Thoracic Imaging

  • Javier Campos
  • Kalpaj R. Parekh


Radiological images play an important role during the evaluation of patients undergoing thoracic surgery. Radiological studies must be reviewed, including a posterior–anterior chest radiograph and computed tomography scan of the chest. Special emphasis should be given to mediastinal mass with compromise to the airway or great vessels by reviewing the computed tomography scan of the chest. Multidetector computed tomography (CT) scan and tracheobronchial reconstruction are more specific studies in the thoracic surgical patient, and allow measurements of the airway. Magnetic resonance imaging (MRI) provides greater contrast resolution than CT scans and offers the potential for tissue characterization. An MRI is indicated in selected cases, i.e., mediastinal mass with invasion of the superior vena cava.


Acute Lung Injury Chest Radiograph Chest Tube Mediastinal Mass Pleural Space 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Boiselle PM. Imaging of the large airways. Clin Chest Med. 2008;29:181–93.PubMedCrossRefGoogle Scholar
  2. 2.
    Seymour AH. The relationship between the diameters of the adult cricoid ring and main tracheobronchial tree: a cadaver study to investigate the basis for double-lumen tube selection. J Cardiothorac Vasc Anesth. 2003;17:299–301.PubMedCrossRefGoogle Scholar
  3. 3.
    Minnich DJ, Mathisen DJ. Anatomy of the trachea, carina and bronchi. Thorac Surg Clin. 2007;17:571–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Stene R, Rose M, Weigner MB, et al. Bronchial trifurcation at the carina complicating use of a double-lumen tracheal tube. Anesthesiology. 1994;80:162–1164.CrossRefGoogle Scholar
  5. 5.
    Campos JH. Update on tracheobronchial anatomy and flexible fiberoptic bronchoscopy in thoracic anesthesia. Curr Opin Anaesthesiol. 2009;22:4–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Goldwin RL, Reed JC. Radiology of the chest. Chapter 2. In: Kaplan J, Slinger P, editors. Thoracic anesthesia. 3rd ed. New York: Churchill Livingstone; 2003. p. 24–56.Google Scholar
  7. 7.
    Fraser RS, Pare’ JA, Fraser RG, et al. Synopsis of diseases of the chest. 2nd ed. Philadelphia: WB Saunders; 1994.Google Scholar
  8. 8.
    Datt V, Tempe DK. Airway management in patients with mediastinal masses. Indian J Anaesth. 2005;49:344–52.Google Scholar
  9. 9.
    Ahmed-Nusrath A, Swanevelder J. Anesthesia for mediastinoscopy. Contin Educ Anaesth Crit Care Pain. 2007;7:6–9.CrossRefGoogle Scholar
  10. 10.
    Campos JH. Managing the patient with an anterior mediastinal mass. Chapter 11. In: Cohen NH, editor. Medically challenging patients undergoing cardiothoracic surgery, Society of Cardiovascular Anesthesiologists Monograph. Baltimore: Lippincott Williams & Wilkins; 2009. p. 285–302.Google Scholar
  11. 11.
    Harris GJ, Harman PK, Trinkle JK, et al. Standard biplane roentgenography is highly sensitive in documenting mediastinal masses. Ann Thorac Surg. 1987;44:238–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Morgan MDL, Edward CW, Morris J, et al. Origin and behavior of emphysematous bullae. Thorax. 1989;44:533–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Schipper PH, Meyers BF, Battafarano RJ, et al. Outcomes after resection of giant emphysematous bullae. Ann Thorac Surg. 2004;78:976–82.PubMedCrossRefGoogle Scholar
  14. 14.
    O’Connor AR, Morgan WE. Radiological review of pneumothorax. BMJ. 2005;330:1493–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Glazer H, Anderson DJ, Wilson BS, et al. Pneumothorax: appearances on lateral chest radiographs. Radiology. 1989;173:707–11.PubMedGoogle Scholar
  16. 16.
    Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003;58 Suppl 2:ii39–52.PubMedGoogle Scholar
  17. 17.
    Light RW. Tension pneumothorax. Intensive Care Med. 1994;20:468–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Baumann MH, Sahn SA. Tension pneumothorax: diagnostic and therapeutic pitfalls. Crit Care Med. 1994;22:896.CrossRefGoogle Scholar
  19. 19.
    Symbas PN. Chest drainage tubes. Surg Clin North Am. 1989;69:41–6.PubMedGoogle Scholar
  20. 20.
    Baldt MM, Bankier AA, Germann PS, et al. Complications after emergency tube thoracostomy: assessment with CT. Radiology. 1995;195:539–43.PubMedGoogle Scholar
  21. 21.
    Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med. 1984;144:1447–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Konen E, Rozenman J, Simansky DA, et al. Prevalence of the juxtaphrenic peak after upper lobectomy. Am J Roentgenol. 2001;177:869–73.Google Scholar
  23. 23.
    Wechsler RJ, Goodman LR. Mediastinal position and air-fluid height after pneumonectomy: the effect of the respiratory cycle. Am J Roentgenol. 1985;145:1173–6.Google Scholar
  24. 24.
    Brodsky JB, Macario A, Mark JB. Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg. 1996;82:861–4.PubMedGoogle Scholar
  25. 25.
    Licker M, de Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg. 2003;97:1558–65.PubMedCrossRefGoogle Scholar
  26. 26.
    Hayes JP, Williams EA, Goldstraw P, et al. Lung injury in patients following thoracotomy. Thorax. 1995;50:990–1.PubMedCrossRefGoogle Scholar
  27. 27.
    McLoud T. Imaging the lungs. Chapter 36. In: Patterson, ­Cooper, Deslauriers, Lerut, Luketich, Rice, editors. Pearson’s thoracic surgery. 3rd ed. New York: Churchill Livingstone; 2008. p. 415–28.Google Scholar
  28. 28.
    Harte BH, Jaklitsch MT, McKenna SS, et al. Use of a modified single-lumen endobronchial tube in severe tracheobronchial compression. Anesthesiology. 2002;96:510–1.PubMedCrossRefGoogle Scholar
  29. 29.
    Slinger P, Karsli C. Management of the patient with a large anterior mediastinal mass: recurring myths. Curr Opin Anaesthesiol. 2007;20:1–3.PubMedCrossRefGoogle Scholar
  30. 30.
    Chiles C, Woodard PK, Gutierrez FR, et al. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics. 2001;21:439–49.PubMedGoogle Scholar
  31. 31.
    Shepard JA, Grillo HC, McLoud TC, et al. Right-pneumonectomy syndrome: radiologic findings and CT correlation. Radiology. 1986;161:661–4.PubMedGoogle Scholar
  32. 32.
    Le Guen M, Beigelman C, Bouhemad B, et al. Chest computed tomography with multiplanar reformatted images for diagnosing traumatic bronchial rupture: a case report. Crit Care. 2007;11:1–8.Google Scholar
  33. 33.
    Rubin GD, Beaulieu CF, Argiro V, et al. Perspective volume rendering of CT and MR images: applications for endoscopic imaging. Radiology. 1996;199:321–30.PubMedGoogle Scholar
  34. 34.
    Boiselle PM, Reynolds KF, Ernst A. Multiplanar and three-dimensional imaging of the central airways with multidetector CT. Am J Roentgenol. 2002;179:301–8.Google Scholar
  35. 35.
    Higgins WE, Ramaswamy K, Swift RD, et al. Virtual bronchoscopy for three-dimensional pulmonary image assessment: state of the art and future needs. Radiographics. 1998;18:761–78.PubMedGoogle Scholar
  36. 36.
    Higgins WE, Helferty JP, Lu K, et al. 3D CT-video fusion for image-guided bronchoscopy. Comput Med Imaging Graph. 2008;32:159–73.PubMedCrossRefGoogle Scholar
  37. 37.
    Moore EH, Webb WR, Muller N, et al. MRI of pulmonary airspace disease: experimental model and preliminary clinical results. Am J Roentgenol. 1986;146:1123–8.Google Scholar
  38. 38.
    Bader TR, Semelka RC, Pedro MS, et al. Magnetic resonance imaging of pulmonary parenchymal disease using a modified breath-hold 3D gradient-echo technique: initial observations. J Magn Reson Imaging. 2002;15:31–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Bergin CJ, Glover GH, Pauly JM. Lung parenchyma: magnetic susceptibility in MR imaging. Radiology. 1991;180:845–8.PubMedGoogle Scholar
  40. 40.
    Bremerich J, Roberts TP, Wendland MF, et al. Three-dimensional MR imaging of pulmonary vessels and parenchyma with NC100150 injection (Clariscan). J Magn Reson Imaging. 2000;11:622–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Bittner RC, Felix R. Magnetic resonance (RM) imaging of the chest: state-of-the-art. Eur Respir J. 1998;11:1392–404.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Javier Campos
    • 1
  • Kalpaj R. Parekh
    • 2
  1. 1.Department of AnesthesiaUniversity of Iowa Health Care, Roy and Lucille Carver College of MedicineIowa CityUSA
  2. 2.Department of Cardiothoracic SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityUSA

Personalised recommendations