In conjunction with cardiomyopathy, two-thirds of cases of chronic dyspnea in a pulmonary clinic were caused by asthma, COPD, and ILD. Pratter et al [7] later employed a prospective algorithmic approach to chronic dyspnea that used the chest radiograph as part of a Tier I evaluation. Karnani et al [2] advocated an algorithm that used the history and physical examination to guide appropriate testing, with the chest radiograph a component of a Level 1 diagnostic workup. Wahls [3] addressed the importance of the chest radiograph in the initial workup of chronic dyspnea in patients both with and without other physical examination findings. A chest radiograph might reveal a wide variety of abnormalities in chronic dyspnea that may guide further imaging choices as outlined in subsequent variants. Examples include COPD, ILD, central airways disease, and pleural, chest wall, and diaphragmatic pathology. CT Chest In cases where the chest radiograph is normal or does not provide a direct answer, CT can be beneficial for documenting abnormalities not identified on a chest radiograph and guiding further workup [8,12]. In the Multi- Ethnic Study of Atherosclerosis lung study, CT imaging for parenchymal disease was considered to be the most informative imaging test [13]. MRI Chest MRI has not been evaluated in a systematic manner for the assessment of patients with nonspecific chronic dyspnea, although it may have a role in specific clinical situations. US Chest Transthoracic US has good test characteristics for peripheral thoracic abnormalities, although it does not provide the comprehensive evaluation that CT does in the setting of an unspecified cause. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has not been evaluated in a systematic manner for the assessment of patients with nonspecific chronic dyspnea, although it may have a role in specific clinical situations. Variant 2: Chronic dyspnea. Suspected chronic obstructive pulmonary disease (COPD). Initial imaging.
Chronic Dyspnea Noncardiovascular Origin. In conjunction with cardiomyopathy, two-thirds of cases of chronic dyspnea in a pulmonary clinic were caused by asthma, COPD, and ILD. Pratter et al [7] later employed a prospective algorithmic approach to chronic dyspnea that used the chest radiograph as part of a Tier I evaluation. Karnani et al [2] advocated an algorithm that used the history and physical examination to guide appropriate testing, with the chest radiograph a component of a Level 1 diagnostic workup. Wahls [3] addressed the importance of the chest radiograph in the initial workup of chronic dyspnea in patients both with and without other physical examination findings. A chest radiograph might reveal a wide variety of abnormalities in chronic dyspnea that may guide further imaging choices as outlined in subsequent variants. Examples include COPD, ILD, central airways disease, and pleural, chest wall, and diaphragmatic pathology. CT Chest In cases where the chest radiograph is normal or does not provide a direct answer, CT can be beneficial for documenting abnormalities not identified on a chest radiograph and guiding further workup [8,12]. In the Multi- Ethnic Study of Atherosclerosis lung study, CT imaging for parenchymal disease was considered to be the most informative imaging test [13]. MRI Chest MRI has not been evaluated in a systematic manner for the assessment of patients with nonspecific chronic dyspnea, although it may have a role in specific clinical situations. US Chest Transthoracic US has good test characteristics for peripheral thoracic abnormalities, although it does not provide the comprehensive evaluation that CT does in the setting of an unspecified cause. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has not been evaluated in a systematic manner for the assessment of patients with nonspecific chronic dyspnea, although it may have a role in specific clinical situations. Variant 2: Chronic dyspnea. Suspected chronic obstructive pulmonary disease (COPD). Initial imaging.