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Diagnostic Radiology: Chest and Cardiovascular Imaging
Niranjan Khandelwal, Veena Chowdhury, Arun Kumar Gupta, Sanjiv Sharma, Anjali Prakash
CHEST IMAGING: TECHNIQUES, NORMAL ANATOMY AND BASIC PATTERNS IN CHEST DISEASES
1:
Chest X-ray: Techniques and Anatomy
INTRODUCTION
CONVENTIONAL CHEST RADIOGRAPHY
Technical Advances
High kV Technique
New Screen Film Combinations
BEAM EQUALIZATION RADIOGRAPHY
DIGITAL RADIOGRAPHY
Digital Radiography and Chest
RADIOGRAPHIC PROJECTIONS
Posteroanterior View (PA View)
Patient Positioning
Patient Respiration
Film Exposure
Kilovoltage
Grids and Filters
Lateral View
Anteroposterior View (AP View)
Decubitus View
Lordotic View
Oblique View
SPECIAL RADIOGRAPHIC TECHNIQUES
Inspiratory-Expiratory Radiography
Valsalva and Müller Maneuvers
Bedside/Portable Radiography
NORMAL ANATOMY ON CHEST X-RAY
Trachea
Tracheobronchial Divisions
Lungs
Bronchopulmonary Segments
Hilum and Pulmonary Vasculature
Pleura
Mediastinum
Mediastinal Lines and Interfaces
Heart
Diaphragm
CONCLUSION
2:
MDCT Chest: Techniques and Anatomy
INTRODUCTION AND TECHNIQUES
COMPUTED TOMOGRAPHY
Indications for CT of the Chest
Definition of Spiral Pitch
Dose Considerations
Intravenous Contrast Medium Enhancement
Window Settings
HIGH RESOLUTION COMPUTED TOMOGRAPHY (HRCT)
Sequential HRCT Protocol
Volumetric HRCT Protocol
Volumetric Standard CT Protocol
Volumetric Low Dose CT Protocol
Pediatric MDCT Chest
ANATOMY
Tracheobronchial Tree
Lungs
Mediastinum
Esophagus
Lymph Nodes
Mediastinal Spaces
3:
Basic Patterns of Lung Diseases
PATTERN RECOGNITION
High Resolution CT Patterns of Disease
LUNG DISEASES THAT INCREASE RADIOGRAPHIC DENSITY
Predominantly Airspace Disease
Parenchymal Consolidation
Radiographic Criteria of Airspace Disease
The Airspace Nodule
Coalescence
Distribution Characteristics
Margination
Air Bronchogram
Time Factor
Parenchymal Atelectasis
Maintenance of Lung Volume
Resorption Atelectasis
Passive Atelectasis
Adhesive Atelectasis
RADIOGRAPHIC SIGNS OF ATELECTASIS
Direct Signs
Indirect Signs
Local Increase in Density
Elevation of the Hemidiaphragm
Mediastinal Displacement
Compensatory Overinflation
Displacement of the Hila
Changes in the Chest Wall
Predominantly Interstitial Disease
Radiographic Patterns of Diffuse Interstitial Disease
Reticular Pattern
Nodular Pattern
Reticulonodular Pattern
Linear Pattern
Combined Airspace and Interstitial Disease
General Signs in Diseases that Increase Radiographic Density
Characteristics of the Border of a Pulmonary Lesion
Changes in Position of Interlobar Fissures
Cavitation
Calcification and Ossification
Bullae and Cysts
Distribution of Disease within the Lungs (Anatomic Basis)
Radiologic Localization of Pulmonary Disease (The Silhouette's Sign)
Line Shadows
Tubular Shadows (Bronchial Wall Shadows)
Parenchymal Scarring
Line Shadow of Pleural Origin
Horizontal or Obliquely Oriented Linear Opacities of Unknown Nature
HIGH RESOLUTION CT SCAN FINDINGS MANIFESTING AS INCREASED LUNG OPACITY
Linear Abnormalities
Interlobular Septal Thickening
Parenchymal Bands
Subpleural Lines
Reticular Abnormalities
Ground-Glass Opacity
Consolidation
LUNG DISEASES THAT DECREASE RADIOGRAPHIC DENSITY
Increased Air but Unchanged Blood and Tissue
Increased Air with Decreased Blood and Tissue
Normal Amount of Air but Decreased Blood and Tissue
Reduction in All Three Components
RADIOGRAPHIC SIGNS
Alteration in Lung Volume
General Excess of Air in the Lungs
Local Excess of Air
Static Signs
Dynamic Signs
Alteration in Vasculature
General Reduction in Vasculature
Local Reduction in Vasculature
Pulmonary Air Cysts
HIGH-RESOLUTION CT SCAN FINDINGS MANIFESTING AS DECREASED OPACITY
Areas of Decreased Attenuation with Walls
Bronchiectasis
Honeycomb Pattern
Cystic Pattern
Areas of Decreased Attenuation without Walls
Emphysema
Mosaic Perfusion and Inhomogeneous Lung Opacity
Normal Inspiratory Scans with Air Trapping on Expiratory Imaging
Multi Detector CT (MDCT) in Assessment of Diffuse Lung Disease
CONCLUSION
PULMONARY INFECTIONS AND THE PULMONARY INTERSTITIUM
4:
Radiographic Manifestations of Pulmonary Tuberculosis
INTRODUCTION
NEW CONCEPT OF RADIOLOGIC MANIFESTATIONS OF PULMONARY TB
RADIOLOGICAL PATTERNS OF PULMONARY TB
Typical Radiological Patterns of Primary TB
Postprimary TB or Phtysis
Radiological Patterns Encountered in Both Primary and/or Postprimary TB
Miliary TB
Exudative Pleuritis
Tracheobronchial TB
Tuberculoma
Complications and Sequelae of Pulmonary TB
Atypical Patterns
PET/CT IN TUBERCULOSIS
5:
Nontubercular Pulmonary Infections
INTRODUCTION
IMAGING MODALITIES
RADIOGRAPHIC PATTERN
ETIOPATHOGENESIS OF PULMONARY INFECTIONS
SPECIFIC PNEUMONIAS
Bacterial Pneumonias
Pneumococcal pneumonia
Staphylococcal Pneumonia
Gram-negative Pneumonias
Chlamydia Pneumonia
Anaerobic Pneumonias
Actinomycosis
Mycoplasma Pneumonia
Viral Pneumonia
Influenza Virus
Respiratory Syncytial Virus (RSV)
Varicella
Adenovirus
FUNGAL INFECTIONS
Opportunistic Invaders
Aspergillosis
Cryptococcosis
Primary Pathogens
Histoplasmosis
Coccidioidomycosis
PARASITIC INFECTIONS
Protozoal Infections
Metazoal Infestations
Roundworm, Hookworm and Strongyloides Infections
Filariasis
Echinococcus Infection/Hydatid Disease
COMPLICATIONS OF PNEUMONIA
Pleural Effusion and Empyema
Hydropneumothorax
Pneumatoceles
Abscess
Bronchiectasis
Miscellaneous Complications
Delayed Resolution of Pneumonia
INTERVENTIONAL PROCEDURES IN THE PATIENTS WITH PNEUMONIA
CONCLUSION
6:
Imaging of the Tracheobronchial Tree
INTRODUCTION
IMAGING MODALITIES
Chest Radiograph
Computed Tomography (CT)
Acquisition
Axial CT Images
Advanced Reconstruction Techniques
NORMAL AIRWAY ANATOMY
Anatomic Variants
TRACHEOBRONCHIAL LESIONS
Central Airways
Tracheobronchomalacia
Strictures
Inflammatory Tracheal Stenosis due to Tuberculosis
Fungal Infections
Postintubation Stenosis
Neoplasms of Tracheobronchial Tree
Malignant Tumors
Benign Tumors
Miscellaneous
Mucous Plug/ Mucoid Pseudotumor
Broncholithiasis
Tracheopathia Osteoplastica
Tracheo-esophageal Fistulas
Diffuse Diseases Involving Tracheobronchial Tree
Amyloidosis
Relapsing Polychondritis
Sarcoidosis
Wegener Granulomatosis
Saber Sheath Trachea
Peripheral Airways
Bronchiectasis
Congenital Airway Wall Abnormality
Tracheobronchomegaly (Mounier-Kuhn Disease)
Williams-Campbell Syndrome
Congenital Bronchial Atresia
Acquired Wall Abnormalities
Mucociliary Clearance Abnormalities
Hyperimmune Response
Small Airway Disease/Bronchiolitis
Cellular Bronchiolitis
Bronchiolitis Obliterans with Intraluminal Polyps
Obliterative or Constrictive Bronchiolitis
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
CONCLUSION
7:
Imaging of Interstitial Lung Disease
PLAIN RADIOGRAPHY
High Resolution CT (HRCT)
Anatomy of The Secondary Pulmonary Lobule
SARCOIDOSIS
Imaging Features
CONNECTIVE TISSUE DISEASE ASSOCIATED INTERSTITIAL LUNG DISEASE
RHEUMATOID ARTHRITIS ASSOCIATED INTERSTITIAL LUNG DISEASE
Imaging Features
PROGRESSIVE SYSTEMIC SCLEROSIS
Imaging Features
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Imaging Features
HYPERSENSITIVITY PNEUMONITIS
Imaging Features
SILICOSIS AND COAL WORKER'S PNEUMOCONIOSIS
Imaging Features
ASBESTOSIS
LYMPHANGIOLEIOMYOMATOSIS
Imaging Features
LANGERHANS CELL HISTIOCYTOSIS (LCH)
Imaging Features
PULMONARY ALVEOLAR PROTEINOSIS
Imaging Features
IDIOPATHIC INTERSTITIAL PNEUMONIAS
IDIOPATHIC PULMONARY FIBROSIS
Imaging Features
NONSPECIFIC INTERSTITIAL PNEUMONITIS
Imaging Features
CRYPTOGENIC ORGANIZING PNEUMONIA
Imaging Features
RESPIRATORY BRONCHIOLITIS–ASSOCIATED INTERSTITIAL LUNG DISEASE
Imaging Features
DESQUAMATIVE INTERSTITIAL PNEUMONIA
Imaging Features
LYMPHOID INTERSTITIAL PNEUMONIA
Imaging Features
ACUTE INTERSTITIAL PNEUMONIA
Imaging Features
8:
Pulmonary Manifestations in Immunocompromised Host (HIV and Solid Organ Transplant Patients)
INTRODUCTION
HIV/AIDS
Systematic Approach to Imaging Diagnosis
Imaging Methods
Radiological Pattern Approach to Diagnosis
Normal Chest Radiograph
Ground Glass Opacities
Consolidation
Multiple Pulmonary Nodules
Lymphadenopathy
Pleural Effusion
NON-HIV IMMUNOCOMPROMISED HOSTS
Imaging Approach
BACTERIAL INFECTIONS
PNEUMOCYSTIS JEROVECI PNEUMONIA
MYCOBACTERIAL INFECTIONS
HIV/AIDS Patients
HIV Negative Immunocompromised Patients
VIRAL INFECTIONS
FUNGAL INFECTIONS
NONINFECTIOUS MANIFESTATIONS OF AIDS
Kaposi's Sarcoma (KS)
Lymphoma
Lymphocystic Interstitial Pneumonitis (LIP)
Post-transplant Lymphoproliferative Disorder (PTLD)
CONCLUSION
9:
Chest in Immunocompromised Host (Hematological Infections and Bone Marrow Transplant)
INTRODUCTION
COMPLICATIONS NOT SPECIFIC TO HSCT
Infections
Bacterial Pneumonia
Pneumocystis Jiroveci Pneumonia
Fungal Infections
Tuberculosis
Drug Toxicity
Pulmonary Hemorrhage
COMPLICATIONS SPECIFIC TO HSCT
Infections
Cytomegalovirus Pneumonia
Pulmonary Edema
Idiopathic Pneumonia Syndrome
Bronchiolitis Obliterans
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
Radiation Injury
Spontaneous Pneumothorax
MEDIASTINUM, LUNG NODULES AND MASSES
10:
Imaging the Mediastinum
INTRODUCTION
IMAGING MODALITIES
Chest Radiograph
Computed Tomography (CT)
Magnetic Resonance Imaging
DIFFERENTIAL DIAGNOSIS OF MEDIASTINAL MASSES
ANTERIOR MEDIASTINUM
Lesions of Thymus
Thymic Rebound
Thymic Hyperplasia
Thymoma
Germ Cell Tumors
Thyroid Mass
Parathyroid Adenoma
Lymphangioma (Cystic Hygroma)
Other Vascular Tumors
Pericardial Cyst
MIDDLE MEDIASTINUM
Bronchogenic Cyst
Esophageal Duplication Cyst
Neurenteric Cyst
Esophageal Lesions
POSTERIOR MEDIASTINUM
Neurogenic Tumors
Peripheral Nerve Tumors
Tumors from Sympathetic Ganglia
Paraganglioma
Lateral Thoracic Meningocele
Paraspinal Infection
Extramedullary Hemopoiesis
Mediastinal Varices
MULTICOMPARTMENT MEDIASTINAL MASSES/LESIONS
Mediastinal Lymphadenopathy
Tuberculosis
Sarcoidosis
Lymphoma
Metastasis
Vascular Lesions
Aortic Aneurysm
Aortic Dissection
Superior Vena Cava Obstruction
Abnormalities of the Mediastinal Fat
Mediastinal Lipomatosis
Lipoma
Herniation of Abdominal Fat
MISCELLANEOUS LESIONS OF THE MEDIASTINUM
Mediastinal Hemorrhage
Pneumomediastinum
Acute Mediastinitis
Fibrosing Mediastinitis
CONCLUSION
11:
Imaging of Solitary and Multiple Pulmonary Nodules
MORPHOLOGIC CHARACTERISTICS OF SPN
Size
Shape
Location
Edge Characteristics
INTERNAL CHARACTERISTICS OF A SPN
Calcification
Calcification in a Benign Nodule
Indeterminate Calcification
Fat
Nodule Attenuation
Cavitation
Air Bronchograms and Pseudocavitation
Air Crescent Sign
Air Fluid Level
Satellite Nodules
Feeding Vessel Sign
Positive Bronchus Sign
INDETERMINATE SOLITARY PULMONARY NODULE
Contrast Enhancement/Hemodynamic Characteristics on Dynamic Helical CT
Growth Rate Assessment
VOLUME QUANTIFICATION ON CT/THREE–DIMENSIONAL EVALUATION
COMPUTER AIDED DIAGNOSIS (CAD)
IMAGE REGISTRATION
Bayesian Analysis
Decision Analysis
FDG Positron Emission Tomography
Biopsy
Transthoracic Needle Aspiration Biopsy (TNAB)
Fiberoptic Bronchoscopy (FOB)
Video Assisted Thoracic Surgery
NEWER TECHNIQUES FOR THE EVALUATION OF SPN
Dynamic MR Imgaing
Diffusion Weighted MRI Imaging
Dual Energy CT in the Evaluation of SPN
DIFFERENTIAL DIAGNOSIS OF SOLITARY PULMONARY NODULE73
Malignant Neoplasm
Benign Neoplasm and Neoplasm Like Condition
Infective Causes
Inflammatory (Noninfectious)
Airway and Inhalational Disease
Vascular Lesions
Congenital Lesions
Idiopathic/Miscellaneous
MORPHOLOGICAL CHARACTERISTICS IN SPECIFIC LESIONS
Malignant Lesions
Lung Malignancies
Lymphoma
Metastatic Neoplasm
Carcinoid Tumor
Benign Neoplasms
Pulmonary Hamartoma
Other Benign Tumors
Infective Causes
Granuloma
Mycetoma
Hydatid Cyst
Round Pneumonia
Lung Abscess
Inflammatory (Noninfectious)
Rheumatoid Nodules
Airway or Inhalational Disease
Lipoid Pneumonia
Vascular Lesions
Pulmonary Artery Aneurysm
Pulmonary Vein Varix
Arteriovenous Malformation
Pulmonary Infarction
Congenital Lesions
Pulmonary Bronchogenic Cyst
Sequestration
Miscellaneous
Round Atelectasis
MULTIPLE PULMONARY NODULES
MORPHOLOGICAL CHARACTERISTICS IN SPECIFIC CAUSES
Metastatic Lung Nodules
Kaposi's Sarcoma
Sarcoidosis
Rheumatoid Nodules and Caplan Syndrome
Progresive Massive Fibrosis
Wegener's Granulomatosis
Septic Emboli with Infarction
Arteriovenous Malformation
Amyloidosis
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
CONCLUSION
12:
Lung Malignancies
INTRODUCTION
PATHOLOGY
CLINICAL FEATURES
IMAGING FEATURES
Peripheral Tumors
Central Tumors
Methods to Establish Tissue Diagnosis
STAGING OF NSCLC
Imaging Work-up for the Staging of NSCLC
Mediastinal Invasion
CHEST WALL INVASION
Pancoast Tumor
Lymph Node Staging
Additional Lung Nodules
Pleural Effusion
Distant Metastases
PET in Management of Lung Cancer
Bronchoalveolar Carcinoma
TREATMENT OF NSCLC
Follow-up Imaging
Recurrent Lung Cancer
SCREENING FOR LUNG CANCER
NEUROENDOCRINE TUMORS OF THE LUNG
Bronchial Carcinoid
Small Cell Lung Cancer
Treatment of Neuroendocrine Tumors
RARE LUNG MALIGNANCIES
LUNG METASTASES
Detection of Lung Metastases
Lymphangitis Carcinomatois
Treatment of Lung Metastases
LYMPHOMA OF THE LUNG
EMERGENCY CHEST
13:
Intensive Care Chest Radiology
INTRODUCTION
CHEST X-RAY IN IMAGING OF ICU PATIENTS
Atelectasis
Aspiration Pneumonitis
Pneumonia
Hydrostatic Pulmonary Edema
CT in Hydrostatic Pulmonary Edema
Non-cardiogenic Pulmonary Edema
Pulmonary Embolism
Barotrauma
Pulmonary Interstitial Emphysema
Pneumomediastinum
Pneumothorax
Subcutaneous Emphysema
Support and Monitoring Apparatus
Respiratory Support
Endotracheal and Tracheostomy Tube
Intravascular Catheters
Central Venous Line
Swan-Ganz Catheter
ULTRASOUND IN IMAGING OF ICU PATIENTS
CT SCAN IN IMAGING OF ICU PATIENTS
14:
Imaging in Pulmonary Thromboembolism
INTRODUCTION
PLAIN RADIOGRAPHS
PULMONARY ANGIOGRAPHY
Echocardiography
D-dimer
Scintigraphy
Duplex Ultrasound and Compression Ultrasound of Lower Limbs
COMPUTERIZED TOMOGRAPHY (CT)
Spiral CT
Technique
VASCULAR FINDINGS
PARENCHYMAL FINDINGS
Acute Thromboembolism
Chronic Thromboembolism
Acute Versus Chronic Thromboembolism
PITFALLS IN DIAGNOSIS OF PULMONARY EMBOLISM
EFFICACY AND ACCURACY OF MDCT
ISOLATED SUBSEGMENTAL PULMONARY EMBOLISM
CT VENOGRAPHY
MAGNETIC RESONANCE IMAGING (MRI)
MR Venography
IMAGING-GUIDED INTERVENTION IN THE MANAGEMENT OF PULMONARY THROMBOEMBOLISM
Pulmonary Embolism in Pregnancy
ACKNOWLEDGMENTS
15:
Imaging in Thoracic Trauma
INTRODUCTION
PULMONARY PARENCHYMAL INJURIES
Pulmonary Contusion
Pulmonary Laceration
Aspiration Pneumonitis
Atelectasis
Traumatic Lung Herniation
PLEURAL INJURIES
Pneumothorax
Hemothorax
INJURIES OF THE MEDIASTINUM
Tracheobronchial Injury
Esophageal Injury
Pneumomediastinum
Vascular Injury
Cardiac and Pericardial Injury
INJURY OF DIAPHRAGM
Injury of Chest Wall
CONCLUSION
PLEURA AND DIAPHRAGM
16:
Pleura
INTRODUCTION
IMAGING MODALITIES
PLEURAL EFFUSION
Types of Effusion: Exudates and Transudates
Exudates
Transudate
Fibrin Body
IMAGING IN PLEURAL EFFUSION
Plain Radiographs
USG OF PLEURAL EFFUSION
COMPUTED TOMOGRAPHY
PLEURAL EFFUSION OR ASCITIS
Loculated Pleural Fluid (Encysted/Encapsulated)
MRI OF PLEURAL EFFUSION
Specific Causes of Pleural Effusion
Parapneumonic Effusion with Empyema9–14
Organization Stage (Pleural Peel)
Empyema Necessitans
Tube Drainage of Empyema
BRONCHOPLEURAL FISTULA (BPF)
Postsurgical BPF
Infective BPF
PLEURAL THICKENING
Visceral Pleural Thickening
Pleural Apical Cap and Fibrous Thickening
Pleural Thickening
MIMICS
PLEURA AND ASBESTOSIS18–19
ASBESTOSIS PSEUDOTUMOR (ROUND ATELECTASIS)
PLEURAL CALCIFICATION
PNEUMOTHORAX
Spontaneous Pneumothorax
Primary Spontaneous Pneumothorax
Secondary Spontaneous Pneumothorax
Pneumothorax Ex-Vacuo
Traumatic Pneumothorax
Catamenial Pneumothorax
IMAGING FINDINGS
X-ray
Upright Patient
Supine Patients
Ultrasonography
Computed Tomography
Tension Pneumothorax
SIZE OF PNEUMOTHORAX21
PLEURAL NEOPLASM
Pleural or Extra Pleural
Pleural Effusion
Pleural Thickening
MESOTHELIOMA (MALIGNANT PLEURAL MESOTHELIOMA-MPM)23–24
Radiographic Findings
USG
CT
MRI
Positron Emission Tomography
Localized Fibrous Tumor
Pleural Metastasis
Pleural Lymphoma
17:
Imaging of the Diaphragm and Chest Wall
DIAPHRAGM
Anatomy
Imaging Modalities
Plain Radiograph
Ultrasonography (USG)
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Radionuclide Scan
Normal Variants
Accessory Diaphragm
Elevated Hemidiaphragm
Unilateral Elevation
Bilateral Elevation
Low Lying Diaphragm
Inversion of the Diaphragm
Peridiaphragmatic Collections
DIAPHRAGMATIC MOVEMENTS
Diaphragmatic Hernias
Bochdalek Hernia
Morgagni Hernia
Intrapericardial Hernia
Diaphragmatic Injury
Tumors of the Diaphragm
CHEST WALL
Congenital and Developmental Anomalies
Inflammatory and Infectious Diseases
Tumors of the Chest Wall
Malignant Chest Wall Tumors
INTERVENTIONS IN CHEST
18:
Bronchial Artery Embolization
INTRODUCTION
Pathophysiology and Etiology
DIAGNOSTIC WORK-UP
Conventional Radiography (Figures 18.2A to C)
Fiberoptic Bronchoscopy (FB)
Computed Tomography (CT) (Figures 18.1 A to D and 18.3A to E)
BRONCHIAL ARTERY ANATOMY
NONBRONCHIAL SYSTEMIC ARTERY ANATOMY
TECHNIQUE OF BRONCHIAL ARTERY EMBOLIZATION
RESULTS
COMPLICATIONS
CONCLUSION
19:
Diagnostic and Therapeutic Interventions in Chest
INTRODUCTION
IMAGE GUIDANCE MODALITIES
Nonvascular Interventions
Transthoracic Needle Biopsy of Pulmonary Lesions
Indications
Patient Evaluation
Contraindications
Image Guidance
Biopsy Technique
Complications
Results
Transthoracic Needle Biopsy from Other Sites
Percutaneous Needle Biopsy of the Pleura
Localization of a Nodule for Thoracoscopic Resection
Diagnostic Thoracocentesis
PERCUTANEOUS DRAINAGE OF PLEURAL SPACE FLUID COLLECTIONS
Pleural Sclerotherapy or Pleurodesis
Pneumothorax Drainage
Lung Abscess Drainage
Mediastinal Abscess Drainage
Pericardial Effusion Drainage
Pneumatocele and Bulla Drainage
SECONDARY PULMONARY ASPERGILLOMA
Endoluminal Tracheobronchial Stenting
RADIOFREQUENCY ABLATION OF LUNG LESIONS
VASCULAR INTERVENTIONS
Pulmonary Artery Embolization
Endovascular Therapy of SVC Obstruction
Percutaneous Vascular Foreign Body Retrieval
CONCLUSION
CARDIOVASCULAR IMAGING: CARDIAC IMAGING
20:
Chest X-ray Evaluation in Cardiac Disease
INTRODUCTION
CARDIAC SILHOUETTE
Cardiac Shape
Cardiac Contour
Posteroanterior (PA) View
Right Anterior Oblique View
Left Anterior Oblique View
Lateral View
Cardiac Size
Cardiac Volume
Assessment of Chamber Enlargement
Right Atrium
Left Atrium
Left Ventricle
Right Ventricle
Aorta
PULMONARY VASCULATURE
Normal Radiographic Anatomy
Increased Pulmonary Blood Flow (Pulmonary Plethora)
Radiological Signs of Plethora (Figure 20.6)
Decreased Pulmonary Blood Flow (Pulmonary Oligemia)
Radiological Signs (Figure 20.7)
Pulmonary Arterial Hypertension (Figure 20.8)
Pulmonary Venous Hypertension (PVH)
Stage 1: Redistribution/Cephalization of the Blood Flow (Figure 20.9)
Stage 2: Interstitial Edema (Figure 20.10)
Stage 3: Alveolar Edema (Figure 20.11)
Asymmetrical Pulmonary Blood Flow (Figure 20.12)
Orientation of Pulmonary Outflow Tract
21:
Imaging in Ischemic Heart Disease
INTRODUCTION
PATHOPHYSIOLOGY OF ISCHEMIC HEART DISEASE
Myocardial Ischemia
Myocardial Viability and Myocardial Infarction (MI)
Rationale for Ischemia and Viability Imaging
Imaging Modalities
ECHO
Nuclear Imaging
CMR
Imaging Sequences
Stress CMR
CMR for Viability
CMR for Myocardial Mass and Function
Other Useful Sequences
Multidetector Computed Tomography
Limitations of MDCT
Evaluation of Various Components of IHD
Coronary Artery Imaging
Plaque Imaging
Detection of Myocardial Ischemia
Myocardial Viability
Myocardial Function
FUTURE DIRECTIONS
Appropriateness Criteria for use of Cardiac MDCT and CMR in the Investigation of IHD
CONCLUSION
22:
Imaging Approach in Children with Congenital Heart Disease
INTRODUCTION
PHYSICAL EXAMINATION
RADIOLOGICAL APPROACH
Chest Radiograph
Left-to-Right (L-R) Shunt
Large Aorta
Normal Aorta
Pre-tricuspid Shunt
Post-tricuspid L-R Shunt
Right-to-Left (R-L) Shunt
Large Aorta with Decreased Lung Vascularity
Small Aorta with Increased Vascularity
Large Pedicle with Increased Vascularity
Normal Aorta with Decreased Lung Vascularity
Other Conditions
MULTISLICE CARDIAC CT
CARDIAC MRI
Analyzing CT or MRI Images
Anatomy
Normal Connections
Cardiac Tumors
Follow-up after Surgery or after Endovascular Intervention
CARDIAC CATHETERIZATION
23:
Imaging in Cardiomyopathies
INTRODUCTION
CLASSIFICATION
DIAGNOSTIC TECHNIQUES
DILATED CARDIOMYOPATHY (DCM)
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy (RCM)
Amyloidosis
Sarcoidosis
Siderotic (or Iron Overload) Cardiomyopathy
Endomyocardial Fibrosis (EMF)
Anderson-Fabry Disease (AFD)
Tuberculosis
CONCLUSION
24:
Imaging Evaluation of Cardiac Masses
INTRODUCTION
CLINICAL FEATURES
Imaging Techniques
Angiocardiography
ECHO
MDCT
MRI
MR Imaging Sequences for Evaluation of Cardiac Masses
Spin Echo (SE) Sequences
Gradient Echo (GRE) and Steady State Free Precession (SSFP) Sequences
Contrast-enhanced Imaging
Other Techniques
Classification (Table 24.1)
NEOPLASTIC LESIONS OF THE HEART
Primary
Benign Tumors
Malignant Tumors
Secondary Neoplasms
Paracardiac and Extracardiac Tumors
NON-NEOPLASTIC LESIONS
Thrombus
Aneurysm of Sinus of Valsalva (SOV)
Atrial Septal Aneurysm
Pleuro-pericardial Cyst
Infective Lesions
Valvular Vegetation
Hydatid Cyst
Tuberculoma
VARIANT AND NORMAL ANATOMICAL STRUCTURES SIMULATING A CARDIAC MASS
Pericardium
Left Atrium
Left Ventricle
Right Atrium
Right Ventricle
CONCLUSION
25:
Imaging Diagnosis of Valvular Heart Disease
INTRODUCTION
AORTIC VALVULAR DISEASE
MITRAL VALVULAR DISEASE
TRICUSPID VALVULAR DISEASE
HEMODYNAMIC EFFECTS ON PULMONARY VASCULATURE
Associated Pulmonary Pathologies
Effects of Treatment During Follow-up
Heart Size
Left Atrial Size
Other Changes
ECHOCARDIOGRAPHY
Valvular Stenosis
Valvular Regurgitation
Infective Endocarditis
Prosthetic Valves
CARDIAC MAGNETIC RESONANCE (CMRI)
Valve Leaflet Morphology
Valvular Stenosis
Valvular Regurgitation
Valve Endocarditis and Tumors
Prosthetic Valve
COMPUTED TOMOGRAPHY
ANGIOCARDIOGRAPHY
CONCLUSION
26:
Imaging of the Pericardium
INTRODUCTION
ANATOMY
Transverse Sinus
Superior Aortic Recess
Inferior Aortic Recess
Right and Left Pulmonic Recesses
Oblique Sinus
Recesses of the Pericardial Cavity Proper
Right and Left Pulmonary Venous Recesses
Postcaval Recess
PHYSIOLOGY
CONGENITAL PERICARDIAL ANOMALIES
Pericardial Cysts
CONGENITAL ABSENCE OF THE PERICARDIUM
PERICARDIAL EFFUSION
Cardiac Tamponade
Pericarditis
Nonconstrictive Pericarditis
Constrictive Pericarditis
Pneumopericardium
PERICARDIAL TUMORS
Metastases
Primary Pericardial Tumors
CONCLUSION
NUCLEAR MEDICINE
27:
Nuclear Medicine in CVS and Chest
NUCLEAR MEDICINE IN CVS AND CHEST
MYOCARDIAL PERFUSION IMAGING
Radiopharmaceuticals
Rationale of Myocardial Perfusion Imaging
Study Protocol for Stress MPI
Clinical Indications of Myocardial Perfusion Imaging
Detection of Coronary Artery Disease
Assessment of Prognosis and Risk Stratification
Evaluation of Myocardial Perfusion after Revascularization
Detection of Myocardial Viability
RADIONUCLIDE VENTRICULOGRAPHY
Patient Preparation
Data Acquisition
Interpretation
Clinical Application
Chemotherapy Toxicity
Coronary Artery Disease
Cardiomyopathy
CARDIAC POSITRON EMISSION TOMOGRAPHY
Clinical Application of Cardiac PET
Diagnosis of CAD
Assessment of Myocardial Viability
NEW DIRECTIONS IN NUCLEAR CARDIOLOGY
LUNG VENTILATION: PERFUSION IMAGING
Lung Perfusion Scan
Ventilation Scan
Interpretation of V-Q Scan for Pulmonary Embolism
Current Status and Future Developments in V-Q Imaging
POSITRON EMISSION TOMOGRAPHY IN LUNG CANCER
Patient Preparation for F-18 FDG Study
PET-CT in Solitary Pulmonary Nodules (SPN)
PET-CT in Staging Lung Cancer
Restaging and Assessment of Response to Therapy
PET in Radiotherapy Planning
VASCULAR IMAGING
28:
Imaging of Aorta
INTRODUCTION
ANGIOGRAPHIC ANATOMY
The Measurement (Diameter) of Aorta
Normal Anatomic Variations
Indications for Imaging the Aorta
IMAGING MODALITIES
Ultrasound (US)
Transesophageal Echocardiography (TEE)
Intravascular Ultrasound (IV US)
Computed Tomography (CT)
Conventional Technique
Spiral/Helical Technique
The Limitations Include
Magnetic Resonance Imaging (MRI) and MR Angiography
Black Blood Imaging
White Blood Imaging
Contrast MR Angiography
Catheter Angiography
Technique
Complications of Angiography
CONGENITAL AORTIC ANOMALIES
Aortic Arch Anomalies
Coarctation of Aorta
Associated Anomalies
Hemodynamics in Adults
Radiological Findings
Conventional X-ray Chest
Noninvasive Imaging
ACQUIRED AORTIC DISEASES
Aortic Aneurysms
Incidence
Classification
Growth Rates of Aneurysm and Risk of Rupture
Objectives of Imaging
Plain Radiography
Ultrasound (US)
CT and MRI
Catheter Angiography
AORTIC DISSECTION
Classification
Imaging
Aortography
CT
Precontrast Images
Postcontrast Images
MRI
TAKAYASU'S ARTERITIS
Types31
Imaging Findings
AORTIC TRAUMA
Grading of Aortic Injuries37
Imaging
CT
MRI
ATHEROSCLEROSIS
Pathology
Imaging
Postoperative Aorta
CONCLUSION
29:
Imaging of Peripheral Vascular Disease
EVALUATION OF THE PERIPHERAL ARTERIAL SYSTEM
Imaging Modalities
Ultrasound and Doppler Scanning
Arterial Flow Patterns on Spectral Doppler
CT Angiography (CTA)
MR Angiography (MRA)
Conventional Angiography/DSA9,10
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (PAOD)
Clinical Features
Radiological Evaluation
Angiography
LOWER LIMB ARTERIOGRAPHY9
Arteritis9,10
Upper Extremities20,21
Treatment
Evaluation of Bypass Grafts10,22–24
Acute Limb Ischemia9,10,20,25
Etiology
Clinical Features
Imaging
Angiography
Thoracic Outlet Syndrome (TOS)20,22,24
Clinical Features
Imaging
Aneurysms
Pseudoaneurysms
Vascular Malformations9,20,26,29
Capillary Malformations
Venous Malformations
Arteriovenous Malformations
Arteriovenous Fistulae (AVF)23,24
Dialysis Fistulae
Trauma9,10,20,21
EVALUATION OF THE PERIPHERAL VEINS
Lower Extremity
Acute Deep Venous Thrombosis
Sonography and Color Doppler Flow Imaging
Color Doppler Flow Imaging
Upper Extremity DVT (UE – DVT)20,24,32,33
Acute vs Chronic DVT
CT Venography33,34
MR and MR Venography33–36
Venography30,31,35
Chronic Venous Disease30,37,38
Imaging
Sonography
Perforating Veins
Venography
Venous Mapping
OTHER DISORDERS
Venous Aneurysms30,31
CONCLUSION
INDEX
TOC
Index
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