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How read chest ct 2

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How  read  chest ct  2 How read chest ct 2 Presentation Transcript

  • HOW READ CHEST CT -2 ANAS SAHLE ,MD
  • Basic elements Appearance pattern DistributionPatient data pattern Ct interpretation
  • Normal HRCT Findings airwaysNormal airways are visible only towithin 3 cm of the pleura.The centrilobular bronchiole, with a diameter of 1mm and a wall thickness of 0.15 mm, is notnormally visible on HRCT.
  • Normal HRCT Findingssmall pulmonary arteries and veins More peripherally, numerous small "dots" and a few branching lines represent small pulmonary arteries and veins. Throughout, arteries branch at acute angles, and veins branch at 90° angles Centrilobular arteries (1 mm in diameter) are V- or Y-shaped structures on HRCT seen within 5 to 10 mm of the pleural surface. Pulmonary veins (0.5 cm) are occasionally seen as linear or dotlike structures within 1 to 2 cm of the pleura and, when visible, indicate the locations of interlobular septa
  • FIGURE 17.3. HRCT Findings in Interstitial Lung Disease1- Interlobular (Septal) Lines2-Intralobular Lines3-Thickened Fissures4-Thickened bronchovascularstructures Dot lik5-Centrilobular (Lobular tree-in-budCore) Abnormalities lldefined6- Subpleural lines7-Parenchymal bands8-Honeycombing9-Thin-walled cysts10-Irregularity of Lung Interfaces11-Ground-Glass or HazyIncreased Density12-Architectural Distortion andTraction Bronchiectasis13-Conglomerate Masses14-Consolidation
  • Appearance pattern Increased Decreased Nodular Linear lung lung opacities opacitiesattenuation attenuation
  • Increased lung attenuation Ground-glass opacity Consolidation
  • Ground-glass opacity(GGO)• GGO: • hazy increase in lung density, • with preservation of airway vessel margins. • The density of the intra-bronchial air appears darker as the air in the surrounding alveoli. This is called the dark bronchus sign• Occurs when: • there is mild decrease in the amount of air in air- spaces(Air space disease ) • when there is mild increase in size andor amount of soft tissue structures (Interstitial lung disease ). • two phenomena that often occur simultaneously.
  • High Attenuation pattern1. Ground-glass- opacity (GGO)2. Consolidation High Attenuation
  • WHAT IS DOMINANT PATTERN ?
  • Ground-glass opacityTreatable or not treatable?
  • Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern60-80% Active Treatable 2. Ground-glassof cases pathology opacity 1. Taction20-40% Chronic not Bronchiectasisof cases pathology treatable 2. Honeycombing 3. Cysts
  • Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern60-80% Potentially Activeof cases treatable 2. Ground-glass pathology opacity 1. Taction20-40% Chronic not Bronchiectasisof cases pathology treatable 2. Honeycombing 3. Cysts
  • Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern60-80% Potentially Activeof cases treatable 2. Ground-glass pathology opacity 1. Taction20-40% Chronic not Bronchiectasisof cases pathology treatable 2. Honeycombing 3. Cysts
  • Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern60-80% Potentially Activeof cases treatable 2. Ground-glass pathology opacity 1. Taction20-40% Chronic not Bronchiectasisof cases pathology treatable 2. Honeycombing 3. Cysts
  • Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern60-80% Potentially Activeof cases treatable 2. Ground-glass pathology opacity 1. Taction20-40% Chronic Not Bronchiectasisof cases pathology treatable 2. Honeycombing 3. Cysts
  • Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern60-80% Potentially Activeof cases treatable 2. Ground-glass pathology opacity 1. Taction20-40% Chronic Not Bronchiectasisof cases pathology treatable 2. Honeycombing 3. Cysts
  • Ground-glass opacity Treatable or not treatable?• Potentially treatable lung disease
  • Ground-glass opacity Treatable or not treatable?• Radiological Findings of fibrosis:• Traction bronchiectasis• Honeycombing
  • Ground-glass opacity Treatable or not treatable? • Traction Bronchiectasis • HoneycombingNon specific interstitial pneumonitis (NSIP)
  • Crazy Paving
  • Crazy Paving in a patient with Alveolar proteinosis Linear Crazy- GGO pattern paving• Crazy Paving is a combination of ground glass opacity with superimposed septal thickening
  • Consolidation• Defined as: • Increased in lung density • with obscuration of underlying vessels and airway walls, – an air-bronchogram may be present.• Air-space nodules, focal area of GGO are often seen in association with consolidation.
  • Increased lung attenuation Preservation of B-V Obscuration of vascular marking=GGO marking=consolidation Symptoms course Symptoms course(acute,sub-acute,chronic) (acute,sub-acute,chronic) Centri-lobularLinear pattern sub-pleural Other pattern No linear patternsuperimposed patchy diffuse also lobar Centri-lobular DD for otherCRAZY PAVING Sub-pleural pattern Patchy,diffuse
  • Increased lung attenuation Appearance pattern GGO Cosolidation Patient data(symptoms course) Acute Sub-acute Chronic Distribution patternother patternCentri-lobular Sub-pleural Patchy Diffuse Lobar Regional lung distribution Upper lowerdiffuse Central peripheral
  • AcuteGGOconsolidationcrazy-paving Pulmonary infection Pulmonary edema Pulmonary hemorrhage ARDS Acute intrstitial pneumonia Eosinophilic pnrumonia Radiation pneumonia
  • Sub-acutechronic course GGO Hyper-sensitivity pneumonitis Smoking related paranchymal disease UIPIPF NSIP Lymphocytic interstitial pneumoniaLIP Alveolar proteinosis Asbestosis Vasculitis(churg-strauss syn) Eosinophylic pneumonia(chronic) COP Bronchoalveolar CA Lipoid pneumonia Sarcoidosis
  • Sub-acutechronic course cosolidation COP Bronchoalveloar CA UIPIPF NSIP Lymphocytic interstitial pneumoniaLIP Lymphoma Vasculitis(churg-strauss syn) Eosinophylic pneumonia(chronic) Hyper-sensitivity pneumonitis Lipoid pneumonia Sarcoidosis
  • Sub-acutechronic course crazy-paving UIPIPF NSIP Lymphangitic spread of tumor Alveolar proteinosis Vasculitis(churg-strauss syn) Eosinophylic pneumonia(chronic) COP Bronchoalveolar CA Lipoid pneumonia Sarcoidosis
  • Centri-lobular nodular GGO Hyper-sensitivity pneumonitis Organizing pneumonia Pulmonary infection Pulmonary edema Pulmonary hemorrhage vasculitis Metastatic calcificationLymphocytic interstitial pneumonia(sjogren,AIDS)
  • Centri-lobular nodular consolidation• Hyper-sensitivity pneumonitis• Organizing pneumonia• Pulmonary infection• Pulmonary edema• Pulmonary hemorrhage• Bronchoalveolar carcinoma• Aspiration• vasculitis• Lymphocytic interstitial pneumonia(sjogren,AIDS)
  • Sub-pleural GGO UIPIPFOrganizing pneumoniaEosinophylic pneumonia Asbestosis
  • Sub-pleural consolidation• Eosinophylic pneumonia• Organizing pneumonia• UIPIPF
  • Patchy GGOHyper-sensitivity pneumonitis NSIP DIP Alveolar proteinosis Pulmonary hemorrhage vasculitis Sarcoidosis
  • Patchy consolidation• Hyper-sensitivity pneumonitis• NSIP• DIP• Pulmonary hemorrhage• vasculitis• Sarcoidosis
  • Diffuse GGO Hyper-sensitivity pneumonitis Smoking related lung diseases Pulmonary infection Pulmonary edema Pulmonary hemorrhage Alveolar proteinosisAcute interstitial pneumonia(AIP) ARDS NSIP
  • Diffuse consolidation• Hyper-sensitivity pneumonitis• Pulmonary infection• Pulmonary edema• Pulmonary hemorrhage• Alveolar proteinosis• AIP• ARDS• NSIP
  • Lobar consolidation• Pulmonary infection• Bronchoalveolar carcinoma• Organising pneumonia• Lymphoma
  • Regional distributionUpperlowerdiffuse Centralperipherial Posterioranterior zone zone zone
  • Regional distribution Upper zone Lower zone diffuse zone• Sarcoidosis • oedema • Hyper-sensetivity• Tuberculosis • UIP pneumonitis• Chronic • NSIP • Diffuse eosinophylic • DIP pneumonia pneumonia. • COP • Lymphangitic • Lipoid pneumonia spread of tumor • Alveolar • Sarcoidosis hemorrhage
  • Regional distribution Central zone Peripheral zone• Sarcoidosis • Asbestosis• Lymphagitic spread of tumor • UIP• Alveolar proteinosis. • NSIP • DIP • COP • Chronic eosinophylic pneumonia • Hyper-sensitivity pneumonitis. • Acute interstitial pneumonia. • Septic emboli • Pulmonary embolisem.
  • Regional distribution Posterior• oedema• ARDS• UIP• NSIP• Asbestosis• Sarcoidosis• Hyper-sensitivity pneumonitis• Lipoid pneumonia
  • High Attenuation