Abstract
Thoracic complaints including cough, shortness of breath, and pleuritic chest pain are common but nonspecific presenting symptoms in the emergency department, and as many as 5% of visits are due to acute chest pain. Acute chest pain in the absence of trauma remains a diagnostic challenge because of extensive etiology that ranges from benign to potentially lethal. After cardiac and aortic etiologies are ruled out, three main categories of disease origin should be considered: mediastinum (including pulmonary vasculature only), lung, and pleura. Nontraumatic, noncardiac mediastinal processes which can present with chest symptoms include, but are not limited to, pulmonary embolism (technically lung but will be considered with mediastinum), esophageal perforation, mediastinitis, and abscess. Pulmonary pathology also tends to affect the pleural space, so these two categories will be considered together. Pneumonia and pulmonary edema are the most common pulmonary diagnoses in the emergency room. It is equally important to delineate any associated complications including pulmonary abscess and empyema. Pneumothorax can also be nontraumatic in etiology and present with acute thoracic symptoms.
This is a preview of subscription content, log in via an institution.
References
Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008;358:1037–52.
Coche EE, Verschuren F, Hainaut P, Goncette L. Pulmonary embolism findings on chest radiographs and multislice spiral CT. Eur Radiol. 2004;14:1241–8.
Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators. Radiology. 2007;242(1):15–21.
Han D, Lee KS, Franquet T, Müller NL, Kim TS, Kim H, et al. Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. Radiographics. 2003;23:1521–39.
Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics. 2004;24(5):1219–38.
Coche EE, Müller NL, Kim KI, Wiggs BR, Mayo JR. Acute pulmonary embolism: ancillary findings at spiral CT. Radiology. 1998;207(3):753–8.
Giménez A, Franquet T, Erasmus JJ, Martínez S, Estrada P. Thoracic complications of esophageal disorders. Radiographics. 2002;22:S247–58.
Hingston CD, Saayman AG, Frost PJ, Wise MP. Boerhaave’s syndrome—rapidly evolving pleural effusion; a radiographic clue. Minerva Anestesiol. 2010;76(10):865–7.
Nair GB, Niederman MS. Community-acquired pneumonia: an unfinished battle. Med Clin North Am. 2011;95:1143–61.
Tarver RD, Teague SD, Heitkamp DE, Conces DW. Radiology of community-acquired pneumonia. Radiol Clin N Am. 2005;43(3):497–512.
Waite S, Jeudy J, White CS. Acute lung infections in normal and immunocompromised hosts. Radiol Clin N Am. 2006;44:295–315.
Heffner JE, Klein JS, Hampson C. Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 2010;137:467–79.
Ware LB, Matthay MA. Acute pulmonary edema. N Engl J Med. 2005;353:2788–96.
Glueker T, Capasso P, Schnyder P, Gudinchet F, Schaller MD, Revelly JP, et al. Clinical and radiologic features of pulmonary edema. Radiographics. 1999;19:1507–31.
Luh S. Diagnosis and treatment of primary spontaneous pneumothorax. J Zhejiang Univ Sci B. 2010;11(10):735–44.
Jeudy J, Waite S, White CS. Nontraumatic thoracic emergencies. Radiol Clin N Am. 2006;44:273–93.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Carter, B.W., Muse, V.V., Mansouri, M. (2018). Imaging of Nontraumatic Mediastinal and Pulmonary Processes. In: Singh, A. (eds) Emergency Radiology. Springer, Cham. https://doi.org/10.1007/978-3-319-65397-6_23
Download citation
DOI: https://doi.org/10.1007/978-3-319-65397-6_23
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-65396-9
Online ISBN: 978-3-319-65397-6
eBook Packages: MedicineMedicine (R0)