So, it is obvious that differentiation may be difficult to early changes in chronic obstructive lung disease or interstitial lung disease.įor example, the finding of a moderate basal lung fibrosis may be due to age-related changes or findings of interstitial lung disease (usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP)), which can be found along with autoimmune disease or idiopathic interstitial lung disease. There are no normative values described in the literature, but age-related changes are usually described to be moderate. Borderlands of the Normal: Possible Problems in Differentiation between Age-Related Changes and PathologyĪs described previously, it has been shown that emphysematous changes and basal fibrotic changes are a common finding in elderly patients, especially on CT. Further morphological changes with ageing are progressive calcifications of the airways and the rib cage ( Figure 3).ĥ. The frequent finding of small basal atelectasis in asymptomatic elderly patients has been reported. showed an increased air trapping with age. In another study, 25% of the elderly asymptomatic patients showed small cysts. Bronchial wall thickening was shown in 50%. In the same study, interstitial changes of the lung with a subpleural reticular pattern could be found in 60% of the elderly patients. In a recent study, there were more elderly asymptomatic adults (age > 75 years) with centrilobular emphysematous changes in CT imaging compared to a younger control group (age < 55 years). As a result, signs of hyperinflation can be seen on conventional chest radiography. Histologically, a homogeneous dilatation of the airspaces without signs of inflammation, fibrosis, or other architectural distortions can be seen. Imaging was ordered because of suspected mesenterial ischemia. Chest X-ray (on the left) and centrilobular emphysematous changes on computed tomography (on the right). Senile emphysema in an 88-year-old patient. Another strategy to minimize the dose of contrast media is the use of low kV settings. We have shown that even with low flow rates (2.0 or 2.5 mL/s) and 60 mL of contrast media, sufficient vascular enhancement can be obtained. Unfortunately, poor peripheral venous access is common in the elderly and sometimes only small bore cannulas can be placed. A high flow rate is usually recommended to obtain a good vascular enhancement. CTPA requires optimal opacification of the lung vessels, and therefore a minimum of 60 mL contrast media should be used. Interestingly, it has been reported that even thoracic CT scans with 15 mL iodinated contrast media showed satisfactory diagnostic quality for routine chest scans, for example, in the staging of mediastinal lymph nodes. The incidence of CIN is also related to the amount of used contrast media. The most important prophylaxis is adequate hydration, which is especially important in elderly patients who often drink too little. It has to be considered, however, that only a very small part of patients with CIN require hemodialysis. Age > 75 years is also an independent risk factor for CIN. In some cases, renal function is already impaired and there are other risk factors like diabetes, high blood pressure, heart insufficiency, hypovolemia, and atherosclerosis. Elderly patients are at higher risk for contrast medium-induced nephropathy (CIN). Imaging of the lung parenchyma is possible without contrast media, but for imaging of lung vessels with computed tomographic pulmonary angiography (CTPA) or tumor staging, contrast media are mandatory. An additional scan with the use of a standard high resolution technique is substantially improving diagnostic performance. Motion artifacts due to breathing in an elderly patient impairing interpretation of the interstitial changes. 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.
Therefore, diagnostic imaging of older patients requires special knowledge. Sometimes it is difficult to separate the process of ageing from disease itself. 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. With age, the frequency of multimorbidity increases. In fact, around 15% of patients treated in German hospitals are already older than 80 years. At this time, there will be more people older than 65 years than children younger than 15 years. 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. The population in many societies is getting older.
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