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HRCT of Common HRCT of Common Lung Diseases Lung Diseases W. Richard Webb MD W. Richard Webb MD

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Page 1: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

HRCT of CommonHRCT of CommonLung DiseasesLung Diseases

W. Richard Webb MDW. Richard Webb MD

Page 2: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Common Lung Diseases: HRCTCommon Lung Diseases: HRCTCommon Lung Diseases: HRCTCommon Lung Diseases: HRCT

• Infections (pneumonia, airways disease)Infections (pneumonia, airways disease)

• SarcoidosisSarcoidosis

• Hypersensitivity pneumonitisHypersensitivity pneumonitis

• UIP and idiopathic pulmonary fibrosis (IPF)UIP and idiopathic pulmonary fibrosis (IPF)

• Nonspecific interstitial pneumonia (NSIP)Nonspecific interstitial pneumonia (NSIP)

• Organizing pneumonia (OP or BOOP)Organizing pneumonia (OP or BOOP)

• Infections (pneumonia, airways disease)Infections (pneumonia, airways disease)

• SarcoidosisSarcoidosis

• Hypersensitivity pneumonitisHypersensitivity pneumonitis

• UIP and idiopathic pulmonary fibrosis (IPF)UIP and idiopathic pulmonary fibrosis (IPF)

• Nonspecific interstitial pneumonia (NSIP)Nonspecific interstitial pneumonia (NSIP)

• Organizing pneumonia (OP or BOOP)Organizing pneumonia (OP or BOOP)

Page 3: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

SarcoidosisSarcoidosisSarcoidosisSarcoidosis

• microscopic noncaseating granulomas in clustersmicroscopic noncaseating granulomas in clusters

• 60-70% have characteristic plain film findings60-70% have characteristic plain film findings

• 10% have normal chest radiographs10% have normal chest radiographs

• HRCT abnormal in most with normal radiographsHRCT abnormal in most with normal radiographs

• microscopic noncaseating granulomas in clustersmicroscopic noncaseating granulomas in clusters

• 60-70% have characteristic plain film findings60-70% have characteristic plain film findings

• 10% have normal chest radiographs10% have normal chest radiographs

• HRCT abnormal in most with normal radiographsHRCT abnormal in most with normal radiographs

Page 4: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

• small nodules, usually well-defined are typicalsmall nodules, usually well-defined are typical

• patchy distributionpatchy distribution

• upper lobe predominance in mostupper lobe predominance in most

• the nodules show a “perilymphatic” distributionthe nodules show a “perilymphatic” distribution

• typical lymph node enlargement or calcification in typical lymph node enlargement or calcification in some patients is suggestive, but is not necessary some patients is suggestive, but is not necessary for diagnosisfor diagnosis

• small nodules, usually well-defined are typicalsmall nodules, usually well-defined are typical

• patchy distributionpatchy distribution

• upper lobe predominance in mostupper lobe predominance in most

• the nodules show a “perilymphatic” distributionthe nodules show a “perilymphatic” distribution

• typical lymph node enlargement or calcification in typical lymph node enlargement or calcification in some patients is suggestive, but is not necessary some patients is suggestive, but is not necessary for diagnosisfor diagnosis

Sarcoidosis: HRCT findingsSarcoidosis: HRCT findingsSarcoidosis: HRCT findingsSarcoidosis: HRCT findings

Page 5: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

• perilymphatic nodules predominate in relation to perilymphatic nodules predominate in relation to the peripheral pleural surfaces and fissures, the peripheral pleural surfaces and fissures, and the peribronchovascular interstitiumand the peribronchovascular interstitium

• interlobular septal nodules are less frequent and interlobular septal nodules are less frequent and less numerousless numerous

• centrilobular nodules can be seen involving the centrilobular nodules can be seen involving the centrilobular peribronchovascular interstitiumcentrilobular peribronchovascular interstitium

• in rare patients, the nodules appear random in in rare patients, the nodules appear random in distributiondistribution

• perilymphatic nodules predominate in relation to perilymphatic nodules predominate in relation to the peripheral pleural surfaces and fissures, the peripheral pleural surfaces and fissures, and the peribronchovascular interstitiumand the peribronchovascular interstitium

• interlobular septal nodules are less frequent and interlobular septal nodules are less frequent and less numerousless numerous

• centrilobular nodules can be seen involving the centrilobular nodules can be seen involving the centrilobular peribronchovascular interstitiumcentrilobular peribronchovascular interstitium

• in rare patients, the nodules appear random in in rare patients, the nodules appear random in distributiondistribution

Sarcoidosis: NodulesSarcoidosis: NodulesSarcoidosis: NodulesSarcoidosis: Nodules

Page 6: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis

Subpleural and peribronchovascular nodules

Page 7: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Perilymphatic nodules in sarcoidosis:peribronchovascular and subpleural

Page 8: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Perilymphatic nodules in sarcoidosis:peribronchovascular and subpleural

Page 9: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)
Page 10: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Perilymphatic nodules in sarcoidosis:peribronchovascular and subpleural

Page 11: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: interlobular septal nodules.

Page 12: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

. Sarcoidosis with interlobular septal nodules

Page 13: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

interlobular septal noduleswith atypical basal

distribution

.

Page 14: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Centrilobular (peribronchovascular) nodules

Page 15: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Sarcoidosis:centrilobular opacitiesmimicking tree-in-bud

Page 16: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis:centrilobular nodules

Page 17: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Sarcoidosis:nodules with a

“random”distribution

Page 18: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

• large nodules or masses - 15-25%large nodules or masses - 15-25%» often upper lobe, parahilar » often upper lobe, parahilar

(peribronchovascular) (peribronchovascular) » air bronchograms (i.e. consolidation)» air bronchograms (i.e. consolidation)» confluence of granulomas» confluence of granulomas» satellite nodules (“galaxy sign”)» satellite nodules (“galaxy sign”)» “alveolar sarcoid”» “alveolar sarcoid”

• ground-glass opacityground-glass opacity» confluence of small granulomas» confluence of small granulomas

• large nodules or masses - 15-25%large nodules or masses - 15-25%» often upper lobe, parahilar » often upper lobe, parahilar

(peribronchovascular) (peribronchovascular) » air bronchograms (i.e. consolidation)» air bronchograms (i.e. consolidation)» confluence of granulomas» confluence of granulomas» satellite nodules (“galaxy sign”)» satellite nodules (“galaxy sign”)» “alveolar sarcoid”» “alveolar sarcoid”

• ground-glass opacityground-glass opacity» confluence of small granulomas» confluence of small granulomas

Sarcoidosis: additional findingsSarcoidosis: additional findingsSarcoidosis: additional findingsSarcoidosis: additional findings

Page 19: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: subpleural and

peribronchovascular nodules

confluent nodules:masses with satellites

.

Page 20: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

.

Sarcoidosis: subpleural and

peribronchovascular nodules

confluent nodules:masses with satellites

Page 21: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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confluent nodules:masses with satellites

the “galaxy sign”

Sarcoidosis: subpleural and

peribronchovascular nodules

Page 22: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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confluent nodules: masses with satellites

Page 23: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Sarcoidosis: confluent nodules withair bronchograms

Page 24: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: confluent nodules withair bronchograms

Page 25: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Sarcoidosis: clustered small nodules with satellitesand ground-glass opacity

Page 26: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: nodules and

ground-glass opacity

.

Page 27: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: ground-glass opacity

.

Page 28: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

• obstruction of large airwaysobstruction of large airways

• endobronchial granulomasendobronchial granulomas

• small airway obstruction with mosaic perfusion small airway obstruction with mosaic perfusion and/or air trapping on expiratory scansand/or air trapping on expiratory scans

• obstruction of large airwaysobstruction of large airways

• endobronchial granulomasendobronchial granulomas

• small airway obstruction with mosaic perfusion small airway obstruction with mosaic perfusion and/or air trapping on expiratory scansand/or air trapping on expiratory scans

Sarcoidosis: airway abnormalitiesSarcoidosis: airway abnormalitiesSarcoidosis: airway abnormalitiesSarcoidosis: airway abnormalities

Page 29: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoid: airway abnormalities

Page 30: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

45 year oldwith dyspnea

bronch: sarcoidosis.

Page 31: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

1 year later

.

Page 32: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

dynamic expiration

Sarcoidosis: nodules andair trapping

.

Page 33: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

.

Sarcoidosis: subpleural and

peribronchovascular nodules

Page 34: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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dynamic expiration

Sarcoidosis: air trapping

inspiration

Page 35: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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dynamic expiration

Sarcoidosis: air trapping

Page 36: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: late or fibroticSarcoidosis: late or fibroticSarcoidosis: late or fibroticSarcoidosis: late or fibrotic

• nodules decrease (but often remain visible)nodules decrease (but often remain visible)

• distortion of fissures, reticulationdistortion of fissures, reticulation

• interlobular septal thickeninginterlobular septal thickening

• peribronchovascular fibrosis, usually upper lobeperibronchovascular fibrosis, usually upper lobe

• conglomerate masses of fibrous tissueconglomerate masses of fibrous tissue

• traction bronchiectasistraction bronchiectasis

• subpleural honeycombing in a few percentsubpleural honeycombing in a few percent

• emphysema and cystsemphysema and cysts

• nodules decrease (but often remain visible)nodules decrease (but often remain visible)

• distortion of fissures, reticulationdistortion of fissures, reticulation

• interlobular septal thickeninginterlobular septal thickening

• peribronchovascular fibrosis, usually upper lobeperibronchovascular fibrosis, usually upper lobe

• conglomerate masses of fibrous tissueconglomerate masses of fibrous tissue

• traction bronchiectasistraction bronchiectasis

• subpleural honeycombing in a few percentsubpleural honeycombing in a few percent

• emphysema and cystsemphysema and cysts

Page 37: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: early fibrosis withreticulation and

distortion of fissures

.

Page 38: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Sarcoidosis: fibrosis with reticulation andseptal thickening

Page 39: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: conglomerate fibrosis,

traction bronchiectasis,posterior displacement

of the hila

.

Page 40: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: fibrosis with

traction bronchiectasis

.

Page 41: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

.

Sarcoidosis: peribronchovascular

fibrosis withtraction bronchiectasis,

mild honeycombing

Page 42: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: traction bronchiectasis

and cysts

.

Page 43: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: traction bronchiectasis

and cysts

.

Page 44: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

.

Sarcoidosis: fibrosis with cysts

Page 45: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Sarcoidosis: traction bronchiectasis,

cysts, emphysema,aspergilloma

Page 46: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Sarcoidosis: traction bronchiectasis

and honeycombing

.

Page 47: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

HypersensitivityPneumonitis

Page 48: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Hypersensitivity Pneumonitis (HP)Hypersensitivity Pneumonitis (HP)Hypersensitivity Pneumonitis (HP)Hypersensitivity Pneumonitis (HP)

• commoncommon

• caused by inhalation of organic antigenscaused by inhalation of organic antigens

• responsible antigen identified in only 50%responsible antigen identified in only 50%

• acute, subacute, and chronic stagesacute, subacute, and chronic stages

• repeated exposures produce fever, chills, dry repeated exposures produce fever, chills, dry cough, dyspneacough, dyspnea

• progressive symptoms over months or yearsprogressive symptoms over months or years

• commoncommon

• caused by inhalation of organic antigenscaused by inhalation of organic antigens

• responsible antigen identified in only 50%responsible antigen identified in only 50%

• acute, subacute, and chronic stagesacute, subacute, and chronic stages

• repeated exposures produce fever, chills, dry repeated exposures produce fever, chills, dry cough, dyspneacough, dyspnea

• progressive symptoms over months or yearsprogressive symptoms over months or years

Page 49: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

• ongoing exposureongoing exposure

• progressive symptoms over weeks to monthsprogressive symptoms over weeks to months

• ill-defined peribronchiolar granulomasill-defined peribronchiolar granulomas

• alveolitis and interstitial infiltrationalveolitis and interstitial infiltration

• cellular bronchiolitiscellular bronchiolitis

• ongoing exposureongoing exposure

• progressive symptoms over weeks to monthsprogressive symptoms over weeks to months

• ill-defined peribronchiolar granulomasill-defined peribronchiolar granulomas

• alveolitis and interstitial infiltrationalveolitis and interstitial infiltration

• cellular bronchiolitiscellular bronchiolitis

Hypersensitivity Pneumonitis: subacute stageHypersensitivity Pneumonitis: subacute stageHypersensitivity Pneumonitis: subacute stageHypersensitivity Pneumonitis: subacute stage

Page 50: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

• ill-defined centrilobular nodules (50-60%),ill-defined centrilobular nodules (50-60%),usually of ground-glass opacity (granulomas)usually of ground-glass opacity (granulomas)

• patchy ground-glass opacity (75-90%) (alveolitis)patchy ground-glass opacity (75-90%) (alveolitis)

• patchy mosaic perfusion; air trapping on patchy mosaic perfusion; air trapping on expiratory scans (bronchiolitis) expiratory scans (bronchiolitis)

• diffuse or predominant in mid lung zones; diffuse or predominant in mid lung zones; entire cross section of lung involved; entire cross section of lung involved; no subpleural predominanceno subpleural predominance

• a few lung cysts in a few patientsa few lung cysts in a few patients

• ill-defined centrilobular nodules (50-60%),ill-defined centrilobular nodules (50-60%),usually of ground-glass opacity (granulomas)usually of ground-glass opacity (granulomas)

• patchy ground-glass opacity (75-90%) (alveolitis)patchy ground-glass opacity (75-90%) (alveolitis)

• patchy mosaic perfusion; air trapping on patchy mosaic perfusion; air trapping on expiratory scans (bronchiolitis) expiratory scans (bronchiolitis)

• diffuse or predominant in mid lung zones; diffuse or predominant in mid lung zones; entire cross section of lung involved; entire cross section of lung involved; no subpleural predominanceno subpleural predominance

• a few lung cysts in a few patientsa few lung cysts in a few patients

Hypersensitivity Pneumonitis: subacute stageHypersensitivity Pneumonitis: subacute stageHypersensitivity Pneumonitis: subacute stageHypersensitivity Pneumonitis: subacute stage

Page 51: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

.

Subacute hypersensitivity pneumonitis

Page 52: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Subacute hypersensitivity pneumonitis

Page 53: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

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Page 54: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Subacute hypersensitivity pneumonitis

.

Page 55: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)
Page 56: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)
Page 57: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)
Page 58: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

.

Subacute hypersensitivity pneumonitis

Page 59: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Subacute HP:patchy GGO

Page 60: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

post-treatment

Hypersensitivitypneumonitis

ground-glassopacity

.

Page 61: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

.

ground-glass opacity + mosaic perfusion

“Headcheese sign”

ground-glass opacity = interstitial infiltrationmosaic perfusion = bronchiolitis

Page 62: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Hypersensitivity pneumonitis

Headcheese sign

.

Page 63: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

lobular (geographic)ground-glass opacityand mosaic perfusion

(air trapping)

indicative of mixedinfiltrative diseaseand bronchiolitis

Headcheese sign

Hypersensitivity Pneumonitis

Page 64: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)
Page 65: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

mosaic perfusion.

Page 66: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

expiration.

Page 67: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

66 year old bird fancier with progressive dyspnea

Hypersensitivity pneumonitis.

Page 68: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Hypersensitivity pneumonitis

dynamic expiration

.

Page 69: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Subacute HP:air trapping

Page 70: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

.

Biopsy proven HP

Page 71: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

. expiratory scan

Page 72: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

expiration

Hypersensitivitypneumonitis

air-trappingwith lung cyst

.

Page 73: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

HRCT Diagnosis: Chronic HP, IPF, NSIPHRCT Diagnosis: Chronic HP, IPF, NSIPHRCT Diagnosis: Chronic HP, IPF, NSIPHRCT Diagnosis: Chronic HP, IPF, NSIP

• chronic HP: lobular areas of low attenuation, chronic HP: lobular areas of low attenuation, centrilobular ground-glass opacity nodules, centrilobular ground-glass opacity nodules, absence of lower lobe predominanceabsence of lower lobe predominance

• IPF: basal predominance of honeycombing, IPF: basal predominance of honeycombing, absence of subpleural sparing and nodulesabsence of subpleural sparing and nodules

• NSIP: subpleural sparing, absence of NSIP: subpleural sparing, absence of honeycombing and lobular low attenuationhoneycombing and lobular low attenuation

• confident diagnosis in 53%; correct in 94%confident diagnosis in 53%; correct in 94%

• chronic HP: lobular areas of low attenuation, chronic HP: lobular areas of low attenuation, centrilobular ground-glass opacity nodules, centrilobular ground-glass opacity nodules, absence of lower lobe predominanceabsence of lower lobe predominance

• IPF: basal predominance of honeycombing, IPF: basal predominance of honeycombing, absence of subpleural sparing and nodulesabsence of subpleural sparing and nodules

• NSIP: subpleural sparing, absence of NSIP: subpleural sparing, absence of honeycombing and lobular low attenuationhoneycombing and lobular low attenuation

• confident diagnosis in 53%; correct in 94%confident diagnosis in 53%; correct in 94%

Silva et al. Radiology 2008; 246:288288Silva et al. Radiology 2008; 246:288288

Page 74: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

48 year old man with dyspnea

Page 75: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)
Page 76: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)
Page 77: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Hot tub lung

Page 78: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

““Hot tub lung”Hot tub lung”““Hot tub lung”Hot tub lung”

• Immunocompetent subjectsImmunocompetent subjects

• symptoms within hours of hot tub usesymptoms within hours of hot tub use

• dyspnea, cough, hypoxemia, feverdyspnea, cough, hypoxemia, fever

• nonnecrotizing granulomas, often bronchiolocentricnonnecrotizing granulomas, often bronchiolocentric

• MAC (mycobactium avium) found on culture, less MAC (mycobactium avium) found on culture, less often on biopsy, and in the hot tubeoften on biopsy, and in the hot tube

• likely a hypersensitivity reactionlikely a hypersensitivity reaction

• resolution without antibiotic treatmentresolution without antibiotic treatment

• Immunocompetent subjectsImmunocompetent subjects

• symptoms within hours of hot tub usesymptoms within hours of hot tub use

• dyspnea, cough, hypoxemia, feverdyspnea, cough, hypoxemia, fever

• nonnecrotizing granulomas, often bronchiolocentricnonnecrotizing granulomas, often bronchiolocentric

• MAC (mycobactium avium) found on culture, less MAC (mycobactium avium) found on culture, less often on biopsy, and in the hot tubeoften on biopsy, and in the hot tube

• likely a hypersensitivity reactionlikely a hypersensitivity reaction

• resolution without antibiotic treatmentresolution without antibiotic treatment

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Hypersensitivity Pneumonitis: chronic stageHypersensitivity Pneumonitis: chronic stageHypersensitivity Pneumonitis: chronic stageHypersensitivity Pneumonitis: chronic stage

• long term or repeated exposurelong term or repeated exposure

• irregular fibrosis: coarse scars, septal thickening, irregular fibrosis: coarse scars, septal thickening, traction bronchiectasis, honeycombing in sometraction bronchiectasis, honeycombing in some

• patchy, lacks a subpleural distribution in mostpatchy, lacks a subpleural distribution in most

• diffuse or predominantly involving mid lung zonesdiffuse or predominantly involving mid lung zones

• upper lobe involvement (atypical for IPF)upper lobe involvement (atypical for IPF)

• superimposed findings of subacute disease in some: superimposed findings of subacute disease in some: ground-glass opacity or nodulesground-glass opacity or nodules

• ““headcheese sign” with findings of fibrosisheadcheese sign” with findings of fibrosis

• long term or repeated exposurelong term or repeated exposure

• irregular fibrosis: coarse scars, septal thickening, irregular fibrosis: coarse scars, septal thickening, traction bronchiectasis, honeycombing in sometraction bronchiectasis, honeycombing in some

• patchy, lacks a subpleural distribution in mostpatchy, lacks a subpleural distribution in most

• diffuse or predominantly involving mid lung zonesdiffuse or predominantly involving mid lung zones

• upper lobe involvement (atypical for IPF)upper lobe involvement (atypical for IPF)

• superimposed findings of subacute disease in some: superimposed findings of subacute disease in some: ground-glass opacity or nodulesground-glass opacity or nodules

• ““headcheese sign” with findings of fibrosisheadcheese sign” with findings of fibrosis

Page 80: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

Hypersensitivity Pneumonitis: progression

6 month follow-up.

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.Chronic HP

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.

Chronic HP

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chronic HP:reticulation and

tractionbronchiectasis

.

Page 88: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

chronic hypersensitivity pneumonitis

.

Page 89: HRCT of Common Lung Diseases W. Richard Webb MD. Common Lung Diseases: HRCT Infections (pneumonia, airways disease) Infections (pneumonia, airways disease)

subacute HP:ground-glass opacity

chronic HP:reticulation and

tractionbronchiectasis

.

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HRCT of CommonHRCT of CommonLung DiseasesLung Diseases

W. Richard WebbW. Richard Webb