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3
P, Iannotti Joseph, and Schnall Mitchell D, eds. MRI of the shoulder. Raven Press, 1991.
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Willis, Judith. Why women don't get mammograms (and why they should): By Judith Willis. Dept. of Health and Human Services, Public Health Service, Food and Drug Administration, Office of Public Affairs, 1988.
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J, Sartoris David, ed. Principles of shoulder imaging. McGraw-Hill, Health Professions Division, 1995.
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(Editor), A. Mark Davies, and Jürg Hodler (Editor), eds. Imaging of the Shoulder: Techniques and Applications (Medical Radiology / Diagnostic Imaging). Springer, 2004.
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(Contributor), Juergen Maeurer, J. Jerosch (Contributor), J. Kramer (Contributor), et al., eds. Imaging Strategies for the Shoulder. Thieme Medical Publishers, 2004.
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8
Zlatkin, Michael B. MRI of the Shoulder. 2nd ed. Lippincott Williams & Wilkins, 2002.
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9
Brockmeier, Stephen F. MRI-Arthroscopy Correlations: A Case-Based Atlas of the Knee, Shoulder, Elbow and Hip. Springer, 2016.
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Hughes, Jim. Shoulder and humerus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198813170.003.0009.
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Surgical intervention is sometimes required to ensure correct reduction and functionality of the limb. Due to the location of the shoulder and humerus next to the torso and the relative infrequency of such procedures, they can represent a challenge for the radiographer. This chapter covers a selection of orthopaedic procedures involving the shoulder and proximal humerus, covering clavicle plating, tuberosity fracture fixation with screws, plating of the proximal humerus and shoulder, plating of the humeral shaft, and antegrade and retrograde intramedullary nailing of the humerus. Each procedure includes images that demonstrate the position of the C-arm, patient, and surgical equipment, with accompanying radiographs demonstrating the resulting images.
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Mosby. Shoulder Girdle (Radiographic Anatomy, Positioning and Procedures). C.V. Mosby, 1996.
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Mosby. Radiographic Anatomy, Positioning and Procedures: Unit 5: Shoulder Girdle CD-ROM. Mosby Elsevier Health Science, 1996.
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13
Sahetya, Sarina. Acute Uncomplicated Bronchitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0029.
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Acute bronchitis is a respiratory illness characterized predominantly by cough with or without sputum production that lasts for up to 3 weeks in the presence of normal chest radiography. Additional presenting symptoms include rhinorrhea, congestion, sneeze, sore throat, wheezing, low-grade fever, myalgia, and fatigue. Causative organisms include viral and bacterial pathogens. The disease course is characterized by self-limited inflammation of the airways. Chest radiographs should be utilized to distinguish acute bronchitis from pneumonia or interstitial disease. Therapeutic recommendations are typically supportive; however, studies reveal that between 60% and 80% of patients receive unwarranted antibiotic therapy. Only those patients at high risk for serious complications (including patients over 65 with a history of hospitalization, diabetes mellitus, congestive heart failure, or current use of oral glucocorticoids) usually require routine antibiotic therapy directed toward both typical and atypical bacterial pathogens.
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Maksymowych, Walter P., and Robert G. W. Lambert. Imaging: sacroiliac joints. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0013.
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Radiography of the sacroiliac (SI) joints still forms the cornerstone of diagnosis of axial spondyloarthritis (axSpA), although its limitations in early disease preclude early diagnosis. Equivocal radiographic findings of sacroiliitis should be followed by MRI evaluation of the SI joints, especially if clinical suspicion of SpA is high. Routine diagnostic evaluation for SpA by MRI of the SI joints should include simultaneous evaluation of T1-weighted (T1W) and short tau inversion recovery (STIR) or T2 fat-suppressed scans. Bone marrow oedema (BME) in subchondral bone is the primary MRI feature that points to the diagnosis of SpA, although structural lesions such as erosion and fat metaplasia may also be evident in early disease and enhance confidence in the diagnosis. Both inflammatory and structural lesions in the SI joints on MRI can now be quantified in a reliable manner to facilitate therapeutic evaluation in clinical trials and for basic and clinical research.
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Williams, Jerry R. Diagnostic radiology equipment. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199655212.003.0012.
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The chapter is concerned with the features of radiographic and fluoroscopic equipment that present radiation protection issues for both patients and staff. These are managed through regulation, manufacturing standards, and adherence to safe working practices. It is different for patients who are deliberately irradiated in accordance with justification protocols not considered here. Radiation protection is based on the ALARP principle which requires the resultant dose to be minimized consistent with image quality is sufficient to provide accurate and safe diagnosis. Dose minimization is critically dependent on detector efficiency. Quality control of dose for individual examinations is particularly important to provide assurance of ALARP. It should include not only patient dose assessment but also detector dose indicators, particularly in radiography. These issues are discussed in detail together with other dose-saving features and discussion on objective methods of image quality assessment. Commissioning and lifetime tests are required for quality assurance programmes. These are described.
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Hayashi, Daichi, Ali Guermazi, and Frank W. Roemer. Radiography and computed tomography imaging of osteoarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0016.
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Osteoarthritis (OA) is the most prevalent joint disorder in the elderly worldwide and there is still no effective treatment, other than joint arthroplasty for end-stage OA, despite ongoing research efforts. Imaging is essential for assessing structural joint damage and disease progression. Radiography is the most widely used first-line imaging modality for structural OA evaluation. Its inherent limitations should be noted including lack of ability to directly visualize most OA-related pathological features in and around the joint, lack of sensitivity to longitudinal change and missing specificity of joint space narrowing, and technical difficulties regarding reproducibility of positioning of the joints in longitudinal studies. Magnetic resonance imaging (MRI) is widely applied in epidemiological studies and clinical trials. Computed tomography (CT) is an important additional tool that offers insight into high-resolution bony anatomical details and allows three-dimensional post-processing of imaging data, which is of particular importance for orthopaedic surgery planning. However, its major disadvantage is limitations in the assessment of soft tissue structures compared to MRI. CT arthrography can be useful in evaluation of focal cartilage defects or meniscal tears; however, its applicability may be limited due to its invasive nature. This chapter describes the roles and limitations of both conventional radiography and CT, including CT arthrography, in clinical practice and OA research. The emphasis is on OA of the knee, but other joints are also mentioned where appropriate.
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Chong, Ji Y., and Michael P. Lerario. A Horner’s Syndrome Following Trauma. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190495541.003.0017.
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Carotid dissection should be considered as a stroke etiology, especially in young patients with a history of trauma. Carotid dissection can be recognized by exam findings and radiographic studies. Treatment can include aspirin or anticoagulation.
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Anderson, Paul A. Upper cervical injuries. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.012039.
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♦ Upper cervical spine injuries should be considered in all blunt trauma patients.♦ Critical review of plain radiographs or CT should carefully examine the alignment of the articulations between the occiput-C1 and C1-2 to determine if ligamentous injury is present.♦ The initial stabilization of unstable upper cervical injuries usually should avoid the use of traction in favour of the halovest.♦ Definitive stabilization is based on fracture type and the status of the cranio-cervical ligaments.
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Javaid, Kassim, and Paul Wordsworth. Osteoarthritis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.010007.
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♦ Osteoarthritis is the outcome of many different disease processes♦ Correlation between radiographic appearance and symptoms is poor♦ Prevalence increases rapidly with age♦ A multidimensional approach in treatment should include patient education, physical therapy, analgesia, and ergonomic assessment♦ Surgical approaches to treatment should adopt a holistic approach.
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Cleverley, Joanne. The imaging of fungal disease. Edited by Christopher C. Kibbler, Richard Barton, Neil A. R. Gow, Susan Howell, Donna M. MacCallum, and Rohini J. Manuel. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755388.003.0041.
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The imaging of fungal infection is diverse and often non-specific with multiple abnormalities commonly identified, frequently with more than one organ involved. By correlating the clinical information, which should include patient immune status, pre-existing chronic disease, and potential exposure to endemic fungi, and using this information with an awareness of the radiographic findings of fungal infection, a potential diagnosis can be ascertained. In this chapter, the imaging of fungal infection is discussed, concentrating on the various imaging modalities available, their role, and the major organs involved, highlighting any distinguishing radiographic findings, which may help in the search for a definitive diagnosis.
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McNally, Martin A., and Maurizio A. Catagni. Principles of circular external fixation in trauma. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.012015.
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♦ The ideal frame should be versatile, stable during load bearing and allow joint movement, correction of deformity and closed application♦ Circular fixators consist of rings, connecting rods, fine wires and special parts♦ Meticulous preoperative planning with the patient and radiographs is essential♦ Recovery of limb function is the primary goal of fracture care; the patient must be fully involved in the rehabilitation♦ Fixator removal once union is complete should be performed under general anaesthetic for children or with sedation and analgesia in adults
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Safriel, Yair. Clinical Imaging of the Spine. Edited by Mehul J. Desai. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199350940.003.0002.
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Spinal conditions are one of the most common situations necessitating a referral for imaging. As spine therapies advance, there is a greater need for accurate spine imaging. There are four primary modalities used to image the spine: radiography, magnetic resonance imaging, computed tomography, and nuclear imaging. The most important fact to remember is that these modalities are often complementary rather than mutually exclusive. The appropriate use of spine imaging is an evolving topic. Imaging that involves ionizing radiation should be used judiciously. Understanding the intricacies of imaging may allow the physician to make an optimal choice.
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Rosenow, III, Edward C. Mayo Clinic Challenging Images for Pulmonary Board Review. Oxford University Press, 2010. http://dx.doi.org/10.1093/med/9780199756926.001.0001.
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This resource features a collection of more than 150 very unusual intrathoracic conditions that every pulmonologist, thoracic surgeon, and chest radiologist should know and understand. Featuring a broad array of chest images and corresponding pearls of wisdom on how to best interpret the chest radiograph and other images that are reviewed primarily by pulmonologists, thoracic surgeons, radiologists, and pathologists, the conditions are presented in a didactic, user-friendly, and interactive tutorial format to help practitioners recognize these conditions when encountered in practice.
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Cruz, Andrea T., and Jeffrey R. Starke. Central Nervous System Tuberculosis. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0154.
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Mycobacterium tuberculosis is a common cause of bacterial meningitis in areas with high HIV prevalence and its diagnosis often is delayed in industrialized nations. Children (particularly infants) and immunocompromised persons are at higher risk of developing TB meningitis. Lymphocytic meningitis, high CSF protein, and (in children) frequently an abnormal chest radiograph should raise clinician index of suspicion for TB meningitis. Neuroimaging may show hydrocephalus, basilar leptomeningeal enhancement, ischemia, and/or tuberculomas. Prompt recognition and initiation of antituberculous antibiotics and corticosteroids can decrease morbidity and mortality.
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Li Bassi, Gianluigi, and Carles Agusti. Toilet bronchoscopy in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0122.
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Critically-ill patients retain respiratory secretions. Toilet bronchoscopy is applied to aspirate retained secretions and revert lung atelectasis. Toilet bronchoscopy is particularly indicated when retained secretions are visible during the procedureand air-bronchograms are not present at the chest radiograph. Yet, toilet bronchoscopy should only be applied when other less invasive methods of secretion removal have failed. Ventilatory settings during the intervention, the inspiratory fraction of oxygen should be increased to 100%. In volume control ventilation, the pressure limit alarm needs to be increased; during pressure-controlled ventilation, the set inspiratory pressure should be increased. The external PEEP should be decreased to at least 50% of the baseline values, to prevent barotrauma. The use of sedatives, analgesics, and topical anaesthetics is mandatory to achieve favourable procedural condition. Toilet bronchoscopy is also feasible and safe in critically-ill patients undergoing non-invasive ventilation.
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Hughes, Jim. Distal femur and knee. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198813170.003.0014.
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The knee is one of the main load-bearing joints of the body, and injuries to it can involve damage to the joint or articular surfaces, or fractures to the long bones in case of high-energy trauma. The position of the contralateral leg can cause difficulty in positioning for imaging, but good positioning and technique should allow demonstration of the region for intervention. This chapter covers a selection of orthopaedic procedures involving the distal femur and knee, covering distal femoral plating and LISS plates, tension band wiring of the patella, and cerclage wiring of the patella. Each procedure includes images that demonstrate the position of the C-arm, patient, and surgical equipment, with accompanying radiographs demonstrating the resulting images.
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Barzilai, Ori, Mark H. Bilsky, and Ilya Laufer. Spine Metastases. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190696696.003.0028.
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A decision-making framework called NOMS (neurologic, oncologic, mechanical, and systemic) facilitates and guides therapeutic decisions for patients with spinal metastases. Patients should be evaluated for signs of myelopathy or cauda equina. The Epidural Spinal Cord Compression scale facilitates reporting of the degree of radiographic spinal cord compression. A determination of the expected histology-specific tumor response to conventionally fractionated external beam radiation and systemic therapy should be made. Radiation therapy effectively treats biologic pain and radiosensitive tumors such as multiple myeloma. Patients should undergo a careful evaluation of movement-associated pain as tumor-induced spinal instability is an independent indication for surgery. Determination of tumor-associated mechanical instability can be facilitated by the Spinal Instability Neoplastic Score. Herein, the authors present a case of spinal multiple myeloma managed using the NOMS framework and in consideration of current evidence and treatment paradigms.
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Ripamonti, Carla I., Alexandra M. Easson, and Hans Gerdes. Bowel obstruction. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0143.
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In this chapter, malignant bowel obstruction is defined as the clinical presentation of patients with symptoms, signs, and radiographic evidence of obstruction to the transit of gastrointestinal contents caused by cancer, or the consequences of anticancer therapy including surgery, chemotherapy, or radiation therapy. Malignant bowel obstruction secondary to cancer or its treatments is encountered relatively frequently in supportive care as well as in in hospice/palliative care practice, carries a poor prognosis, and is associated with significant symptoms. Careful clinical assessment and an understanding of the patient’s disease trajectory are crucial in recommending the best way of providing palliation. In someone with a single-level obstruction and good functional status, surgery should be offered. Those with multilevel obstruction are almost never surgical candidates and should be managed with changes in oral intake and medications.
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Hughes, Jim. Working in theatre. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198813170.003.0006.
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This chapter covers the typical layout and requirements of an operating theatre or surgery room, including the requirements for infection control and sterile fields/sterile techniques and effective working with the surgical team. Radiation protection and the management of a radiation-controlled area is also covered. Theatre practice can be an intimidating and unfamiliar place for newly qualified staff, especially when working without assistance for the first time. It is important to try and gain as much familiarity with the theatre environment before working as the lone radiographer in the department. However, there are some basic guidelines that, if followed, should help avoid most potential issues.
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Oshiro, Thomas, and Lawrence W. Bassett. An Overview of Digital Mammography Technology and MQSA Requirements. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0006.
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Understanding the fundamentals of mammographic imaging is essential for any practicing physician. The elements described in this section should serve as a brief review of how digital mammography systems acquire and generate images. Equipment including digital receptor design and technical factors to optimize the radiographic contrast and spatial resolution while reducing breast doses to lower levels are outlined. General image processing features as well as commonly encountered clinical artifacts will be reviewed. MQSA (Mammography Quality Standards Act) and ACR standards that define qualifications for personnel (interpreting physicians, radiologic technologists and medical physicists), minimum equipment performance characteristics and methodologies for routine quality control testing are summarized.
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An, Howard. Cervical spine disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.003001.
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♦ Degenerative cervical spine disorders may manifest clinically with axial neck pain, radiculopathy, myelopathy, or a combination of these clinical symptoms♦ The findings on radiographs and MRI are pertinent if they correlate with the clinical symptoms♦ The initial treatment for patients with degenerative cervical spine disorders is conservative, including non-narcotic analgesics, anti-inflammatory medications, exercise program, physiotherapy, and occasional injections♦ Surgical indications include significant radicular pain despite conservative treatment, profound neurologic deficits, and presence of significant myelopathy♦ Surgical treatment for cervical radiculopathy includes lamino-foraminotomy, anterior cervical discectomy and fusion (ACDF), and artificial disk replacement, and surgical treatment for myelopathy includes anterior discectomy and/or corpectomy with fusion, posterior laminoplasty, and posterior laminectomy and fusion. The surgeon should be familiar with the specific indications as well as advantages and disadvantages of each procedure.
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Abhishek, Abhishek, and Michael Doherty. Investigations of calcium pyrophosphate deposition. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0051.
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Joint aspiration and microscopic examination of the aspirated synovial fluid remains the gold standard for the diagnosis of calcium pyrophosphate crystal deposition (CPPD). If synovial fluid aspiration is not feasible, plain radiography and/or ultrasound scanning may be used to detect chondrocalcinosis (CC) which predominantly occurs due to calcium pyrophosphate (CPP) crystals, and this can be used as a diagnostic surrogate for CPPD as suggested by the EULAR Task Force. Acute CPP crystal arthritis often associates with a brisk acute phase response (elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR), plasma viscosity) and neutrophilia. A mildly raised CRP and/or ESR may be present in chronic CPP crystal inflammatory arthritis. On the contrary, asymptomatic CC, or CPPD with osteoarthritis does not cause raised acute phase reactants. As CPPD most commonly occurs due to increasing age and osteoarthritis, investigations to screen for underlying metabolic abnormalities should be carried out in those with early-onset CPPD (under 55 years), or in those with florid polyarticular CC. As hyperparathyroidism gets more common with ageing its presence should be specifically sought in all age groups. Tests for other predisposing metabolic conditions should only be carried out in the presence of specific clinical features. Genotyping for mutations, especially in the ANKH gene, may be warranted in those with a family history of premature CPPD and no evidence of inherited metabolic predisposition, but such testing is unavailable to most clinicians.
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Seipel, Catherine P., and Titilopemi A. O. Aina. Tracheoesophageal Fistula Repair. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0048.
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Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a congenital malformation occurring in approximately 1:4,000 live births. TEF/EA is characterized by disrupted continuity of the esophagus. There are five distinct types, but the most common is EA with a distal TEF. Most cases are diagnosed postnatally after an inability to pass a nasogastric tube (NGT), with subsequent radiographic imaging finding the NGT coiled within the esophageal pouch. The anesthetic management of TEF/EA repair can be complicated by the presence of cardiac, renal, and vertebral anomalies. Additionally, ventilation can be challenging, and care must be taken to minimize insufflation of the stomach through the fistula. Postoperative analgesia should include consideration of intravenous opioids, nonopioid adjunct medications, and regional and neuraxial techniques.
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Johnson, Nicholas J., and Judd E. Hollander. Management of cocaine poisoning. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0324.
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Cocaine is powerful central nervous system (CNS) stimulant derived from the coca plant. It affects the body via a number of mechanisms including blockade of fast sodium channels, increased catecholamine release, inhibition of catecholamine reuptake, and increased concentration of excitatory amino acid concentrations in the CNS. It is rapidly absorbed via the aerodigestive, respiratory, gastrointestinal, and genitourinary mucosa, and also may be injected. When injected intravenously or inhaled, cocaine is rapidly distributed throughout the body and CNS, with peak effects in 3–5 minutes. With nasal insufflation, absorption peaks in 20 minutes. Its half-life is approximately 1 hour. Common clinical manifestations include agitation, euphoria, tachycardia, hyperthermia, and hypertension. Chest pain is a common presenting complaint among cocaine users; 6% of these patients will have myocardial infarction. Other life-threatening sequelae include stroke, intracranial haemorrhage, seizures, dysrhythmias, and rhabdomyolysis. Clinical signs and symptoms, as well as severity of intoxication, should dictate the diagnostic evaluation and treatment of cocaine intoxicated patients. If the patient has chest pain, an ECG, chest radiograph, and measurement of cardiac biomarkers should be performed. A brief observation period may be useful in these patients. Many manifestations of cocaine intoxication, including agitation, hypertension, and chest pain, are effectively treated with benzodiazepines. Beta-blockers should be avoided in patients with suspected cocaine intoxication. Special attention should be paid to pregnant patients and those who present after ingesting packets filled with cocaine, as they may exhibit severe toxicity if these packets rupture.
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O’Dwyer, Michael, and David Watson. Pathophysiology and management of thyroid disorders in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0263.
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Although overt thyroid disease as a primary admission diagnosis to an intensive care unit is uncommon, failure to recognize and adequately manage this condition can have fatal consequences. Hyperthyroidism is usually manifested by signs and symptoms of an exaggerated sympathomimetic response. In its most severe forms, a thyroid storm will necessitate a multimodal treatment. Although robust evidence is lacking, radiographic contrast dyes containing iodine are becoming popular as a first-line treatment. Hypothyroidism can similarly present as a diagnostic dilemma, particularly in the elderly. Management is difficult with little consensus as to the optimal pharmacological approach. Treatment should be individually tailored, while remaining vigilant for the unwanted side effect of treatment with thyroid hormones. In contrast, sick euthyroid syndrome is commonly observed in the critically ill. A sound understanding of the action of thyroid hormones in health and in the critically ill will benefit clinicians in recognizing these disorders and also in guiding their management in an area where significant variability remains in therapeutic approaches.
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Gattinon, Luciano, and Eleonora Carlesso. Acute respiratory failure and acute respiratory distress syndrome. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0064.
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Respiratory failure (RF) is defined as the acute or chronic impairment of respiratory system function to maintain normal oxygen and CO2 values when breathing room air. ‘Oxygenation failure’ occurs when O2 partial pressure (PaO2) value is lower than the normal predicted values for age and altitude and may be due to ventilation/perfusion mismatch or low oxygen concentration in the inspired air. In contrast, ‘ventilatory failure’ primarily involves CO2 elimination, with arterial CO2 partial pressure (PaCO2) higher than 45 mmHg. The most common causes are exacerbation of chronic obstructive pulmonary disease (COPD), asthma, and neuromuscular fatigue, leading to dyspnoea, tachypnoea, tachycardia, use of accessory muscles of respiration, and altered consciousness. History and arterial blood gas analysis is the easiest way to assess the nature of acute RF and treatment should solve the baseline pathology. In severe cases mechanical ventilation is necessary as a ‘buying time’ therapy. The acute hypoxemic RF arising from widespread diffuse injury to the alveolar-capillary membrane is termed Acute Respiratory Distress Syndrome (ARDS), which is the clinical and radiographic manifestation of acute pulmonary inflammatory states.
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Gattinon, Luciano, and Eleonora Carlesso. Acute respiratory failure and acute respiratory distress syndrome. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0064_update_001.
Full textAbstract:
Respiratory failure (RF) is defined as the acute or chronic impairment of respiratory system function to maintain normal oxygen and CO2 values when breathing room air. ‘Oxygenation failure’ occurs when O2 partial pressure (PaO2) value is lower than the normal predicted values for age and altitude and may be due to ventilation/perfusion mismatch or low oxygen concentration in the inspired air. In contrast, ‘ventilatory failure’ primarily involves CO2 elimination, with arterial CO2 partial pressure (PaCO2) higher than 45 mmHg. The most common causes are exacerbation of chronic obstructive pulmonary disease (COPD), asthma, and neuromuscular fatigue, leading to dyspnoea, tachypnoea, tachycardia, use of accessory muscles of respiration, and altered consciousness. History and arterial blood gas analysis is the easiest way to assess the nature of acute RF and treatment should solve the baseline pathology. In severe cases mechanical ventilation is necessary as a ‘buying time’ therapy. The acute hypoxemic RF arising from widespread diffuse injury to the alveolar-capillary membrane is termed Acute Respiratory Distress Syndrome (ARDS), which is the clinical and radiographic manifestation of acute pulmonary inflammatory states.
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Chiumello, Davide, and Silvia Coppola. Management of pleural effusion and haemothorax. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0125.
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The main goal of management of pleural effusion is to provide symptomatic relief removing fluid from the pleural space. The options depend on type, stage, and underlying disease. The first diagnostic instrument is the chest radiography, while ultrasound can be very useful to guide thoracentesis. Pleural effusion can be a transudate or an exudate. Generally, a transudate is uncomplicated effusion treated by medical therapy, while an exudative effusion is considered complicated effusion and should be managed by drainage. Refractory non-malignant effusions can be transudative (congestive heart failure, cirrhosis, nephrosis) or exudative (pancreatitis, connective tissue disease, endocrine dysfunction), and the management options include repeated therapeutic thoracentesis, in-dwelling pleural catheter for intermittent external drainage, pleuroperitoneal shunts for internal drainage, or surgical pleurectomy. Parapneumonic pleural effusions can be classified as complicated when there is persistent bacterial invasion of the pleural space, uncomplicated and empyema with specific indications for pleural fluid drainage. Malignancy is the most common cause of exudative pleural effusions in patients aged >60 years and the decision to treat depends upon the presence of symptoms and the underlying tumour type. Options include in-dwelling pleural catheter drainage, pleurodesis, pleurectomy, and pleuroperitoneal shunt. Haemothorax needs to be differentiated from a haemorrhagic pleural effusion and, when suspected, the essential management is intercostal drainage. It achieves two objectives to drain the pleural space allowing expansion of the lung and to allow assessment of rates of blood loss to evaluate the need for emergency or urgent thoracotomy.
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Blasi, Francesco, and Paolo Tarsia. Pathophysiology and causes of haemoptysis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0126.
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The main goal of management of pleural effusion is to provide symptomatic relief removing fluid from pleural space and the options depend on type, stage and underlying disease. The first diagnostic instrument is the chest radiography while ultrasound can be very useful to guide thoracentesis. Pleural effusion can be a transudate or an exudate. Generally a transudate is uncomplicated effusion treated by medical therapy, while an exudative effusion is considered complicated effusion and should be managed by drainage. Refractory non-malignant effusions can be transudative (congestive heart failure, cirrhosis, nephrosis) or exudative (pancreatitis, connective tissue disease, endocrine dysfunction), and the management options include repeated therapeutic thoracentesis, indwelling pleural catheter for intermittent external drainage, pleuroperitoneal shunts for internal drainage, or surgical pleurectomy. Parapneumonic pleural effusions can be divided in complicated when there is persistent bacterial invasion of the pleural space, uncomplicated and empyema with specific indications for pleural fluid drainage. Malignancy is the most common cause of exudative pleural effusions in patients aged >60 years and the decision to treat depends upon the presence of symptoms and the underlying tumour type. Options include indwelling pleural catheter drainage, pleurodesis, pleurectomy and pleuroperitoneal shunt. Hemothorax needs to be differentiated from a haemorrhagic pleural effusion and when is suspected the essential management is the intercostal drainage. It achieves two objectives to drain the pleural space allowing expansion of the lung and to allow assessment of rates of blood loss to evaluate the need for emergency or urgent thoracotomy.