Diagnostic Radiology/Chest Imaging/Chest Indications

Indications of chest CT

1. Evaluation of an abnormality identified on conventional radiographs
   1. Densitometry of solitary pulmonary nodule
   2. Localization and characterization of mediastinal mass
2. Staging of Lung Cancer
   1. Assessment of extent of primary tumor, The relationship of tumor to pleura, chest wall, airways, mediastinum
   2. Detection of hilar and mediastinal LAD
3. Detection of occult pulmonary metastases
   1. Extra-thoracic malignancies with propensity to involve the lungs (osteogenic sarcoma, breast, RCC)
4. Detection of mediastinal nodes
   1. Lymphoma, mets, infection
5. Distinction of empyema from periph lung abscess (contrast enhanced)
6. Detection and eval aortic disease
   1. Aneurysm, dissection, intramural hematoma, aortitis, trauma

Indications of chest HRCT (High Resolution CT)

1. Solitary pulmonary nodule
   1. Volumetric exam, accurate density determination
2. Detection of lung disease in patient with pulmonary signs and symptoms or abnormal PFT but normal or equivocal CXR
   1. Emphysema, Extrinisic allergic alveolitis, small airway disease, immunocompromised patient
3. Evaluation of diffusely abnormal CXR
   1. Cystic fibrosis, Sarcoidosis, Interstitial lung disease, Histocytosis X, ARDS
4. Approach for biopsy
   1. Bronchoscopy vs. VATS or needle biopsy