Most common of the idiopathic interstitial pneumonias. Most cases are sporadic. 30% of cases associated with collagen vascular or immunologic disorder. Findings: Irregular septal or subpleural thickening. Intralobular lines. Honeycombing. Traction bronchiectasis. Typically most severe in peripheral and basal lungs.
Acute Interstitial Pneumonia
"Diffuse ground-glass opacity and consolidation with air bronchograms. Linear opacities
"Conditions associated with BOOP
organizing pneumonia. "
Cryptogenic Organizing Pneumonia
Idiopathic form of organizing pneumonia. Most common finding: Patchy consolidation or ground-glass opacity with subpleural or peribronchial distribution. Scattered nodular opacities may be present.
95% are cigarette smokers. Cannot be radiologically distinguished from UIP. Bibasilar reticular opacities. Normal or midly decreased lung volumes. May have ground-glass opacities. Honeycombing is rare.
Generally asymmetric upper lung bullae. Generally symmetric lower lung interstitial fibrosis.
Tuberous Sclerosis (TS) ILD
Indistinguishable from LAM. Symmetric bilateral reticular or reticulonodular opacities. Scattered lung cysts. Normal to increased lung volumes. Pneumothorax is common
Exclusively in women. Lung cysts separated by interlacing bundles of smooth muscle. May obstruct lymphatics causing chylothorax. Poor prognosis.
Alveolar Septal Amyloidosis
Simulates silicosis or lung sarcoidosis. Upper lung reticulonodular opacities.
"Common findings: Symmetric hilar adenopathy allows distinction from malignancy and TB. Symmetric mid and upper lung reticulonodular opacities. Perilymphatic interstitial nodules
Langerhans Cell Histiocytosis of Lung
Very high association with cigarette smoking. Mid and upper lung centrilobular small nodules. In late stages may develop cysts or bullae. Risk of pneumothorax. Nodule-cyst evolution: Nodule to Cavitated nodule to Thick-walled cyst to Thin-walled cyst.
Necrotizing granulomatous vasculitis involving upper and lower respiratory tracts and kidneys. Discrete nodules or masses with central necrosis and cavitation. May mimic Goodpasture syndrome and idiopathic pulmonary hemorrhage. Tracheal or bronchial lesions may be present. c-ANCA positive.
Chronic Eosinophilic Pneumonia
"Symptoms and radiographic abnormalities last longer than 1 month. Predilection for women. Responds to corticosteroid therapy
Male predominance. Blood eosinophilia. Cardiomegaly. Pulmonary edema. Pleural effusions. Pulmonary parenchymal infiltration with eosinophils may produce interstitial or airspace opacities.
Eosinophilic Lung Disease Associated With Autoimmune Diseases
Eosinophilic Lung Disease of Identifiable Etiology
"Drugs (Nitrofurantoin and Penicillins). Parasites (Ascaris lumbricoides
Pulmonary alveolar proteinosis
"Lipoproteinaceous material deposits within alveoli. Predilection for males in their 20s to 40s. Bilateral symmetric perihilar airspace opacification. Crazy paving CT finding: Geographic ground-glass opacities with thickened interlobular and intralobular septa. Prone to superinfection with Nocardia
Deposition of minute calculi within alveolar spaces. Confluent bilateral dense micronodular opacities. So-called black pleura sign. Apical bullous disease is common.
Diffuse pulmonary ossification
Formation of bone within lung parenchyma. Associations: Mitral stenosis. UIP. Amyloidosis.
Paratracheal air cysts. True diverticula. Occur at weakened posterior membrane of cervical trachea.
Bronchus suis. Accessory bronchus to all or a portion of right upper lobe. Arises from right lateral tracheal wall within 2 cm of tracheal carina. Associated with congenital tracheal stenosis and aberrant left pulmonary artery.
Coronal diameter is less than two thirds of sagittal diameter. Affects older men with chronic obstructive pulmonary disease (COPD).
Multiple submucosal osseous and cartilaginous deposits within trachea and central bronchi of elderly men. Spares membranous posterior wall of trachea.
"Systemic autoimmune disorder. Affects cartilage of earlobes
Tracheobronchomegaly (Mounier-Kuhn syndrome)
Congenital. Associated with Ehlers-Danlos syndrome. Men under age 50. Trachea and central bronchi measure greater than 3.0 cm and 2.5 cm.
"Diffuse tracheal and central bronchial dilation. Congenital or acquired (COPD
Fallen lung sign
Subtended lung remains collapsed against lateral chest wall. Secondary to bronchial injury. Responds poorly to chest tube evacuation.
Calcified material within bronchus. Usually from eroding calcified lymph nodes (Histoplasmosis or TB).
"Transient bronchial narrowing. Peribronchial cuffing and tram tracking. Air trapping: Hyperinflation
Excess production of sputum on most days for at least 3 months in 2 consecutive years. 50% have normal chest radiographs. Some patients show peribronchial cuffing or tram tracks.
Permanent dilation of bronchi. Cylindric bronchiectasis: mild diffuse dilation. Varicose bronchiectasis: cystic dilation interrupted by focal areas of narrowing. Cystic bronchiectasis: localized saccular dilation. Caused by chronic inflammation with cartilage damage and dilation. Localized bronchiectasis is most commonly a result of prior TB. Generalized bronchiectasis is seen in cystic fibrosis. Central bronchiectasis: Allergic bronchopulmonary aspergillosis. Cystic fibrosis. Bronchial atresia. Acquired central bronchial obstruction.
"Production of abnormally thick
Dysmotile cilia syndrome
May result in Rhinitis. Sinusitis. Bronchiectasis. Dysmotile spermatozoa and sterility. Situs inversus. Dextrocardia.
Kartagener syndrome triad
Sinusitis. Situs inversus.. Bronchiectasis.
Allergic bronchopulmonary aspergillosis
"Hypersensitivity reaction to Aspergillus. Asthma
Permanent enlargement of airspaces distal to terminal bronchiole. Destruction of alveolar walls without obvious fibrosis.
Airspace distention in central portion of lobule. Spares distal portions of the lobule. Upper lobe predominance. Associated with cigarette smoking.
Distention of airspaces throughout lobule. Destruction of central respiratory bronchioles and peripheral alveolar sacs and alveoli. Predilection of lower lobes. Associated with alpha-1 antitrypsin deficiency.
Distention of peripheral airspaces adjacent to interlobular septa. Spares centrilobular region. Generally involves subpleural regions of upper lobes.
Paracicatricial or irregular emphysema
Lung destruction associated with fibrosis. No consistent relationship to a given portion of the lobule. Commonly associated with old granulomatous inflammation.
Diffuse hyperlucency (panlobular). Flattening and depression of hemidiaphragms. Increased retrosternal airspace (panlobular > centrilobular). Bulla. Enlarged central pulmonary arteries. Right heart enlargement (centrilobular). Loss of pulmonary capillary bed.
Arterial deficiency emphysema versus increased markings emphysema.
Arterial deficiency: Predominantly panlobular emphysema. Hyperinflated lungs with peripheral vascular attenuation and bullae. Pink Puffers. Increased markings: Increased linear parenchymal markings. Small airways thickening of chronic bronchitis. Bullae uncommon. Blue Bloaters.
Thin-walled cystic space > 1 cm in diameter. Found within lung parenchyma.
"Bullae may be seen in diseases that cause chronic upper lobe fibrosis
Primary bullous disease
Isolated bullae without intervening emphysema or interstitial lung disease. Associated with: Marfan or Ehlers-Danlos syndromes. Intravenous drug use. HIV infection. Vanishing lung syndrome.
CT findings and associations of infectious bronchiolitis
Tree-in-bud opacities. Generally due to infection: Viral. Atypical. Mycobacterial.
CT findings of diffuse panbronchiolitis
Tree-in-bud opacities. Bronchial dilation and thickening.
CT findings and associations of Respiratory bronchiolitis�associated interstitial lung disease
Centrilobular and geographic ground-glass opacities. Cigarette smoking.
CT findings and associations of Hypersensitivity pneumonitis (subacute)
Centrilobular ground-glass nodules. Air trapping on expiratory scans. Inhaled organic antigen.
CT findings and associations of Follicular bronchiolitis
H-shaped or Lincoln log vertebrae on lateral chest radiographs
Sickle cell anemia.
Rugger jersey appearance to thoracic spine on lateral chest radiographs
"Pectus excavatum is commonly associated with congenital connective tissue disorders
Outward bowing of sternum. May be congenital or acquired.
Eventration of the diaphragm
Congenital absence or underdevelopment of diaphragmatic musculature. Localized elevation of anteromedial hemidiaphragm in older individuals.
Unilateral diaphragmatic paralysis is usually caused by
Surgical injury or neoplastic involvement of phrenic nerve.
Bilateral Diaphragmatic Elevation that is not effort related may be caused by
Neuromuscular disturbance. Intrathoracic or intra-abdominal disease.
"Herniation through embryonic pleuroperitoneal canal. Neonates present with large hernias with lung hypoplasia and respiratory distress. Adults present with small hernias
Parasternal diaphragm defect. Invariably right sided. Asymptomatic cardiophrenic angle mass.
Primary diaphragmatic tumors
Benign: Lipomas. Fibromas. Schwannomas. Neurofibromas. Leiomyomas. Echinococcal cysts and extralobar sequestrations may be found within the diaphragm. Metastatic invasion more common than primary malignancy (Fibrosarcoma): Lower lobe bronchogenic carcinoma. Mesothelioma.
Cystic adenomatoid malformation
"Usually seen in infancy. One or several large cysts lined with respiratory epithelium with scattered mucous glands
Bronchial atresia presentation
"Central bronchial mucocele with peripheral hyperlucency in a young
Intralobar and extralobar sequestration blood supply and drainage
"Intralobar sequestration: Single large artery from infradiaphragmatic aorta. Pulmonary vein drainage. Extralobar sequestration: Small branches systemic arteries and occasionally pulmonary arteries. Systemic venous drainage (inferior vena cava
Hypogenetic lung-scimitar syndrome
Variant of hypoplastic lung with abnormal venous drainage to the IVC just above or below right hemidiaphragm. Small right hemithorax with diaphragmatic elevation or eventration. Dextroposition of heart. Herniation of left lung anteriorly into right hemithorax.
Three radiographic patterns of aspiration pneumonitis
Extensive bilateral airspace opacification. Diffuse but discrete airspace nodular opacities. Irregular parenchymal opacities that are not obviously airspace.
Exogenous lipoid pneumonia
Older patients with swallowing disorders or gastroesophageal reflux. Use mineral oil as a laxative or inhale oily nose drops. Fat density opacity.
Drug that cause drug induced chest diseases
"Lupus-like syndrome (procainamide
A confident diagnosis of hamartoma can be made when HRCT shows
Nodule less than 2.5 cm with a smooth or lobulated border and containing focal fat. May have popcorn calcification.
Benign neoplasm arising from neural elements in the central airways or lung parenchyma. The skin is the most common site for these tumors.
Granular cell myoblastoma.
Bronchogenic adenocarcinoma features
"Most common type of lung cancer (nonsmokers
Bronchioloalveolar cell carcinoma (BAC)
Grows along bronchiolar and alveolar walls (lepidic growth). May appear as: Solitary nodule. Focal ground-glass opacity. May mimic pneumonia or bilateral nodular airpsace processes.
Squamous cell carcinoma features
Arises centrally within lobar or segmental bronchi. Central necrosis with cavitation may be seen. Generally presents as hilar mass and atelectasis.
Small cell carcinoma features
Arises centrally within main or lobar bronchi from bronchial neuroendocrine (Kulchitsky) cells. Hematogenous dissemination. Hilar/mediastinal mass.
Large cell bronchogenic carcinoma radiographic feature
Large peripheral mass.
"In addition to cigarette smoke
well-recognized risk factors for the development of bronchogenic carcinoma include"
Most common radiographic findings from endobronchial tumor obstruction.
Resorptive atelectasis. Obstructive pneumonitis.
"Majority of pancoast tumors
Pancoast tumor symptoms
"Arm pain and muscular atrophy due to brachial plexus involvement. Horner syndrome (ptosis
CT angiogram sign and BAC
Filling of airspaces with mucoid material produced by malignant cells creates low-density airspace opacification surrounding enhanced pulmonary arteries.
Typical radiologic findings of lymphangitic carcinomatosis
Linear and reticulonodular opacities. Peribronchial cuffing. Subpleural edema or pleural effusion.
Helps distinguish lymphangitic carcinomatosis due to lung cancer from other metastases
Unilateral or asymmetric involvement of lungs suggests lung cancer rather than an extrapulmonary site.
Two patient groups of small cell lung cancer
Disease limited to one hemithorax (limited disease). Contralateral lung or extrathoracic spread (extensive disease).
Two most common primary tracheal malignancies
SCC > Adenoid cystic carcinoma
Tracheal mass size and malignancy
Masses > 2 cm are likely to be malignant. Less than 2 cm are more likely benign.
less common primary tracheal malignancies"
Primary malignant neoplasms of the central bronchi include
Spectrum of entities. Ranging from benign polyclonal lymphoid proliferation to aggressive non-Hodgkin lymphoma.
Rare malignant tumor affecting children and young adults. Histology simulates fetal lung at 10 to 16 weeks� gestation. Tend to be extremely large at presentation.
Lobar pneumonia features
Typical of pneumococcal pulmonary infection. Inflammatory process spreads via pores of Kohn and canals of Lambert to produce nonsegmental consolidation. Air bronchograms are common.
Most common pattern of pneumonia. Typical of staphylococcal pneumonia. Inflammation centered around lobular bronchi. Multifocal opacities produce patchwork quilt of scattered normal and diseased lobules. No air bronchograms due to exudate within bronchi.
Interstitial pneumonia features
Viral and mycoplasma infection. Inflammatory thickening of bronchial and bronchiolar walls and pulmonary interstitium. Peribronchial cuffing and reticulonodular opacities.
Pneumatoceles may be distinguished from abscesses by
Thin walls. Rapid change in size. Generally develop during late phase of infection.
Reactivation occurs in apical and posterior segments of upper lobes and superior segments of lower lobes. Ill-defined patchy and nodular opacities. Cavitation usually indicates active and transmissible disease.
Erosion of cavitary focus into pulmonary artery branch can produce an aneurysm.
May complicate primary or reactivation disease. Hematogenous dissemination. Diffuse bilateral 2- to 3-mm pulmonary nodules.
Opportunistic fungal lung pathogens
Aspergillus. Candida. Cryptococcus.
Aspergillus lung involvement
Aspergilloma or mycetoma within preexisting cavities. Semi-invasive (chronic necrotizing) aspergillosis in mildly impaired immunity. Invasive pulmonary aspergillosis in neutropenia. Allergic bronchopulmonary aspergillosis in hyperimmunity.
Pulmonary echinococcal cysts are composed of three layers:
"Inside out: Endocyst
CT halo sign
"Decreased attenuation surrounding a dense
Most common AIDS-defining opportunistic infection.
Interlobular (Septal) Lines
Interlobular (septal) lines DDx:
Interstitial edema. � Lymphangitic carcinomatosis. � Sarcoidosis. � Idiopathic pulmonary fibrosis (IPF) (other forms of usual interstitial pneumonia UIP).
"5- to 10-cm-long curvilinear opacities are found within 1 cm of the pleura and parallel the chest wall. Most often seen in patients with asbestosis and
"Nontapering linear opacities
Small (6 to 10 mm) cystic spaces with thick (1 to 3 mm) walls. usually have shared walls . Usually in posterior subpleural regions. End-stage pulmonary fibrosis: IPF (UIP). Chronic hypersensitivity pneumonitis. Occasionally sarcoidosis.
Slightly larger in diameter (10 mm) than honeycomb cysts. Uniform in size. Thinner walls. Do not share walls with adjacent cysts. Cysts of LCH and LAM are usually evenly distributed from central to peripheral portions of upper lobes
1- to 3-mm. Sharply marginated. Round opacities seen on HRCT. Represent conglomerates of granulomas or tumor cells within the interstitium.
Ground-Glass or Hazy Increased Density
Granular appearance with maintained visibility of pulmonary vessels. Absence of air bronchograms. Desquamative interstitial pneumonia (DIP). Pneumocystis jiroveci (formerly P carinii) pneumonia. Acute hypersensitivity pneumonitis. Nonspecific interstitial pneumonia (NSIP). Interstitial pulmonary edema.
Substernal chest pain caused by intramediastinal extension of infection.
Causes of unilateral pulmonary artery enlargement incluce
Poststenotic dilation from valvular or postvalvular pulmonic stenosis. Pulmonary artery aneurysms. Distension of pulmonary artery by thrombus or tumor.
Rare vasculitides that may present with pulmonary artery aneurysms
Beh�et disease and Hughes-Stovins syndrome
Sarcoidosis 1-2-3 sign
1: Right paratracheal. 2. Right hilar. 3. Left hilar lymph node enlargement
Coronary calcification is detected at angiography in ____% of patients with 50% diameter stenosis.
A_____% diameter narrowing is the physiologic point at which flow is restricted enough to result in ischemia under stress conditions.
50% diameter narrowing. Roughly predicts a 75% cross-sectional area reduction.
Cardiac MR uses?
Define location and size of previous myocardial infarctions. Demonstrate complications of previous infarctions. Establish presence of viable myocardium for possible revascularization. Differentiate acute versus chronic myocardial infarction. Evaluate regional myocardial wall motion and systolic wall thickening. Demonstrate global myocardial function with right ventricular and left ventricular ejection fractions. Demonstrate regional myocardial perfusion. Evaluate papillary muscle and valvular abnormalities.
Myocardial rupture (may occur ______ days after infarction.
3 to 14 days.
"Onset is typically 1 week to 3 months postinjury. Fever
Hibernating myocardium versus stunned myocardium?
"Hibernating: High-grade stenosis resulting in chronically ischemic myocardium. May act like postinfarction scar. Improved function with revascularization. At risk for acute infarction. Stunned myocardium: Postischemic
Causes of dilated cardiomyopathies
"Ischemic cardiomyopathy (most common cause): Chronic ischemia. Prior infarction. Anomalous coronary arteries. Long-term sequelae of myocarditis: Coxsackie virus. Toxins: Ethanol
Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of dilated cardiomyopathy?
LV thin. LV dilated. Decreased contractility. Normal to decreased compliance.
Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of hypertrophic cardiomyopathy?
LV thick. LV normal to decreased. Increased contractility. Decreased compliance.
Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of restrivice cardiomyopathy?
Normal LV wall. Normal LV cavity. Normal to decreased contractility. Severely decreased compliance.
Ventricular Wall. Ventricular Cavity. Contractility. Compliance features of Uhl anomaly?
RV thin. RV dilated. Decreased contractility. Normal to decreased compliance.
Hypertrophic cardiomyopathies are divided into two basic types:
"Concentric hypertrophy: may be diffuse
Hypertrophic cardiomyopathy causes?
May be familial (60%). Autosomal dominant with variable penetrance. Associated with neurofibromatosis and Noonan syndrome. Secondary to pressure overload.
Features of ASH (asymmetric septal hypertrophy)?
Hypertrophy of the interventricular septum (>12 to 13 mm). Abnormal ratio of thickness of interventricular septum to left ventricular posterior wall (>1.3:1). Narrowing of left ventricular outflow tract during systole.
What other disease should be ruled out when considering restrictive cardiomyopathy?
MR finding in restrictive cardiomyopathy caused by amyloidosis or sarcoidosis?
high signal in the myocardium on T2WIs.
Defined as right ventricular failure secondary to pulmonary parenchymal or pulmonary arterial disease.
Etiologies of cor pulmonale include
"destructive pulmonary disease (pulmonary fibrosis and chronic obstructive pulmonary disease). hypoxic pulmonary vasoconstriction resulting from chronic bronchitis
Acquired disorder in infants or adults. Also called arrhythmogenic right ventricular dysplasia. Dilation of RV with marked thinning of anterior right ventricular wall. MR may show fatty infiltration of anterior RV free wall. Premature death from early congestive failure or arrhythmias.
Enlargement of pulmonary outflow tract causes
Left-to-right shunts. Poststenotic dilation secondary to pulmonary stenosis. Pulmonary arterial hypertension. Marfan syndrome. Takayasu arteritis. Idiopathic dilation of pulmonary artery.
Differential diagnosis for pulmonary arterial hypertension includes
"Intra-atrial thrombi are usually associated with atrial fibrillation
Intracardiac lipomas or lipomatous hypertrophy features
High T1 signal and fat suppression. Second most common benign cardiac tumor.
Atrial myxoma features
50% of primary cardiac tumors. Most common primary benign cardiac tumor. Most (75% to 80%) are in LA. May mimic rheumatic valvular disease clinically.
Benign cardiac tumors
Atrial myxoma. Lipoma. Rhabdomyoma (50% to 85% of tuberous sclerosis). Fibromas (12% may calcify). Rare teratoma.
Metastatic cardiac tumor features
10 to 20 times more common than primary cardiac tumors. Breast. Lung. Melanoma. Lymphoma.
Primary malignant cardiac tumors
Angiosarcoma (most common). Rhabdosarcoma. Liposarcoma. Other sarcomas.
Constrictive pericardial disease features
Fibrous or calcific thickening of pericardium. Compromises ventricular filling through restriction of cardiac motion. Most common cause is postpericardiotomy. Other causes: Coxsackie B. Tuberculosis. Chronic renal failure. Rheumatoid arthritis. Neoplastic involvement. Radiation pericarditis.
Differential diagnosis for a cardiophrenic angle mass includes