Download PDF
Semin Respir Crit Care Med 2022; 43(06): 899-923
DOI: 10.1055/s-0042-1750041
Review Article

Imaging in the Intensive Care Unit

Dennis Toy
1   Department of Medical Imaging, Colorado Permanente Medical Group, Lafayette, Colorado
,
Mark D. Siegel
2   Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
,
Ami N. Rubinowitz
3   Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Radiology plays an important role in the management of the most seriously ill patients in the hospital. Over the years, continued advances in imaging technology have contributed to an improvement in patient care. However, even with such advances, the portable chest radiograph (CXR) remains one of the most commonly requested radiographic examinations. While they provide valuable information, CXRs remain relatively insensitive at revealing abnormalities and are often nonspecific. Chest computed tomography (CT) can display findings that are occult on CXR and is particularly useful at identifying and characterizing pleural effusions, detecting barotrauma including small pneumothoraces, distinguishing pneumonia from atelectasis, and revealing unsuspected or additional abnormalities which could result in increased morbidity and mortality if left untreated. CT pulmonary angiography is the modality of choice in the evaluation of pulmonary emboli which can complicate the hospital course of the ICU patient. This article will provide guidance for interpretation of CXR and thoracic CT images, discuss some of the invasive devices routinely used, and review the radiologic manifestations of common pathologic disease states encountered in ICU patients. In addition, imaging findings and complications of more specific clinical scenarios in which the incidence has increased in the ICU setting, such as patients who are immunocompromised, have interstitial lung disease, or COVID-19, will also be discussed. Communication between the radiologist and intensivist, particularly on complicated cases, is important to help increase diagnostic accuracy and leads to an improvement in the management of the most critically ill patients.

Keywords

intensive care unit - portable chest X-ray - invasive devices - pulmonary edema - acute respiratory distress syndrome - atelectasis - pulmonary embolism


Publication History

Article published online:
28 November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Radiation Dose in X-Ray and CT Exams. 02/01/2021. Accessed May 16, 2022 at: https://www.radiologyinfo.org/en/info/safety-xray
    PubMed
  • 2 Waydhas C. Intrahospital transport of critically ill patients. Crit Care 1999; 3 (05) R83-R89
    CrossrefPubMedGoogle Scholar
  • 3 Davenport MS, Perazella MA, Yee J. et al. Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020; 294 (03) 660-668
    CrossrefPubMedGoogle Scholar
  • 4 McDonald JS, McDonald RJ, Williamson EE, Kallmes DF, Kashani K. Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med 2017; 43 (06) 774-784
    CrossrefPubMedGoogle Scholar
  • 5 Williams LS, Walker GR, Loewenherz JW, Gidel LT. Association of contrast and acute kidney injury in the critically ill: a propensity-matched study. Chest 2020; 157 (04) 866-876
    CrossrefPubMedGoogle Scholar
  • 6 Cohan R, Dillman J, Hartman R, Jafri S, Wang C, Newhouse J. American College of Radiology Manual on Contrast Media. Am Coll Radiol 2013; 9 (02) 45-50
    PubMedGoogle Scholar
  • 7 Krivopal M, Shlobin OA, Schwartzstein RM. Utility of daily routine portable chest radiographs in mechanically ventilated patients in the medical ICU. Chest 2003; 123 (05) 1607-1614
    CrossrefPubMedGoogle Scholar
  • 8 Clec'h C, Simon P, Hamdi A. et al. Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study. Intensive Care Med 2008; 34 (02) 264-270
    CrossrefPubMedGoogle Scholar
  • 9 Graat ME, Kröner A, Spronk PE. et al. Elimination of daily routine chest radiographs in a mixed medical-surgical intensive care unit. Intensive Care Med 2007; 33 (04) 639-644
    CrossrefPubMedGoogle Scholar
  • 10 Hejblum G, Chalumeau-Lemoine L, Ioos V. et al. Comparison of routine and on-demand prescription of chest radiographs in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study. Lancet 2009; 374 (9702): 1687-1693
    CrossrefPubMedGoogle Scholar
  • 11 Oba Y, Zaza T. Abandoning daily routine chest radiography in the intensive care unit: meta-analysis. Radiology 2010; 255 (02) 386-395
    CrossrefPubMedGoogle Scholar
  • 12 Ganapathy A, Adhikari NK, Spiegelman J, Scales DC. Routine chest X-rays in intensive care units: a systematic review and meta-analysis. Crit Care 2012; 16 (02) R68
    CrossrefPubMedGoogle Scholar
  • 13 Tolsma M, Rijpstra TA, Schultz MJ, Mulder PG, van der Meer NJ. Significant changes in the practice of chest radiography in Dutch intensive care units: a web-based survey. Ann Intensive Care 2014; 4 (01) 10
    CrossrefPubMedGoogle Scholar
  • 14 Amorosa JK, Bramwit MP, Mohammed TL. et al. ACR appropriateness criteria routine chest radiographs in intensive care unit patients. J Am Coll Radiol 2013; 10 (03) 170-174
    CrossrefPubMedGoogle Scholar
  • 15 Halpern SD, Becker D, Curtis JR. et al; Choosing Wisely Taskforce; American Thoracic Society; American Association of Critical-Care Nurses; Society of Critical Care Medicine. An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine policy statement: the Choosing Wisely® Top 5 list in Critical Care Medicine. Am J Respir Crit Care Med 2014; 190 (07) 818-826
    CrossrefPubMedGoogle Scholar
  • 16 Gershengorn HB, Wunsch H, Scales DC, Rubenfeld GD. Trends in use of daily chest radiographs among US adults receiving mechanical ventilation. JAMA Netw Open 2018; 1 (04) e181119
    CrossrefPubMedGoogle Scholar
  • 17 Corwin HL, McDonald J, Cargile CS. Reducing routine chest radiographs in the intensive care unit. J Thorac Imaging 2019; 34 (05) W127-W128
    CrossrefPubMedGoogle Scholar
  • 18 Scott J, Waite S, Napolitano A. Restricting daily chest radiography in the intensive care unit: implementing evidence-based medicine to decrease utilization. J Am Coll Radiol 2021; 18 (3, Pt A): 354-360
    CrossrefPubMedGoogle Scholar
  • 19 Laroia AT, Donnelly EF, Henry TS. et al; Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® intensive care unit patients. J Am Coll Radiol 2021; 18 (5S): S62-S72
    CrossrefPubMedGoogle Scholar
  • 20 Oks M, Cleven KL, Cardenas-Garcia J. et al. The effect of point-of-care ultrasonography on imaging studies in the medical ICU: a comparative study. Chest 2014; 146 (06) 1574-1577
    CrossrefPubMedGoogle Scholar
  • 21 Peris A, Tutino L, Zagli G. et al. The use of point-of-care bedside lung ultrasound significantly reduces the number of radiographs and computed tomography scans in critically ill patients. Anesth Analg 2010; 111 (03) 687-692
    CrossrefPubMedGoogle Scholar
  • 22 Awerbuch E, Benavides M, Gershengorn HB. The impact of computed tomography of the chest on the management of patients in a medical intensive care unit. J Intensive Care Med 2015; 30 (08) 505-511
    CrossrefPubMedGoogle Scholar
  • 23 Moloney F, Fama D, Twomey M. et al. Cumulative radiation exposure from diagnostic imaging in intensive care unit patients. World J Radiol 2016; 8 (04) 419-427
    CrossrefPubMedGoogle Scholar
  • 24 Ablordeppey EA, Drewry AM, Beyer AB. et al. Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2017; 45 (04) 715-724
    CrossrefPubMedGoogle Scholar
  • 25 Abdalla W, Elgendy M, Abdelaziz AA, Ammar MA. Lung ultrasound versus chest radiography for the diagnosis of pneumothorax in critically ill patients: a prospective, single-blind study. Saudi J Anaesth 2016; 10 (03) 265-269
    CrossrefPubMedGoogle Scholar
  • 26 Bitar ZI, Maadarani OS, El-Shably AM, Al-Ajmi MJ. Diagnostic accuracy of chest ultrasound in patients with pneumonia in the intensive care unit: a single-hospital study. Health Sci Rep 2018; 2 (01) e102
    CrossrefPubMedGoogle Scholar
  • 27 Winkler MH, Touw HR, van de Ven PM, Twisk J, Tuinman PR. Diagnostic accuracy of chest radiograph, and when concomitantly studied lung ultrasound, in critically ill patients with respiratory symptoms: a systematic review and meta-analysis. Crit Care Med 2018; 46 (07) e707-e714
    CrossrefPubMedGoogle Scholar
  • 28 Hourmozdi JJ, Markin A, Johnson B, Fleming PR, Miller JB. Routine chest radiography is not necessary after ultrasound-guided right internal jugular vein catheterization. Crit Care Med 2016; 44 (09) e804-e808
    CrossrefPubMedGoogle Scholar
  • 29 Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically ill patients. Am J Respir Crit Care Med 2019; 199 (06) 701-714
    CrossrefPubMedGoogle Scholar
  • 30 Chiumello D, Formenti P, Coppola S. Lung recruitment: What has computed tomography taught us in the last decade?. Ann Intensive Care 2019; 9 (01) 12
    CrossrefPubMedGoogle Scholar
  • 31 Chiumello D, Sferrazza Papa GF, Artigas A. et al. ERS statement on chest imaging in acute respiratory failure. Eur Respir J 2019; 54 (03) 1900435
    CrossrefPubMedGoogle Scholar
  • 32 Zember J, Saul D, Delgado J, Boyer D, Reid J. Radiology rounds in the intensive care units through a telepresence model. J Am Coll Radiol 2018; 15 (11) 1655-1657
    CrossrefPubMedGoogle Scholar
  • 33 Mortani Barbosa Jr EJ, Lynch MC, Langlotz CP, Gefter WB. Optimization of radiology reports for intensive care unit portable chest radiographs: perceptions and preferences of radiologists and ICU practitioners. J Thorac Imaging 2016; 31 (01) 43-48
    CrossrefPubMedGoogle Scholar
  • 34 Siegel MD, Tocino I. Chest radiology in the intensive care unit, Part I. Clin Pulm Med 1999; 6 (06) 347-355
    CrossrefPubMedGoogle Scholar
  • 35 Brunel W, Coleman DL, Schwartz DE, Peper E, Cohen NH. Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position. Chest 1989; 96 (05) 1043-1045
    CrossrefPubMedGoogle Scholar
  • 36 Goodman LR, Conrardy PA, Laing F, Singer MM. Radiographic evaluation of endotracheal tube position. AJR Am J Roentgenol 1976; 127 (03) 433-434
    CrossrefPubMedGoogle Scholar
  • 37 Rollins RJ, Tocino I. Early radiographic signs of tracheal rupture. AJR Am J Roentgenol 1987; 148 (04) 695-698
    CrossrefPubMedGoogle Scholar
  • 38 Chen J-D, Shanmuganathan K, Mirvis SE, Killeen KL, Dutton RP. Using CT to diagnose tracheal rupture. AJR Am J Roentgenol 2001; 176 (05) 1273-1280
    CrossrefPubMedGoogle Scholar
  • 39 Pillai JB, Vegas A, Brister S. Thoracic complications of nasogastric tube: review of safe practice. Interact Cardiovasc Thorac Surg 2005; 4 (05) 429-433
    CrossrefPubMedGoogle Scholar
  • 40 Tocino I. Chest imaging in the intensive care unit. Eur J Radiol 1996; 23 (01) 46-57
    CrossrefPubMedGoogle Scholar
  • 41 Jhala K, Tang A, Hammer MM. Five-step guide to central venous catheter placement with 3D anatomic references. Radiographics 2021; 41 (05) E149-E150
    CrossrefPubMedGoogle Scholar
  • 42 Webb WR, Higgins CB, Elicker BM. et al. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Philadelphia: Lippincott Williams & Wilkins; 2017
    Google Scholar
  • 43 Godoy MC, Leitman BS, de Groot PM, Vlahos I, Naidich DP. Chest radiography in the ICU: Part 2, Evaluation of cardiovascular lines and other devices. AJR Am J Roentgenol 2012; 198 (03) 572-581
    CrossrefPubMedGoogle Scholar
  • 44 Lee S, Chaturvedi A. Imaging adults on extracorporeal membrane oxygenation (ECMO). Insights Imaging 2014; 5 (06) 731-742
    CrossrefPubMedGoogle Scholar
  • 45 Cheng R, Hachamovitch R, Kittleson M. et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg 2014; 97 (02) 610-616
    CrossrefPubMedGoogle Scholar
  • 46 Parissis H, Graham V, Lampridis S, Lau M, Hooks G, Mhandu PC. IABP: history-evolution-pathophysiology-indications: what we need to know. J Cardiothorac Surg 2016; 11 (01) 122
    CrossrefPubMedGoogle Scholar
  • 47 Goodman LR. Felson's Principles of Chest Roentgenology: A Programmed Text. Elsevier; 2021
    PubMedGoogle Scholar
  • 48 Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246 (03) 697-722
    CrossrefPubMedGoogle Scholar
  • 49 Rubin GD, Ryerson CJ, Haramati LB. et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society. Chest 2020; 158 (01) 106-116
    CrossrefPubMedGoogle Scholar
  • 50 Wong HYF, Lam HYS, Fong AH. et al. Frequency and distribution of chest radiographic findings in patients positive for COVID-19. Radiology 2020; 296 (02) E72-E78
    CrossrefPubMedGoogle Scholar
  • 51 Guérin C, Reignier J, Richard JC. et al; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368 (23) 2159-2168
    CrossrefPubMedGoogle Scholar
  • 52 Kwee TC, Kwee RM. Chest CT in COVID-19: what the radiologist needs to know. Radiographics 2020; 40 (07) 1848-1865
    CrossrefPubMedGoogle Scholar
  • 53 Chung M, Bernheim A, Mei X. et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020; 295 (01) 202-207
    CrossrefPubMedGoogle Scholar
  • 54 Han X, Fan Y, Alwalid O. et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology 2021; 299 (01) E177-E186
    CrossrefPubMedGoogle Scholar
  • 55 Simpson S, Kay FU, Abbara S. et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. J Thorac Imaging 2020; 35 (04) 219-227
    CrossrefPubMedGoogle Scholar
  • 56 Guan WJ, Ni ZY, Hu Y. et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
    CrossrefPubMedGoogle Scholar
  • 57 Maes M, Higginson E, Pereira-Dias J. et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care 2021; 25 (01) 25
    CrossrefPubMedGoogle Scholar
  • 58 McGuinness G, Zhan C, Rosenberg N. et al. Increased incidence of barotrauma in patients with COVID-19 on invasive mechanical ventilation. Radiology 2020; 297 (02) E252-E262
    CrossrefPubMedGoogle Scholar
  • 59 Léonard-Lorant I, Delabranche X, Séverac F. et al. Acute pulmonary embolism in patients with COVID-19 at CT angiography and relationship to D-Dimer levels. Radiology 2020; 296 (03) E189-E191
    CrossrefPubMedGoogle Scholar
  • 60 Gosangi B, Rubinowitz AN, Irugu D, Gange C, Bader A, Cortopassi I. COVID-19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications. Emerg Radiol 2022; 29 (01) 23-34
    CrossrefPubMedGoogle Scholar
  • 61 Kuhlman JE, Fishman EK, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology 1985; 157 (03) 611-614
    CrossrefPubMedGoogle Scholar
  • 62 Cantini F, Niccoli L, Goletti D. Tuberculosis risk in patients treated with non-anti-tumor necrosis factor-α (TNF-α) targeted biologics and recently licensed TNF-α inhibitors: data from clinical trials and national registries. J Rheumatol Suppl 2014; 91: 56-64
    CrossrefPubMedGoogle Scholar
  • 63 Fishman JA, Hogan JI, Maus MV. Inflammatory and infectious syndromes associated with cancer immunotherapies. Clin Infect Dis 2019; 69 (06) 909-920
    CrossrefPubMedGoogle Scholar
  • 64 Travis WD, Costabel U, Hansell DM. et al; ATS/ERS Committee on Idiopathic Interstitial Pneumonias. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013; 188 (06) 733-748
    CrossrefPubMedGoogle Scholar
  • 65 Raghu G, Freudenberger TD, Yang S. et al. High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. Eur Respir J 2006; 27 (01) 136-142
    CrossrefPubMedGoogle Scholar
  • 66 Savarino E, Carbone R, Marabotto E. et al. Gastro-oesophageal reflux and gastric aspiration in idiopathic pulmonary fibrosis patients. Eur Respir J 2013; 42 (05) 1322-1331
    CrossrefPubMedGoogle Scholar
  • 67 Collard HR, Ryerson CJ, Corte TJ. et al. Acute exacerbation of idiopathic pulmonary fibrosis. An International Working Group Report. Am J Respir Crit Care Med 2016; 194 (03) 265-275
    CrossrefPubMedGoogle Scholar
  • 68 Sprunger DB, Olson AL, Huie TJ. et al. Pulmonary fibrosis is associated with an elevated risk of thromboembolic disease. Eur Respir J 2012; 39 (01) 125-132
    CrossrefPubMedGoogle Scholar
  • 69 Marom EM, McAdams HP, Erasmus JJ, Goodman PC. The many faces of pulmonary aspiration. AJR Am J Roentgenol 1999; 172 (01) 121-128
    CrossrefPubMedGoogle Scholar
  • 70 Shifrin RY, Choplin RH. Aspiration in patients in critical care units. Radiol Clin North Am 1996; 34 (01) 83-96
    CrossrefPubMedGoogle Scholar
  • 71 Franquet T, Giménez A, Rosón N, Torrubia S, Sabaté JM, Pérez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics 2000; 20 (03) 673-685
    CrossrefPubMedGoogle Scholar
  • 72 Shevland JE, Hirleman MT, Hoang KA, Kealey GP. Lobar collapse in the surgical intensive care unit. Br J Radiol 1983; 56 (668) 531-534
    CrossrefPubMedGoogle Scholar
  • 73 Felson B, Felson H. Localization of intrathoracic lesions by means of the postero-anterior roentgenogram; the silhouette sign. Radiology 1950; 55 (03) 363-374
    CrossrefPubMedGoogle Scholar
  • 74 Swensen SJ, Peters SG, LeRoy AJ, Gay PC, Sykes MW, Trastek VF. Radiology in the intensive-care unit. Mayo Clin Proc 1991; 66 (04) 396-410
    CrossrefPubMedGoogle Scholar
  • 75 Kattan KR, Wlot JF. Cardiac rotation in left lower lobe collapse. “The flat waist sign”. Radiology 1976; 118 (02) 275-279
    CrossrefPubMedGoogle Scholar
  • 76 Rubinowitz AN, Siegel MD, Tocino I. Thoracic imaging in the ICU. Crit Care Clin 2007; 23 (03) 539-573
    CrossrefPubMedGoogle Scholar
  • 77 Hill JR, Horner PE, Primack SL. ICU imaging. Clin Chest Med 2008; 29 (01) 59-76 , vi
    CrossrefPubMedGoogle Scholar
  • 78 Ranieri VM, Rubenfeld GD, Thompson BT. et al; ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307 (23) 2526-2533
    PubMedGoogle Scholar
  • 79 Rubenfeld GD, Caldwell E, Peabody E. et al. Incidence and outcomes of acute lung injury. N Engl J Med 2005; 353 (16) 1685-1693
    CrossrefPubMedGoogle Scholar
  • 80 Sheard S, Rao P, Devaraj A. Imaging of acute respiratory distress syndrome. Respir Care 2012; 57 (04) 607-612
    CrossrefPubMedGoogle Scholar
  • 81 Chung JH, Kradin RL, Greene RE, Shepard JA, Digumarthy SR. CT predictors of mortality in pathology confirmed ARDS. Eur Radiol 2011; 21 (04) 730-737
    CrossrefPubMedGoogle Scholar
  • 82 Anzueto A, Frutos-Vivar F, Esteban A. et al. Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. Intensive Care Med 2004; 30 (04) 612-619
    CrossrefPubMedGoogle Scholar
  • 83 Gammon RB, Shin MS, Buchalter SE. Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors. Chest 1992; 102 (02) 568-572
    CrossrefPubMedGoogle Scholar
  • 84 Tocino IM. Pneumothorax in the supine patient: radiographic anatomy. Radiographics 1985; 5 (04) 557-586
    CrossrefPubMedGoogle Scholar
  • 85 Rierson D, Bueno J. Pneumothorax in the supine patient: subtle radiographic signs. J Thorac Imaging 2016; 31 (04) W16-W22
    CrossrefPubMedGoogle Scholar
  • 86 Kollef MH. Risk factors for the misdiagnosis of pneumothorax in the intensive care unit. Crit Care Med 1991; 19 (07) 906-910
    CrossrefPubMedGoogle Scholar
  • 87 Husain LF, Hagopian L, Wayman D, Baker WE, Carmody KA. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock 2012; 5 (01) 76-81
    CrossrefPubMedGoogle Scholar
  • 88 Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA. Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. Chest 1997; 111 (04) 1018-1023
    CrossrefPubMedGoogle Scholar
  • 89 Woodring JH. Recognition of pleural effusion on supine radiographs: how much fluid is required?. AJR Am J Roentgenol 1984; 142 (01) 59-64
    CrossrefPubMedGoogle Scholar
  • 90 Light RW. Clinical practice. Pleural effusion. N Engl J Med 2002; 346 (25) 1971-1977
    CrossrefPubMedGoogle Scholar
  • 91 Stark DD, Federle MP, Goodman PC, Podrasky AE, Webb WR. Differentiating lung abscess and empyema: radiography and computed tomography. AJR Am J Roentgenol 1983; 141 (01) 163-167
    CrossrefPubMedGoogle Scholar
  • 92 Abramowitz Y, Simanovsky N, Goldstein MS, Hiller N. Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol 2009; 192 (03) 618-623
    Google Scholar
  • 93 Raptopoulos V, Davis LM, Lee G, Umali C, Lew R, Irwin RS. Factors affecting the development of pneumothorax associated with thoracentesis. AJR Am J Roentgenol 1991; 156 (05) 917-920
    CrossrefPubMedGoogle Scholar
  • 94 Grogan DR, Irwin RS, Channick R. et al. Complications associated with thoracentesis. A prospective, randomized study comparing three different methods. Arch Intern Med 1990; 150 (04) 873-877
    CrossrefPubMedGoogle Scholar
  • 95 Kearon C. Natural history of venous thromboembolism. Circulation 2003; 107 (23, Suppl 01) I22-I30
    CrossrefPubMedGoogle Scholar
  • 96 Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993; 189 (01) 133-136
    CrossrefPubMedGoogle Scholar
  • 97 Westermark N. On the roentgen diagnosis of lung embolism. Acta Radiol 2013; 19 (04) 357-372
    CrossrefPubMedGoogle Scholar
  • 98 Stein PD, Fowler SE, Goodman LR. et al; PIOPED II Investigators. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354 (22) 2317-2327
    CrossrefPubMedGoogle Scholar
  • 99 Hutchinson BD, Navin P, Marom EM, Truong MT, Bruzzi JF. Overdiagnosis of pulmonary embolism by pulmonary CT angiography. AJR Am J Roentgenol 2015; 205 (02) 271-277
    CrossrefPubMedGoogle Scholar
  • 100 Dudzinski DM, Giri J, Rosenfield K. Interventional treatment of pulmonary embolism. Circ Cardiovasc Interv 2017; 10 (02) e004345
    CrossrefPubMedGoogle Scholar
  • 101 Libby LS, King TE, LaForce FM, Schwarz MI. Pulmonary cavitation following pulmonary infarction. Medicine (Baltimore) 1985; 64 (05) 342-348
    CrossrefPubMedGoogle Scholar
  • 102 ten Wolde M, Söhne M, Quak E, Mac Gillavry MR, Büller HR. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004; 164 (15) 1685-1689
    CrossrefPubMedGoogle Scholar
  • 103 Kang DK, Thilo C, Schoepf UJ. et al. CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging 2011; 4 (08) 841-849
    CrossrefPubMedGoogle Scholar
  • 104 Morris MF, Gardner BA, Gotway MB, Thomsen KM, Harmsen WS, Araoz PA. CT findings and long-term mortality after pulmonary embolism. AJR Am J Roentgenol 2012; 198 (06) 1346-1352
    CrossrefPubMedGoogle Scholar
  • 105 Meinel FG, Nance Jr JW, Schoepf UJ. et al. Predictive value of computed tomography in acute pulmonary embolism: systematic review and meta-analysis. Am J Med 2015; 128 (07) 747-59 .e2
    CrossrefPubMedGoogle Scholar