Thoracic radiology in the ICU (Intensive Care Unit): What the radiologist needs to know

Congress:

ECR 2018

Poster Number:

C-0369

Type:

Educational Exhibit

Keywords:

Education, CT, Conventional radiography, Thorax, Education and training

Authors:

M. J. GAYÁN BELMONTE¹, C. Botía González¹, A. Sánchez González¹, R. Rodríguez Mondéjar¹, M. L. Rodriguez Rodriguez¹, E. Cruces Fuentes², A. P. Solano Romero¹, I. CASES SUSARTE¹, A. García Chiclano¹; ¹Murcia/ES, ²Murcia, MU/ES

DOI:

10.1594/ecr2018/C-0369

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0369

Fig. 1: Figure 1a and 1b. Fig 1a: Anteroposterior chest X-ray of a 73-year-old male...

Fig. 2: Figure 2. Phases of ARDS with pathological and radiological findings.

Fig. 3: Figure 3. Anteroposterior chest X-ray of a 41-year-old male with Varicella...

Fig. 4: Figure 4a and b. Chest X-ray (Fig. 4a) and thoracic Computed Tomography (CT)...

Learning objectives

1. To remember the indications of chest X-ray in the ICU. 2. To review the most frequent pathological findings of thoracic radiology in critical patients. 3. To emphasize the normal position and possible complications of the different tubes and catheters used in the ICU.

Background

Chest X-ray is a very useful tool in the critical patient. However, it is important to know about its indications, as an overuse of this technique not only does not bring any additional information, but also means more radiation for the patient. The American College of Radiology (ACR) established, in its ACR Appropriateness Criteria (revised in 2014), that routine daily chest radiographs in the ICU are not indicated and the correct indications include a change in the clinical state of the patient and the placement...

Findings and procedure details

The most common thoracic findings in the ICU patients are pulmonary edema, barotrauma, atelectasis, pneumonia, aspiration, pulmonary embolism, pulmonary hemorrhage, pleural effusion and pneumothorax. Radiological findings in an ICU patient with acute lung disease may be nonspecific and it is essential to know the clinical history to establish the appropriate diagnosis. 1) PULMONARY EDEMA Frequently, pulmonary edema is classified as cardiogenic (due to cardiac insufficiency) and non-cardiogenic (due to fluid overload, acute respiratory distress syndrome (ARDS), toxic inhalation…). But there is another classification of pulmonary...

Conclusion

To know the indications of the chest X-ray, the radiological characteristics of the most frequent pathologies, and the correct position and complications of the tubes and catheters in critical patients, allows the radiologist make a report that helps the intensive care doctor in the management of these complex patients.

Personal information

References

Robert D. Suh, Scott J. Genshaft, Jacobo Kirsch, Jeffrey P. Kanne, Jonathan H. Chung, Edwin F. Donnelly, et al. American College of Radiology (ACR) Committee on Appropriateness Criteria in Intensive Care Unit patients. Last review in 2014. Albi Rodríguez G, Álvarez Benito M, Arenaza Choperena G, Artigas Martín JM, Ayuso Colella C, Ayuso Colella JR, et al. Recomendaciones de “No hacer”. Documento de la Sociedad Española de Radiología Médica (SERAM). 2014: 35. Thomas Gluecker, Patrizio Cpasso, Pierre Schnyder, François Gudinchet, Marie-Denise Schaller, Jean-Pierre Revelly, et...