Version May 2024
| Imaging | ||
| Abnormality | Interpretation | Further testing |
| Normal or increased reticular markings on chest radiograph | Review PFTs re: evidence of restriction, abnormal DLCO, or low SpO2 at rest or with exertion. If abnormalities suggest ILD, obtain HRCT. | Review HRCT pattern to differentiate types of ILD; obtain appropriate tests for rheumatic diseases, HP, pneumoconiosis. Refer to UpToDate topics on evaluation of interstitial lung disease. |
| Hyperinflation | DDx includes COPD/emphysema, asthma, normal variant, bronchiolitis, lymphangioleiomyomatosis, Marfan syndrome, Birt-Hogg-Dube. | Correlate with PFTs. If airflow limitation, empiric bronchodilator therapy. Consider HRCT. |
| Pleural effusion or thickening on chest radiograph | Pleural effusion, trapped lung, and fibrothorax can lead to dyspnea through altered pleural mechanics and compressive atelectasis. | Evaluation usually requires thoracentesis of pleural effusion, sometimes with measurement of pleural pressures. In addition, chest computed tomography with contrast is frequently part of the evaluation. |
| Abnormal spine, rib cage, or diaphragm | Review PFTs to assess degree of functional impairment. | For patients with chest wall disease and an FVC <1 L, consider assessment for hypercapnia. |
| Enlarged or abnormal heart contour on chest radiograph | Obtain BNP and echocardiogram with Doppler assessment of PA pressures: Review pericardium, systolic/diastolic function, valvular function. | If echocardiogram normal, consider MRI or CT scan to evaluate abnormal heart size/contour. |
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