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ACR Appropriateness Criteria on chronic dyspnea: suspected pulmonary origin
Debra Sue Dyer1, Arfa R Khan, Tan-Lucien Mohammed
1Department of Radiology, National Jewish Health, Denver, CO 80121-2192, USA. DebraDyer1@comcast.net
Journal of Thoracic Imaging
|May 14, 2010
Summary
Chronic dyspnea evaluation starts with chest X-rays. If unclear, high-resolution computed tomography (CT) of the chest, including expiratory scans for air trapping, is recommended for diagnosing lung diseases.
Area of Science:
- Pulmonary Medicine
- Radiology
- Diagnostic Imaging
Background:
- Chronic dyspnea (shortness of breath) often indicates serious pulmonary conditions.
- Chronic obstructive pulmonary disease (COPD) and interstitial lung disease are common causes.
- Initial diagnostic imaging is crucial for accurate patient management.
Purpose of the Study:
- To outline the recommended imaging pathway for chronic dyspnea of pulmonary origin.
- To emphasize the role of chest radiography and computed tomography (CT) in diagnosis.
- To highlight the importance of expiratory imaging in specific CT protocols.
Main Methods:
- Review of diagnostic imaging guidelines for pulmonary diseases.
- Description of the sequential use of chest radiography and high-resolution CT.
- Specification of optimal CT techniques, including expiratory imaging.
Main Results:
- Chest radiography is the recommended initial imaging modality.
- High-resolution chest CT is indicated when radiography is non-diagnostic.
- Expiratory CT imaging is essential for detecting air trapping in relevant cases.
Conclusions:
- A stepwise imaging approach is vital for diagnosing chronic pulmonary conditions causing dyspnea.
- High-resolution chest CT, particularly with expiratory scans, enhances diagnostic accuracy for air trapping.
- Appropriate imaging selection optimizes the diagnosis of chronic obstructive pulmonary disease and interstitial lung disease.
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