Thoracic Imaging in the ICU
Section snippets
Portable chest radiograph
The CXR is one of the most commonly requested radiographic examinations and is an integral supplement to the physical examination in the critically ill patient. At their institution, the authors perform, on average, 250 portable CXRs per day, half of which are on adult patients in the ICU. They are readily available, easy and quick to perform at the patient's bedside, and much less expensive than any other imaging modality. The CXR plays a key role in aiding diagnosis and management and
Picture archiving and communication systems
Before the introduction of CR and PACS, radiology departments struggled to offer prompt, reliable access to ICU CXRs; a certain number of films would be lost either temporarily or permanently when frustrated clinicians would remove them from the radiology department for rounds and patient management. This occasionally would result in overlooking subtle but important findings and delay the radiologist's interpretation, potentially resulting in a negative impact on patient care.
The introduction
Chest radiographs: technical issues
The quality of the portable CXR can be highly variable, ranging from good to uninterpretable. Obtaining diagnostic quality studies on unstable, uncooperative patients, or patients who have numerous support devices poses unique challenges to the technologist and is not always possible. There are limitations to obtaining quality portable CXRs, including the inability of critically ill patients to cooperate, the nature of the ICU environment with critically ill patients (some on life-support
Chest CT
Chest CT plays a crucial role in the care of the critically ill patient. A study performed by Miller and colleagues [33] concluded that the most common indications for requesting a CT scan were sepsis of unknown origin, evaluation of pleural effusion, evaluation of patient with malignancy, and assessment of complications of thoracic surgery. At the authors' institution, approximately 25 chest CTs are performed on ICU patients per month. It is not uncommon for the clinicians to request a CT in
Pulmonary edema
Pulmonary edema can be divided into two categories depending on its etiology: cardiogenic or noncardiogenic (Fig. 5). In the ICU setting, the most common causes of pulmonary edema are CHF, fluid overload, and damage to the pulmonary microvasculature resulting in capillary leak edema [5]. There are many causes of noncardiogenic edema, some of which include uremia, sepsis, neurogenic, trauma, drug overdose, toxic fume inhalation, and near-drowning.
Cardiogenic edema can be graded as mild,
Summary
ICU radiology plays an integral role in the care of the most critically ill patients in the hospital. Although there are limitations to the portable CXR, on a routine basis, it serves as an indispensable tool in evaluating these patients, especially when the physical examination is difficult to perform or noncontributory. A systematic approach should be applied when interpreting these films, and knowledge of the radiographic features of the disease states common to this group of patients is of
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