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Copyrighted Material INDEX Abscess, 92 fi rst radiographic abnormalities, Absorption 81 coeffi cient, 7 infi ltrates, 153–154 of scatter, 9 mortality rates, 81 Acute lung injury (ALI), 79–81, 83 radiographic appearance of, Acute myocardial infarction, 73, 76, 81–83 151. See also Myocardial recovery phase, 85 infarction severe, 83 Acute respiratory distress Adenopathy, 18 syndrome (ARDS) Adhesive atelectasis, 90 case studies, 152–158 AIDS patients, 65, 141 characteristics of, 50, 60, 70, Air alveolograms, 137, 140 78–79 Air bronchograms, 18, 60–61, co-existing pneumonia, 157–158 63–64, 79, 82–85, 90–93, 138, CT scans, 83–84 142, 153–154 defi ned, 80COPYRIGHTEDAir cysts, MATERIAL 55 diagnosis, 80–81 Air-fl uid levels, 44 etiologies, 80, 82–83 Air space density, 78 exudate phase of, 81–82 Air to tissue ratio, 47 ICU Chest Radiology: Principles and Case Studies, by Harold Moskowitz Copyright © 2010 John Wiley & Sons, Inc. 171 172 INDEX Airway obstruction, 21 development of, 60, 63 Alignment, grid-x-ray beam, 9, 11 effusion distinguished from, 92 Allergic pneumonitis, 128 etiologies, 25, 90 Alveoli incidence of, 90 air conditions, 46 left lung, 170 capillary membrane, 82–83 lobar, 93, 120 consolidation, 65 lower lobe, 120, 129 densities, 16, 78, 155–156, 158 obstructive, 90–91 distension of, 50, 83 passive, 90–92 edema, 71–72, 75–76 peripheral subsegmental, 93 overinfl ation of, 50 plate-like, 93 Aneurysms, 19, 89 pneumonia associated with, Angel wings, 75–76 93–94, 163 Angiograms radiographic appearance of, coronary, 166 93–94 selective pulmonary, 114 treatment of, 77 Angiography, 88, 160, 166 upper lobe, 151 Angle of acceptance, 11–12 Atomic number, 7 Angulation, 11 Atrial septal defect (ASD), 125 Anterior posterior (AP) position, 8 Atria, 19, 77, 92, 125 Aorta, 19, 42, 52, 115 Auricle, 77 Arch of the aorta, 19 Automatic processing, 12 Arrhythmias, 28, 37 Artery(ies) Bacteria common carotid, 52 Cryptococcus, 68 coronary, 19 Klebsiella pneumonia, 63–64 innominate, 52 Legionella, 58 mammary, 115 Pneumocystis carinii pneumonia, pulmonary, 19, 36–37, 42, 70, 77, 65, 141 113–115, 164 Pseudomonas, 63 subclavian, 42, 52, 72–73 Staphylococcus aureus, 57–58, 88, Aspergillus, 58, 68 119 Aspiration, tube placement and, 26, Streptococci, 88 34 Balloon pumps, intra-aortic, 22, 37, Asthma, 74 41–43 Atelectasis Barotrauma adhesive, 90 case studies, 126–133 basilar, 61 defi ned, 46 case studies, 121, 129, 161–170 impact of, 81 cicatricial, 90, 92–93 interstitial emphysema, 54–55 compressive, 90, 92, 112 pneumomediastinum, 52, 55 CT scan, 66, 92, 167 pneumonia, 126 INDEX 173 pneumothorax (PTX), 47–52 Bypass surgery positive end expiratory pressure cardiac, 110, 116 (PEEP) ventilation, 46–47, mammary artery, 115 83–84 positive pressure ventilation Calcifi cations, 18 (PPV), 46 Candida pneumonia, 58 secondary, 83 Capillary pressure, 72 subcutaneous emphysema, 55–56 Carcinoma tension pneumothorax, 50, 53–54 of the breast, 140 ventilator-induced, 50 bronchogenic, 31 Basement membrane, 70, 83 of the colon, 138 Bat wings, 75–76, 146 of the lungs, 123 Bilateral confl uent densities, 84 Cardiac asthma, 74 Bipolar catheter, 43 Cardiac border, 18–19, 95–96, 110, Bipolar pacemaker, 43–45 136, 139, 150, 162, 168 Bleeding, see Hemorrhage Cardiac catheterization, 47, 111 thoracotomy tubes, 33 Cardiac contour, 16 variceal, 38 Cardiac shadow, 16–17, 19, 72, Blood 94–95, 131 fl ow, 50, 73 Cardiac silhouette, 52, 72 oxygenation, infl uential factors, Cardiogenic pulmonary edema, 46 70–71, 77, 82 transfusions, 80 Cardiomegaly, 8, 72, 74, 113, 150, Bony structures, 7, 18. See also 166 specifi c types of vertebrae Cardiopulmonary status, 5 Breathing guidelines Cardiothoracic ratio, 72 expiration, 6, 17 Cardiovascular collapse, 50 inspiration, 6, 8, 15, 17 Carina, 21–23, 26, 77 negative-pressure, 53 Case studies Bronchi acute respiratory distress characteristics of, 18 syndrome, 152–158 major, 52 atelectasis, 161–170 right main stem, 23 barotrauma, 126–133 upper lobe, 77 pneumonia, 134–144 Bronchial intermedius, 165 pulmonary edema, 145–151 Bronchieatasis, 85 pulmonary embolus, 152–160 Bronchiectosis, 89 tubes, lines, and catheters, Bronchopneumonia, 63–65 109–125 Bronchopulmonary fi stula, 31 Catheters Bronchoscopy, 59, 91, 96 bipolar, 43 Bucky, defi ned, 10 case studies, 113–114 Bucky, Gustav, 10 central venous, 26–30 174 INDEX Catheters (cont’d) Congestive heart failure, 71, 77–78, knotting of, 38 81 location of, 9, 14 Congestive myopathy, 146–147 placement of, 27 Connective tissue, 54 Swan-Ganz, 36–38, 70, 92, 113, Consulting physician, 13 115, 117–118, 120 Contrast, 7, 13, 66 triple lumen, 27 Contusions, pulmonary, 60 Central venous catheters Conventional radiography, 12–13 complications of, 27, 29–30 Coronary angiography, 166 indications for, 26 Coronary arteries, 19 misplacement of, 28–29 Coronary artery disease, 146–147, placement from left side, 29 166 placement from right side, Costophrenic sulcus, 18, 51–52, 26–28 121 venous anatomy, 27 Critically ill patients Cephalization, 73, 75, 78, 146 breathing, 6, 17 Cervical vertebrae, 18 challenges of, 5 Chemical processing, 12 dialysis for, 27 Chest tissue, interstitial, 51 immunocompromised, 58 Chest tube, 53, 55–56. See also immunodepressed, 87 Thoracotomy tubes mechanical ventilation, 21, 26, 46, Chronic obstructive lung disease, 50, 58, 91 77, 118, 121, 130, 132 positioning of, 6, 8, 16, 47, 54, 61, Chronic obstructive pulmonary 77 disease (COPD), 17, 71–72, quality of care, 14 135–136 size of, 8 Clavicles, 16, 28 Cross-hatched grids, 11 Coalescence, 154–155 Cross-table lateral view, 48 Common carotid artery, 52 Cuffi ng Communications peribronchial, 75 clinical-radiologist, 14 perivascular, 73–74, 77, 146 consulting physicians, 13 Cytomegalovirus (CMV), 65 physician-radiologist, 14 recordkeeping guidelines, 7, 14 Decubitus view, 48, 77 team conferences, 14 Deep sulcus sign, 121, 130 Computed tomography (CT) scan, Defi brillators, 43–45, 111–112 3, 34, 65–66, 78, 83, 88–89 Density Computer radiography, 12–13 abnormal, 18 Computerized tomography measurement of, 7 angiogram (CTA), 88 signifi cance of, 5, 7–8, 14, 68, 78, Congestion, 149 83–84, 93, 95, 110, 117, 120, 139 Congestive failure, 150–151 triangular, 86–87 INDEX 175 Developer solutions, 12 malposition of, 25 Diabetes, 58 placement of, 20–23, 36, 58–59, Dialysis patients, 27 140 Diaphragm, 18, 47, 50, 91, 94, 96, postintubation x-ray, 25 117, 122 removal of, 118 Digital radiography, 12–14 Esophageal gastric junction, 138 Dmax, 7 Esophagus, 25, 52, 116, 1 40 Dmin, 7 Exit beam, 9 Dobhoff tubes, 34–35, 138 Expiratory fi lm, 17, 30 Draining tubes, 116 Exposure Drug abuse, 87, 144 distance and, 9 Drug toxicity, 70 grids and, 13 Dynamic range, 13 infl uential factors, 8 signifi cance of, 15–17 Echocardiogram (ECG), 41, 144 Edema, pulmonary. See Pulmonary Fat embolism, 87 edema Feeding tubes. See Nasogastric Effusion (NG) tubes atelectasis distinguished from, 92 Fiber optic bronchoscopy, 59 pleural, 36, 75, 77, 91, 96, 112 Fibrillation pulmonary emboli, 87 atrial, 125 Emboli, septic, 30, 66–67, 87–88, ventricular, 111 144 Fibrosis, 18, 77, 93, 118, 127, 147 Emphysema Film etiologies, 25, 34 AP, 77, 94 interstitial, 54–55 contrast, 7, 13, 66 mediastinal, 51, 129, 137, 155 conventional systems, 12 subcutaneous, 46, 55–56, 67, 84, daily, 25 132 expiratory, 17, 30 Endobronchial obstruction, 91 fogging of, 12 Endocarditis, 68, 87–88, 144 follow-up, 8 Endocardium, 43, 68, 87–88, 144 high resolution, 7, 14 Endothelial damage, 28, 37 lateral, 33–34, 44 Endotracheal tubes (ETTs) low resolution, 7 case studies, 110, 129–130, 132, PA, 75, 77 142–143, 146, 154, 156, 168–169 processing, see Processing complications from, 24–26, 118 approaches daily fi lms of, 25 quality of, 4–6, 9–10 displacement of, 25 noise, 7, 13 extubation, 23 resolution, types of, 7, 13–14 improper placement of, 23 spatial resolution, 7, 13 infl ation of, 24 system speed, 8 176 INDEX Focused grid strips, 11 pulmonary edema, 70 Follow-up fi lms, 8 shift of structures, 94 Fungal diseases, 65 Heimlich tube, 136 Gallstones, 18 Hematoma, 28, 33 Gas exchange, 21 Hemidiaphragm, 17, 49, 60, 62, 91, Gas gangrene, 44 124, 129, 136, 138–139, 162, Gastrointestinal (GI) tract, 164 166, 168 Goodpasture syndrome, 89 Hemithorax, 47, 124, 163–164 Grafts, 18 Hemopericardium, 44 Gram negative pneumonias, 57–58, Hemorrhage 61 indications of, 39, 60, 79 Great vessels, 52 intrapulmonary, 113 Grid ratio, 10–12 pulmonary, 87, 89 Grids Herniation, 164, 167 alignment and, 9, 11 Hiatal hernia, 167 angulation, 11 High resolution, 7, 14 computerized radiography and, Histoplasmosis, 65, 68 13 Homeostasis, 72 conventional, 10 Hospital information system (HIS), cutoff, 9, 11 14 ideal, 11 Hyaline membrane objections to, 9 disease, 155 scatter and, 11–12 implications of, 82–83 signifi cance of, 8–9 Hydrostatic pulmonary edema, types of, 9–11 69–71, 79 width of, 11 Hyperinfl ation, 23 Hypertension Hampton hump, 86–87 pulmonary, 18, 70–71, 73 Head, in endotracheal tube venous, 77 placement, 22–23 Hypoxia, 81 Health hazards, 12 Heart, see specifi c parts of heart ICU anatomy ancillary personnel, 12 cardiac output, 36 patients in, see Critically ill cardiac size, 18, 26, 75–76 patients cardiac valves, 19 personnel, roles of, 6 cardiovascular collapse, 50 physician, 14 chamber enlargement, 18–19, rounds in, 14 146, 150 Image characteristics of, 52 acquisition systems, 14 density of, 7 degradation factors, 10 enlarged, 44, 92 manipulation of, 13 INDEX 177 navigation, 13 end-diastolic pressure, 73–74 postprocessing, 13 enlargement of, 77 quality, infl uential factors, 12–13 failure of, 70–71 receptor, 8 size of, 75 sharpness, 7–8 Lesions, nodular, 65, 67 transmission, 13 Level measurement, 13 Immunocompromised patients, 58 Linear grids, 11 Immunodepressed patients, 87 Lines Immunosuppressant therapy, 58 case studies, 109–112 Impaction, mucoid, 91 Kerley, 71, 74–75, 149 Infected endocarditis, 87 picc, 27 Infection, 25, 29–30, 44, 54, 58–59, removal of, 6 87 replacement of, 111 Intensive care unit.
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