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Geriatric chest imaging: when and how to image the elderly lung, age-related changes, and common pathologies.

Gossner J, Nau R - Radiol Res Pract (2013)

Bottom Line: Even in a global perspective, societies are getting older.It is especially important to separate the process of ageing from the disease itself.Pathologies with a special relevance for the elderly patient are discussed in detail: pneumonia, aspiration pneumonia, congestive heart failure, chronic obstructive pulmonary disease, the problem of overlapping heart failure and chronic obstructive pulmonary disease, pulmonary drug toxicity, incidental pulmonary embolism pulmonary nodules, and thoracic trauma.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Radiology, Göttingen-Weende Hospital, An der Lutter 24, 37074 Göttingen, Germany.

ABSTRACT
Even in a global perspective, societies are getting older. We think that diagnostic lung imaging of older patients requires special knowledge. Imaging strategies have to be adjusted to the needs of frail patients, for example, immobility, impossibility for long breath holds, renal insufficiency, or poor peripheral venous access. Beside conventional radiography, modern multislice computed tomography is the method of choice in lung imaging. It is especially important to separate the process of ageing from the disease itself. Pathologies with a special relevance for the elderly patient are discussed in detail: pneumonia, aspiration pneumonia, congestive heart failure, chronic obstructive pulmonary disease, the problem of overlapping heart failure and chronic obstructive pulmonary disease, pulmonary drug toxicity, incidental pulmonary embolism pulmonary nodules, and thoracic trauma.

No MeSH data available.


Related in: MedlinePlus

Computed tomography in 77-year-old patients showing signs of congestive heart failure with ground glass opacities, smooth thickening of interlobular septae, and bilateral effusions.
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fig6: Computed tomography in 77-year-old patients showing signs of congestive heart failure with ground glass opacities, smooth thickening of interlobular septae, and bilateral effusions.

Mentions: Cardiac disease, especially left heart failure, is a major differential diagnosis for dyspnea in the elderly. With pulmonary venous, hypertension hydrostatic edema of the lungs occurs with a well-known appearance on conventional chest X-ray: cranialization of the pulmonary blood flow, increased vascular and interstitial markings with Kerley B lines, peribronchial cuffing, heart enlargement, and pleural effusions. With progression, alveolar edema occurs which in most cases can be differentiated from edema of noncardiogenic causes, like renal edema or capillary permeability edema (e.g., ARDS) [34]. From our experience, the diagnosis of early stages of congestive heart failure may be complicated by concomitant fibrotic changes. Correlation with already existing images or serial imaging will help to solve this problem. In patients with emphysema due to chronic obstructive pulmonary disease (COPD) the distribution relies on the remaining intact parenchyma, so atypical findings are common. Pulmonary edema in the right upper lobe can occur in patients with severe mitral regurgitation. Pulmonary venous hypertension has typical features on CT imaging (enlargement of the upper lobe pulmonary vessels, thickening of the bronchial walls, diffuse smooth thickening of the interlobular septae, and ground glass opacities accompanied by effusions and heart enlargement, Figure 6) [35].


Geriatric chest imaging: when and how to image the elderly lung, age-related changes, and common pathologies.

Gossner J, Nau R - Radiol Res Pract (2013)

Computed tomography in 77-year-old patients showing signs of congestive heart failure with ground glass opacities, smooth thickening of interlobular septae, and bilateral effusions.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3713368&req=5

fig6: Computed tomography in 77-year-old patients showing signs of congestive heart failure with ground glass opacities, smooth thickening of interlobular septae, and bilateral effusions.
Mentions: Cardiac disease, especially left heart failure, is a major differential diagnosis for dyspnea in the elderly. With pulmonary venous, hypertension hydrostatic edema of the lungs occurs with a well-known appearance on conventional chest X-ray: cranialization of the pulmonary blood flow, increased vascular and interstitial markings with Kerley B lines, peribronchial cuffing, heart enlargement, and pleural effusions. With progression, alveolar edema occurs which in most cases can be differentiated from edema of noncardiogenic causes, like renal edema or capillary permeability edema (e.g., ARDS) [34]. From our experience, the diagnosis of early stages of congestive heart failure may be complicated by concomitant fibrotic changes. Correlation with already existing images or serial imaging will help to solve this problem. In patients with emphysema due to chronic obstructive pulmonary disease (COPD) the distribution relies on the remaining intact parenchyma, so atypical findings are common. Pulmonary edema in the right upper lobe can occur in patients with severe mitral regurgitation. Pulmonary venous hypertension has typical features on CT imaging (enlargement of the upper lobe pulmonary vessels, thickening of the bronchial walls, diffuse smooth thickening of the interlobular septae, and ground glass opacities accompanied by effusions and heart enlargement, Figure 6) [35].

Bottom Line: Even in a global perspective, societies are getting older.It is especially important to separate the process of ageing from the disease itself.Pathologies with a special relevance for the elderly patient are discussed in detail: pneumonia, aspiration pneumonia, congestive heart failure, chronic obstructive pulmonary disease, the problem of overlapping heart failure and chronic obstructive pulmonary disease, pulmonary drug toxicity, incidental pulmonary embolism pulmonary nodules, and thoracic trauma.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Radiology, Göttingen-Weende Hospital, An der Lutter 24, 37074 Göttingen, Germany.

ABSTRACT
Even in a global perspective, societies are getting older. We think that diagnostic lung imaging of older patients requires special knowledge. Imaging strategies have to be adjusted to the needs of frail patients, for example, immobility, impossibility for long breath holds, renal insufficiency, or poor peripheral venous access. Beside conventional radiography, modern multislice computed tomography is the method of choice in lung imaging. It is especially important to separate the process of ageing from the disease itself. Pathologies with a special relevance for the elderly patient are discussed in detail: pneumonia, aspiration pneumonia, congestive heart failure, chronic obstructive pulmonary disease, the problem of overlapping heart failure and chronic obstructive pulmonary disease, pulmonary drug toxicity, incidental pulmonary embolism pulmonary nodules, and thoracic trauma.

No MeSH data available.


Related in: MedlinePlus