Handbook of Chest Radiology

I. General Techniques A. Studies-how to; uses; special considerations 1. CXR a. PA and Lateral b. AP c. Obliques d. Apical lordotic e. Lateral Decubitus f. Inspiratory/Expiratory views 2. Fluoroscopy a. Diaphragm motion b. Foreign body aspiration c. Localization of opacities d. Localization during biopsy 3. CT a. Conventional b. Use of intravenous contrast c. High-resolution CT d. Spiral or helical CT B. Integration of data derived from imaging studies with history, physical exam, and laboratory data II. Lungs A. Anatomy 1. Lobes/segments 2. Interstitium 3. Airspaces 4. Secondary pulmonary lobule B. Diseases of the airspaces 1. Radiologic characteristics - pattern recognition 2. Pneumonia 3. Edema a. Cardiogenic b. Noncardiogenic 1. Neurogenic 2. Re-expansion 3. Upper airway obstruction 4. High-altitude 4. Aspiration-bland, gastric contents, foreign body 5. Hemorrhage 6. Atelectasis/drowned lung 7. Miscellaneous a. Lipoid pneumonia-endogenous, exogenous b. Alveolar proteinosis c. Bronchiolitis obliterans with organizing pneumonia d. Eosinophilic pneumonia e. Neoplasm-bronchioloalveolar carcinoma, lymphoma f. Pseudoalveolar disease-sarcoidosis C. Diseases of the interstitium 1. Radiologic characteristics-pattern recognition a. Morphology (reticular, nodular, reticulonodular) b. Chronology- acute, subacute, chronic c. Distribution-central vs. Peripheral, basilar vs upper lobe vs diffuse d. Associated findings-adenopathy, pleural effusions/calcification e. When both alveolar and interstitial disease are present, the interstitial abnormality may be obscured by the alveolar process and become invisible 2. Pulmonary edema 3. Atypical pneumonia 4. Miliary infection-tb, histo 5. Pulmonary fibrosis 6. Pneumoconiosis 7. Lymphangitic spread of carcinoma 8. Sarcoidosis 9. Eosinophilic granuloma-Langerhans cell histiocytosis D. Miscellaneous 1. Nodules/Masses-nodules may be either interstitial or alveolar a. Solitary nodule/mass b. Multiple nodules/masses 2. Cavities-including bullae a. Solitary b. Multiple 3. Radiation change 4. Abnormalities of vascular distribution III. Pleura A. Anatomy 1. Visceral/Parietal 2. Fissures 3. Accessory Fissures B. Pneumothorax effects of position C. Soft tissue abnormalities in the pleura/pleural space 1. Radiographic differences between pleural/extrapleural soft tissue processes and pulmonary parenchymal abnormalities 2. Pleural fluid collections a. Freeflowing fluid 1. Effects of gravity 2. Use of decubitus views b. Loculated fluid collections 1. Use of sonography 2. Use of CT 3. Bronchopleural fistula 4. Percutaneous catheter drainage 3. Pleural plaques/masses a. Noncalcified 1. Asbestosrelatedbenign 2. Mesothelioma 3. Metastases 4. Lymphoma b. Calcified 1. Asbestosrelated 2. Empyemahealed 3. Hemothoraxresolved 4. Miscellaneous a. Postthoracotomy 1. Normal course 2. Abnormal courseinfection, hemorrhage, bp fistula recurrent tumor 3. Obliteration of postop space IV. Mediastinum and hili A. Anatomy 1. Anterior 2. Middle 3. Posterior 4. Superior 5. Hilipulmonary arteries B. Techniques for evaluating 1. CXR 2. CT 3. MR 4. US 5. Ba Swallow 6. Angiography C. Disorders of the Superior mediastinum D. Disorders of the Anterior Mediastinumthe Four T's E. Disorders of the Middle Mediastinumheart, esophagus, aorta F. Disorders of the Posterior Mediastinumspine, paraspinal soft tissues G. Disorders of the Hili V. Chest Wall A. Anatomyspine, fascia, fat, ribs, muscle B. Soft tissue abnormalities 1. Abnormal lucency 2. Abnormal density 3. Foreign bodies C. Ribs 1. Congenital anomalies 2. Fractures 3. Tumorsprimary (benign, malignant), metastatic 4. Infection D. Spine 1. Congenital abnormalities 2. Developmental abnormalities scoliosis 3. Trauma 4. Infection Tbc, bacterial 5. Neoplasm 6. Pagets 7. Renal disease 8. Sickle cell anemia VI. Airways A. Anatomy 1. Tracheadimensions 2. Carina 3. Mainstem and lobar bronchi B. Techniques for evaluation 1. CXR 2. CT 3. FOB C. Disorders of size 1. Too big a. Tracheo/bronchomalacia b. Tracheobronchomegaly c. Bronchiectasis 2. Too small a. Stenosispostintubation, tuberculosis b. Croup/epiglottitis c. Tumorendobronchial/extrinsic D. Disorders of position E. Disorders of density F. Bronchiolitis VII. Diaphragm A. Anatomy 1. Position 2. Configuration B. Abnormalities of position 1. Too high a. Paralysis b. Volume loss in thorax c. Volume increase in the abdomen 2. Pseudoelevation a. Subpulmonic effusion b. Right middle and lower lobe atelectasis c. Tumorof the diaphragm, pleura or thymus (thymoma) 3. Too low a. Hyperinflation b. Inversioneffusion C. Abnormalities of contour 1. Eventration 2. Hernia 3. Traumatic rupture VIII. Chest Trauma A. Airextrapulmonic B. Airway C. Aorta D. Parenchyma 1. contusion 2. laceration 3. fat embolism 4. drowning/near drowning E. Spine/ribs F. Diaphragm IX. ICU radiography A. Lines and tubes B. Barotrauma C. ARDS X. The postoperative chest A. Thoracic surgery 1. Pneumonectomy 2. CABG B. Nonthoracic surgery XI. The immunocompromised host A. NonHIV B. HIV+ XII. Bronchogenic carcinoma A. Screening - detection B. Diagnosis - needle aspiration biopsy C. StagingCT/MRI/PET D. Followup XIII. Physical agents A. Drug-induced pulmonary disease B. Radiation C. Pneumoconiosis D. Hypersensitivity pneumonitis XIV. The pediatric chest A. Normal neonate 1. normal anatomy 2. pifalls B. Abnormal neonatecauses of respiratory distress 1. transient tachypnea of the newborn 2. pulmonary edema 3. shunts 4. CAM 5. CLE 6. congenital diaphragmatic hernia C. The infant D. The older child 1. bronchiolitis 2. pneumonia round 3. tuberculosis 4. aspirated foreign body 5. epiglottitis 6. croup