis
5.19. Vascular
5.19.1. PULMONARY HAEMORRHAGE AND ITS EVALUATION
Introduction
Clinical features
Causes
Diagnosis
Diffuse pulmonary haemorrhage
Takayasu arteritis
Giant cell arteritis
Medium-vessel vasculitis
Small-vessel vasculitis (SVV)
Granulomatosis with polyangiitis (GPA)
Microscopic polyangiitis
Eosinophilic granulomatosis with polyangiitis
Anti-glomerular basement membrane disease
Cryoglobulinaemic vasculitis
Immunoglobulin a vasculitis (Henoch–Schönlein purpura)
Hypocomplementaemic urticarial vasculitis (anti-C1Q vasculitis)
Behçet disease
Vasculitis associated with systemic disease
Vasculitis associated with probable aetiology
Management of vasculitis
Conclusion
5.19.2. PULMONARY ARTERIOVENOUS MALFORMATIONS: IMAGING
Introduction
Aetiology
Clinical features
Hereditary haemorrhagic telangiectasia
Imaging modalities
Imaging features
Types of PAVM
Special situations
Differential diagnoses
CT reporting format for PAVM
5.20. Large and small airway diseases
5.20.1. LARGE AIRWAY DISEASES
Introduction
Function and anatomy
Imaging techniques
Approach
Pathology
Airway stents
The future
Acknowledgements
5.20.2. SMALL AIRWAY DISEASE AND COPD
Introduction
Anatomy of small airways
Pathology
Clinical presentation
Investigations
Imaging of small airway disease
Imaging manifestations of small airway disease
Aetiology of small airway disease
Chronic obstructive pulmonary disease
5.21. Pleura
Introduction
Normal anatomy
Parts of pleura
Blood supply and lymphatic drainage
The pleural surface and the intercostal stripe
Pleural pathologies
Postsurgical BPF
Pleural thickening
Pleural calcification
Pneumothorax
Pleural neoplasms
Lymphoma
Pleural lipoma
Sarcomas
Fibrin body
Thoracolith
Thoracic splenosis
Hydatid cyst
Conclusion
5.22. Mediastinum and hilum
5.22.1. MEDIASTINUM – GENERAL CONSIDERATIONS
Introduction
Mediastinal divisions
Chest X-ray anatomy of the mediastinum
CT-based compartmentalization of the mediastinum
ITMIG classification of mediastinal compartments
The older CT classifications
Mediastinal imaging techniques
5.22.2. APPROACH TO MEDIASTINAL AND HILAR ADENOPATHY
Introduction: Anatomy and terminology
Imaging approach
Imaging approach in chest computed tomography
Imaging approach – fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT)
Imaging approach – MRI
Endobronchial ultrasound and guided transbronchial needle aspiration
Conclusion
5.22.3. HILAR ENLARGEMENT – UNILATERAL VERSUS BILATERAL
Introduction
Anatomy of hilum
Radiological evaluation of abnormal hilum
Unilateral hilar involvement
Bilateral hilar involvement
Conclusion
5.22.4. ANTERIOR MEDIASTINAL LESIONS
Introduction
Thymus
Uncommon thymic neoplasms
Secondary tumours of the thymus
Conclusion
5.22.5. MEDIASTINAL GERM CELL TUMOURS (M-GCT)
Definition
Introduction
Embryology
Classification of mediastinal germ cell tumours
Staging of mediastinal germ cell tumour
Clinical features of germ cell tumours
Teratoma
Seminoma
Nonseminomatous germ cell tumours
Imaging mediastinal GCT: Pearls and pitfalls
Key points
5.22.6. INTRATHORACIC THYROID MASSES
Introduction
Definitions
Incidence
Embryology
Location
Clinical presentation
Imaging
Differential diagnosis
Management
Imaging pearls of intrathoracic goitre
Key points
5.22.7. MEDIASTINAL LYMPHOMA
Introduction
Clinical presentation
Hodgkin lymphoma
Non-hodgkin lymphoma
Imaging features
Differential diagnosis
5.22.8. MIDDLE MEDIASTINAL LESIONS
Introduction
Bronchogenic cyst
Oesophageal duplication cysts
Hiatus hernia
Para-oesophageal hernia
Oesophageal varices
Retrosternal goitre and ectopic mediastinal goitre
Pseudomasses
Conclusion
5.22.9. POSTERIOR MEDIASTINAL LESIONS
Neurogenic neoplasms of posterior mediastinum
C Peripheral nerve sheath tumours
C Benign peripheral nerve tumours
Neurofibromatosis type I and plexiform neurofibroma
Malignant peripheral nerve sheath tumours
Sympathetic ganglion tumours
Thoracic paragangliomas
Summary
Posterior mediastinal neurogenic tumours: Imaging pearls and pitfalls
5.22.10. NON-NEUROGENIC POSTERIOR MEDIASTINAL LESIONS
Contents of posterior mediastinum
Posterior mediastinal lymphoma
Bochdalek hernia
Infective spondylitis
Retrosternal thyroid presenting as posterior mediastinal mass
Mediastinal pancreatic pseudocyst
Intrathoracic kidney
Primary mediastinal germ cell tumour presenting as posterior mediastinal mass
Extramedullary haematopoiesis
Posterior mediastinal cystic lesions with associated vertebral changes/defects
5.22.11. MISCELLANEOUS MEDIASTINAL LESIONS
Introduction
Mediastinal lymphangioma
Acute mediastinitis
Mediastinal abscess
Acute descending necrotizing mediastinitis (ADNM)
Mediastinal fibrosis or fibrosing mediastinitis/sclerosing mediastinitis
Pneumomediastinum
Mediastinal haematoma
Inflammatory pseudotumour/inflammatory myofibroblastic tumour
Mediastinal lipoma
Mediastinal lipomatosis
Mediastinal liposarcoma
Mediastinal haemangioma
5.22.12. DIFFERENTIAL DIAGNOSIS OF CYSTIC LESIONS OF MEDIASTINUM
Introduction
Differential diagnoses (Table 5.22.12.1)
5.22.13. DIFFERENTIAL DIAGNOSIS OF FAT-CONTAINING MEDIASTINAL LESIONS
Introduction
Differential diagnoses of mediastinal fat-containing lesions (Table 5.22.13.1 and Fig. 5.22.13.5)
5.23. Chest wall and diaphragm
Introduction
Imaging of chest wall masses
Chest wall soft-tissue masses
Benign tumours
Infections
Malignant tumours
Osseous lesions
Approach to chest wall soft-tissue lesions in adults (Fig. 5.23.17)
Approach to rib lesion: With/without an adjacent soft-tissue mass, solitary or multiple (Fig. 5.23.22)
Approach to erosion of lateral end of clavicle
Chest wall deformities
Approach to rib notching, inferior and superior surfaces (Fig. 5.23.30)
Approach to ribbon ribs/wide or thick ribs
Imaging of the diaphragm
Diaphragmatic tumours/masses (Box 5.23.8)
Diaphragmatic dysfunction
Approach to elevated diaphragm (Fig. 5.23.43 and Box 5.23.9)
Conclusion
5.24. Trauma, emergencies, ICU, miscellaneous
5.24.1. IMAGING IN CHEST TRAUMA
Introduction
Mechanisms of chest injury
Indications for chest imaging
Protocols and roles of chest radiograph, ultrasound, CT and magnetic resonance imaging
Pleural injury
Lung injury
Imaging pearls and pitfalls in lung and pleural injuries
Tracheobronchial injury
Oesophageal injury
Diaphragm injury
Injuries to the great vessels
Cardiac trauma
Osseous injuries
Conclusion
5.24.2. LINES AND TUBES SEEN ON CHEST RADIOGRAPHS
Introduction
Cardiac devices
Vascular devices
Musculoskeletal implants/devices
Miscellaneous
Conclusion
5.24.3. APPROACH TO ICU RADIOGRAPHS
Technique
Indications
Imaging appearances of common ICU conditions and differential diagnoses
Limitations
Role of MDCT
Role of lung ultrasound
The future: Artificial intelligence (AI) applications
5.24.4. PULMONARY OEDEMA AND ARDS
Introduction
Classification and causes
Pulmonary oedema because of raised hydrostatic pressure (cardiogenic pulmonary oedema)
Pulmonary oedema because of raised capillary permeability with diffuse alveolar damage: Acute respiratory distress syndrome
Permeability oedema without diffuse alveolar damage
Mixed oedema
Approach to pulmonary oedema
Imaging differential diagnoses
Management of pulmonary oedema
ARDS
Reporting checklists
Conclusion
5.25. Chest vascular intervention
5.25.1. BRONCHIAL ARTERY EMBOLIZATION
Introduction
Aetiology of haemoptysis
Pathogenesis of haemoptysis
Clinical approach and evaluation of haemoptysis
Role of noninvasive imaging
Role of bronchoscopy
Role of nonbronchial systemic arteries
Relation between spinal cord perfusion and bronchial and nonbronchial systemic arteries
Indications of bronchial and nonbronchial embolization in haemoptysis
Technique of bronchial and nonbronchial artery embolization
Outcome of bronchial artery embolization, recurrence
Complications of BAE
Conclusion
5.25.2. PULMONARY ARTERIOVENOUS MALFORMATIONS: INTERVENTIONS
Introduction
Modes of treatment of PAVMs
Endovascular therapy of PAVMs
Conclusion
5.26. Nonvascular interventions in chest
Tissue sampling
Drainage
Pleurodesis
Ablation
Conclusion
5.27. Imaging of post-lung transplant complications
Introduction
Surgical techniques
Post-lung transplant complications (Table 5.27.1)
Airway complications
Vascular complications
Complications because of size mismatch
Pleural complications
Primary graft dysfunction (PGD)
Infections
Allogeneic immune responses
Summary
5.28. Dual-energy computed tomography (DECT)
Types
Clinical applications in chest imaging
SECTION 6. Cardiovascular System
Introduction
Key features
6.1. Imaging modalities in cardiovascular system
6.1.1. PLAIN CHEST RADIOGRAPHIC EVALUATION OF CARDIOVASCULAR SYSTEM
Introduction
Cardiac borders
Cardiac size
Factors influencing the cardiac size
Assessment of specific chamber enlargement of chest radiograph
Assessment of aorta
Assessment of pulmonary vascularity
Chest radiography in congenital heart diseases
Clinicoradiological classification of congenital heart lesions
Conclusion
6.1.2. ECHOCARDIOGRAPHY IN CARDIAC DISEASES
Introduction
Principles of echo and imaging methods
Standard echocardiographic examination
Advanced echo imaging modalities
Evaluation of some common cardiac pathologies on echocardiography
When to use other imaging modalities
Conclusion
6.1.3. COMPUTED TOMOGRAPHY OF THE HEART
Introduction
MDCT technology
Factors affecting radiation dose and dose optimization in cardiac CT
Clinical applications of cardiac CT
Performing cardiac CT
Postprocessing software
Conclusion
6.1.4. CARDIAC MRI TECHNIQUES
Introduction
Preparation
CMR sequences
Advanced sequences
Imaging planes
Postprocessing
Protocols: Common indications
Special scenarios
Conclusion
6.1.5. CORONARY ANGIOGRAPHY AND VENTRICULOGRAPHY
Introduction
Anatomy of coronary arteries
Optimal catheter angiography
Basics of X-ray imaging in catheterization laboratory
Performing coronary angiogram
How to interpret the angiogram
Prevention of contrast-induced nephropathy (CIN)
Conclusion
6.1.6. CARDIAC SPECT: MYOCARDIAL PERFUSION IMAGING
Introduction
Fundamental basis of MPI
Clinical indications
Patient preparation
Stress protocols
SPECT protocol
Image display
Image analysis
Myocardial viability
Recent advances
Conclusion
6.1.7. PET/CT IN CARDIOLOGY
Why PET over SPECT?
Perfusion imaging
Viability imaging
Cardiomyopathy
Infection imaging
Vasculitis
Plaque imaging
Autonomic dysfunction
Conclusion
6.2. Radiological anatomy with normal variants
6.2.1. IMAGING ANATOMY OF HEART AND PERICARDIUM WITH CIRCULATION PHYSIOLOGY: Including Normal Variants
Introduction
Right atrium
Left atrium
Interatrial septum
Right ventricle
Left ventricle
Interventricular septum
Cardiac valves
Pericardium
Circulation physiology
Conclusion
6.2.2. IMAGING ANATOMY OF CORONARY ARTERIES AND VEINS
Introduction
Coronary artery anatomy
Why CT coronary angiogram
Coronary anatomy
Variability of coronary artery circulation
Myocardial bridging
Common variants of coronary artery
Anomalies of coronary arteries
Coronary distribution: Mapping to myocardial segments
Coronary venous system
Conclusion
6.2.3. IMAGING ANATOMY OF AORTA (INCLUDING NORMAL VARIANTS)
Introduction
Gross anatomy of the aorta
Imaging strategies
Quantitative assessment of aorta
Age-related changes
Normal anatomical variants
Normal anatomy mimicking diseases
Conclusion
6.2.4. IMAGING ANATOMY OF PULMONARY ARTERIES AND BRANCHES
Introduction
Embryology
Pulmonary arterial anatomy
Physiology of pulmonary circulation
6.2.5. PULMONARY VENOUS ANATOMY
Introduction
Embryology
Imaging of pulmonary veins
Retrospective ECG-gated CT protocol
Normal anatomy
Pulmonary vein anatomical variants
6.2.6. IMAGING ANATOMY OF SVC AND IVC WITH TRIBUTARIES
Introduction
Superior vena cava
Inferior vena cava
Conclusion
6.2.7. IMAGING OF UPPER AND LOWER LIMB ARTERIAL ANATOMY
Imaging of upper limb arterial anatomy
Arterial anatomy of lower extremity
Key collateral pathways in lower extremity
6.2.8. IMAGING ANATOMY OF UPPER LIMB AND LOWER LIMB VEINS
Introduction
Imaging modalities
Upper limb venous anatomy
Lower limb venous anatomy
Conclusion
References
6.3. Nomograms
Nomograms
Normal dimensions of heart chambers
Normal calibre of coronary arteries
Normal calibre of aorta and its branches
Normal calibre of pulmonary artery and its branches
Normal thickness of myocardium and pericardium
Nomograms of peripheral arteries
Nomograms of veins
References
6.4. Imaging approaches in cardiac pathologies
6.4.1. IMAGING APPROACH TO CONGENITAL HEART DISEASES
Introduction
Basic concepts of sequential and segmental approach
Anatomical analysis of each segment
Functional evaluation of the heart
Imaging for treatment decision making
Conclusion
Pediatric cardiac CT (CCT)/ cardiac MRI (CMR) reporting format
A Anatomical findings
B Physiological data
Discussion
6.4.2. IMAGING ALGORITHM IN ISCHAEMIC CARDIOMYOPATHY
Introduction
Pathophysiology
Imaging modalities
Components of ischaemic cardiomyopathy and their assessment
Appropriate imaging approach for IC according to indications
Conclusion
6.4.3. PRACTICAL APPROACH TO NONISCHAEMIC CARDIOMYOPATHIES
Introduction
Diagnostic approach to nonischaemic cardiomyopathies
Analysis of CMR images
Conclusion
6.4.4. IMAGING APPROACH IN VALVULAR HEART DISEASE
Introduction
Prevalence
Clinical presentation
Management
Evaluation of the patient
Goals of imaging in valvular heart disease
Imaging modalities
Appropriate imaging tools for VHD according to indications
Conclusion
6.4.5. IMAGING APPROACH TO CARDIAC MASSES
Introduction
Imaging modalities
Conclusions
6.5. Radiological signs in cardiovascular system
Introduction
Image contributors
6.6. Embryology of cardiovascular system
Introduction
Early development
Cardiac looping
Heart chambers, valves and outflow tracts
Development of vasculature
Conduction system
Fetal circulation and transition to postnatal circulation
Conclusion
6.7. Imaging in acyanotic congenital heart diseases
Introduction
Ventricular septal defects
Atrial septal defects
Atrioventricular septal defect
Patent ductus arteriosus
Partial anomalous pulmonary venous connection
Scimitar syndrome
Outflow tract obstructions
6.8. Imaging in cyanotic congenital heart diseases
Introduction
Tetralogy of fallot
Pulmonary atresia with ventricular septal defect
Pulmonary atresia with intact ventricular septum
Transposition of great arteries (d-TGA and l-TGA)
Anomalous pulmonary venous drainage
Imaging of single ventricle
Double outlet right ventricle
6.9. Imaging of heterotaxy-related anomalies
Introduction
Genetic background
Imaging in heterotaxy syndrome
Anomalies associated with heterotaxy syndrome
Management
Conclusion
6.10. Congenital aortic anomalies
Introduction
Normal anatomy of the aorta (Fig. 6.10.2)
Imaging protocols
Aortic root anomalies
Aortic arch anomalies
Obstructive arch anomalies
Genetic anomalies affecting the aorta
6.11. Coronary artery and venous anomalies
Introduction
Coronary artery anomalies
Classification
Shepherd’s crook RCA
Coronary ostial stenosis or atresia (COSA)
Absent LMCA
Single coronary artery
High ‘take-off’
Anomalous origin of the left or right coronary artery from the pulmonary artery (ALCAPA/ARCAPA)
Anomalous origin of the coronary artery from a ventricle
Anomalous origin from opposite sinus/artery
Myocardial bridging
Duplication
Coronary arterial fistula
Aorto-atrial tunnel
Coronary arcade
Extracardiac termination
Kawasaki disease
Coronary venous anomalies
6.12. Systemic venous anomalies
Introduction
Anomalies of SVC
Anomalies of IVC
Anomalies of azygos venous system
Total anomalous systemic venous return
Anomalies of the ductus venosus
Miscellaneous
6.13. Imaging in ischaemic heart disease
6.13.1. CORONARY ARTERY CALCIUM SCORING
Introduction
Procedure and techniques
Role of coronary artery calcium scoring in coronary atherosclerosis
Pitfalls
Interpretation
Repeat coronary artery calcium testing
6.13.2. CORONARY CT ANGIOGRAPHY
Introduction
Interpretation of coronary artery disease on CTCA
Accuracy of CTCA in diagnosis of obstructive CAD
Assessment of noncoronary cardiac structures
Assessment of noncardiac structures
6.13.3. CMR IN ISCHAEMIC HEART DISEASE
Myocardial viability
Complications of myocardial infarction
Stress CMR for inducible ischaemia
Coronary artery imaging
Advances in cardiac imaging
Prognosis of ischaemic cardiomyopathy
6.14. Role of CMR in nonischaemic cardiomyopathies
Introduction
Classification
Cardiac MR protocols for cardiomyopathy assessment
CMR applications
Peripartum cardiomyopathy
Conclusion
6.15. Valvular heart diseases
Introduction
Mitral valve
Pulmonary valve
Tricuspid valve
Aortic valve
Prosthetic heart valve
Conclusion
6.16. Tumours of the heart
Introduction
Metastases
Myxoma
Lipoma and lipomatous hypertrophy of atrial septum
Papillary fibroelastoma
Rhabdomyoma
Fibroma
Teratoma
Haemangioma
Pericardial cyst
Sarcomas
Angiosarcoma
Rhabdomyosarcoma
Fibrosarcoma
Liposarcoma
Leiomyosarcoma
Primary osteosarcoma
Myxosarcoma
Undifferentiated sarcomas
Cardiac lymphoma
Paraganglioma
Mesothelioma
Conclusion
6.17. Pericardial diseases
Introduction
Normal pericardium
Pericarditis
Constrictive pericarditis
Pericardial effusion
Pericardial tumours
Absence of the pericardium
Summary
6.18. Imaging in heart transplant
Background
Acute rejection
Chronic rejection/cardiac allograft vasculopathy
Imaging modalities
Conclusion
6.19. Pulmonary vasculature
6.19.1. PULMONARY ARTERIAL HYPERTENSION
6.19.2. PULMONARY VENOUS HYPERTENSION
Imaging of pulmonary venous hypertension
Conclusion
6.19.3. ACUTE PULMONARY THROMBOEMBOLISM
Epidemiology and clinical presentation
Pretest probability and role of D-dimer
Role of imaging in diagnosis and management of acute PE
Diagnostic algorithm of acute PE
6.19.4. CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION
Epidemiology, pathology and clinical presentation
Role of imaging in diagnosis of chronic PE
Differential diagnosis of chronic PE
6.19.5. INTERVENTION IN THE PULMONARY THROMBOEMBOLISM
Role of catheter-directed intervention
Role of IVC filter
Role of balloon angioplasty
Role of bronchial artery embolization
Conclusion
6.19.6. IMAGING MANIFESTATIONS OF PULMONARY THROMBOEMBOLISM
Introduction
Chest radiography
Computed tomography pulmonary angiography
Dual-energy CT (DECT)
Ventilation/perfusion scan
Magnetic resonance imaging (MRI)
Lower extremity ultrasound
Computed tomography venography
Interventional radiology (IR) role in PE
PE in the paediatric population
COVID-19 and PE
Artificial intelligence (AI) in PE
Conclusion
MCQ
6.20. The role of interventional radiology in the management of pulmonary embolism
Introduction
Diagnosis and risk stratification
Imaging
Pathophysiology and risk factors
Treatment
Conclusion
6.21. Aortic abnormalities
Introduction
Acute aortic syndrome (AAS)
Traumatic aortic injury (TAI)
Aortic aneurysm
Preoperative evaluation
Imaging findings
Management
Vasculitis affecting aorta (aortitis)
Aortic occlusive disease
Management of aortic disease
Conclusion
6.22. Peripheral vascular diseases
6.22.1. PERIPHERAL ARTERIAL DISEASE: GENERAL CONSIDERATIONS
Introduction
Prevalence
Risk factors for atherosclerosis and PAD
Pathophysiology of PAD
Diagnosis
Treatment options and follow-up
Conclusion
6.22.2. ANATOMY OF EXTREMITY ARTERIES
Arterial anatomy of extremities
Upper limb arteries
Lower limb arteries
6.22.3. TECHNIQUE OF PERIPHERAL ARTERIAL DOPPLER EXAMINATION
Introduction
Instrumentation
Lower limb doppler evaluation
Upper limb doppler evaluation
6.22.4. DOPPLER ASSESSMENT OF UPPER LIMB ARTERIAL DISEASE
Introduction
Doppler assessment
Occlusive diseases
Atherosclerotic plaque, stenosis and occlusion
Thoracic outlet syndrome
Raynaud phenomenon
Arteritis
Thromboangiitis obliterans (Buerger disease)
Thromboembolic occlusion
Trauma
Aneurysm
Arteriovenous malformation
Post-treatment assessment
6.22.5. DOPPLER ASSESSMENT OF LOWER EXTREMITY ARTERIAL DISEASE
Introduction
Prevalence
Pathophysiology
Clinical presentation
Diagnostic tests
Role of imaging
Common pathologies affecting the lower limb arteries
Treatment of PAD
6.22.6. ROLE OF NONINVASIVE PROCEDURES AND IMAGING IN PLANNING AND MANAGEMENT OF PERIPHERAL ARTERIAL DISEASE
Introduction
Approach to a patient with lower extremity peripheral arterial disease
Noninvasive imaging modalities
Computed tomography angiography
Magnetic resonance angiography
Recent advances and novel developments in imaging of peripheral arterial disease
Conclusion
6.23. Peripheral vascular diseases: Veins
6.23.1. VENOUS ANATOMY OF UPPER AND LOWER EXTREMITIES
Introduction
Upper extremity vein
Lower extremity venous system
6.23.2. TECHNIQUE OF PERIPHERAL VENOUS DOPPLER STUDY
Anatomy of lower extremity veins
Factors influencing venous doppler imaging
Normal B-mode characteristics of a vein on ultrasound (Fig. 6.23.2.3A–G)
Scanning protocol
Systematic color doppler assessment of the venous system
Systematic assessment of the deep venous system
Systematic assessment of the superficial venous system
6.23.3. ACUTE VENOUS THROMBOSIS AND OTHER CAUSES OF LEG SWELLING
Introduction
Acute deep vein thrombosis
Differential diagnosis
Nonvascular causes of limb swelling
Conclusion
6.23.4. DOPPLER ASSESSMENT OF CHRONIC VENOUS INSUFFICIENCY
Introduction
Anatomy
Causes
Normal physiology
Pathophysiology
Risk factors
Clinical presentation
Anatomical considerations
Aims of color doppler
Doppler study
Primary varicose veins
Secondary varicose veins (Post-thrombotic syndrome)
Postablation
Recurrent varicose veins
6.23.5. DOPPLER EXAMINATION FOR PLANNING AND ASSESSMENT OF HAEMODIALYSIS ACCESS
Introduction
Preoperative mapping of vessels
Assessment of AVF for maturity
Complications
6.23.6. ROLE OF NONINVASIVE PROCEDURES IN PLANNING AND MANAGEMENT OF PERIPHERAL VENOUS DISEASE
Introduction
Approach to a patient with peripheral venous disease
Imaging modalities for diagnosis of peripheral venous disease
Imaging during treatment and follow-up
Future directions
Conclusion
6.24. Central and peripheral arterial interventions
6.24.1. SUPRA-AORTIC ARTERIAL INTERVENTIONS
Introduction to arteries
Internal carotid artery
Brachiocephalic diseases
Carotid stenosis
Subclavian occlusion
Vertebral artery stenosis/vertebrobasilar stroke
Stroke
Endovascular thrombectomy
6.24.2. INTERVENTIONS IN AORTIC ARCH ANEURYSMS
Introduction
Techniques in endovascular repair
Conclusion
6.24.3. VASCULAR ANATOMY
Aorta
Coeliac artery (SMA)
Superior mesenteric artery (SMA)
Inferior mesenteric artery
Renal artery
Main pulmonary artery (MPA)
Superior vena cava (SVC)
Inferior vena cava (IVC)
Superficial leg veins: Great and short saphenous vein (GSV and SSV)
6.24.4. PATHOPHYSIOLOGY OF ARTERIAL OCCLUSIVE DISEASE: Aortoarteritis/Fibromuscular Dysplasia/Atherosclerosis
Introduction
Atherosclerosis
Aortoarteritis
Fibromuscular dysplasia
6.24.5. ANGIOPLASTY: HOW IT WORKS
Introduction
History
Composition of atherosclerotic plaque
Angioplasty
Vascular access
Patient selection
Endovascular treatment options
Anatomy and lesion consideration
Planning the interventional procedure
Lesion
Choice of stent
Embolic protection device
Renal artery stenosis
Femoropopliteal anatomy
6.25. Peripheral arterial occlusive disease
6.25.1. AORTOILIAC INTERVENTIONS
Introduction
Clinical presentation
Rutherford classification for chronic limb ischaemia
Diagnosis
Indications
Contraindications
Treatment
Periprocedural care
Postprocedure follow-up and care
Follow-up
Complications
Conclusion (Fig. 6.25.1.4)
6.25.2. SUPERFICIAL FEMORAL ARTERY INTERVENTIONS
Introduction
Anatomy
Clinical presentation
Examination
Diagnostic modalities – USG/CT/MRI/Angio
Endovascular treatment options for the SFA in PAD
6.25.3. IN-STENT RESTENOSIS
Introduction
Pathophysiology
Risk factors
Classification
Incidence and clinical presentation
Endovascular revascularization treatment options
Postprocedure care
Outcomes and conclusion
6.25.4. REVASCULARIZATION ACROSS JOINTS
Dynamic changes to vessels secondary to posture
Considerations in revascularizations across joints
Conclusion
6.25.5. INFRAPOPLITEAL INTERVENTIONS
Introduction
Epidemiology and distinct nature of infrapopliteal peripheral arterial disease
Infrapopliteal arterial anatomy (refer Fig. 6.25.5.1)
Clinical evaluation
Imaging
Principle of recanalization
Complications
6.26. Venous interventions
6.26.1. VARICOSE VEINS
Introduction
Pathophysiology
Epidemiology
Signs and symptoms
Risk factors
Diagnosis
Treatment
6.26.2. ENDOVASCULAR MANAGEMENT OF ACUTE DEEP VEIN THROMBOSIS
Introduction
Preprocedure evaluation
Indications
Contraindications
Treatment
Postprocedure management
Results
Conclusion
6.26.3. CHRONIC LOWER-LIMB VENOUS THROMBOSIS AND ITS ENDOVASCULAR MANAGEMENT
Pathophysiology
Diagnosis
Risk factors for chronic venous thrombosis and PTS
Imaging in chronic venous thrombosis
Treatment
Endovascular treatment of chronic deep venous thrombosis and resultant obstructive syndrome
Complications
Summary and recommendations
6.26.4. MAY–THURNER SYNDROME
Introduction
Pathology
Clinical presentation
Differential diagnosis
Management
Endovascular interventions (refer Figs. 6.26.4.5 and 6.26.4.6)
Complications
Postprocedure management and follow-up
Conclusion
6.26.5. CENTRAL LINES AND PORTS
Introduction
Catheter selection
General principles
Central venous access devices
After-care
Key points to remember
6.27. Connective tissue disorders in CVS
Introduction
Role of imaging
Classification of connective tissue disorders
Conclusion
6.28. Newer imaging techniques in CT and MRI in cardiac imaging
Introduction
Newer advances in CT
Newer advances in MRI
Conclusion

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