CT Chest CT is superior to US and radiography in determination of disease extent, including characterization of deep compartments and intrathoracic involvement. Osseous involvement, including cortical erosion, fragmentation, and sequestra, are readily depicted on CT. Gas formation within necrotic tissues or in the setting of serious infections, such as necrotizing fasciitis, is easily depicted on CT [48,52]. Chronic chest wall infections (eg, empyema necessitans, actinomycosis, Aspergillus) are well characterized with CT [52]. Administration of IV contrast may help to characterize and define fluid collections and soft-tissue sinus tract formation. Advantages of CT include rapid image acquisition, isotropic data, and high spatial resolution. Limitations include decreased sensitivity related to streak artifacts around metallic hardware. CT may be utilized for image-guided drainage procedures or during percutaneous biopsy. MRI Chest MRI is highly effective at detecting and characterizing infectious and inflammatory disorders of the chest wall soft tissues and osseous structures, maintaining a high negative predictive value in excluding disease in the setting of normal imaging findings [48,58]. Fluid-sensitive sequences, especially those with applied fat signal suppression, detect early edema and readily define extent of soft tissue and osseous involvement that may not be apparent on CT [52]. Administration of gadolinium-based contrast material further characterizes areas of hyperemia and defines fluid collections and soft-tissue sinus tract formation. Unlike CT, gas formation is not as well appreciated on MRI but may be seen as signal void, especially on gradient-echo sequences [48]. MRI may be useful for defining infectious involvement of skin and fascial layers, muscle, bursae, and tendons.
Nontraumatic Chest Wall Pain. CT Chest CT is superior to US and radiography in determination of disease extent, including characterization of deep compartments and intrathoracic involvement. Osseous involvement, including cortical erosion, fragmentation, and sequestra, are readily depicted on CT. Gas formation within necrotic tissues or in the setting of serious infections, such as necrotizing fasciitis, is easily depicted on CT [48,52]. Chronic chest wall infections (eg, empyema necessitans, actinomycosis, Aspergillus) are well characterized with CT [52]. Administration of IV contrast may help to characterize and define fluid collections and soft-tissue sinus tract formation. Advantages of CT include rapid image acquisition, isotropic data, and high spatial resolution. Limitations include decreased sensitivity related to streak artifacts around metallic hardware. CT may be utilized for image-guided drainage procedures or during percutaneous biopsy. MRI Chest MRI is highly effective at detecting and characterizing infectious and inflammatory disorders of the chest wall soft tissues and osseous structures, maintaining a high negative predictive value in excluding disease in the setting of normal imaging findings [48,58]. Fluid-sensitive sequences, especially those with applied fat signal suppression, detect early edema and readily define extent of soft tissue and osseous involvement that may not be apparent on CT [52]. Administration of gadolinium-based contrast material further characterizes areas of hyperemia and defines fluid collections and soft-tissue sinus tract formation. Unlike CT, gas formation is not as well appreciated on MRI but may be seen as signal void, especially on gradient-echo sequences [48]. MRI may be useful for defining infectious involvement of skin and fascial layers, muscle, bursae, and tendons.