Geriatric chest imaging: when and how to image the elderly lung, age-related changes, and common pathologies

Abstract

Even in a global perspective, societies are getting older. We think that diagnostic lung imaging of older patients requires special knowledge. Imaging strategies have to be adjusted to the needs of frail patients, for example, immobility, impossibility for long breath holds, renal insufficiency, or poor peripheral venous access. Beside conventional radiography, modern multislice computed tomography is the method of choice in lung imaging. It is especially important to separate the process of ageing from the disease itself. Pathologies with a special relevance for the elderly patient are discussed in detail: pneumonia, aspiration pneumonia, congestive heart failure, chronic obstructive pulmonary disease, the problem of overlapping heart failure and chronic obstructive pulmonary disease, pulmonary drug toxicity, incidental pulmonary embolism pulmonary nodules, and thoracic trauma.

Figure 1

Motion artifacts due to breathing in an elderly patient impairing interpretation of the interstitial changes. An additional scan with the use of a standard high resolution technique is substantially improving diagnostic performance.

Scheme 1

Figure 2

Senile emphysema in an 88-year-old patient. Chest X-ray (on the left) and centrilobular emphysematous changes on computed tomography (on the right). Imaging was ordered because of suspected mesenterial ischemia.

Figure 3

Extensive calcifications of the cartilaginous parts of the rib cage in an 85-year-old patient (suspected fracture).

Figure 4

Consolidation in the right lower lobe due to aspiration in an 85-year-old patient (aspiration was confirmed using fluoroscopy).

Figure 5

Spot view from a fluoroscopic examination in a 76-year-old patient after stroke showing aspiration.

Figure 6

Computed tomography in 77-year-old patients showing signs of congestive heart failure with ground glass opacities, smooth thickening of interlobular septae, and bilateral effusions.

Figure 7

Drug induces lung changes with the use of amiodarone in an 81-year-old patient. Computed tomography shows the pattern of cryptogenic organizing pneumonia.