Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Dec 2022
ReviewChronic Thromboembolic Pulmonary Disease and Chronic Thromboembolic Pulmonary Hypertension.
Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) are two terms characterizing symptomatic patients with chronic thromboembolic occlusions of pulmonary arteries with or without pulmonary hypertension at rest. Their diagnosis follows evolving schemas that integrate technological advances of pivotal imaging modalities among which computed tomography angiography plays a major role. ⋯ The requirements for imaging at the time of therapeutic decisions are also described in the light of recent updates in the literature from multidisciplinary groups of experts. Because an early diagnosis of CTEPH remains a challenge for the medical community, several practical issues are included in this article with the objective of improving the knowledge and collaboration between radiologists and clinicians in service to the patient.
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Semin Respir Crit Care Med · Dec 2022
ReviewImaging of Lung Disease Associated with Connective Tissue Disease.
There is a well-known association between the connective tissue disorders (CTDs) and lung disease. In addition to interstitial lung disease, the CTDs may affect the air spaces and pulmonary vasculature. Imaging tests are important not only in diagnosis but also in management of these complex disorders. In the present review, key aspects of the imaging of CTD-reated diseases are discussed.
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Semin Respir Crit Care Med · Dec 2022
ReviewImaging of Occupational and Environmental Lung Disease.
The respiratory tract is continuously exposed to and filters toxins from the home and work environments. Certain occupations and environmental exposures can cause unique injuries to the upper and lower respiratory system. Despite increasing federal regulations in the workplace, occupation-associated lung disease is still a major cause of lung disease and disability and continues to evolve with changes in industry, regulation, and new emerging exposures and toxins. ⋯ Identifying key imaging features of occupational lung disease along with a multidisciplinary approach can aid in accurate and timely diagnosis. In this review, we will discuss the importance of a comprehensive patient history, multidisciplinary approach to diagnosis, and key imaging features of occupation-related lung injuries. Radiographic and computed tomographic findings will be described and illustrated.
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Clinical applications of novel anticancer agents in the past few decades brought marked advances in cancer treatment, enabling remarkable efficacy and effectiveness; however, these novel agents are also associated with toxicities. Among various toxicities, drug-related pneumonitis is one of the major clinical challenges in the management of cancer patients. Imaging plays a key role in detection, diagnosis, and monitoring of drug-related pneumonitis during cancer treatment. ⋯ Then, we will discuss pneumonitis from representative agents of precision cancer therapy, including mammalian target of rapamycin inhibitors, epidermal growth factor receptor inhibitors, and ICI, focusing on the incidence, risk factors, and the spectrum of CT patterns. Finally, the article will address emerging challenges in the diagnosis and monitoring of pneumonitis, including pneumonitis from combination ICI and radiation therapy and from antibody conjugate therapy, as well as the overlapping imaging features of drug-related pneumonitis and coronavirus disease 2019 pneumonia. The review is designed to provide a practical overview of drug-related pneumonitis from cutting-edge cancer therapy with emphasis on the role of imaging.