Imaging in Critical Pulmonology

Abstract

Respiratory failure is a common life threatening problem that encounters the ICU physicians every day. So it is important to have good knowledge of different chest imaging studies. Chest imaging studies are essential aids to both diagnosis and evaluating responses to therapy. Good knowledge of thoracic anatomy and pathophysiology of respiratory failure improve ability of interpretation of different imaging studies and allow better understanding of disease process which help prevention and treatment of respiratory failure. Portable chest radiography plays a major role in critically ill patients' care. It is a rapid, non-invasive and reliable bedside investigation. It can demonstrate difference between nodular and diffuse pattern of lung infiltration. It is reliable in diagnosing pulmonary edema, pneumonia and atelectasis but CXR can miss small pleural effusion and small pneumothorax. Ultrasound is an immediate and accurate method of investigating the lung with accuracy close to that of CT. A simple device and a particular probe are required for lung examination. Ten signs allow detection of the precise location of the lung abnormalities. The BLUE-protocol proposes a step-by-step analysis, achievable in three minutes for diagnosing the cause of respiratory failure. Flexible bronchoscopy is a procedure that visualizes the lumen and mucosa of the trachea, proximal airways, and segmental airways to the third generation of branching. It can be used to diagnose or treat abnormalities within or adjacent to these airways. Computed tomography is generally considered to be the best imaging modality for the assessment of the lung parenchyma. High resolution computed tomography (HRCT) is able to provide very high morphological detail of the normal and abnormal lung parenchyma and has been widely accepted as the imaging gold standard for the lung parenchyma. MRI is an important tool in the evaluation of chest structures.It is useful in assessment of lung apices, pleural disease, diaphragm, and spinal column,local tumor extension and certain aspects of staging of bronchogenic carcinoma. So as we previously show we can conclude that better understanding and interpretation of different imaging study of the chest will definitely helpbetter understanding, handling, and management of respiratory failure. This better handling will allow a possible important reduction of mortality and morbidity.