Interpretation of CT chest1.0

Interpretation of CT chest v1.0

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Interpretation of CT chest / Description

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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
Interstitial disease
Aortic Dissection
Mediastinal Masses
Mediastinal abnormalities
Nodules and Masses
Abnormalities of the Diaphragm
Pleural effusion
Plueral Diseases
Lung Fields Abnormalities
Pulmonary emphysema
Diaphragmatic hernia
Pericardial effusion
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.

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