MR imaging of the chest: Mediastinum and chest wall

This review presents the options and limitations of MRI in non-vascular diseases of the mediastinum and the chest wall. In numerous thoracic pathologies, MRI is a useful supplement to spiral CT. This imaging procedure also allows a contrast-media-free differentiation of solid tumors and vascular lesions (e. g., aortic aneurysms). The advantages of MRI over CT are particularly useful when multiplanar tumor imaging is required prior to surgery to establish the exact spatial relationship between tumor and the other mediastinal structures. Primary indications for MRI in diseases of the mediastinum and chest wall are therefore: (a) tumors of the posterior mediastinum for determining their position in relation to the neural foramina and the spinal canal; (b) chest wall tumors; (c) preoperative multiplanar imaging of primary mediastinal tumors; and (d) contraindications against CT exams with iodine contrast media.     

胸部X线摄影术与CT诊断胸壁结核的对照研究

目的评价胸部X线摄影术及CT在胸壁结核诊断中的价值。方法对21例经手术、穿刺活检证实的胸壁结核作了影像学分析，其中男8例，女13例，年龄在19—84岁，中位年龄34岁；全部病例均作了胸部X线摄影术和CT扫描，9例作了增强CT扫描。结果（1）胸部X线平片仅4例显示骨质破坏。（2）CT平扫则全部可见肋骨旁软组织肿块；16例边缘密度较高，中央密度较低，3例呈较高密度中有多发低密度，2例呈均匀较低密度。5例肋骨破坏，3例为膨胀性溶骨性骨破坏。增强扫描时8例肿块呈边缘强化。（3）21例CT所见的胸壁肿块，胸片均未能发现（X^2=42．000，P〈0．01）；4例CT上可见的4个纵隔及腋窝肿大淋巴结，胸片上均未能见到（X^2=4．421，P〈0．05）；2种影像学检查差异具有统计学意义。结论CT，特别是增强CT扫描是确诊本病的首选方法。     

Trauma of the chest

Trauma to the chest may cause a wide range of injuries including fractures of the thoracic skeleton, contusion or laceration of pulmonary parenchyma, damage to the tracheobronchial tree, diaphragmatic rupture or cardiac contusion. Conditions affecting primarily extrathoracic sites may have indirect effects on the lungs causing adult respiratory distress syndrome or fat embolism. Laceration of the aorta is the typical and likewise most life threatening complication of massive blunt chest trauma necessitating immediate diagnosis and repair.Conventional radiography rather than cross-sectional imaging is the mainstay in diagnosing thoracic trauma. During the critical phase with often concomitant shock, pelvic and spinal injuries tailored radiographic views or even upright chest radiographs are impractical. The severely traumatized patient is usually radiographed in the supine position and suboptimal roentgenograms may have to be accepted for several reasons. It is well documented that many abnormalities detected on CT were not apparent on conventional radiographs, but CT is reserved for hemodynamical stable patients. Nevertheless certain situations like aortic rupture require further evaluation by CT and aortography.The value of conventional radiography, CT, MRI and aortography in chest trauma is reviewed and typical radiographic findings are presented.     

Tuberculosis of the chest

The relationship between tuberculosis and mankind has been known for many centuries, with the disease being one of the major causes of illness and death. During the early 1980s, there was a widespread belief that the disease was being controlled, but by the mid-1980s, the number of cases increased. This change in the epidemiological picture has several causes, of which the AIDS epidemic, the progression of poverty in developing countries, the increase in the number of elderly people with an altered immune status and the emergence of multidrug-resistant tuberculosis are the most important. Mainly due to this epidemiological change, the radiological patterns of the disease are also being altered, with the classical distinction between primary and postprimary disease fading and atypical presentations in groups with an altered immune response being increasingly reported. Therefore, the radiologist must be able not only to recognize the classical features of primary and postprimary tuberculosis but also to be familiar with the atypical patterns found in immuno-compromised and elderly patients, since an early diagnosis is generally associated with a greater therapeutic efficacy. Radiologists are, in this way, presented with a new challenge at the beginning of this millennium.     

Pediatric chest ultrasound

Ultrasound examination of the thorax can be quite rewarding in children, because their unique thoracic anatomy provides many acoustic windows into the chest. With only a modest effort, chest ultrasonography can provide many clinically relevant answers, without the radiation exposure from CT, or the need for sedation sometimes required for CT and MR imaging.     

Interventional chest radiology

The authors review the various interventional radiology techniques currently used in 1996 by a Medico-Radio-Surgical team. CT guided needle biopsy has an important place in the diagnostic approach to parenchymal as well as mediastinal tumours. But CT guidance allows also routine drainage of thoracic collections and sometimes thoracic sympatholysis. Superior vena cava and tracheobronchial stenting are palliative treatments as the percutaneous aspergilloma treatment. Embolization of bronchial and thoracic systemic arteries are also palliative buot effective therapeutic procedures as well as vasoocclusion for arterio-venous fistulae.     

X线平片与CT扫描对胸部外伤的诊断价值

目的分析胸部外伤的X线与CT表现类型并评价其诊断价值。方法回顾性分析60例临床胸部外伤患者的X线平片及CT表现。结果 60例中,皮下气肿见于38例,骨折55例,胸膜伤38例,肺损伤48例,创伤湿肺22例,肺不张9例,纵隔伤15例。伴发其他部位的损伤包括颅脑损伤42例,椎体及附件骨折20例,腹腔积血32例。结论 X线平片及CT扫描在胸部外伤中具有重要的诊断价值,X线平片可作为常规检查及随访的最主要影像技术,而CT对探测或判定胸外伤具有更高的敏感性和特异性,应作为重要补充。     

Interventional chest radiology

Radiologically guided percutaneous drainage procedures are commonly performed to manage a variety of intrathoracic collections. As a natural extension of similar procedures performed for abdominal and pelvic collections, these procedures use both the conventional and cross-sectional imaging modalities to detect intrathoracic collections and to guide safe percutaneous diagnostic aspiration and drainage. The high-resolution images obtainable on current computed tomographic and ultrasound units allow detection of lung abscesses, empyemas, malignant effusions, and infected mediastinal fluid collections that are amenable to percutaneous drainage. Advances in catheter design and introduction techniques have allowed drainage of collections previously managed by open procedures. The case of fluoroscopically guided catheter placement for treatment of spontaneous or biopsy-induced pneumothorax has provided a safe, effective, and comfortable alternative to blind large-bore surgical tube placement.

Transthoracic needle biopsy of lung, mediastinal, and pleural or chest-wall masses has resulted from the availability of image intensifiers and cross-sectional imaging modalities useful in guiding needle placement and tissue sampling. Equally important has been the development of cytopathology as a subspecialty that can provide diagnoses of malignant and benign thoracic conditions from needle aspirates. This technique has had a major impact on the preoperative evaluation of the patient with a solitary pulmonary nodule and has eliminated unnecessary surgery in a significant percentage of such patients.

Transcatheter arterial embolization has made a significant contribution to the management of the patient with massive hemoptysis and is the procedure of choice for treatment of pulmonary arteriovenous malformations. A thorough knowledge of the vascular anatomy of the thorax and expertise in catheterization and embolization techniques are prerequisites for the safe performance of these procedures.     

The neonatal chest

Lung diseases represent one of the most life threatening conditions in the newborn. Important progresses in modern perinatal care has resulted in a significantly improved survival and decreased morbidity, in both term and preterm infants. Most of these improvements are directly related to the better management of neonatal lung conditions, and infants of very low gestational ages are now surviving. This article reviews the common spectrum of diseases of the neonatal lung, including medical and surgical conditions, with emphasis to the radiological contribution in the evaluation and management of these infants. Imaging evaluation of the neonatal chest, including the assessment of catheters, lines and tubes are presented.