Impact of Lung Imaging on Clinical Decision Making in Critically ill Patients An Essay Submitted for partial fulfillment of the Master Degree in intensive care medicine Submitted by Ahmed Abdelnaby Elsaid Raby M.B.B.Ch, Supervised by Prof. Dr. Sherif Farouk Ibrahim Professor of Anesthesia, Intensive care and Pain Management Faculty of medicine – Ain Shams University. Prof. Dr. SaharKamal Hasanin Professor of Anesthesia, Intensive care and Pain Management Faculty of medicine – Ain Shams University. Dr. Rasha Mahmoud Hassan lecturer of Anesthesia, Intensive care and Pain Management Faculty of medicine – Ain Shams University. Faculty of Medicine Ain Shams University 2016

Abstract

Radiologic imag¬ing relies on the change of morphology of any of the anatomic structures in the chest to detect and char¬acterise disease. For this reason, a good knowledge of thoracic anatomy and pathophysiology of respiratory failure improves the ability of interpretation of different imaging studies and allow better understanding of disease process which helps prevention and treatment of respiratory failure. The most frequently used primary imaging technique to examine the chest is the chest X-Ray. It is widely available, fast and relatively cheap. Many diseases can be diagnosed or excluded with a chest radiograph, for example pneumonia, pneumothorax or fluid overload due to heart problems. Ultrasound is also becoming more widely accessible, along with the ensuing benefits in diagnosis and treat¬ment. Ultra¬sound is mainly used for pleural diseases (e.g. character¬isation of pleural fluid) or diseases that are located close to the chest wall. Ultrasound is an immediate and accurate method of investigating the lung with accuracy close to that of CT. CT is superior to chest radiogra¬phy at detecting small lesions and characterising them. That’s because CT has a higher spatial resolution and it does not produce a shadow image like a chest radio¬graph. It creates a true cross-sectional image that does not suffer from superimposition of various structures. Certain diseases such as pulmonary embolism require to confirm the diagnosis by the CT pulmonary angiography. Magnetic resonance imaging (MRI) of the lung is emerging as a valuable lung imaging modality, together with x-ray and CT. It offers a unique combination of morphological and functional information in a single examination without any radiation burden to the patient. Chest imaging, and imaging in general, serves many goals. It is initially used to diagnose or exclude a disease. During this process, imaging is frequently only one of many components and is combined with information provided by the physical examination, patient history, laboratory results and pathological findings, in order to come to the right diagnosis. Once a diagnosis has been made, imaging can be used to show the response to treatment.