eMedicine Specialties > Radiology > Chest

Asthma

Author: Peter G Canaday, MD, Private Practice, St Luke's Regional Medical Center, Sioux City, Iowa
Coauthor(s): Jannette Collins, MD, MEd, FCCP, Professor, Departments of Radiology and Medicine, University of Wisconsin Medical School
Contributor Information and Disclosures

Updated: May 1, 2009

Introduction

Background

Asthma is a common disorder that primarily involves the airways. Traditionally, asthma has been considered a disorder of airway smooth muscle mediators and anatomic elements of the airway mucosa. The roles of immune mediators, such as leukotrienes, prostaglandins, and platelet-activating factor, as well as the more traditionally considered roles of histamine and other bronchoconstrictors, have been increasingly understood. Although the causes of asthma are separated into allergic and nonallergic ones, considerable crossover is observed in the features of both types of asthma, and treatment varies little between them.

Asthma. Graph demonstrates results in right upper...

Asthma. Graph demonstrates results in right upper lobe matched pairs before and after a methacholine challenge. The resulting frequency distribution of regional lung density in the midright upper lobe demonstrates a leftward shift to lower attenuation after methacholine administration. Courtesy of Jonathan Goldin, MD, University of California, Los Angeles.

[ CLOSE WINDOW ]
Asthma. Graph demonstrates results in right upper...

Asthma. Graph demonstrates results in right upper lobe matched pairs before and after a methacholine challenge. The resulting frequency distribution of regional lung density in the midright upper lobe demonstrates a leftward shift to lower attenuation after methacholine administration. Courtesy of Jonathan Goldin, MD, University of California, Los Angeles.



Posteroanterior chest radiograph demonstrates a p...

Posteroanterior chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Mediastinal air is noted adjacent to the anteroposterior window and airtrapping extends to the neck, especially on the right side. Same patient as in Image 2 in Multimedia.

[ CLOSE WINDOW ]
Posteroanterior chest radiograph demonstrates a p...

Posteroanterior chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Mediastinal air is noted adjacent to the anteroposterior window and airtrapping extends to the neck, especially on the right side. Same patient as in Image 2 in Multimedia.


While asthma has been considered a disorder of the airways, a number of conditions have a presentation similar to that of bronchial asthma. These conditions originate, often silently, in organ systems other than the lungs, and they either provoke airway responses equivalent to those found in asthma or mimic the clinical findings of asthma.

For excellent patient education resources, see eMedicine's Asthma Center. Also, visit eMedicine's patient education articles Asthma and Asthma in Children.

Pathophysiology

Signs of asthma

Primarily, asthma is manifested by a sudden or prolonged onset of airway narrowing, which accounts for the varying degrees of airway obstruction and accompanying sensation of an inability to breathe in and, more importantly, to breathe out; these symptoms herald hyperinflation. The total lung capacity (TLC), functional residual capacity (FRC), and residual volume (RV) increase.

The hallmark of airway obstruction is a reduction in ratio of the forced expiratory volume in 1 second (FEV1) and the FEV1 to the forced vital capacity (FVC). However, the earliest effects of airway disease are believed to occur in the small airways (<2 mm in diameter), and they are more difficult to measure reliably with standard pulmonary function tests (PFTs), such as tests of the following: forced expiratory flow after 50% of vital capacity has been expelled (FEF50), forced expiratory flow after 25-75% of vital capacity has been expelled (FEF25-FEF75) and maximum midexpiratory flow rate (MMEFR). Less common evaluations include tests of airway resistance (RAW) and single-breath carbon monoxide diffusion capacity (DLCO/VA). With the former, resistance is markedly increased, although the findings are highly variable; with the latter, results are normal or slightly elevated in uncomplicated asthma.1,2

Whether the more severe and permanent features of distal airway obstruction and coexisting emphysema supervene in the later and more complicated stages of asthma is controversial. However, in one study, patients with partially reversible airway obstruction that persisted after optimal corticosteroid treatment had a normal diffusion capacity that was comparable to that of patients with completely reversible asthma.3 The functional abnormalities reflect airway narrowing that results from multiple causes, including bronchial smooth muscle contraction; mucous plugging from mucous gland hypersecretion; submucosal, peribronchial, and interstitial edema from loss of capillary and arteriolar cellular interconnections; and cellular infiltrative changes involving plasma cells, lymphocytes, macrophages, and leukocytes.

Chronic or incompletely reversible asthma is characterized by variable obstruction; a more fixed degree of airway narrowing may also be present in some patients. With repeated episodes of clinically important airway narrowing, generalized thickening of the airways occurs as a result of smooth muscle hyperplasia, postinflammatory thickening of the bronchial basement membranes, and mucous gland hypertrophy.

Childhood asthma

Approximately 80-85% of childhood asthma episodes are associated with prior viral exposure. Prior childhood pneumonia due to infection by respiratory syncytial virus, Mycoplasma pneumoniae, and/or Chlamydia species was found in more than 50% of a small sample of children aged 7-9 years who later had asthma.4 Treatment with antibiotics appropriate for these organisms improves the clinical signs and symptoms of asthma.

Genetic mutations

Research on genetic mutations casts further light on the synergistic nature of multiple mutations in the pathophysiology of asthma, particularly as it is related to the role of platelet-activating factor hydrolase, an intrinsic neutralizing agent of platelet-activating factor in most humans.5

Environmental factors

Agents inhaled in the workplace and the general environment are implicated in reactive airway dysfunction syndrome, an acute asthmalike condition without a definite allergic substrate and with a somewhat nebulous definition. Occupational asthma involves the triggering of an acute and prolonged airway responses to various agents, including the glutaraldehyde used in endoscopy suites and the formaldehyde in darkroom processing chemicals to which radiographers are exposed.6,7 A discussion of the extensive array of environmental agents, which are responsible for as many as one third of the cases of occupational asthma, is beyond the scope of this article.

Treatment agents

The list of chemical agents used to treat asthma has grown beyond the usual mediators of histamine, the slow-reacting substance of anaphylaxis (SRS-A), and immunoglobulin E (IgE) that is associated with allergen-mediated mast cell mediator release. The current list includes the prostaglandin E and F subtypes, interleukin 4, interleukin 12, and interleukin 13, among other agents.8,9,10,11,12,13,14,15,16,17

Frequency

United States

The accuracy of statistics about asthma is limited by confounding factors in patients older than age 35 years, changes in the International Classification of Diseases, the lower confirmation rates at autopsy, and problems related to the interpretation of death certificates.18
 

The Asthma Research Center of the American Lung Association indicates that 17.7 million patients are affected; of these, more than one third are children younger than 18 years. The percentage of children with asthma has increased in the last 20 years, and asthma is the leading serious chronic illness in children. The permanent remission of childhood bronchial asthma is uncommon; 85% of girls and 72% of boys continue to have chronic asthma in adulthood. The number of hospitalizations for a primary diagnosis of asthma currently is 444,000 cases per annum, which represents a 25% increase since 1979. The average length of stay in hospital is 3.2 days. Office visits for a principal diagnosis of asthma numbered 10.6 million in 2006.19,20

According to the Centers for Disease Control and Prevention (CDC), the prevalence rates of asthma for various populations in the United States in 2005 was 8.8% for females; 6.4% for males; 7.2% for persons 18 years of age and over; 8.9% for persons under 18 years of age; 9.5% for blacks; and 7.4% for whites.20

In the United States, the regional prevalence of asthma includes 3.3 million cases in the northeast, 3.6 million cases in the midwest, 4.7 million cases in the southeast, and 3 million cases in the west.

International

The prevalence of asthma depends on the definition of asthma, which varies worldwide. Rates in industrialized countries vary from 0.7% in Tokyo to a high of 6.3% in Birmingham, United Kingdom, with an average of 5%. In general, prevalence rates are lower in nonindustrialized countries, although a rate as high as 49% is described in the Western Caroline Islands, where asthma is defined as recurrent wheezing and dyspnea.

When the same criteria based on questionnaires and exercise provocation testing are used, prevalence rates are higher in New Zealand than in South Wales, Australia; this finding suggests that differences between cultures, however defined, are likely to be real.18

Mortality/Morbidity

  • Mortality statistics from the United States indicate that a total of 3884 deaths due to asthma occurred in 2005. This number correlates with a mortality prevalence of 1.4 deaths per 100,000 population.20
    • In 2003, 4,055 people died of asthma. Of these, 195 were children, or 0.3 deaths per 100,000 children, compared with 1.4 per 100,000 for adults. Non-Hispanic blacks had an asthma-related death rate 200% higher than non-Hispanic whites.
    • In 2005, 4.2% of the population (12.2 million people) had at least one asthma attack; 5.2% of children (3.8 million) and 3.9% of adults (8.4 million) had an asthma attack
  • Internationally, asthma-related mortality rates vary widely by country.
    • According to World Health Organization (WHO) estimates, 300 million people had asthma and 255,000 people died of asthma in 2005. It is the most common chronic disease in children worldwide.21

Race

Prevalence by race in the United States in 2005 was as follows20 :

  • Mexican: 2.8%
  • Puerto Rican: 10%
  • Total Hispanic: 3.5%
  • Non-Hispanic black: 4.4%
  • Non-Hispanic white: 4.2%
  • Asian 3.1%
  • American Indian/Alaskan Native: 5.8%
  • Black: 4.6%
  • White: 4.1%

Sex

Prevalence by sex in the United States in 2005 was as follows{{180}:

  • Females: 8.8%
  • Males 6.4%
  • Boys: 5.9%
  • Girls: 4.5%

Age

Prevalence by age in the United States in 2005 was as follows{{180}:

  • 18 years and older: 7.2%
  • 0-17 years: 8.9%

Anatomy

The airways of the lungs consist of the cartilaginous bronchi, membranous bronchi, and gas-exchanging bronchi termed the respiratory bronchioles and alveolar ducts. While the first 2 types function mostly as anatomic dead space, they also contribute to airway resistance. The smallest non–gas-exchanging airways, the terminal bronchioles, are approximately 0.5 mm in diameter; airways are considered small if they are less than 2 mm in diameter.22

Airway structure consists of the following: (1) mucosa, which is composed of epithelial cells that are capable of specialized mucous production and a transport apparatus, (2) basement membrane, (3) a smooth-muscle matrix extending to the alveolar entrances, and (4) predominantly fibrocartilaginous or fibroelastic-supporting connective tissue.

Cellular elements include mast cells, which are involved in the complex control of releasing histamine and other mediators. Basophils, eosinophils, neutrophils, and macrophages also are responsible for extensive mediator release in the early and late stages of bronchial asthma. Stretch and irritant receptors reside in the airways, as do cholinergic motor nerves, which innervate the smooth muscle and glandular units. In bronchial asthma, smooth muscle contraction in an airway is greater than that expected for its size if it were functioning normally, and this contraction varies in its distribution.22

Mucous gland hyperplasia leads to inspissated secretions and bronchial obstruction, which is one of the primary causes of morbidity and mortality in patients with asthma. Death from asthma is associated with epithelial desquamation, smooth muscle hypertrophy, thickening of the basement membrane, and eosinophilic proliferation.

Presentation

Patients with asthma may be asymptomatic most of the time, with periodic exacerbations induced by various factors, including the following:23,24

  • Family and personal history of atopy
  • Cigarette smoke
  • Intercurrent bronchiolitis or pneumonia
  • Congestive heart failure
  • Pulmonary embolism
  • Dusty and windy environments
  • Air pollutants such as fine particulates and oxides of nitrogen and sulfur
  • Exposure to pets or previously dampened floor coverings that harbor molds
  • Other known and probably unknown allergic factors, some of which can be determined with several modalities of allergy testing.

The cardinal symptom with which patients present is breathlessness; one should take into account the difficulty the patient has in breathing out as well as breathing in. Tightness, as patients describe it, also includes the sensation of respiratory confinement.

Symptoms of bronchial asthma include the following:

  • Breathlessness
  • Anxiety
  • Cough
  • Chest tightness
  • Diaphoresis
  • Exacerbation with exercise

Signs of bronchial asthma include the following:

  • Barrel chest
  • Global or focal wheezes25
  • Pallor
  • Pulsus paradoxus
  • Use of accessory muscles
  • Exercise limitation

Complications of asthma often are more apparent than the direct airway imaging findings that are the sequelae of asthma.

  • Spontaneous pneumothorax is an uncommon but well-recognized phenomenon.
    • The chest radiograph (CXR) is an important tool in the examination of patients with an exacerbation of asthma, but patients should not be left waiting in the treatment room for CXR before treatment.26
    • Pneumothorax may be evident radiographically before it is identified clinically.27
    • Pneumothorax often occurs during recurrent episodes of bronchospasm, as well as in other conditions. The presence of an air-fluid level in a hydropneumothorax can be confused with pneumatocele, infected cysts, and cavitary lung disease.
    • An unusual condition of diffuse pulmonary ossification associated with pneumothorax is described in a patient with bronchial asthma.28
  • Pneumomediastinum can occur, particularly in young adults (see Images 1-2). The pathophysiologic nature of the process, as previously determined from animal studies, is reported.29 Using perfluorocarbon liquid ventilation in a hypoxic patient with status asthmaticus and tension pneumothorax, the authors traced the heavily radiopaque substance through ruptured alveoli, the interlobular spaces, and the axial interstitium to the mediastinum. The liquid agent remained in the interstitial space for 30 days without complications. Pneumomediastinum generally is self-limited, and it requires no additional therapeutic measures beyond those for asthma exacerbation.30
Posteroanterior chest radiograph demonstrates a p...

Posteroanterior chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Mediastinal air is noted adjacent to the anteroposterior window and airtrapping extends to the neck, especially on the right side. Same patient as in Image 2 in Multimedia.

[ CLOSE WINDOW ]
Posteroanterior chest radiograph demonstrates a p...

Posteroanterior chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Mediastinal air is noted adjacent to the anteroposterior window and airtrapping extends to the neck, especially on the right side. Same patient as in Image 2 in Multimedia.


Lateral chest radiograph demonstrates a pneumomed...

Lateral chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Air is noted anterior to the trachea. Same patient as in Image 1 in Multimedia.

[ CLOSE WINDOW ]
Lateral chest radiograph demonstrates a pneumomed...

Lateral chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Air is noted anterior to the trachea. Same patient as in Image 1 in Multimedia.

  • Emphysema can occur in the subdural space, especially in children. Air moves posteriorly from a pneumomediastinum into the intervertebral foramina and further into the most nondependent potential spaces adjacent to the brain coverings.31 Spinal epidural emphysema is also described in asthmatics, tracking along the great vessels bound by the mediastinal pleural layers.32 As reported, these events typically have no neurologic sequelae.
  • Pneumopericardium is uncommon and more likely to occur in younger persons because their pericardial layers are more loosely apposed than those in adults.33 As with pneumomediastinum, pneumopericardium generally has a benign course.
  • Pneumothorax, pneumomediastinum, pneumoretroperitoneum, pneumorrhachis (ie, spinal epidural air), and extensive subcutaneous emphysema are more likely to occur with episodes of coughing or increased intrathoracic pressure that accompany the recruitment of expiratory muscles when normal airflow is substantially reduced.33
  • More serious is subarachnoid hemorrhage, which developed in a patient with status asthmaticus who received ventilation with permissive hypercapnia. This technique minimizes the overall delivered minute ventilation and airway pressures to maintain adequate oxygenation. However, because of elevated carbon dioxide partial pressures, it also led to cerebral vasodilatation and increased intracranial pressure; when combined with coughing spells and other forms of transmitted intrathoracic pressure, the ventilation was believed to promote cerebral edema and limit cerebral venous drainage.34
  • Noisy breathing may mask potential physical findings in pneumothorax, pneumomediastinum, and pneumonia; therefore, CXR should be performed prior to the use of mechanical ventilation.

Preferred Examination

CXR remains the initial imaging evaluation in most individuals with symptoms of asthma. The value of CXR is in revealing complications or alternative causes of wheezing and the minor importance of wheezing in the diagnosis of asthma and its exacerbations. CXR usually is more useful in the initial diagnosis of bronchial asthma than in the detection of exacerbations, although it is valuable in excluding complications such as pneumonia and asthma mimics, even during exacerbations.

High-resolution CT (HRCT) is a second-line examination. It is useful in patients with chronic or recurring symptoms and in those with possible complications such as allergic bronchopulmonary aspergillosis and bronchiectasis.35

Limitations of Techniques

CXR is limited by frequent and sometimes subjective findings that are not specific for asthma; these nonspecific findings include airway thickening and hyperinflation. Nevertheless, in the appropriate clinical setting, CXR findings can support the diagnosis of asthma.

HRCT is more costly than CXR and exposes the patient to more radiation. Nevertheless, CT scans can demonstrate a number of findings that support the diagnosis of asthma; examples of such findings include bronchial wall thickening, bronchiectasis, mucoid impaction, and airtrapping, among others.

Differential Diagnoses

Airway Foreign Body
Lung, Carcinoid
Aspergillosis, Thoracic
Lung, Metastases
Aspiration Pneumonia
Pneumonia, Atypical Bacterial
Atelectasis, Lobar
Pneumonia, Typical Bacterial
Bronchiectasis
Pneumonia, Viral
Bronchopulmonary Dysplasia
Pneumothorax
Congestive Heart Failure
Polyarteritis Nodosa
Emphysema
Pulmonary Edema, Noncardiogenic
Epiglottitis, Acute
Pulmonary Hypertension
Gastroesophageal Reflux
Sarcoidosis, Thoracic
Hamartoma, Lung
Sinusitis
Laryngeal Carcinoma
Trachea, Stenosis
Lung Cancer, Non-Small Cell
Lung Cancer, Small Cell

Other Problems to Be Considered

Asthma mimics


The aphorism attributed to Chevallier Jackson states, "All that wheezes is not asthma." This recognition suggests that imaging has an important role in differentiating asthma from its mimics and that further diagnostic evaluation and treatment of nonasthma conditions may be necessary. With his or her knowledge of the imaging findings in alternative disorders, the consulting radiologist may be valuable during the workup; he or she can recognize clinical signs and symptoms that indicate the use of high-resolution chest CT, sinus CT, CT pulmonary angiography, or MRI as the best modality for further imaging in the diagnosis.

Various tracheal tumors, foreign bodies, and other conditions can contribute to wheezing. These may be misdiagnosed for several years before they are recognized.

Tracheal and bronchial lesions

Tracheal hamartoma may occur.36 Reduction of airflow during both inspiration and expiration occurs with this condition, and the increased velocity of airflow with partial obstruction can sound precisely like refractory bronchial asthma.37

Tracheal schwannoma appeared as status asthmaticus in a 16-year-old boy.38

A central bronchogenic cyst, adjacent to the mediastinal trachea, may produce the same pathophysiologic features as asthma.39

Approximately 20 cases of leiomyoma of the trachea that were reported in the Japanese-language and English-language literature were reviewed.40 Male patients typically were aged 50 years, but female patients had no such age pattern. Of the patients in whom a diagnosis ultimately was determined, 50% had received a misdiagnosis of bronchial asthma had been misdiagnosed, and 2 patients died of respiratory failure.

A rare disease called tracheobronchopathia osteoplastica typically occurs in older men, and its symptoms may simulate those of asthma. On CT scans of the trachea and major bronchi, cartilaginous and bony submucosal nodules cover the intact mucosa, causing the upper airways to become narrow and rigid. The process may be evident with initial spirometric findings, which indicate an obstructive pattern with variable flattening of the inspiratory and expiratory limbs of the flow-volume loop.41

A solitary bronchial papilloma, when present at the carina, can be mobile. It may be seen only on CT scans. Images of bronchial papilloma may demonstrate a lack of extraluminal extension.42

Patients with asthma can have endobronchial carcinoid and mucoepidermoid tumors (see Images 5-6).43

Asthma. High-resolution CT scan of the thorax obt...

Asthma. High-resolution CT scan of the thorax obtained during inspiration in a patient with recurrent left lower lobe pneumonia shows a bronchial mucoepidermoid carcinoma (arrow).

[ CLOSE WINDOW ]
Asthma. High-resolution CT scan of the thorax obt...

Asthma. High-resolution CT scan of the thorax obtained during inspiration in a patient with recurrent left lower lobe pneumonia shows a bronchial mucoepidermoid carcinoma (arrow).


Asthma. High-resolution CT scan of the thorax obt...

Asthma. High-resolution CT scan of the thorax obtained during expiration in a patient with recurrent left lower lobe pneumonia shows a bronchial mucoepidermoid carcinoma (same patient as in Image 5 in Multimedia). Note the normal increase in right lung attenuation during expiration (right arrow). The left lung remains lucent, especially the upper lobe, secondary to bronchial obstruction with airtrapping (left upper arrow). The vasculature on the left is diminutive, secondary to reflex vasoconstriction. Left pleural thickening and abnormal linear opacities are noted in the left lower lobe; these are the result of prior episodes of postobstructive pneumonia (left lower arrow).

[ CLOSE WINDOW ]
Asthma. High-resolution CT scan of the thorax obt...

Asthma. High-resolution CT scan of the thorax obtained during expiration in a patient with recurrent left lower lobe pneumonia shows a bronchial mucoepidermoid carcinoma (same patient as in Image 5 in Multimedia). Note the normal increase in right lung attenuation during expiration (right arrow). The left lung remains lucent, especially the upper lobe, secondary to bronchial obstruction with airtrapping (left upper arrow). The vasculature on the left is diminutive, secondary to reflex vasoconstriction. Left pleural thickening and abnormal linear opacities are noted in the left lower lobe; these are the result of prior episodes of postobstructive pneumonia (left lower arrow).


In one report, left mainstem bronchial narrowing produced longitudinal airway narrowing, with coarse airway sounds that mimicked asthma; the narrowing was the result of bronchocentric granulomatosis.44

Subglottic stenosis, which can occur after prolonged endotracheal intubation, and subglottic web are additional tracheal entities that can cause wheezing.45

Exercise-induced asthma is another presentation of asthma. In one case, a 14-year-old boy with hyperlucency in the left lung was ultimately found to have a bronchial carcinoid in the left mainstem bronchus.43

Foreign bodies

Foreign body aspiration may cause not only localized wheezing but also generalized wheezing. Wheezing occurs in toddlers as well as in adults. As described in one patient, foreign body aspiration may necessitate bronchoscopic retrieval before the patient even recalls the inciting event, and as many as 25% of patients may never recall the event.46 Usually, a cause of localized wheezing, a foreign body can nevertheless cause generalized wheezing in some circumstances.

Other contributing conditions

Other extrinsic conditions, such as lymphadenopathy from Hodgkin lymphoma of the upper mediastinum, can contribute to asthma.

Vocal cord dysfunction syndrome usually is misdiagnosed as bronchial asthma and presents with a sudden onset and offset of wheezes and stridor in an anxious young person with a cough, upper respiratory tract infection, or hoarseness. Vocal cord dysfunction may exist alone or with asthma, it is caused by paradoxical adduction of the vocal cords in inspiration, and it often persists during expiration and disappears with panting.47

A misdiagnosis as refractory bronchial asthma has resulted in inappropriate chronic treatment with corticosteroids. Flattening of the inspiratory flow-volume loop is noted with PFTs. While vocal cord dysfunction syndrome is usually diagnosed with laryngoscopy, fluoroscopy with a soft tissue technique has been used expeditiously and successfully when airway compromise or patient compliance is a consideration.48

Pulmonary embolism may appear as asthma when wheezing results from the release of vasoactive and bronchoactive mediators. Local alveolar hypocapnia in which blood-borne carbon dioxide is diverted is suggested as a cause of localized bronchoconstriction that can cause wheezing.49 Although pulmonary embolism can occur in previously healthy individuals, pulmonary embolism especially is suggested when it occurs in individuals with recurrent asthma after years of minimal or no exacerbation of the disease.50 However, wheezing is not common in patients with pulmonary embolism. A high index of suspicion for the underlying disease is important, particularly when symptoms are out of proportion to PFT results and/or the response to treatment is poor.51 Pulmonary embolism is a particular problem in elderly people.52

Congestive heart failure causes engorged pulmonary vessels and interstitial pulmonary edema, which reduce lung compliance and contribute to the sensation of dyspnea and wheezing. Cardiac asthma is characterized by wheezing secondary to bronchospasm in congestive heart failure, and it is related to paroxysmal nocturnal dyspnea and nocturnal coughing.53

In the 1960s, Avery initially described a peculiar syndrome called pulmonary migraine, and her protégé, Tucker, amplified the description in 1977.54 Pulmonary migraine consists of combined recurrent asthma; cough with thick mucoid sputum; lower back pain radiating to the shoulder; subtotal or total atelectasis of a segment or lobe; and, occasionally, nausea with vomiting. The symptoms are often accompanied closely in time by focal headache. Spastic narrowing of the bronchi is postulated, along with retained mucous secretions, smooth muscle hypertrophy, and thickened bronchial walls, to cause expiratory collapse of selected airways. Cerebral and abdominal vascular migraine episodes are believed to accompany pulmonary migraine.

Diffuse panbronchiolitis is prevalent in Japan and the Far East, and it may mimic bronchial asthma with wheezing, coughing, dyspnea on exertion, and sinusitis.55 HRCT findings include centrilobular nodules and linear markings that usually are more profuse compared with the multifocal bronchiolar impaction sometimes observed with asthma.

Aortic arch anomalies may occur later in adulthood. In one case, the anomalies, which simulated exercise-induced asthma, were noticed first in a young woman only after a vigorous exercise program.56 On testing, the flow-volume display of this patient suggested an intrathoracic obstruction. The patient had a right aortic arch with ligamentum arteriosum that extended anterior to the trachea. This condition caused constriction when increased pulmonary blood flow, oxygen demand, and tracheal airflow and decreased intratracheal pressure from downstream turbulence distal to the tracheal ring occurred with exercise; combined, these factors produced wheezing and dyspnea.

Sinus disease, especially in children, is associated with bronchial asthma and wheezing. Although the association is not strong in patients with CT evidence of mild sinus mucosal thickening, a scoring system developed by Newman et al showed that extensive sinus disease was correlated with a substantially higher extent of wheezing than that in patients with only mild thickening.57 Of 104 adults, 39% had extensive disease, as visualized on CT scans, which was correlated with asthma and peripheral eosinophilia.

In a Finnish study of hospital admissions for acute asthma, admission CXRs showed abnormalities in 50% of the patients and resulted in treatment changes in 5%. The numbers were more remarkable when a paranasal sinus series was obtained in unselected patients presented primarily because of asthma. A sinus abnormality of any kind was found in 85% of patients; maxillary sinus abnormalities occurred alone in 63%. In 29% of patients with a sinus abnormality, treatment was immediately altered. All abnormalities were identified on the Waters view alone, which is 6 times more useful than the CXR in directing the treatment of acute asthma.58 Although the findings are provocative and require confirmation, the conventional wisdom regarding the sinus radiographic evaluation of chronic coughing and asthma suggests that a workup for chronic coughing should be performed first.59

Cough, recurrent bronchitis, pneumonia, wheezing, and asthma are associated with gastroesophageal reflux (GER).60,61 The incidence of GER in those with asthma ranges from 38% in patients with only asthma symptoms to 48% in patients with recurrent pneumonia. Scintigraphic studies performed after technetium Tc 99m sulfur-colloid ingestion have shown radionuclide activity in the lungs the next day, but no causal relationship between reflux and asthma has been established. Nevertheless, evidence suggests that increased pulmonary resistance occurs with symptoms of reflux during acid provocation testing; as some have suggested, the changes may be sufficiently significant to produce clinically evident bronchospasm.60

Differential diagnosis of bronchial asthma


The differential diagnosis of bronchial asthma, as adapted from that described by Holden and Mehta,62 includes the following:

Upper airways

Vocal cord dysfunction syndrome
Laryngeal and tracheal neoplasms
Infection - Epiglottitis, Vincent angina, and diphtheria
Subglottic and tracheal stenosis
Laryngeal edema - Angioedema, burns, and systemic lupus erythematosus
Laryngospasm - Infection, tetany, and psychogenic
Tracheomalacia and laryngomalacia
Laryngeal web

Lower airways

Chronic obstructive pulmonary disease
Bronchial neoplasms
Infections - Pyogenic, tuberculosis, fungal, and parasitic
Aspiration of foreign bodies
Allergic bronchopulmonary aspergillosis
Cystic fibrosis
Mediastinal masses and/or lymphadenopathy
Loeffler syndrome
Bronchiolitis syndromes
Bronchiectasis
Chemical bronchitis
Reactive airway dysfunction syndrome
Endobronchial sarcoidosis
Endobronchial amyloidosis
Bronchopulmonary dysplasia

Vascular and other lesions

Cardiac asthma - Congestive heart failure and mitral stenosis
Vasculitis - Polyarteritis nodosa and allergic vasculitis
Primary pulmonary hypertension
Vascular rings
Subglottic hemangioma
Carcinoid syndrome
Factitious lesion

More on Asthma

Overview: Asthma
Imaging: Asthma
Multimedia: Asthma
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Collard P, Njinou B, Nejadnik B, et al. Single breath diffusing capacity for carbon monoxide in stable asthma. Chest. May 1994;105(5):1426-9. [Medline].

  2. Boulet L, Belanger M, Carrier G. Airway responsiveness and bronchial-wall thickness in asthma with or without fixed airflow obstruction. Am J Respir Crit Care Med. Sep 1995;152(3):865-71. [Medline].

  3. Hudon C, Turcotte H, Laviolette M, et al. Characteristics of bronchial asthma with incomplete reversibility of airflow obstruction. Ann Allergy Asthma Immunol. Feb 1997;78(2):195-202. [Medline].

  4. ALA Denver. Resolving the riddle: does chronic infection lead to chronic asthma?In: Denver 2000 Asthma Research Center Progress Report. Available at: http://www.lungusa.org/arc/index1.html#denver. Accessed November 7, 2001.

  5. ALA Utah. Deconstructing asthma to unravel Its genetic basis. In: Utah 2000 Asthma Research Center Progress Report. Available at: http://www.lungusa.org/arc/index2.html#utah. Accessed November 7, 2001.

  6. Gannon PF, Bright P, Campbell M, et al. Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and x ray departments. Thorax. Feb 1995;50(2):156-9. [Medline].

  7. Smedley J, Inskip H, Wield G, et al. Work related respiratory symptoms in radiographers. Occup Environ Med. Jul 1996;53(7):450-4. [Medline].

  8. [Best Evidence] Nair P, Pizzichini MM, Kjarsgaard M, Inman MD, Efthimiadis A, Pizzichini E, et al. Mepolizumab for prednisone-dependent asthma with sputum eosinophilia. N Engl J Med. Mar 5 2009;360(10):985-93. [Medline].

  9. [Best Evidence] Castro-Rodriguez JA, Rodrigo GJ. Efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing and asthma: a systematic review with meta-analysis. Pediatrics. Mar 2009;123(3):e519-25. [Medline].

  10. [Best Evidence] Jaeschke R, O'Byrne PM, Mejza F, Nair P, Lesniak W, Brozek J, et al. The safety of long-acting beta-agonists among patients with asthma using inhaled corticosteroids: systematic review and metaanalysis. Am J Respir Crit Care Med. Nov 15 2008;178(10):1009-16. [Medline].

  11. [Best Evidence] Adams NP, Bestall JC, Jones P, Lasserson TJ, Griffiths B, Cates CJ. Fluticasone at different doses for chronic asthma in adults and children. Cochrane Database Syst Rev. Oct 8 2008;CD003534. [Medline].

  12. [Best Evidence] Compalati E, Penagos M, Tarantini F, Passalacqua G, Canonica GW. Specific immunotherapy for respiratory allergy: state of the art according to current meta-analyses. Ann Allergy Asthma Immunol. Jan 2009;102(1):22-8. [Medline].

  13. [Best Evidence] Cates CJ, Lasserson TJ. Combination formoterol and inhaled steroid versus beta2-agonist as relief medication for chronic asthma in adults and children. Cochrane Database Syst Rev. Jan 21 2009;CD007085. [Medline].

  14. [Best Evidence] Strunk RC, Bacharier LB, Phillips BR, Szefler SJ, Zeiger RS, Chinchilli VM, et al. Azithromycin or montelukast as inhaled corticosteroid-sparing agents in moderate-to-severe childhood asthma study. J Allergy Clin Immunol. Dec 2008;122(6):1138-1144.e4. [Medline].

  15. [Best Evidence] Busse WW, Israel E, Nelson HS, Baker JW, Charous BL, Young DY, et al. Daclizumab improves asthma control in patients with moderate to severe persistent asthma: a randomized, controlled trial. Am J Respir Crit Care Med. Nov 15 2008;178(10):1002-8. [Medline].

  16. [Best Evidence] Cates CJ, Cates MJ, Lasserson TJ. Regular treatment with formoterol for chronic asthma: serious adverse events. Cochrane Database Syst Rev. Oct 8 2008;CD006923. [Medline].

  17. [Best Evidence] Gerald LB, McClure LA, Mangan JM, Harrington KF, Gibson L, Erwin S, et al. Increasing adherence to inhaled steroid therapy among schoolchildren: randomized, controlled trial of school-based supervised asthma therapy. Pediatrics. Feb 2009;123(2):466-74. [Medline].

  18. Busse WW, Holgate ST. Epidemiology of asthma. In: Asthma and Rhinitis. Blackwell Science Inc;1995:15-31.

  19. ALA Facts. Facts about asthma. In: Asthma Research Centers 2000 Progress Report. Available at: http://www.lungusa.org/arc/index.html#facts. Accessed November 7, 2001.

  20. US Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics. Asthma Prevalence, Health Care Use and Mortality:United States, 2003-05. CDC National Center for Health Statistics. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-05/asthma03-05.htm. Accessed May 1, 2009.

  21. World Health Organization Media Centre. Asthma: Key Facts. World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs307/en/index.html. Accessed May 1, 2009.

  22. Murray JF, Nadel JA. Structure of the lungs relative to their principal function. In: Textbook of Respiratory Medicine. WB Saunders Co;1988:15-20.

  23. Acimovic S, Plavec G, Tomic I, Karlicic V, Acimovic S, Vukovic J, et al. [Symptoms, physical findings and bronchial hypersensitivity in patients with bronchial asthma and normal spirometry]. Vojnosanit Pregl. Jan 2009;66(1):39-43. [Medline].

  24. Koinis-Mitchell D, McQuaid EL, Seifer R, Kopel SJ, Nassau JH, Klein RB, et al. Symptom perception in children with asthma: Cognitive and psychological factors. Health Psychol. Mar 2009;28(2):226-37. [Medline].

  25. Spottswood SE, Liaw K, Hernanz-Schulman M, Hilmes MA, Moore PE, Patterson B, et al. The clinical impact of the radiology report in wheezing and nonwheezing febrile children: a survey of clinicians. Pediatr Radiol. Apr 2009;39(4):348-53. [Medline].

  26. Swain DG. Pneumothorax in acute asthma. Br Med J (Clin Res Ed). Jul 14 1984;289(6437):109. [Medline].

  27. Gay BB Jr. Radiologic evaluation of the nontraumatized child with respiratory distress. Radiol Clin North Am. Apr 1978;16(1):91-112. [Medline].

  28. Ikeda Y, Yamashita H, Tamura T. Diffuse pulmonary ossification and recurrent spontaneous pneumothorax in a patient with bronchial asthma. Respir Med. Jun 1998;92(6):887-9. [Medline].

  29. Jamadar DA, Kazerooni EA, Hirschl RB. Pneumomediastinum: elucidation of the anatomic pathway by liquid ventilation. J Comput Assist Tomogr. Mar-Apr 1996;20(2):309-11. [Medline].

  30. Ba-Ssalamah A, Schima W, Umek W, Herold CJ. Spontaneous pneumomediastinum. Eur Radiol. 1999;9(4):724-7. [Medline].

  31. Caramella D, Bulleri A, Battolla L, et al. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child. Pediatr Radiol. Dec 1997;27(12):929-31. [Medline].

  32. Tsuji H, Takazakura E, Terada Y, et al. CT demonstration of spinal epidural emphysema complicating bronchial asthma and violent coughing. J Comput Assist Tomogr. Jan-Feb 1989;13(1):38-9. [Medline].

  33. van der Klooster JM, Grootendorst AF, Ophof PJ, et al. Pneumomediastinum: an unusual complication of bronchial asthma in a young man. Neth J Med. Apr 1998;52(4):150-4. [Medline].

  34. Rodrigo C, Rodrigo G. Subarachnoid hemorrhage following permissive hypercapnia in a patient with severe acute asthma. Am J Emerg Med. Nov 1999;17(7):697-9. [Medline].

  35. Woods AQ, Lynch DA. Asthma: an imaging update. Radiol Clin North Am. Mar 2009;47(2):317-29. [Medline].

  36. Tastepe AI, Kuzucu A, Demircan S, et al. Surgical treatment of tracheal hamartoma. Scand Cardiovasc J. 1998;32(4):239-41. [Medline].

  37. Reittner P, Muller NL. Tracheal hamartoma: CT findings in two patients. J Comput Assist Tomogr. Nov-Dec 1999;23(6):957-8. [Medline].

  38. Weiner DJ, Weatherly RA, DiPietro MA, et al. Tracheal schwannoma presenting as status asthmaticus in a sixteen-year- old boy: airway considerations and removal with the CO2 laser. Pediatr Pulmonol. Jun 1998;25(6):393-7. [Medline].

  39. Janahi I, Fan LL. Bronchogenic cyst masquerading as asthma. J Pediatr. Jul 1998;133(1):166. [Medline].

  40. Shirakawa T, Takenaka S, Matsumoto T, et al. [A case of leiomyoma of the trachea]. Nihon Kyobu Shikkan Gakkai Zasshi. Nov 1991;29(11):1464-8. [Medline].

  41. Park SS, Shin DH, Lee DH, et al. Tracheopathia osteoplastica simulating asthmatic symptoms. Diagnosis by bronchoscopy and computerized tomography. Respiration. 1995;62(1):43-5. [Medline].

  42. Abdullah AK, Danial BH, Zeid A, et al. Solitary bronchial papilloma presenting with recurrent dyspnea attacks: case report with computed tomography findings. Respiration. 1991;58(1):62-4. [Medline].

  43. Wynn SR, O''Connell EJ, Frigas E, et al. Exercise-induced "asthma" as a presentation of bronchial carcinoid. Ann Allergy. Aug 1986;57(2):139-41. [Medline].

  44. Khanijo V, Del Giacco DR, Poggi JA, et al. Left mainstem bronchus narrowing in an asthmatic patient. Chest. May 1982;81(5):635-6. [Medline].

  45. Spivey CG Jr, Walsh RE, Perez-Guerra F, et al. Central airway obstruction. Report of seven cases. JAMA. Dec 3 1973;226(10):1186-9. [Medline].

  46. Rolfe LM, Rayner CF. A wheezy man with a bony abnormality. Postgrad Med J. Aug 1999;75(886):503-4. [Medline].

  47. Shao W, Chung T, Berdon WE, et al. Fluoroscopic diagnosis of laryngeal asthma (paradoxical vocal cord motion). AJR Am J Roentgenol. Nov 1995;165(5):1229-31. [Medline].

  48. Nastasi KJ, Howard DA, Raby RB, et al. Airway fluoroscopic diagnosis of vocal cord dysfunction syndrome. Ann Allergy Asthma Immunol. Jun 1997;78(6):586-8. [Medline].

  49. Perol M, Brun P, Arnouk H, et al. Bronchospasm disclosing pulmonary embolism. Rev Pneumol Clin. 1990;46(5):225-8. [Medline].

  50. Olazabal F Jr, Roman-Irizarry LA, Oms JD, et al. Pulmonary emboli masquerading as asthma. N Engl J Med. May 2 1968;278(18):999-1001. [Medline].

  51. Hatch RT, Parker JM, Engler RJ. Wheezing, hypoxia, and dyspnea in a 62-year-old woman. Ann Allergy. May 1993;70(5):363-7. [Medline].

  52. Braman SS, Davis SM. Wheezing in the elderly. Asthma and other causes. Clin Geriatr Med. May 1986;2(2):269-83. [Medline].

  53. Isselbacher KJ. Heart failure. In: Braunwald E, Wilson JD, et al, eds. Harrison's Principles of Internal Medicine. 13th ed. McGraw-Hill;1994:1001.

  54. Tucker GF Jr. Pulmonary migraine. Ann Otol Rhinol Laryngol. Sep-Oct 1977;86(5 Pt 1):671-6. [Medline].

  55. Kim YW, Han SK, Shim YS, et al. The first report of diffuse panbronchiolitis in Korea: five case reports. Intern Med. May 1992;31(5):695-701. [Medline].

  56. Bevelaqua F, Schicchi JS, Haas F, et al. Aortic arch anomaly presenting as exercise-induced asthma. Am Rev Respir Dis. Sep 1989;140(3):805-8. [Medline].

  57. Newman LJ, Platts-Mills TA, Phillips CD, et al. Chronic sinusitis. Relationship of computed tomographic findings to allergy, asthma, and eosinophilia. JAMA. Feb 2 1994;271(5):363-7. [Medline].

  58. Rossi OV, Lahde S, Laitinen J, Huhti E. Contribution of chest and paranasal sinus radiographs to the management of acute asthma. Int Arch Allergy Immunol. Sep 1994;105(1):96-100. [Medline].

  59. Pratter MR, Curley FJ, Dubois J, Irwin RS. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med. Oct 1989;149(10):2277-82. [Medline].

  60. Shapiro GG, Christie DL. Gastroesophageal reflux and asthma. Clin Rev Allergy. Mar 1983;1(1):39-56. [Medline].

  61. Cuevas Hernández MM, Arias Hernández RM. [Pulmonary gammagraphy study in asthmatic children with gastroesophageal reflux]. Rev Alerg Mex. Nov-Dec 2008;55(6):229-33. [Medline].

  62. Holden DA, Mehta AC. Evaluation of wheezing in the nonasthmatic patient. Cleve Clin J Med. Jun 1990;57(4):345-52. [Medline].

  63. Webb WR. Radiology of obstructive pulmonary disease. AJR Am J Roentgenol. Sep 1997;169(3):637-47. [Medline].

  64. Sutherland GR, Hume R, Davison M, Kennedy J. The use of pulmonary x-ray densitometry in evaluating regional bronchospasm in patients with bronchial asthma. Br J Radiol. Jun 1972;45(534):432-6. [Medline].

  65. Blackie SP, al-Majed S, Staples CA, et al. Changes in total lung capacity during acute spontaneous asthma. Am Rev Respir Dis. Jul 1990;142(1):79-83. [Medline].

  66. Salam H, Warwick WJ. Measurement of total lung capacity by a roentgenography-planimetry method in children 4-16 years of age. Respiration. 1978;36(4):177-82. [Medline].

  67. Pappas GP, Brodkin CA, Sheppard L, et al. The validity of radiographic estimation of total lung capacity in patients with respiratory disease. Chest. Aug 1998;114(2):513-20. [Medline].

  68. Hungerford GD, Williams HB, Gandevia B. Bronchial walls in the radiological diagnosis of asthma. Br J Radiol. Nov 1977;50(599):783-7. [Medline].

  69. Alford BA, Armstrong P. Radiographic evaluation of the child who wheezes. Curr Probl Diagn Radiol. May-Jun 1983;12(3):1-38. [Medline].

  70. Gillies JD, Reed MH, Simons FE. Radiologic assessment of severity of acute asthma in children. J Can Assoc Radiol. Mar 1980;31(1):45-7. [Medline].

  71. Joorabchi B, Hammoude E, Khalid MA. Radiographic inversion of pulmonary blood flow in acute asthma. Clin Pediatr (Phila). May 1994;33(5):286-91. [Medline].

  72. Hodson ME, Simon G, Batten JC. Radiology of uncomplicated asthma. Thorax. May 1974;29(3):296-303. [Medline].

  73. Findley LJ, Sahn SA. The value of chest roentgenograms in acute asthma in adults. Chest. Nov 1981;80(5):535-6. [Medline].

  74. Brenner BE. Bronchial asthma in adults: presentation to the emergency department. Part I: Pathogenesis, clinical manifestations, diagnostic evaluation, and differential diagnosis. Am J Emerg Med. Jul 1983;1(1):50-70. [Medline].

  75. Gershel JC, Goldman HS, Stein RE, et al. The usefulness of chest radiographs in first asthma attacks. N Engl J Med. Aug 11 1983;309(6):336-9. [Medline].

  76. Heckerling PS. The need for chest roentgenograms in adults with acute respiratory illness. Clinical predictors. Arch Intern Med. Jul 1986;146(7):1321-4. [Medline].

  77. Buenger RE. Five thousand acute care/emergency department chest radiographs: comparison of requisitions with radiographic findings. J Emerg Med. May-Jun 1988;6(3):197-202. [Medline].

  78. Aronson S, Gennis P, Kelly D, et al. The value of routine admission chest radiographs in adult asthmatics. Ann Emerg Med. Nov 1989;18(11):1206-8. [Medline].

  79. Sherman S, Skoney JA, Ravikrishnan KP. Routine chest radiographs in exacerbations of chronic obstructive pulmonary disease. Diagnostic value. Arch Intern Med. Nov 1989;149(11):2493-6. [Medline].

  80. White CS, Cole RP, Lubetsky HW, Austin JH. Acute asthma. Admission chest radiography in hospitalized adult patients. Chest. Jul 1991;100(1):14-6. [Medline].

  81. Dalton AM. A review of radiological abnormalities in 135 patients presenting with acute asthma. Arch Emerg Med. Mar 1991;8(1):36-40. [Medline].

  82. Rubenstein HS, Rosner BA, LeMay M, Neidorf R. The value of the chest X-ray in making the diagnosis of bronchial asthma. Adolescence. Fall 1993;28(111):505-16. [Medline].

  83. Tsai TW, Gallagher EJ, Lombardi G, et al. Guidelines for the selective ordering of admission chest radiography in adult obstructive airway disease. Ann Emerg Med. Dec 1993;22(12):1854-8. [Medline].

  84. Roback MG, Dreitlein DA. Chest radiograph in the evaluation of first time wheezing episodes: review of current clinical practice and efficacy. Pediatr Emerg Care. Jun 1998;14(3):181-4. [Medline].

  85. Rencken I, Patton WL, Brasch RC. Airway obstruction in pediatric patients. From croup to BOOP. Radiol Clin North Am. Jan 1998;36(1):175-87. [Medline].

  86. Neeld DA, Goodman LR, Gurney JW, et al. Computerized tomography in the evaluation of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis. Nov 1990;142(5):1200-5. [Medline].

  87. Standertskjold-Nordenstam CG, Halttunen PA, Meurala HG. Cinetracheobronchography and surgical correction of central airway collapse in an asthmatic patient. Eur J Radiol. Mar 1981;1(1):20-3. [Medline].

  88. Kessler GF, Austin JH, Graf PD, et al. Airway constriction in experimental asthma in dogs: tantalum bronchographic studies. J Appl Physiol. Nov 1973;35(5):703-8. [Medline].

  89. Forbes AR, Gamsu G. Lung mucociliary clearance after anesthesia with spontaneous and controlled ventilation. Am Rev Respir Dis. Oct 1979;120(4):857-62. [Medline].

  90. Teel GS, Engeler CE, Tashijian JH, duCret RP. Imaging of small airways disease. Radiographics. Jan 1996;16(1):27-41. [Medline].

  91. King GG, Muller NL, Pare PD. Evaluation of airways in obstructive pulmonary disease using high- resolution computed tomography. Am J Respir Crit Care Med. Mar 1999;159(3):992-1004. [Medline].

  92. McNamara AE, Muller NL, Okazawa M, et al. Airway narrowing in excised canine lungs measured by high-resolution computed tomography. J Appl Physiol. Jul 1992;73(1):307-16. [Medline].

  93. Herold CJ, Brown RH, Mitzner W, et al. Assessment of pulmonary airway reactivity with high-resolution CT. Radiology. Nov 1991;181(2):369-74. [Medline].

  94. Brown RH, Herold C, Zerhouni EA, Mitzner W. Spontaneous airways constrict during breath holding studied by high- resolution computed tomography. Chest. Sep 1994;106(3):920-4. [Medline].

  95. Brown RH, Mitzner W, Wagner EM. Interaction between airway edema and lung inflation on responsiveness of individual airways in vivo. J Appl Physiol. Aug 1997;83(2):366-70. [Medline].

  96. Brown RH, Herold CJ, Hirshman CA, et al. In vivo measurements of airway reactivity using high-resolution computed tomography. Am Rev Respir Dis. Jul 1991;144(1):208-12. [Medline].

  97. Kinsella M, Muller NL, Staples C, et al. Hyperinflation in asthma and emphysema. Assessment by pulmonary function testing and computed tomography. Chest. Aug 1988;94(2):286-9. [Medline].

  98. Paganin F, Seneterre E, Chanez P, et al. Computed tomography of the lungs in asthma: influence of disease severity and etiology. Am J Respir Crit Care Med. Jan 1996;153(1):110-4. [Medline].

  99. Snider GL. Distinguishing among asthma, chronic bronchitis, and emphysema. Chest. Jan 1985;87(1 Suppl):35S-39S. [Medline].

  100. Paganin F, Jaffuel D, Bousquet J. Significance of emphysema observed on computed tomography scan in asthma. Eur Respir J. Nov 1997;10(11):2446-8. [Medline].

  101. Kondoh Y, Taniguchi H, Yokoyama S, et al. Emphysematous change in chronic asthma in relation to cigarette smoking. Assessment by computed tomography. Chest. Apr 1990;97(4):845-9. [Medline].

  102. Burrows B, Bloom JW, Traver GA, Cline MG. The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med. Nov 19 1987;317(21):1309-14. [Medline].

  103. Burrows B, Bloom JW, Traver GA, et al. The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med. Nov 19 1987;317(21):1309-14. [Medline].

  104. Lynch DA, Newell JD, Tschomper BA, et al. Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects. Radiology. Sep 1993;188(3):829-33. [Medline].

  105. Mochizuki T, Nakajima H, Kokubu F, et al. Evaluation of emphysema in patients with reversible airway obstruction using high-resolution CT. Chest. Dec 1997;112(6):1522-6. [Medline].

  106. Lucidarme O, Coche E, Cluzel P, et al. Expiratory CT scans for chronic airway disease: correlation with pulmonary function test results. AJR Am J Roentgenol. Feb 1998;170(2):301-7. [Medline].

  107. Muller NL, Staples CA, Miller RR, Abboud RT. "Density mask". An objective method to quantitate emphysema using computed tomography. Chest. Oct 1988;94(4):782-7. [Medline].

  108. Gevenois PA, Scillia P, de Maertelaer V, et al. The effects of age, sex, lung size, and hyperinflation on CT lung densitometry. AJR Am J Roentgenol. Nov 1996;167(5):1169-73. [Medline].

  109. Biernacki W, Redpath AT, Best JJ, MacNee W. Measurement of CT lung density in patients with chronic asthma. Eur Respir J. Nov 1997;10(11):2455-9. [Medline].

  110. Ng CS, Desai SR, Rubens MB, et al. Visual quantitation and observer variation of signs of small airways disease at inspiratory and expiratory CT. J Thorac Imaging. Oct 1999;14(4):279-85. [Medline].

  111. Newman KB, Lynch DA, Newman LS, et al. Quantitative computed tomography detects air trapping due to asthma. Chest. Jul 1994;106(1):105-9. [Medline].

  112. Arakawa H, Webb WR. Air trapping on expiratory high-resolution CT scans in the absence of inspiratory scan abnormalities: correlation with pulmonary function tests and differential diagnosis. AJR Am J Roentgenol. May 1998;170(5):1349-53. [Medline].

  113. Paganin F, Chanez P, Seneterre E, et al. Value of imaging in asthma. Rev Pneumol Clin. 1996;52(2):88-96. [Medline].

  114. Webb WR, Stern EJ, Kanth N, et al. Dynamic pulmonary CT: findings in healthy adult men. Radiology. Jan 1993;186(1):117-24. [Medline].

  115. Park JW, Hong YK, Kim CW, et al. High-resolution computed tomography in patients with bronchial asthma: correlation with clinical features, pulmonary functions and bronchial hyperresponsiveness. J Investig Allergol Clin Immunol. May-Jun 1997;7(3):186-92. [Medline].

  116. Remy-Jardin M, Remy J. Comparison of vertical and oblique CT in evaluation of bronchial tree. J Comput Assist Tomogr. Nov-Dec 1988;12(6):956-62. [Medline].

  117. Grenier P, Mourey-Gerosa I, Benali K, et al. Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intraobserver variability. Eur Radiol. 1996;6(2):199-206. [Medline].

  118. Angus RM, Davies ML, Cowan MD, et al. Computed tomographic scanning of the lung in patients with allergic bronchopulmonary aspergillosis and in asthmatic patients with a positive skin test to Aspergillus fumigatus. Thorax. Jun 1994;49(6):586-9. [Medline].

  119. Carroll N, Elliot J, Morton A, James A. The structure of large and small airways in nonfatal and fatal asthma. Am Rev Respir Dis. Feb 1993;147(2):405-10. [Medline].

  120. Seneterre E, Paganin F, Bruel JM, et al. Measurement of the internal size of bronchi using high resolution computed tomography (HRCT). Eur Respir J. Mar 1994;7(3):596-600. [Medline].

  121. Paganin F, Trussard V, Seneterre E, et al. Chest radiography and high resolution computed tomography of the lungs in asthma. Am Rev Respir Dis. Oct 1992;146(4):1084-7. [Medline].

  122. Webb WR. High-resolution computed tomography of obstructive lung disease. Radiol Clin North Am. Jul 1994;32(4):745-57. [Medline].

  123. Awadh N, Muller NL, Park CS, et al. Airway wall thickness in patients with near fatal asthma and control groups: assessment with high resolution computed tomographic scanning. Thorax. Apr 1998;53(4):248-53. [Medline].

  124. Okazawa M, Muller N, McNamara AE, et al. Human airway narrowing measured using high resolution computed tomography. Am J Respir Crit Care Med. Nov 1996;154(5):1557-62. [Medline].

  125. Kee ST, Fahy JV, Chen DR, Gamsu G. High-resolution computed tomography of airway changes after induced bronchoconstriction and bronchodilation in asthmatic volunteers. Acad Radiol. May 1996;3(5):389-94. [Medline].

  126. Carr DH, Hibon S, Rubens M, et al. Peripheral airways obstruction on high-resolution computed tomography in chronic severe asthma. Respir Med. Mar 1998;92(3):448-53. [Medline].

  127. Guckel C, Wells AU, Taylor DA, et al. Mechanism of mosaic attenuation of the lungs on computed tomography in induced bronchospasm. J Appl Physiol. Feb 1999;86(2):701-8. [Medline].

  128. Stern EJ, Frank MS. Small-airway diseases of the lungs: findings at expiratory CT. AJR Am J Roentgenol. Jul 1994;163(1):37-41. [Medline].

  129. Goldin JG, McNitt-Gray MF, Sorenson SM, et al. Airway hyperreactivity: assessment with helical thin-section CT. Radiology. Aug 1998;208(2):321-9. [Medline].

  130. Mclean AN, Sproule MW, Cowan MD, et al. High resolution computed tomography in asthma. Thorax. Apr 1998;53(4):308-14. [Medline].

  131. de Lange EE, Altes TA, Patrie JT, Battiston JJ, Juersivich AP, Mugler JP 3rd, et al. Changes in regional airflow obstruction over time in the lungs of patients with asthma: evaluation with 3He MR imaging. Radiology. Feb 2009;250(2):567-75. [Medline].

  132. de Lange EE, Mugler JP III, Brookeman JR, et al. Lung air spaces: MR imaging evaluation with hyperpolarized 3He gas. Radiology. Mar 1999;210(3):851-7. [Medline].

  133. Altes TA, Powers PL, Knight-Scott J, et al. Hyperpolarized (3)He MR lung ventilation imaging in asthmatics: Preliminary findings. J Magn Reson Imaging. Mar 2001;13(3):378-84. [Medline].

  134. Chen Q, Jakob PM, Griswold MA, et al. Oxygen enhanced MR ventilation imaging of the lung. MAGMA. Dec 1998;7(3):153-61. [Medline].

  135. Ohno Y, Chen Q, Hatabu H. Oxygen-enhanced magnetic resonance ventilation imaging of lung. Eur J Radiol. Mar 2001;37(3):164-71. [Medline].

  136. Pfister R, Lutolf M, Schapowal A, et al. Screening for sinus disease in patients with asthma: a computed tomography-controlled comparison of A-mode ultrasonography and standard radiography. J Allergy Clin Immunol. Nov 1994;94(5):804-9. [Medline].

  137. Kaya M, Salan A, Tabakoglu E, Aydogdu N, Berkarda S. The bronchoalveolar epithelial permeability in house painters as determined by Tc-99m DTPA aerosol scintigraphy. Ann Nucl Med. Jun 2003;17(4):305-8. [Medline].

  138. Hirst RH, Newman SR, Clark DA, Hertog MG. Lung deposition of budesonide from the novel dry powder inhaler Airmax. Respir Med. Jun 2002;96(6):389-96. [Medline].

  139. Hirst PH, Pitcairn GR, Weers JG, Tarara TE, Clark AR, Dellamary LA, et al. In vivo lung deposition of hollow porous particles from a pressurized metered dose inhaler. Pharm Res. Mar 2002;19(3):258-64. [Medline].

  140. Newman SP, Pitcairn GR, Adkin DA, Vidgren MT, Silvasti M. Comparison of beclomethasone dipropionate delivery by easyhaler dry powder inhaler and pMDI plus large volume spacer. J Aerosol Med. Summer 2001;14(2):217-25. [Medline].

  141. Saari SM, Vidgren MT, Herrala J, Turjanmaa VM, Koskinen MO, Nieminen MM. Possibilities of formoterol to enhance the peripheral lung deposition of the inhaled liposome corticosteroids. Respir Med. Dec 2002;96(12):999-1005. [Medline].

  142. Yüksel H, Yüksel D, Demir E, Tanaç R, Kayaliodlu M. Effect of inhaled steroid therapy on distribution of Tc-99m DTPA radioaerosol in asthmatic children. Allergy Asthma Proc. Nov-Dec 2000;21(6):361-5. [Medline].

  143. Corren J, Tashkin DP. Evaluation of efficacy and safety of flunisolide hydrofluoroalkane for the treatment of asthma. Clin Ther. Mar 2003;25(3):776-98. [Medline].

  144. Martin RJ. Therapeutic significance of distal airway inflammation in asthma. J Allergy Clin Immunol. Feb 2002;109(2 Suppl):S447-60. [Medline].

  145. Devadason SG, Huang T, Walker S, Troedson R, Le Souëf PN. Distribution of technetium-99m-labelled QVAR delivered using an Autohaler device in children. Eur Respir J. Jun 2003;21(6):1007-11. [Medline].

  146. Newman SP. Can lung deposition data act as a surrogate for the clinical response to inhaled asthma drugs?. Br J Clin Pharmacol. Jun 2000;49(6):529-37. [Medline].

  147. Dolovich MB. Measuring total and regional lung deposition using inhaled radiotracers. J Aerosol Med. 2001;14 Suppl 1:S35-44. [Medline].

  148. Berridge MS, Lee Z, Heald DL. Pulmonary distribution and kinetics of inhaled [11C]triamcinolone acetonide. J Nucl Med. Oct 2000;41(10):1603-11. [Medline].

  149. Jones HA, Marino PS, Shakur BH, Morrell NW. In vivo assessment of lung inflammatory cell activity in patients with COPD and asthma. Eur Respir J. Apr 2003;21(4):567-73. [Medline].

  150. Aoki T, Inoue H, Sasaki H, et al. Relation between selective alveolo-bronchograms and pulmonary function tests in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. Mar 1984;129(3):465-72. [Medline].

  151. Beales JS, Saxton HM. The radiographic demonstration of bronchospasm and its relief by aminophylline. Br J Radiol. Dec 1968;41(492):899-901. [Medline].

  152. BMJ. Editorial: chest radiographs in asthma. Br Med J. Oct 19 1974;4(5937):123-4. [Medline].

  153. Boulet LP, Turcotte H, Hudon C, et al. Clinical, physiological and radiological features of asthma with incomplete reversibility of airflow obstruction compared with those of COPD. Can Respir J. Jul-Aug 1998;5(4):270-7. [Medline].

  154. Brown RH, Zerhouni EA, Mitzner W. Airway edema potentiates airway reactivity. J Appl Physiol. Oct 1995;79(4):1242-8. [Medline].

  155. Brown RH, Zerhouni EA, Mitzner W. Visualization of airway obstruction in vivo during pulmonary vascular engorgement and edema. J Appl Physiol. Mar 1995;78(3):1070-8. [Medline].

  156. Castro-Rodriguez JA, Holberg CJ, Wright AL, et al. Association of radiologically ascertained pneumonia before age 3 yr with asthmalike symptoms and pulmonary function during childhood: a prospective study. Am J Respir Crit Care Med. Jun 1999;159(6):1891-7. [Medline].

  157. Chang AB, Masel JP, Masters B. Post-infectious bronchiolitis obliterans: clinical, radiological and pulmonary function sequelae. Pediatr Radiol. Jan 1998;28(1):23-9. [Medline].

  158. Charpin J, Gayrard P. [Localization of airway obstruction demonstrated by dynamic bronchography]. Bronches. Sep-Oct 1974;24(5):240-51. [Medline].

  159. Clinton JE, Yaron M, Tsai SH. Chest radiography in the emergency department. Ann Emerg Med. Mar 1986;15(3):254-6. [Medline].

  160. Cozanitis DA, Halttunen P, Edgren J. A cinebronchographic study demonstrating the effect of galanthamine hydrobromide on conscious asthmatic volunteers. Anaesthesist. Feb 1972;21(2):63-6. [Medline].

  161. Cullinan P, Hayes J, Cannon J, et al. Occupational asthma in radiographers. Lancet. Dec 12 1992;340(8833):1477. [Medline].

  162. Dijkman JH, Vooren PH, Kramps JA. Occupational asthma due to inhalation of chloramine-T. I. Clinical observations and inhalation-provocation studies. Int Arch Allergy Appl Immunol. 1981;64(4):422-7. [Medline].

  163. Gershel J. Criteria for deciding when to obtain chest radiographs in first time wheezers. Pediatr Emerg Care. Dec 1998;14(6):452. [Medline].

  164. Gettler JF. Acute asthma. Utility of admission chest radiography. Chest. Jun 1992;101(6):1744. [Medline].

  165. Gillies DR, Conway SP, Littlewood JM. Chest X-rays and childhood asthma. Lancet. Nov 12 1983;2(8359):1149. [Medline].

  166. Giudicelli R, Dupin B, Surpas P, et al. Gastroesophageal reflux and respiratory manifestations: diagnostic approach, therapeutic indications and results. Ann Chir. 1990;44(7):552-4. [Medline].

  167. Goddard PR, Nicholson EM, Laszlo G, Watt I. Computed tomography in pulmonary emphysema. Clin Radiol. Jul 1982;33(4):379-87. [Medline].

  168. Gordon SB, Curran AD, Fishwick D, et al. Respiratory symptoms among glass bottle workers--cough and airways irritancy syndrome?. Occup Med (Lond). Oct 1998;48(7):455-9. [Medline].

  169. Gourdon C, Dietemann A, Beigelman C, et al. Recurrent interlobar pneumothorax in an asthmatic patient. Eur Respir J. May 1993;6(5):748-9. [Medline].

  170. Hartman TE, Primack SL, Lee KS, et al. CT of bronchial and bronchiolar diseases. Radiographics. Sep 1994;14(5):991-1003. [Medline].

  171. Hurwitz S, Conlan AA. A tracheal tumor simulating asthma in a child. Heart Lung. Sep-Oct 1981;10(5):880-2. [Medline].

  172. Ikeda K, Tanno N, Tamura G, et al. Endoscopic sinus surgery improves pulmonary function in patients with asthma associated with chronic sinusitis. Ann Otol Rhinol Laryngol. Apr 1999;108(4):355-9. [Medline].

  173. Jones DK, Cavanagh P, Shneerson JM, et al. Does bronchography have a role in the assessment of patients with haemoptysis?. Thorax. Sep 1985;40(9):668-70. [Medline].

  174. Kelly MA, Joos TH. All that wheezes is not asthma: the pediatric radiologist saves the day. J Asthma. 1992;29(1):55-6. [Medline].

  175. Kuhn JP. High-resolution computed tomography of pediatric pulmonary parenchymal disorders. Radiol Clin North Am. May 1993;31(3):533-51. [Medline].

  176. Lillington GA, Muller NL. Radiological imaging in the detection and differentiation of diffuse obstructive airway diseases. Clin Rev Allergy. Summer-Fall 1990;8(2-3):277-90. [Medline].

  177. Lucidarme O, Grenier P, Coche E, et al. Bronchiectasis: comparative assessment with thin-section CT and helical CT. Radiology. Sep 1996;200(3):673-9. [Medline].

  178. Lynch DA. Imaging of asthma and allergic bronchopulmonary mycosis. Radiol Clin North Am. Jan 1998;36(1):129-42. [Medline].

  179. Mahabee-Gittens EM, Bachman DT, Shapiro ED, Dowd MD. Chest radiographs in the pediatric emergency department for children < or = 18 months of age with wheezing. Clin Pediatr (Phila). Jul 1999;38(7):395-9. [Medline].

  180. Marmorstein BL, Cianciulli FD. Planimetric measurement of total lung capacity in asthma. Chest. Oct 1974;66(4):378-81. [Medline].

  181. Mayo JR. MR imaging of pulmonary parenchyma. Magn Reson Imaging Clin N Am. Feb 2000;8(1):105-23. [Medline].

  182. Meneghello A, Molfese G, Rampazzo F, et al. [Thickening of the bronchial wall in asthma and asthma-like bronchitis]. Minerva Med. Jan 28 1986;77(3-4):109-12. [Medline].

  183. Milne EN, Bass H. The roentgenologic diagnosis of early chronic obstructive pulmonary disease. J Can Assoc Radiol. Mar 1969;20(1):3-15. [Medline].

  184. Mitchell TA, Hamilos DL, Lynch DA, Newell JD. Distribution and severity of bronchiectasis in allergic bronchopulmonary aspergillosis (ABPA). J Asthma. Feb 2000;37(1):65-72. [Medline].

  185. Mitzner W, Brown RH. Potential mechanism of hyperresponsive airways. Am J Respir Crit Care Med. May 2000;161(5):1619-23. [Medline].

  186. Montiel Trujillo A, Ruiz Ruiz M, Jimenez Navarro M, et al. [Pneumopericardium in an asthmatic patient. A case report and review of the bibliography]. Rev Esp Cardiol. Nov 1999;52(11):1015-8. [Medline].

  187. Murata T, Imamura M, Taniguchi M, et al. Localization of the bronchodilatory effects of isoproterenol and aminophylline in patients with bronchial asthma: an investigation using selective alveolobronchography. J Int Med Res. Nov-Dec 1997;25(6):325-39. [Medline].

  188. Nuhoglu Y, Bahceciler N, Yuksel M, et al. Thorax high resolution computerized tomography findings in asthmatic children with unusual clinical manifestations. Ann Allergy Asthma Immunol. Mar 1999;82(3):311-4. [Medline].

  189. O''Brien C, Guest PJ, Hill SL, et al. Physiological and radiological characterisation of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax. Aug 2000;55(8):635-42. [Medline].

  190. O''Hagan AR, Stillwell PC, Arroliga A. Airway responsiveness to inhaled albuterol in patients with pulmonary hypertension. Clin Pediatr (Phila). Jan 1999;38(1):27-33. [Medline].

  191. Panchal N, Pant C, Bhagat R, Shah A. Central bronchiectasis in allergic bronchopulmonary aspergillosis: comparative evaluation of computed tomography of the thorax with bronchography. Eur Respir J. Jul 1994;7(7):1290-3. [Medline].

  192. Pifferi M, Marrazzini G, Baldini G, et al. Epidural emphysema in children with asthma. Pediatr Pulmonol. Aug 1997;24(2):125-6. [Medline].

  193. Reinoso MA, Jett JR, Beck KC. Body plethysmography in the evaluation of intrathoracic airway abnormalities. Chest. Jun 1992;101(6):1674-6. [Medline].

  194. Roach PJ, Treves ST. The value of bronchodilator administration in asthmatic patients before lung imaging. Clin Nucl Med. Jun 1995;20(6):491-3. [Medline].

  195. Robards VL Jr, Lubin EN, Medlock TR, et al. Renal transplantation and placement of ileal stoma. Urology. Jun 1975;5(6):787-9. [Medline].

  196. Robinson AE. Dimensional response of large airways during bronchography in the pediatric patient. Invest Radiol. May-Jun 1973;8(3):121-5. [Medline].

  197. Robinson AE, Campbell JB. Bronchography in childhood asthma. Am J Roentgenol Radium Ther Nucl Med. Nov 1972;116(3):559-66. [Medline].

  198. Sasaki H, Okayama H, Aikawa T, et al. Central and peripheral airways as determinants of ventilatory function in patients with chronic bronchitis, emphysema, and bronchial asthma. Am Rev Respir Dis. Dec 1986;134(6):1182-9. [Medline].

  199. Spence DP, Kelly YJ, Ahmed J, et al. Critical evaluation of computerised x ray planimetry for the measurement of lung volumes. Thorax. Apr 1995;50(4):383-6. [Medline].

  200. Stern EJ, Song JK, Frank MS. CT of the lungs in patients with pulmonary emphysema. Semin Ultrasound CT MR. Oct 1995;16(5):345-52. [Medline].

  201. Tarlo SM, Broder I, Prokipchuk EJ, et al. Association between celiac disease and lung disease. Chest. Dec 1981;80(6):715-8. [Medline].

  202. Toral Marin J, del Castillo Otero D, Hurtado Ayuso JE, Calderon Osuna E. [Spontaneous pneumomediastinum as a complication of asthmatic crisis]. Rev Clin Esp. Feb 1999;199(2):78-80. [Medline].

  203. Trigg CJ, Heap DC, Herdman MJ, et al. A radiographer''s asthma. Respir Med. Mar 1992;86(2):167-9. [Medline].

  204. Woolcock AJ, McRae J, Morris JG, Read J. Abnormal pulmonary blood flow distibution in bronchial asthma. Australas Ann Med. Aug 1966;15(3):196-203. [Medline].

[ CLOSE WINDOW ]

Further Reading

Clinical guidelines

Key clinical activities for quality asthma care: recommendations of the National Asthma Education and Prevention Program.
Centers for Disease Control and Prevention - Federal Government Agency [U.S.] National Asthma Education and Prevention Program - Federal Government Agency [U.S.].  2003 Mar 28.  8 pages.  NGC:002960

Managing exacerbations of asthma: Expert panel report 3: guidelines for the diagnosis and management of asthma.
National Asthma Education and Prevention Program - Federal Government Agency [U.S.]
National Heart, Lung, and Blood Institute (U.S.) - Federal Government Agency [U.S.].  1997 (revised 2007 Aug).  45 pages.  NGC:006027

Clinical trials
Pediatric Asthma Alert Intervention for Minority Children With Asthma (PAAL)

Reducing Asthma Disparities by Improving Provider-Patient Communication

Comparing Asthma Action Plans for Pediatric Asthma

Related eMedicine topics

 Asthma (Pulmonology)

Allergic and Environmental Asthma

Asthma (Pediatrics: General Medicine)

Asthma (Emergency Medicine)

Asthma and Sinusitis

[ CLOSE WINDOW ]

Keywords

asthma, imaging of asthma, asthma mimics, bronchial asthma, airway disorder, airway obstruction, airway narrowing, chronic asthma, childhood asthma, exposure to virus, occupational asthma, environmental factors, exercise-induced asthma, breathlessness, chest tightness, bronchial asthma, complications of asthma, use of radiography in asthma, bronchography

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Peter G Canaday, MD, Private Practice, St Luke's Regional Medical Center, Sioux City, Iowa
Peter G Canaday, MD is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Medical Association, American Roentgen Ray Society, Nebraska Medical Association, Radiological Society of North America, Society of Breast Imaging, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Jannette Collins, MD, MEd, FCCP, Professor, Departments of Radiology and Medicine, University of Wisconsin Medical School
Jannette Collins, MD, MEd, FCCP is a member of the following medical societies: Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey A Miller, MD, Associate Professor of Clinical Radiology, University of Medicine and Dentistry of New Jersey; Associate Chief of Service, Department of Radiology, Veterans Affairs of New Jersey Health Care System
Jeffrey A Miller, MD is a member of the following medical societies: North American Society for Cardiac Imaging, Society for Health Services Research in Radiology, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

John D Newell, Jr, MD, FACR, FCCP, FASER, Co-Director of Thoracic Imaging, UCDHSC; Director of Lung Imaging Center, Professor of Radiology and Professor of Medicine, Department of Radiology, University of Colorado Health Sciences Center, National Jewish Medical and Research Center; Univ. Colorado Hospital
John D Newell, Jr, MD, FACR, FCCP, FASER is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, American Thoracic Society, Association of University Radiologists, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Siemens Medical Grant/research funds Consulting; Forevision Technologies Ownership interest Consulting; Vida Corporation Ownership interest Board membership; TeraRecon Grant/research funds Consulting; eMedicine Honoraria Consulting

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.