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. 1. Introduction The population in many societies is getting older. The United Nations estimate that the number of people older than 65 years will increase from 743 million in 2009 to 2 billions in 2050. At this time, there will be more people older than 65 years than children younger than 15 years [1]. In fact, around 15% of patients treated in German hospitals are already older than 80 years [2]. With age, the frequency of multimorbidity increases. Geriatric medicine uses the term frailty to describe the process of progredient loss of mental and physical performance making the patients more vulnerable to further disease [3]. Sometimes it is difficult to separate the process of ageing from disease itself. Therefore, diagnostic imaging of older patients requires special knowledge. In this review, after a short description of imaging strategies, ethical considerations, and the normal ageing processes of the lung, distinct pathologies with a special relevance for the elderly patient are discussed. 2. Imaging Strategies In contrast to younger people, handling of elderly patients is different and usually takes more time. In most cases, elderly patients have to be transferred to the radiology department and may need supervision while waiting. Positioning requires more time, and often patients need assistance. With bedridden patients, more than one person is needed for proper positioning. This need for more time and staff has to be kept in mind but is in most cases not reimbursed [4]. The ideal imaging test for elderly patient is fast and needs few changes in positioning. 2.1. Chest Radiography The standard examination in imaging of the lung is chest radiography with a
References
[1]
United Nations, “Commission on Population and Development. 42nd Session: programme implementation and future work of the secretariat in the field of demographic trends,” Geneva, Switzerland, 2009.
[2]
Statistisches Bundesamt, Diagnosedaten der Patienten und Patientinnen in Krankenh？usern, Statistisches Bundesamt, Wiesbaden, Germany, 2011.
[3]
J. E. Morley, H. M. Perry III, and D. K. Miller, “Something about frailty,” Journals of Gerontology. Series A, vol. 57, no. 11, pp. M698–M704, 2002.
[4]
S. L. Torres, A. G. Dutton, and T. A. Linn-Watson, Patient Care in Imaging Technology, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 2010.
O. Toprak and M. Cirit, “Risk factors for contrast-induced nephropathy,” Kidney and Blood Pressure Research, vol. 29, no. 2, pp. 84–93, 2006.
[7]
R. G. Cigarroa, R. A. Lange, R. H. Williams, and L. D. Hillis, “Dosing of contrast material to prevent contrast nephropathy in patients with renal disease,” American Journal of Medicine, vol. 86, no. 6, pp. 649–652, 1989.
[8]
D. R. Engelkemier, A. Tadros, and A. Karimi, “Lower iodine load in routine contrast-enhanced CT: an alternative imaging strategy,” Journal of Computer Assisted Tomography, vol. 36, no. 2, pp. 191–195, 2012.
[9]
J. Gossner, “Feasibility of computed tomography pulmoary angiography with low flow rates,” Journal of Clinical Imaging Science, vol. 2, p. 57, 2012.
[10]
Z. Szucs-Farkas, F. Schibler, J. Cullmann et al., “Diagnostic accuracy of pulmonary CT angiography at low tube voltage: intraindividual comparison of a normal-dose protocol at 120 kVp and a low-dose protocol at 80 kVp using reduced amount of contrast medium in a simulation study,” American Journal of Roentgenology, vol. 197, no. 5, pp. W852–W859, 2011.
[11]
S. Sartori and P. Tombesi, “Emerging roles for transthoracic ultrasonography in pleuropulmonary pathology,” World Journal of Radiology, vol. 2, pp. 83–90, 2010.
[12]
L. M. Freeman, E. G. Stein, S. Sprayregen, M. Chamarthy, and L. B. Haramati, “The current and continuing important role of ventilation-perfusion scintigraphy in evaluating patients with suspected pulmonary embolism,” Seminars in Nuclear Medicine, vol. 38, no. 6, pp. 432–440, 2008.
[13]
M. Wielpütz and H. U. Kauczor, “MRI of the lung: state of the art,” Diagnostic and Interventional Radiology, vol. 18, pp. 344–355, 2012.
[14]
P. S. Mueller, C. C. Hook, and K. C. Fleming, “Ethical issues in geriatrics: a guide for clinicians,” Mayo Clinic Proceedings, vol. 79, no. 4, pp. 554–562, 2004.
[15]
E. K. Verbeken, M. Cauberghs, I. Mertens, J. Clement, J. M. Lauweryns, and K. P. van de Woestijne, “The senile lung; Comparison with normal and emphysematous lungs. 1. Structural aspects,” Chest, vol. 101, no. 3, pp. 793–799, 1992.
[16]
G. Sharma and J. Goodwin, “Effect of aging on respiratory system physiology and immunology,” Clinical Interventions in Aging, vol. 1, no. 3, pp. 253–260, 2006.
[17]
A. Heinrich, Alternsvorg？nge im R？ntgenbild, Leipzig, 1941.
[18]
S. J. Copley, A. U. Wells, K. E. Hawtin et al., “Lung morphology in the elderly: comparative CT study of subjects over 75 years old versus those under 55 years old,” Radiology, vol. 251, no. 2, pp. 566–573, 2009.
[19]
K. W. Lee, S. Y. Chung, I. Yang, Y. Lee, E. Y. Ko, and M. J. Park, “Correlation of aging and smoking with air trapping at thin-section CT of the lung in asymptomatic subjects,” Radiology, vol. 214, no. 3, pp. 831–836, 2000.
[20]
B. Hochhegger, G. Pontes de Mereiles, K. Irion, et al., “The chest and ageing: radiological findings,” Jornal Brasileiro de Pneumologia, vol. 38, no. 5, pp. 656–665, 2012.
[21]
C. I. Caskey, E. A. Zerhouni, E. K. Fishman, and A. D. Rahmouni, “Aging of the diaphragm: a CT study,” Radiology, vol. 171, no. 2, pp. 385–389, 1989.
[22]
J. H. Reynolds, G. McDonald, H. Alton, and S. B. Gordon, “Pneumonia in the immunocompetent patient,” British Journal of Radiology, vol. 83, no. 996, pp. 998–1009, 2010.
[23]
S. Bernatsky, M. Hudson, and S. Suissa, “Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis,” Rheumatology, vol. 46, no. 7, pp. 1157–1160, 2007.
[24]
T. Franquet, “Imaging of pneumonia: trends and algorithms,” European Respiratory Journal, vol. 18, no. 1, pp. 196–208, 2001.
[25]
R. D. Tarver, S. D. Teague, D. E. Heitkamp, and D. J. Conces Jr., “Radiology of community-acquired pneumonia,” Radiologic Clinics of North America, vol. 43, no. 3, pp. 497–512, 2005.
[26]
A. A. El Solh, A. T. Aquilina, H. Gunen, and F. Ramadan, “Radiographic resolution of community-acquired bacterial pneumonia in the elderly,” Journal of the American Geriatrics Society, vol. 52, no. 2, pp. 224–229, 2004.
[27]
Y. J. Jeong and K. S. Lee, “Pulmonary tuberculosis: up-to-date imaging and management,” American Journal of Roentgenology, vol. 191, no. 3, pp. 834–844, 2008.
[28]
P. E. Marik and D. Kaplan, “Aspiration pneumonia and dysphagia in the elderly,” Chest, vol. 124, no. 1, pp. 328–336, 2003.
[29]
T. Nagatake, “Aspiration and aspiration pneumonia,” The Japan Medical Association Journal, vol. 46, pp. 12–18, 2003.
[30]
J. Robbins, J. W. Hamilton, G. L. Lof, and G. B. Kempster, “Oropharyngeal swallowing in normal adults of different ages,” Gastroenterology, vol. 103, no. 3, pp. 823–829, 1992.
[31]
K. Gleeson, D. F. Eggli, and S. L. Maxwell, “Quantitative aspiration during sleep in normal subjects,” Chest, vol. 111, no. 5, pp. 1266–1272, 1997.
[32]
T. Nakagawa, K. Sekizawa, K. Nakajoh, H. Tanji, H. Arai, and H. Sasaki, “Silent cerebral infarction: a potential risk for pneumonia in the elderly,” Journal of Internal Medicine, vol. 247, no. 2, pp. 255–259, 2000.
[33]
H. Wada, K. Nakajoh, T. Satoh-Nakagawa et al., “Risk factors of aspiration pneumonia in Alzheimer's disease patients,” Gerontology, vol. 47, no. 5, pp. 271–276, 2001.
[34]
E. N. C. Milne, M. Pistolesi, M. Miniati, and C. Giuntini, “The radiologic distinction of cardiogenic and noncardiogenic edema,” American Journal of Roentgenology, vol. 144, no. 5, pp. 879–894, 1985.
[35]
M. L. Storto, S. T. Kee, J. A. Golden, and W. R. Webb, “Hydrostatic pulmonary edema: high-resolution CT findings,” American Journal of Roentgenology, vol. 165, no. 4, pp. 817–820, 1995.
[36]
N. M. Hawkins, M. C. Petrie, P. S. Jhund, G. W. Chalmers, F. G. Dunn, and J. J. V. McMurray, “Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology,” European Journal of Heart Failure, vol. 11, no. 2, pp. 130–139, 2009.
[37]
N. L. Müller and H. Coxson, “Chronic obstructive pulmonary disease ？ 4: imaging the lungs in patients with chronic obstructive pulmonary disease,” Thorax, vol. 57, no. 11, pp. 982–985, 2002.
[38]
M. ？zkan, R. A. Dweik, and M. Ahmad, “Drug- induced lung disease,” Cleveland Clinic Journal of Medicine, vol. 68, pp. 782–795, 2001.
[39]
Pneumotox online, http://www.pneumotox.com/.
[40]
P. Camus, P. Foucher, P. Bonniaud, and K. Ask, “Drug-induced infiltrative lung disease,” European Respiratory Journal, vol. 18, supplement 32, pp. 93S–100S, 2001.
[41]
J. E. Ellis, J. R. Cleverly, and N. L. Müller, “Drug- induced lung disease: high resolution CT findings,” American Journal of Roentgenology, vol. 175, no. 4, pp. 1019–1024, 2000.
[42]
G. Ritchie, S. McGurk, C. McCreath, C. Graham, and J. T. Murchison, “Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning,” Thorax, vol. 62, no. 6, pp. 536–540, 2007.
[43]
S. R. Desai, “Unsuspected pulmonary embolism on CT scanning: yet another headache for clinicians?” Thorax, vol. 62, no. 6, pp. 470–472, 2007.
[44]
J. W. Gurney, “No fooling around: direct visualization of pulmonary embolism,” Radiology, vol. 188, no. 3, pp. 618–619, 1993.
[45]
S. M. Holin, R. E. Dwork, S. Glaser, A. E. Rikli, and J. B. Stocklen, “Solitary pulmonary nodules found in a community-wide chest roentgenographic survey; a five-year follow-up study,” American Review of Tuberculosis, vol. 79, no. 4, pp. 427–439, 1959.
[46]
C. Beigelman-Aubry, C. Hill, and P. A. Grenier, “Management of an incidentally found pulmonary nodule,” European Radiology, vol. 17, no. 2, pp. 449–466, 2007.
[47]
H. MacMahon, J. H. M. Austin, G. Gamsu et al., “Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society,” Radiology, vol. 237, no. 2, pp. 395–400, 2005.
[48]
M. Hanamiya, T. Aoki, Y. Yamashita, S. Kawanami, and Y. Korogi, “Frequency and significance of pulmonary nodules on thin-section CT in patients with extrapulmonary malignant neoplasms,” European Journal of Radiology, vol. 81, no. 1, pp. 152–157, 2012.
[49]
P. Ojo, J. O'Connor, D. Kim, K. Ciardiello, and J. Bonadies, “Patterns of injury in geriatric falls,” Connecticut Medicine, vol. 73, no. 3, pp. 139–145, 2009.
[50]
S. J. Bhavnagri and T.-L. H. Mohammed, “When and how to image a suspected broken rib,” Cleveland Clinic Journal of Medicine, vol. 76, no. 5, pp. 309–314, 2009.
