Abstract
Radiology plays an important role in the management of the most seriously ill patients
in the hospital. Over the years, continued advances in imaging technology have contributed
to an improvement in patient care. However, even with such advances, the portable
chest radiograph (CXR) remains one of the most commonly requested radiographic examinations.
While they provide valuable information, CXRs remain relatively insensitive at revealing
abnormalities and are often nonspecific. Chest computed tomography (CT) can display
findings that are occult on CXR and is particularly useful at identifying and characterizing
pleural effusions, detecting barotrauma including small pneumothoraces, distinguishing
pneumonia from atelectasis, and revealing unsuspected or additional abnormalities
which could result in increased morbidity and mortality if left untreated. CT pulmonary
angiography is the modality of choice in the evaluation of pulmonary emboli which
can complicate the hospital course of the ICU patient. This article will provide guidance
for interpretation of CXR and thoracic CT images, discuss some of the invasive devices
routinely used, and review the radiologic manifestations of common pathologic disease
states encountered in ICU patients. In addition, imaging findings and complications
of more specific clinical scenarios in which the incidence has increased in the ICU
setting, such as patients who are immunocompromised, have interstitial lung disease,
or COVID-19, will also be discussed. Communication between the radiologist and intensivist,
particularly on complicated cases, is important to help increase diagnostic accuracy
and leads to an improvement in the management of the most critically ill patients.
Keywords
intensive care unit - portable chest X-ray - invasive devices - pulmonary edema -
acute respiratory distress syndrome - atelectasis - pulmonary embolism
