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KEY POINTS

KEY POINTS

  1. Chest radiography is particularly useful in the initial placement, positioning of invasive hardware, and for monitoring of complications postprocedure in critically ill patients.

  2. Contrast imaging should be used judiciously in critically ill patients. Computed tomography (CT) with contrast helps further evaluation of lung parenchyma and pulmonary vascular lesions.

  3. Atelectasis and pneumonia are common causes of respiratory failure in the intensive care unit (ICU). Unrecognized it can progresses to cavitation and abscess formation.

  4. High probability ventilation perfusion scans have good positive predictive value for Pulmonary Embolism, and is in par with CT Pulmonary Angiography which show intraluminal filling defects for the same.

  5. Pulmonary edema and acute respiratory distress syndrome (ARDS) may have similar radiologic features but have a different time of onset, presentation, and its ensuing clinical progression.

  6. Bedside ultrasound is a convenient option for the evaluation and drainage of the pleural space.

IMAGING PROCEDURES

Imaging is an essential tool in the clinical assessment and management of critically ill patients. Although bedside ultrasound and chest radiography are the mainstays of initial assessment, an extensive variety of imaging options are available to the physician in the ICU, including CT, magnetic resonance imaging (MRI), and nuclear medicine studies. Interventional procedures, either at the bedside or in the radiology suite, are also playing an increasingly important role in the management of critical illness.

The choice of a particular imaging modality is occasionally difficult and should be based on recommendations in the literature, local expertise, type of equipment available, and the experience of the radiologists. Given the increasing emphasis on cost-effective practice, clinicians and radiologists must maximize the diagnostic and therapeutic yield of procedures while minimizing costs. The main indications, strengths, and weaknesses of imaging modalities used in common ICU scenarios are reviewed in this chapter. Although abdominal, neurologic, and musculoskeletal imaging studies play an important role in the care of the critically ill patient, this chapter will focus primarily on imaging of the chest and devices used in the ICU.

IMAGING TECHNIQUES

Plain Radiography

Portable chest radiographs are the most commonly requested imaging examination in the ICU. Despite their limitations, these films play an important role in the management of ICU patients. Chest radiographs are used to identify and follow pulmonary and cardiac disorders as well as evaluate the positions of and complications from catheters and support devices used in the care of critically ill patients.

Imaging of the abdomen can also often begin with plain radiographs, which provide a readily accessible means of diagnosing perforation, bowel obstruction, and ileus. However, because the overall sensitivity of plain radiographs remains low, further imaging with CT is frequently necessary to confirm suspected pathology and to inspect the features of the bowel walls and surrounding fat. Supine radiographs are appropriate for verifying nasogastric or feeding tube placement and for initial investigation of ...

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