HOW READ CHEST CT -2     ANAS SAHLE ,MD
Basic elements               Appearance                 pattern                                 DistributionPatient data  ...
Normal HRCT Findings                        airwaysNormal airways are visible only towithin 3 cm of the pleura.The centril...
Normal HRCT Findingssmall pulmonary arteries and veins              More peripherally, numerous small "dots" and a few    ...
FIGURE 17.3. HRCT Findings in    Interstitial Lung Disease1- Interlobular (Septal) Lines2-Intralobular Lines3-Thickened Fi...
Appearance pattern Increased Decreased                          Nodular      Linear    lung        lung                   ...
Increased lung attenuation         Ground-glass opacity             Consolidation
Ground-glass opacity(GGO)• GGO:     • hazy increase in lung density,     • with preservation of airway vessel margins.    ...
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%  ...
Ground-glass opacity           Treatable or not treatable ?            Acute /                  1.   Reticular Pattern60-8...
Ground-glass opacity           Treatable or not treatable ?            Acute /                  1.   Reticular Pattern60-8...
Ground-glass opacity           Treatable or not treatable ?            Acute /                  1.   Reticular Pattern60-8...
Ground-glass opacity           Treatable or not treatable ?            Acute /                  1.   Reticular Pattern60-8...
Ground-glass opacity           Treatable or not treatable ?            Acute /                  1.   Reticular Pattern60-8...
Ground-glass opacity        Treatable or not treatable?• Potentially treatable  lung disease
Ground-glass opacity        Treatable or not treatable?• Radiological Findings  of fibrosis:• Traction  bronchiectasis• Ho...
Ground-glass opacity    Treatable or not treatable?    • Traction Bronchiectasis    • HoneycombingNon specific interstitia...
Crazy Paving
Crazy Paving in a patient with Alveolar              proteinosis                        Linear           Crazy-         GG...
Consolidation• Defined as:      • Increased in lung density      • with obscuration of underlying vessels        and airwa...
Increased lung attenuation  Preservation of B-V                Obscuration of vascular     marking=GGO                    ...
Increased lung attenuation                          Appearance pattern                 GGO                           Cosol...
AcuteGGOconsolidationcrazy-paving          Pulmonary infection           Pulmonary edema        Pulmonary hemorrhage      ...
Sub-acutechronic course                 GGO         Hyper-sensitivity pneumonitis     Smoking related paranchymal disease ...
Sub-acutechronic course      cosolidation                   COP          Bronchoalveloar CA                  UIPIPF       ...
Sub-acutechronic course     crazy-paving                 UIPIPF                   NSIP     Lymphangitic spread of tumor   ...
Centri-lobular nodular                   GGO         Hyper-sensitivity pneumonitis             Organizing pneumonia       ...
Centri-lobular nodular           consolidation• Hyper-sensitivity pneumonitis• Organizing pneumonia• Pulmonary infection• ...
Sub-pleural        GGO       UIPIPFOrganizing pneumoniaEosinophylic pneumonia     Asbestosis
Sub-pleural          consolidation• Eosinophylic pneumonia• Organizing pneumonia• UIPIPF
Patchy           GGOHyper-sensitivity pneumonitis            NSIP            DIP    Alveolar proteinosis   Pulmonary hemor...
Patchy            consolidation• Hyper-sensitivity pneumonitis• NSIP• DIP• Pulmonary hemorrhage• vasculitis• Sarcoidosis
Diffuse            GGO Hyper-sensitivity pneumonitis Smoking related lung diseases      Pulmonary infection       Pulmonar...
Diffuse            consolidation• Hyper-sensitivity pneumonitis• Pulmonary infection• Pulmonary edema• Pulmonary hemorrhag...
Lobar             consolidation• Pulmonary infection• Bronchoalveolar carcinoma• Organising pneumonia• Lymphoma
Regional distributionUpperlowerdiffuse   Centralperipherial   Posterioranterior       zone                  zone          ...
Regional distribution  Upper zone       Lower zone          diffuse zone• Sarcoidosis    • oedema             • Hyper-sens...
Regional distribution      Central zone                  Peripheral zone• Sarcoidosis                   • Asbestosis• Lymp...
Regional distribution                 Posterior• oedema• ARDS• UIP• NSIP• Asbestosis• Sarcoidosis• Hyper-sensitivity pneum...
High Attenuation
How  read  chest ct  2
How  read  chest ct  2
How  read  chest ct  2
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  1. 1. HOW READ CHEST CT -2 ANAS SAHLE ,MD
  2. 2. Basic elements Appearance pattern DistributionPatient data pattern Ct interpretation
  3. 3. 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.
  4. 4. 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
  5. 5. 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
  6. 6. Appearance pattern Increased Decreased Nodular Linear lung lung opacities opacitiesattenuation attenuation
  7. 7. Increased lung attenuation Ground-glass opacity Consolidation
  8. 8. 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.
  9. 9. High Attenuation pattern1. Ground-glass- opacity (GGO)2. Consolidation High Attenuation
  10. 10. WHAT IS DOMINANT PATTERN ?
  11. 11. Ground-glass opacityTreatable or not treatable?
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. Ground-glass opacity Treatable or not treatable?• Potentially treatable lung disease
  19. 19. Ground-glass opacity Treatable or not treatable?• Radiological Findings of fibrosis:• Traction bronchiectasis• Honeycombing
  20. 20. Ground-glass opacity Treatable or not treatable? • Traction Bronchiectasis • HoneycombingNon specific interstitial pneumonitis (NSIP)
  21. 21. Crazy Paving
  22. 22. 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
  23. 23. 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.
  24. 24. 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
  25. 25. 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
  26. 26. AcuteGGOconsolidationcrazy-paving Pulmonary infection Pulmonary edema Pulmonary hemorrhage ARDS Acute intrstitial pneumonia Eosinophilic pnrumonia Radiation pneumonia
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. Centri-lobular nodular GGO Hyper-sensitivity pneumonitis Organizing pneumonia Pulmonary infection Pulmonary edema Pulmonary hemorrhage vasculitis Metastatic calcificationLymphocytic interstitial pneumonia(sjogren,AIDS)
  31. 31. Centri-lobular nodular consolidation• Hyper-sensitivity pneumonitis• Organizing pneumonia• Pulmonary infection• Pulmonary edema• Pulmonary hemorrhage• Bronchoalveolar carcinoma• Aspiration• vasculitis• Lymphocytic interstitial pneumonia(sjogren,AIDS)
  32. 32. Sub-pleural GGO UIPIPFOrganizing pneumoniaEosinophylic pneumonia Asbestosis
  33. 33. Sub-pleural consolidation• Eosinophylic pneumonia• Organizing pneumonia• UIPIPF
  34. 34. Patchy GGOHyper-sensitivity pneumonitis NSIP DIP Alveolar proteinosis Pulmonary hemorrhage vasculitis Sarcoidosis
  35. 35. Patchy consolidation• Hyper-sensitivity pneumonitis• NSIP• DIP• Pulmonary hemorrhage• vasculitis• Sarcoidosis
  36. 36. Diffuse GGO Hyper-sensitivity pneumonitis Smoking related lung diseases Pulmonary infection Pulmonary edema Pulmonary hemorrhage Alveolar proteinosisAcute interstitial pneumonia(AIP) ARDS NSIP
  37. 37. Diffuse consolidation• Hyper-sensitivity pneumonitis• Pulmonary infection• Pulmonary edema• Pulmonary hemorrhage• Alveolar proteinosis• AIP• ARDS• NSIP
  38. 38. Lobar consolidation• Pulmonary infection• Bronchoalveolar carcinoma• Organising pneumonia• Lymphoma
  39. 39. Regional distributionUpperlowerdiffuse Centralperipherial Posterioranterior zone zone zone
  40. 40. 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
  41. 41. 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.
  42. 42. Regional distribution Posterior• oedema• ARDS• UIP• NSIP• Asbestosis• Sarcoidosis• Hyper-sensitivity pneumonitis• Lipoid pneumonia
  43. 43. High Attenuation

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