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Females have unique physiological considerations that must be considered during image acquisition and interpretation. Familiarity with imaging of pregnant and lactating patients requires modifications from standard protocols to mitigate radiation-induced risk to both the mother and the fetus. Manifestations in the chest related to conception, pregnancy, and gynecologic pathologies are female-specific. Furthermore, there are a number of conditions that exclusively or disproportionately affect females, including diffuse lung diseases. Here, we review the expected normal findings and variant appearances of diseases in female patients on chest imaging to help the radiologist arrive at the correct diagnosis and avoid diagnostic pitfalls. In addition, the general principles of thoracic imaging in women of reproductive age are discussed.

Smooth muscle conditions of the chest have diverse clinical and imaging manifestations and may involve nearly every thoracic structure. Differentiation among these conditions requires the integration of clinical, radiologic, and histopathologic data. Histologic examination in conjunction with immunohistochemistry is essential for differentiation from other spindle cell neoplastic mimics. Familiarity with these entities will ensure the inclusion of smooth muscle conditions in the differential diagnosis of thoracic soft tissue lesions and potentially guide the clinician in appropriate management. We review the clinical, imaging, and histopathologic features of thoracic smooth muscle-related conditions organized by the anatomic structures affected.

Radiology is unique compared with most other medical specialties in that care can sometimes be delivered without speaking to or touching the patient. Although radiologists have increasingly become involved in patient safety, quality improvement, informatics, and advocacy, they must still work harder than other medical specialties to be considered "patient-facing." While cardiothoracic radiologists have likely experienced fewer opportunities to directly interface with patients, shared decision-making with patients around lung cancer screening and radiation dose optimization are both excellent examples of patient-centered and family-centered care in cardiothoracic imaging. Many cardiothoracic examinations necessitate medication administration or customized breath-holds not required of other examinations and create an opportunity for discussion between cardiothoracic radiologists and patients. Opportunities to increase the patient-centered focus in radiology exist at every interface between the radiology practice and the patient. Implementing the principles of patient-centered and family-centered care in a radiology department or practice requires the participation and engagement of all stakeholders, including patients.

Nonuniform contrast opacification of vasculature is frequently encountered on thoracic computed tomographic angiography. The purpose of this pictorial essay is to discuss the appearance of, and factors underlying mixing artifacts, which we term "smoke." We provide an approach to distinguish it from pathology including pulmonary embolism, aortic dissection, and thrombus. Smoke results from a combination of technical factors, abnormal physiology, or inflow of unopacified blood. Smoke produces ill-defined filling defects that may be confidently diagnosed in many cases if these fundamentals are applied.

PURPOSE The purpose of this study was to describe Thoracic magnetic resonance (MR) acquisition time (AT) variability, associations, and technologist insights as to its causes at a large quaternary institution, by MR protocol and imaging site. MATERIALS AND METHODS A retrospective review of our 2017 QI database of 1.5 T MR imaging ATs for adults 19 years and above at the main hospital and outpatient (OPT) satellites was performed for all 5 Thoracic MR protocols. Summary statistics were calculated for ATs. Multivariable linear regression was adjusted for age, sex, body mass index, time of examination relative to shift change, technologist experience, and language interpreter. An anonymous REDCap survey of our MR technologists sought their assessment of reasons for AT variability and techniques that help reduce it. RESULTS A total of 174 adult OPT 1.5 T mediastinal, pleural, and lung MR examinations were analyzed, revealing high variability of median AT by protocol and site (P

Positron emission tomography (PET) is a powerful quantitative molecular imaging technique that is complementary to structural imaging techniques for purposes of disease detection and characterization. This review article provides a brief overview of PET, hybrid PET instrumentation, and PET quantification.

Positron emission tomography is a powerful quantitative molecular imaging technique that is complementary to structural imaging techniques for purposes of disease detection and characterization. This review article provides an overview of the applications of positron emission tomography for evaluation of patients with nononcological diseases that may be encountered in the thorax, such as infection, sarcoidosis, idiopathic interstitial pneumonia, adult respiratory distress syndrome, chronic obstructive pulmonary disease, and atherosclerosis among others.

Cancer is the second most common cause of mortality in the United States, with >500,000 deaths reported annually. Acute or emergent findings in this group of patients can be a life-threatening phenomenon that results from malignancy or as a complication of therapy. In many cases, these events can be the first clinical manifestation of malignant disease. Oncologic emergencies have been classified as metabolic, hematologic, and structural emergencies. Within the thorax, most acute oncologic findings involve the lungs and airways in the form of drug toxicity, pulmonary infections, or malignant airway compression; the cardiovascular system in the form of pulmonary embolism, superior vena cava syndrome, cardiac tamponade, or massive hemoptysis; the mediastinum in the form of esophageal perforation, acute mediastinitis, or esophagorespiratory fistula; and the osseous spine and spinal cord in the form of invasion and cord compression. Given the life-threatening nature of many of these disease processes, awareness of such complications is critical to making an accurate diagnosis and formulating appropriate treatment strategies.

Radiologic signs are recognizable, characteristic patterns used to describe abnormalities visualized on imaging modalities that ultimately aid in the diagnosis and subsequent treatment of disease. This pictorial essay discusses 23 classic roentgenographic signs used in thoracic imaging. Its purpose is to be used as an educational review for residents, whether they are beginning their training or preparing for certification exams, and serve as a refresher and a reference to the practicing radiologist.

Over the past decade, faster CT scan times, thinner collimation, and the development of multirow detectors, coupled with the increasing capability of computers to process large amounts of data in short periods of time, have lead to an expansion in the ability to create diagnostically useful two-dimensional (2D) and three-dimensional (3D) images within the thorax. Applications within the thorax include, but are not limited to, evaluation of pulmonary and systemic vasculature, evaluation of the tracheobronchial tree, and delineation of diffuse lung disease. Pulmonary nodule volume and growth can be more accurately predicted, and represents an improvement in the evaluation of the solitary pulmonary nodule. Multiplanar images increase our understanding of thoracic anatomy and can help to guide bronchoscopic procedures. Because there are strengths and weaknesses to all the reconstruction algorithms, the utility of any given technique is dependent on the clinical question to be answered. For instance, although maximum intensity projection imaging (MIP) is helpful in the evaluation of micronodular lung disease, it is of little value in the diagnosis of aortic dissection. As the ability to generate faster and more precise multidimensional images grow, the demand for such imaging is likely to increase. In this review, the authors discuss the various reconstruction techniques available, followed by a discussion of the clinical applications.

Cardiovascular imaging during pregnancy poses a unique challenge to clinicians in differentiating between physiological changes mimicking pathology and true pathologic conditions, as well as for radiologists in terms of image quality. This review article will focus on 3 goals: first, to familiarize radiologists with safety issues related to imaging pregnant women using computed tomography and magnetic resonance imaging; second, to review the current, evidence-based recommendations for radiology topics unique and common to pregnant and lactating patients; and third, to provide practical algorithms to minimize risk and increase safety for both the pregnant woman and the fetus.

There is increasing perception that thoracic magnetic resonance imaging (MRI) is underutilized. Various obstacles to implementation and utilization of thoracic MRI can be overcome with continuous updating, improvement, and standardization of thoracic MRI protocols, close collaboration with MRI technologists, continued education of MRI technologists, radiologists, and referring health care providers, and incorporation of MRI training into thoracic imaging fellowship programs. The purpose of this article is to share the author's experience in developing a successful nonvascular thoracic MRI practice, discuss the fundamentals of nonvascular thoracic MRI, and provide a "how-to" manual for its performance.

Magnetic resonance imaging (MRI) and computed tomography (CT) are important imaging modalities for the noninvasive characterization of cardiac and paracardiac masses. They are, in general, superior to other modalities (e.g., echocardiography) in their ability to delineate the exact location and the extent of the lesion and to demonstrate the effects of the lesion on surrounding structures. MRI and CT may also be helpful in suggesting a specific diagnosis, because some tumors have rather characteristic locations and appearances. In addition, both modalities can be extremely helpful in both treatment planning and posttreatment follow-up because they are noninvasive, reproducible, and enable detection of residual or recurrent mass.

Ongoing technical developments have substantially improved the potential of magnetic resonance imaging (MRI) in the assessment of the pulmonary circulation. These developments includes improved magnet and hardware design, new k-space sampling techniques (ie, parallel imaging), and alternative contrast materials. With these techniques, not only can pulmonary vessels be visualized by MR angiography with high spatial resolution but also the perfusion of the lungs and its changes in relation to pulmonary thromboembolism (PE) can be assessed. Considering venous thromboembolism as a systemic disease, MR venography might be added for the diagnosis of underlying deep venous thrombosis. A unique advantage of MRI over other imaging tests is its potential to evaluate changes in cardiac function as a result of obstruction of the pulmonary circulation, which may have a significant impact on patient monitoring and treatment. Finally, MRI does not involve radiation, which is advantageous, especially in young patients. Over the years, a number of studies have shown promising results not only for MR angiography but also for MRI of lung perfusion and for MR venography. This review article summarizes and discusses the current evidence on pulmonary MRI for patients with suspected PE.

Asbestos is a group of heterogenous natural fibrous silicate minerals whose heat-resistant properties have been known for thousands of years.1 The effective thermal and electrical insulation properties of asbestos have led to its use in many industrial and domestic fields. It can be found in insulat

The incidence of hiatal hernia (HH) increases with age. Vertebral fracture, kyphosis, and pulmonary emphysema are suspected as possible causes. We aimed to analyze the relationship between thoracic deformities and HH in the elderly, using a deformity index.The study participants comprised 427 inpatients at a long-term-care hospital for the elderly in Japan. The Haller index (HI) was calculated on the transverse thoracic computerized tomography images according to the following formula: transverse diameter of the thorax/anterior-posterior diameter of the thorax. HH was diagnosed when an intrathoracic stomach was seen on the computed tomography images.The average HI calculated for all cases and for women--but not for men--decreased with increasing age. HH was diagnosed in 21 patients (4.9%). The incidence of HH in women was higher than in men (male vs. female = 2.0% vs. 7.4%). The mean value of HI in the HH patients (1.651 ± 0.251) was significantly lower than that in non-HH patients (2.345 ± 0.460).Enlargement of the anterior-posterior diameter of the thorax occurs in the elderly and is associated with the occurrence of HH.

Four patients with infectious costochondritis were studied with computed tomography (CT) and bone scintigraphy. In all four patients the bone scan detected and accurately localized the sites of involvement. CT did not image bilateral involvement in one patient. Three of the four patients were intravenous drug abusers; in two of these patients, a species of Aspergillus was the offending organism. Therefore, in patients with signs and symptoms of chest wall inflammation, scintigraphy is the most direct route to the diagnosis of costochondritis. This entity is apparently occurring more frequently because of the prevalence of intravenous drug abuse. Bone scintigraphy delineates both the extent of individual costochondral lesions and their multiplicity.

Multidetector row computed tomography (MDCT) has been used for cardiothoracic imaging since the advent of 4-slice computed tomography (CT) in 1999. Available since 2004, 64-slice CT systems are currently considered a prerequisite for successfully integrating cardiothoracic CT into routine clinical algorithms. Developments are ongoing that aim to solve the remaining challenges of cardiothoracic CT. In this review article, we focus on 3 aspects that have significantly influenced the design of newer CT scanners. (1) A faster scan speed enables coverage of the cardiothoracic anatomy in shorter scan times, which is beneficial for patients with limited ability to cooperate and opens new clinical possibilities. A coveted goal for cardiac CT is a "snapshot image" of the entire heart in 1 cardiac cycle, which can be obtained by using MDCT systems with area detectors or dual-source CT systems with electrocardiogram (ECG)-triggered high-pitch spiral. (2) Techniques to reduce the radiation dose to the patient, such as ECG-controlled dose modulation, ECG-triggered sequential CT, low kV scanning, and iterative reconstruction, have gained considerable attention as a consequence of the ongoing discussion of radiation exposure by CT. (3) New developments aim to establish a role for CT in the functional imaging of the lung and of the heart beyond the mere visualization of anatomy. Evaluation of the first-pass enhancement of the myocardium, with single-energy or with dual-energy data acquisition, and cardiac perfusion examinations may have the potential to enhance the application spectrum of cardiac CT by providing the means to determine the hemodynamic relevance of coronary artery stenosis.

PURPOSE To describe clinical and imaging characteristics of thoracolithiasis. MATERIALS AND METHODS Medical records from our center from September 2005 to March 2007 were reviewed. A definitive diagnosis was made by multidetector-row computed tomography studies of the chest, which revealed in each patient an intrapleural calcified nodular opacity, which changed in intrapleural location on serial examinations. Eleven patients fulfilled this criteria. The images were analyzed by experienced radiologists, who focused on the distribution, size, and shape of the thoracolithiasis. RESULTS The incidence of thoracolithiasis was 0.086% (11 of 12,835 individuals). All the patients were asymptomatic and did not have any history of intrathoracic disease. The nodules ranged in size from 5 to 15 mm (median 8 mm), and were ovoid and smoothly marginated. Each nodule contained homogeneous diffuse calcification. Eight nodules occurred in the left pleural space and 3 in the right. Their locations varied, which included on the diaphragm, along the posterior chest wall of the lower lung, abutting the left cardiac margin, and near the paraspinal space of the lower thoracic spine. Each of the calcified pleural bodies changed in intrapleural location on follow-up computed tomography examination. CONCLUSIONS The calcified intrapleural nodular opacities of thoracolithiasis tended to be located inferiorly, presumably secondary to the effects of gravity, and they seemed to migrate freely within the pleural cavity.

Collagen vascular diseases (CVDs) are a group of immunologic diseases that affect connective tissue at various locations throughout the body. The article reviews the variable radiographic findings associated with the common and less common CVDs.

A 66-year-old man was referred for evaluation of a "pulmonary nodule" found on a routine chest radiograph. Computed tomography detected a subpleural nodule of 13 mm in diameter between the upper and lower lobes of the right thoracic cavity. Follow-up chest radiograph and computed tomography after 9 months revealed migration and rotation along the right major fissure. Suspecting a pleural tumor, video-assisted thoracic surgery was performed, and a glossy white nodule of 13 x 11 mm in diameter was removed with forceps. Histopathologically, the nodule consisted of adipose and fatty necrotic tissue surrounded by hyalinized fibrous tissue. The diagnosis was thoracolithiasis.

Digital radiography and display systems have revolutionized radiologic practice in recent years and have enabled clinical application of advanced image processing techniques. These include dual energy subtraction and temporal subtraction, both of which can improve diagnostic accuracy for abnormal findings in chest radiographs, especially for subtle lesions such as early lung cancer or focal pneumonia. Dual energy radiography exploits the differential attenuation of low-energy x-ray photons by calcium to produce separate images on the bones and soft tissues, which provides improved detection and characterization of both calcified and noncalcified lung lesions. Dual energy subtraction radiography is currently available from 2 of the major vendors and is in clinical use at many institutions in the United States. Temporal subtraction is a complementary technique that enhances interval change, by using a previous radiograph as a subtraction mask, so that unchanged normal anatomy is suppressed, whereas new abnormalities are enhanced. Though it is not yet a product in the United States, temporal subtraction is available for clinical use in Japan. Temporal subtraction can be combined with energy subtraction to reduce misregistration artifacts, and also has potential to improve computer-aided detection of nodules and other types of lung disease.

Tuberculosis is a disease that has plagued humankind for centuries. In spite of excellent antituberculous chemotherapy, a number of important complications of tuberculosis are still commonly seen. Some of these are caused by the disease, and others are the sequelae of therapy. Thus some are seen immediately, and others occur months or even years after the onset of disease. These complications may involve the lungs, mediastinum, pleura, chest wall, or any combination of these structures. This article reviews the pathophysiology, diagnosis, and treatment of the many complications of thoracic tuberculosis.

Emerging applications in digital radiography offer exciting advances in the evaluation of lung disease. Dual energy subtraction techniques have been recognized as a promising technique in the detection and characterization of pulmonary nodules. This essay will demonstrate a significantly expanded diagnostic role in the assessment of cardiothoracic disease with dual energy subtraction and digital radiography.

The objective of this article was to determine the frequency of referrals for portable chest radiographs from medical and (noncardiac) surgical intensive care units (NICU and SICU) and their respective stepdown units (NICA and SICA). Additionally, the cumulative entrance skin exposure (ESE) using an ion chamber was determined. We retrospectively reviewed the medical records of all adult patients admitted to the MICU, SICU, MICA, and SICA at a tertiary referral center during a 6-month interval. The duration of stay and the number of portable chest radiographs were determined for each patient. The measured ESEs from all portable radiography units ranged from 5 to15 mR (average: 10mR). The cumulative radiation exposure for each patient was calculated. There were 567 patients admitted to the units: 146 surgical and 421 medical. Their ages ranged from 15 to 87 years. The duration of stay varied from 1 to 68 days. A total of 3,794 portable chest radiographs were obtained. The number of radiographs per patient varied from 1 to 94. The number of radiographs and the corresponding cumulative radiation doses were as follows: 406 patients (72%) had fewer than five radiographs (50 mR); 76 (13%) had five to 10 radiographs (100 mR); 35 (6%) had 11 to 20 (200 mR); and 50 (9%) had more than 20 chest radiographs (200 mR). The cumulative ESE ranged from 10 to 940 mR. It exceeded 450 mR in only nine (1.5%) patients. Most (73%) patients undergoing intensive care undergo fewer than five radiographs during their stay in the units. Patient exposure from portable chest radiographs in this population is less than the average annual exposure from background radiation in the USA (450-500 mR), and is much less than the average annual exposure from teratogenic radiation.

Knowledge of the normal radiologic appearance and manifestations of disease in the azygoesophageal recess can facilitate the detection and diagnosis of intrathoracic disease. The azygoesophageal recess is located lateral or posterior to the esophagus and anterior to the spine. It extends from the anterior turn of the azygous vein to the aortic hiatus. The configuration of the azygoesophageal recess is normally a smooth arc convex to the left. Because the right lung extends into the recess, pathology in this region can often be detected radiographically and typically manifests as increased opacity and/or as a contour abnormality. In adults, convexity directed to the right and immediately below the level of the azygous vein on a frontal radiograph is abnormal and requires further evaluation.

Dr Felix Fleischner was born in Vienna in 1893 and received his medical degree in 1919 from the University of Vienna. He was a member of the staff at the Wilhelminen Hospital until 1932, at which time he became Chief of Radiology at Vienna Children's Hospital. Before coming to the United States

The authors used chest computed tomography to determine the distribution of pulmonary lymphadenopathy in 40 patients with sarcoidosis. Using the American Thoracic Society lymph node map, the number and distribution of significant lymph nodes was calculated. Overall, lymphadenopathy was identified in 39 of the 40 patients. Mediastinal adenopathy was present in 38 patients, and hilar adenopathy was present in 27. Commonly involved nodal stations were 4R, 5, 7, 10R, 11R, and 11L, and little involvement was seen in stations 1, 6, and 14. An understanding of the common sites of adenopathy in sarcoidosis is useful when assessing adenopathy in patients without a known diagnosis.

A 21-year-old woman with a high-grade soft-tissue sarcoma developed a lesion in the soft tissues of her chest wall at the same time that she developed pulmonary metastases from her primary neoplasm. The chest wall lesion diminished in size on sequential computed tomography (CT) scans, indicating that it was a pseudometastasis caused by removal of the patient's indwelling Hickman catheter. Awareness that removal of tunneled central venous catheters can produce soft-tissue masses in the chest wall that may mimic metastases may prevent inappropriate staging and treatment of these patients.

Thoracic empyema usually results from pulmonary infection or thoracic surgery. Antibiotic therapy is an essential part of the treatment, but surgical techniques to drain the pleural fluid and obliterate the empyema space often are required. A wide range of closed and open surgical techniques are available. This article reviews the various surgical options for the treatment of nontuberculous bacterial empyema secondary to pulmonary infection in the patient with a normal immune response. Emphasis is placed on a thorough understanding of the pathophysiology and natural history of empyema for selection and timing of appropriate treatment. Thoracic imaging techniques play a substantial role in the evaluation and treatment of empyema and in assessing the outcome of surgical therapy.

Magnetic resonance imaging (MRI) is the newest and most promising imaging modality for evaluating the pediatric thorax. Its ability to distinguish between mediastinal fat, blood vessels, and adjacent soft tissues, without the use of intravenous contrast agents or radiation, makes MRI advantageous for infants and children. The thoracic applications include evaluations of cardiac anomalies, mediastinal masses, extracardiac vascular anomalies, airway obstruction, and chest-wall lesions. This article describes the current and possible future applications of MRI of the pediatric thorax.