Interpretation of CT chest

Tomografia computerizzata del torace: principi di base

chest ct scan

chest ct sectional

ct chest

ct chest atlas

ct chest interpretation

Key points

Computed tomography (CT) scans can detect pathology that may be missed on a conventional chest radiograph.

Clinicians need to be aware of the potentially harmful radiation that patients are exposed to, with each individual CT scan that is performed.

The benefits and risks of i.v. contrast should be discussed with the radiologist before the scan. Not all i.v. access is suitable for administration of contrast media.

Other imaging modalities such as MRI and ultrasound can confer specific advantages to diagnosis in certain conditions.

A detailed knowledge of the anatomy of the thorax is required to fully interpret a CT scan of the chest.

The conventional chest radiograph superimposes a three-dimensional image onto a two-dimensional surface, so limiting its clinical usefulness. Since its introduction in 1971, X-ray computed tomography (CT) has rapidly evolved into an essential diagnostic imaging tool that forms a cross-sectional image, avoiding the super-imposition of structures that occurs in conventional chest imaging, with a >10-fold increase in attenuation sensitivity. Although CT imaging is reported by radiologists, it is important for both anaesthetists and intensivists to be able to interpret the scans, as reporting facilities may not be immediately available. Furthermore, the radiologist may not fully report all facets of a detailed scan and further information may be acquired by a physician with the ability to interpret CT scans. This is the first in a series of two articles written for anaesthetists and intensivists covering both thoracic anatomy and pathology as it relates to CT.

A comprehensve CT Chest app that include chest anatomy and pathollogy as well as various CT chest types

CT Chest Types

CT Chest Anatomy

CT Chest Interpretation

Abnormalities of the Trachea

Abnormalities of the Lung Hilum

Consolidation

Interstitial disease

Atelectasis

Aortic Dissection

Mediastinal Masses

Mediastinal abnormalities

Nodules and Masses

Abnormalities of the Diaphragm

Pleural effusion

Pneumothorax

Plueral Diseases

Lung Fields Abnormalities

Pulmonary emphysema

Diaphragmatic hernia

Cardiomegaly

Pericardial effusion

Pneumomediastinum

Subcutaneous emphysema

Indications for CT chest

There are many indications for a CT chest. CT is the gold standard investigation for diagnosis of pulmonary embolus and after major trauma, CT of the head, neck, and body is now mandatory. In thoracic anaesthesia, preoperative CT scans of the chest are invaluable for planning the insertion of a double-lumen tube. On the intensive care unit (ICU), they are not just used to diagnose conditions such as interstitial lung disease, atypical infection, and acute respiratory distress syndrome (ARDS) but can help detect small or anterior pneumothoraces and evaluate loculated pleural effusions that can aid interventional strategies. Other imaging modalities should always be considered as they may confer certain advantages. Magnetic resonance imaging (MRI) is increasingly used for evaluation of structural and functional cardiac pathology. Positron emission tomography (PET), or PET CT confers advantages for diagnosis of malignant tumours or metastatic disease. Ultrasound (US) scan use is increasing on the ICU for echocardiography, lung ultrasound, and before percutaneous tracheostomy insertion. US has the major advantage of being deliverable at the point of care and is relatively safe with an absence of radiation exposure.