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High Resolution Computed Tomography of the Lungs: A Practical Guide
D Karthikeyan
CHAPTER 1:
Computed Tomography Techniques and Anatomy
INTRODUCTION
INDICATIONS AND ROLE OF RADIOLOGIST
Indications for High-Resolution CT
SCAN TECHNIQUE
VOLUME HRCT MODIFICATIONS
ARTIFACTS ON HRCT
Patient Related
Interpretive
SCAN PROTOCOLS—TECHNIQUE REFINEMENTS
Expiratory Views
SCAN POSITION
LATERAL DECUBITUS CT
ECG Gating
LOW DOSE HRCT
POSTPROCESSING TECHNIQUES
NORMAL CT LUNG ANATOMY
ANATOMIC BASIS OF DISEASE
LUNG PARENCHYMA
SECONDARY PULMONARY LOBULE
Interlobular Septae
Lobular Core
INTERSTITIUM
Peribronchovascular Interstitium
Subpleural Interstitium
Interlobular Septa and Contiguous Subpleural Interstitium
Centrilobular Region
Lobular Parenchyma and Acinus
Intralobular Interstitium
CONCEPT OF CORTICAL AND MEDULLARY LUNG
Cortical Lung
Medullary Lung
Zonal Predilection
CHAPTER 2:
Overview of Lung Disease
INTRODUCTION
LINEAR AND RETICULAR PATTERN
INTERLOBULAR THICKENING
INTRALOBULAR INTERSTITIUM—RETICULAR ABNORMALITIES
PERIBRONCHIAL INTERSTITIAL THICKENING
Subpleural Interstitial Thickening
HONEYCOMBING
Parenchymal Band
Subpleural Lines
IRREGULAR LINEAR OPACITY
Interface Sign
NODULES
CENTRILOBULAR
RANDOM
PERILYMPHATIC
Large Nodules
GROUND GLASS OPACITY
CONSOLIDATION
LUNG CALCIFICATION AND INCREASED LUNG OPACITY
DECREASED LUNG ATTENUATION
BRONCHIECTASIS
Bronchial Dilation (Increased Bronchoarterial Ratio)
Lack of Bronchial Tapering
Visualization of Peripheral Airways
Mucoid Impaction (Figure 2-29)
Pitfalls in the HRCT Diagnosis of Bronchiectasis
Respiratory and Cardiac Motion Artifacts
Consolidation
Cystic Lung Diseases
Traction Bronchiectasis
Emphysema
Bullae and Blebs
Pneumatocele
Cavitatory Nodules
Cystic Lung Disease
Causes of Diffuse Cystic and Cavitary Lung Disease
Causes of Focal or Multifocal Cystic and Cavitary Lung Disease
Cystic (Wall Thickness 3 mm)
Cavitary (Wall Thickness >3 to 4 mm or Surrounding Infiltrate or Mass) (Figures 2-37A to C)
AGING LUNG CHANGES
CHAPTER 3:
Anatomic Patterns and Pathological Correlates in Parenchymatous Lung Disease: An Overview
INTRODUCTION
INTRA-ALVEOLAR PATTERN
Clinical Correlate
INTERSTITIAL PATTERN
Clinical Correlate
COMBINATION OF INTRA-ALVEOLAR/INTERSTITIAL PATTERN
Clinical Correlate
Pivotal Parameters in the Diagnosis of Diffuse Lung Disease (Table 3-3)
Consolidation
Acute
Chronic
Linear or Reticular Opacities
Acute
Chronic
Small Nodules (Round Opacities < 1 cm in Diameter)
Acute
Chronic
Cystic Air Spaces
Acute
Chronic
Ground Glass Opacities
Acute
Chronic
Thickened Interlobular Septa
Acute
Chronic
Bronchocentric
Angiocentric
Chronic Lung Scarring
Physiology of Regional Predilection and Radiologic Perspective of Disease
Upper Lung versus Lower Lung versus Diffuse Distribution
Upper
Lower
Diffuse
Central Lung versus Peripheral Lung
Central
Peripheral
Posterior versus Anterior Lung
Posterior
Anterior
Unilateral or Asymmetric
CHAPTER 4:
Idiopathic Interstitial Pneumonia
INTRODUCTION
IDIOPATHIC PULMONARY FIBROSIS
NONSPECIFIC INTERSTITIAL PNEUMONIA
CRYPTOGENIC ORGANIZING PNEUMONIA
RESPIRATORY BRONCHIOLITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE
DESQUAMATIVE INTERSTITIAL PNEUMONIA
LYMPHOID INTERSTITIAL PNEUMONIA
ACUTE INTERSTITIAL PNEUMONIA
Causes for Suboptimal Assessment in Patients with ILD
CHAPTER 5:
Connective Tissue Disease
INTRODUCTION
SCLERODERMA
RHEUMATOID ARTHRITIS
SYSTEMIC LUPUS ERYTHEMATOSUS
CHAPTER 6:
Inhalational Lung Disease
HYPERSENSITIVE PNEUMONITIS
SMOKING RELATED LUNG DISEASE
RESPIRATORY BRONCHIOLITIS—INTERSTITIAL LUNG DISEASE
DESQUAMATIVE INTERSTITIAL PNEUMONITIS
HRCT Findings (Figures 6-5A and B)
Pulmonary Langerhans Cell Histiocytosis
Combined Emphysema and Fibrosis
PNEUMOCONIOSIS
Consequence of Pneumoconiosis
SILICOSIS
COAL WORKER PNEUMOCONIOSIS
Asbestosis
CHAPTER 7:
Eosinophilic Lung Disease
CLASSIFICATION OF EOSINOPHILIC LUNG DISEASES (TABLE 7-1)
SIMPLE PULMONARY EOSINOPHILIA
ACUTE EOSINOPHILIC PNEUMONIA
CHRONIC EOSINOPHILIC PNEUMONIA
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
Churg-Strauss Syndrome
CHAPTER 8:
Small Airways Disease
DIRECT SIGNS
AIR TRAPPING AND MOSAIC ATTENUATION
BRONCHIOLITIS
Classification of Bronchiolar Disorders
Primary Bronchiolar Disorders
Interstitial Lung Diseases with a Prominent Bronchiolar Involvement
Bronchiolar Involvement in Large Airway Diseases (Chronic Bronchitis, Bronchiectasis, Asthma)
HIGH RESOLUTION COMPUTED TOMOGRAPHY OF VARIOUS BRONCHIOLITIS
CONCLUSION
CHAPTER 9:
Pulmonary Vasculitis
WEGENER'S GRANULOMATOSIS
TAKAYASU'S ARTERITIS
CHURG-STRAUSS SYNDROME
MICROSCOPIC POLYANGIITIS
BEHÇET DISEASE
VASCULITIS ASSOCIATED WITH COLLAGEN VASCULAR DISEASE
GOODPASTURE'S SYNDROME
CHAPTER 10:
Infection in Immunocompetent and Immunocompromised
ROLE OF IMAGING IN INFECTIOUS DISEASE
IMAGING PATTERNS IN INFECTION
COMMUNITY-ACQUIRED PNEUMONIA
HOSPITAL-ACQUIRED: NOSOCOMIAL PNEUMONIA
ASPIRATION PNEUMONIA
ATYPICAL PNEUMONIA SYNDROME
Etiology and Epidemiology
Bacteria
Viruses
Fungi
IMMUNOSUPPRESSED HOST PNEUMONIA
NON-HIV IMMUNOCOMPROMISED PATIENTS
INFECTIONS IN TRANSPLANT RECIPIENTS
BONE MARROW TRANSPLANTATION
AIDS
BACTERIAL INFECTION
PNEUMOCYSTIS CARINII PNEUMONIA
TUBERCULOSIS
Ghon's Focus
Ranke's Complex
Simon Focus
ASPERGILLOSIS
Cryptococcosis
CD4 COUNTS AND INFECTIONS
CHAPTER 11:
Malignancy
SOLITARY PULMONARY NODULE
MARGIN
ATTENUATION
Volume
CHAPTER 12:
Congenital Disease
PULMONARY AGENESIS
BROnCHIAL ATRESIA
Computed Tomography Findings(Figures 12-1 and 12-2)
Typical Triad
Differential Diagnosis
CONGENITAL LOBAR EMPHYSEMA
Computed Tomography Findings (Figure 12-3)
Differential Diagnosis
CONGENITAL CYSTIC ADENOMATOID MALFORMATION
BRONCHOGENIC CYST
Computed Tomography Findings (Figure 12-6)
SEQUESTRATION
Extralobar Sequestrations
Computed Tomography Findings
Intralobar Sequestration (Figures 12-7A to C)
Computed Tomography Findings
TRACHEAL BRONCHUS
INTERRUPTION OF A MAIN PULMONARY ARTERY
ANOMALOUS PULMONARY VENOUS DRAINAGE
PULMONARY ARTERIOVENOUS MALFORMATION (FIGURES 12-11 TO 12-13)
PULMONARY ARTERY SLING
HYPOGENETIC LUNG (SCIMITAR) SYNDROME
CHAPTER 13:
Pulmonary Vascular Disease
PULMONARY HYPERTENSION
ACUTE PULMONARY THROMBOEMBOLISM
CHAPTER 14:
Drug-Induced Pulmonary Patterns
CHAPTER 15:
Practice Cases
SELF-TRAINING MODULE FOR APPROACH AND REPORTING
TRAINING MODULE
DIAGNOSIS: ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA)
Pulmonary Aspergillosis Consists of Other Spectrum of Disease
DIAGNOSIS: PULMONARY ABSCESS
Complications
DIAGNOSIS: ACUTE INTERSTITIAL PNEUMONIA
DIAGNOSIS: AIR TRAPPING
DIAGNOSIS: PULMONARY ALVEOLAR MICROLITHIASIS
DIAGNOSIS: PULMONARY ALVEOLAR PROTEiNOSIS
Types
Differential Diagnosis
DIAGNOSIS: ARCHITECTURAL DISTORTION
DIAGNOSIS: ACUTE LUNG INJURY—ARDS
DIAGNOSIS: ASPERGILLOMA
Computed Tomography Features
DIAGNOSIS: ASPIRATION DISEASE
Complications of Aspiration
DIAGNOSIS: CHRONIC ASTHMA
DIAGNOSIS: AZYGOS LOBE MARKED BY THE AZYGOS FISSURE
DIAGNOSIS: BRONCHIOLOALVEOLAR CARCINOMA (BAC)
DIAGNOSIS: BASAL RETICULAR CHANGES WITH FIBROSIS
Lower Lung Fibrosis
DIAGNOSIS: BRONCHIAL ATRESIA
DIAGNOSIS: BRONCHIECTASIS
Causes
Infection
Hypersensitivity
Inhalation Injury
Other
CONGENITAL SYNDROMES
AIRWAY OBSTRUCTION
TRACTION
ANATOMIC MALFORMATIONS OR VARIANTS
Classification
DIAGNOSIS: BRONCHIOLECTASIS
DIAGNOSIS: BRONCHIOLITIS
Bronchiolar Disease with Tree-in-bud Pattern
Bronchiolar Disease with Poorly Defined Centrilobular Nodules
Bronchiolar Diseases Associated with Decreased Lung Attenuation
DIAGNOSIS: BRONCHOGENIC CYST
Pathophysiology: Anomalous Bud from Tracheobronchial Tree between 5th and 16th Week Gestation
DIAGNOSIS: BRONCHOLITHIASIS
DIAGNOSIS: BULLOUS DISEASE
Reid Classification of Bullae
DIAGNOSIS: CAVITARY PARENCHYMAL LESIONS
DIAGNOSIS: CENTRAL DISTRIBUTION WITH PERIPHERAL SPARING
DIAGNOSIS: CHURG-STRAUSS SYNDROME
DIAGNOSIS: COMPENSATORY HYPERINFLATION
DIAGNOSIS: CONGLOMERATE APICAL MASSES
DIAGNOSIS: CONSOLIDATION
PATTERN OF INVOLVEMENT
DIAGNOSIS: PULMONARY CYSTS
Differential Diagnosis
DIAGNOSIS: EMPHYSEMA VS CYSTIC LUNG DISEASE
DIAGNOSIS: CYSTIC FIBROSIS
Cystic Fibrosis
Definition
CT Findings
Complications
DIAGNOSIS: DARK BRONCHUS SIGN
DIAGNOSIS: DESQUAMATIVE INTESTITIAL PNEUMONIA
DIAGNOSIS: COMBINED PULMONARY FIBROSIS AND EMPHYSEMA
HRCT FINDINGS
DIAGNOSIS: EMPHYSEMATOUS CHANGES
DIAGNOSIS: END STAGE DESTROYED LUNG
DIAGNOSIS: ENDOBRONCHIAL LESIONS WITH ATELECTASIS
DIAGNOSIS: TRACHEOESOPHAGEAL AND BRONCHOPLEURAL FISTULA
Complications
BRONCHOPLEURAL FISTULA
DIAGNOSIS: PULMONARY HEMORRHAGE
DIAGNOSIS: CT HALO SIGN
DIAGNOSIS: PULMONARY LANGERHAN’S CELL DISEASE
DIAGNOSIS: HONEYCOMB PATTERN
DIAGNOSIS: PAIRED INSPIRATORY AND EXPIRATORY IMAGES
DIAGNOSIS: ACUTE HYPERSENSITIVE PNEUMONITIS
DIAGNOSIS: KARTAGENER’S SYNDROME
DIAGNOSIS: PULMONARY CONTUSION—LACERATION
DIAGNOSIS: LYMPHANGIOLEIOMYOMATOSIS
DIAGNOSIS: LOEFFLER’S SYNDROME OR SIMPLE PULMONARY EOSINOPHILIA
DIAGNOSIS: LYMPHANGITIS CARCINOMATOSIS
DIAGNOSIS: PULMONARY METASTASIS
DIAGNOSIS: METASTATIC PULMONARY CALCIFICATION
DIAGNOSIS: RIGHT MIDDLE LOBE SYNDROME
Definition
Complication
CT FINDINGS
Differential Diagnosis
DIAGNOSIS: MILIARY NODULES—KOCH’S
DIAGNOSIS: MOSAIC ATTENUATION
DIAGNOSIS: NONSPECIFIC INTERSTITIAL PNEUMONIA
DIAGNOSIS: OSTEOPHYTE INDUCED ATELECTASIS
DIAGNOSIS: PNEUMOCYSTIS PNEUMONIA
DIAGNOSIS: PERIPHERAL DISTRIBUTION
Common Disease with Peripheral Distribution
DIAGNOSIS: PLEURAL CALCIFICATION
DIAGNOSIS: PNEUMOTHORAX
DIAGNOSIS: PSEUDOTUMOR
DIAGNOSIS: PULMONARY EDEMA
DIAGNOSIS: RADIATION PNEUMONITIS AND FIBROSIS
DIAGNOSIS: RANKE’S COMPLEX
DIAGNOSIS: RASMUSSEN’S ANEURYSM
DIAGNOSIS: RESPIRATORY BRONCHIOLITIS
DIAGNOSIS: RETICULAR FIBROTIC CHANGES
DIAGNOSIS: REVERSE HALO SIGN
DIAGNOSIS: RHEUMATOID-ASSOCIATED INTERSTITIAL LUNG DISEASE
DIAGNOSIS: ROUND ATELECTASIS
Pathogenesis
Computed Tomography Findings
DIAGNOSIS: SARCOIDOSIS
DIAGNOSIS: SCLERODERMA UIP AND NSIP PATTERNS
DIAGNOSIS: SPLIT PLEURA SIGN OF EMPYEMA
DIAGNOSIS: SUBPLEURAL LINE
DIAGNOSIS: TUBERCULOUS OSTEOMYELITIS (COLD ABSCESS)
DIAGNOSIS: TRACHEOMALACIA
INDEX
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Index
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