Computed tomography of the chest in the intensive care unit

Two recent reports evaluated thoracic CT in critically ill patients. One looked at 87 patients with concurrent mobile chest radiographs and CT scans. CT provided unsuspected significant diagnostic information in 61 of the 87 patients. Examples included malpositioned or occluded chest tube, unsuspected large pleural effusion, empyema, pneumothorax, lung abscess, and pericardial effusion/thickening. In addition, two patients with prolonged adult respiratory distress syndrome and fever were shown by CT to have bronchiectasis as the likely explanation for the fever. Similar results were reported in the other series. Our experience concurs, and suggests that although chest CT is not needed in the majority of ICU patients, it is tremendously helpful in patients whose clinical course is not explained by the available information or whose chest radiographs are difficult to interpret.