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| Dr Santosh Konde |
Thoracic imaging is one of the advanced imaging techniques for evaluation of chest and lung diseases. It is an active service with close relationships with internal medicine, pulmonary and critical care, medical oncology, bone marrow transplantation, cardiology divisions, and cardiac as well as thoracic surgery services.
Thoracic radiology is a speciality in radiology that looks at the structure of the lungs and heart. It uses the following imaging modalities: X-Ray plain films, ultrasound, MRI, CT, and fluoroscopy. Need for thoracic imaging also occurs with conditions such as emphysema, pulmonary fibrosis, pulmonary embolism, diffuse lung disease, small airway disease, pulmonary nodules, dyspnea, pneumonia, and tuberculosis. In short, it includes lung disease, thromboembolic disease, and thoracic malignancies as it also incorporates functional imaging of the lung and cardiac imaging.
In addition to conventional chest radiographs and CT, advanced imaging techniques include high-resolution CT scans for the evaluation of focal lung processes, diffuse lung disease and tracheobronchial pathology; digital and advanced multiple-beam equalisation radiography; and thoracic interventional procedures such as lung/ mediastinal fine-needle aspiration and pleural drainage, and MR imaging of mediastinal and paracardiac pathology.
Without the advance technique of thoracic imaging it would have been difficult to diagnose these diseases. Recently at our hospital, thoracic imaging was very helpful in the diagnosis of spontaneous esophageal perforation i.e Boerhaave’s syndrome, in a 59-year old male.
The patient had no prior medical illness or addictions and was referred to the hospital due to progressive breathlessness and severe lower chest pain lasting over three days. Boerhaave’s syndrome is a condition, which is not easily diagnosed and usually confused with other diseases. Thoracic imaging goes a long way in the diagnosis of these kinds of diseases and curing it.
The patient was admitted to the hospital and put on oxygen support with IV fluids and antibiotics to address his complaints. A chest X-ray was done which revealed pleural effusion and hydropneumothorax. Patient was then immediately admitted in the ICU. On the left side, intercostal drain was inserted and 800 ml sero-purulent fluid was drained.
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| Axial oral dynamic CT scan revealed leak of oral contrast from esophagus (arrow) with pneumomediastinum and bilateral pleural effusion |
Without wasting time, an urgent CT thorax with esophagogram was planned by the doctors with heamogram/biochemistry. Finally, the CT Thorax revealed esophageal rupture i.e Boerhaave’s Syndrome. After consultation with medical gastro specialist it was decided to cover the self expandable esophageal stent to close the perforation and thoracoscopic pleural drainage and toileting while feeding the jejunostomy at the same time. Post surgery elective ventilation was provided along with medicines. On the second day of surgery the patient was weaned off and extubated, he was shifted to the ward on the fourth day of surgery.
Oral feeds were started after contrast study ruled out leakage and was then gradually increased. ICD removed on the tenth day (right) and twelfth (left). The patient was discharged on 21 POD. Esophageal stent was removed one month after the surgery.
Thoracic imaging improves the presentation of the organ by capturing two distinct images on a single sheet of double amulsion film with one exposure. This further assists in improving patient care with superior chest examinations without changing techniques or equipment.
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