CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 47Interstitial Lung Disease on
Computed Tomography*

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig C 47-1 Usual interstitial pneumonia. Scan at
the level of the right upper lobe bronchus in a
woman with idiopathic pulmonary fibrosis shows
a reticular pattern and irregular interfaces
predominantly in the subpleural lung regions.87

4. • Fig C 47-2 Desquamative interstitial
pneumonia. Scan at the carinal level shows
patchy areas of airspace opacification
(“ground-glass” density).87

5. • Fig C 47-3 Cryptogenic organizing pneumonia.
Air-space consolidation in the subpleural
regions associated with peribronchial
thickening (arrows).87

6. • Fthe right lower lung shows extensive abnormalities
with ig C 47-4 Lymphangitic carcinomatosis. Scan
through thickening of the interlobular septa (straight
arrows), major fissure, and bronchovascular bundles
(curved arrow). There is also a pleural effusion.87

7. • Fig C 47-5 Pulmonary edema. Thickening of the
interlobular septa (small arrows) and ill-defined
centrilobular opacities (large arrows). Note also
the thickening of the peribronchovascular
interstitium, with peribronchial cuffing.88

8. • Fig C 47-6 Sarcoidosis. (A) Scan at the carinal level
shows central conglomeration of fibrosis and
ectatic bronchi (straight black arrows). Nodular
thickening of the interlobular septa (curved
arrow) and subpleural granulomas (white arrows)
are also identified. (B) Scan through the lower
lung zones demonstrates nodular thickening of
the bronchovascular bundles (straight arrows)
and interlobular septa (curved arrows).87

9. • Fig C 47-7 Asbestosis. Supine scan shows moderate
thickening of interlobular septal (arrows) and peribronchial
(arrowheads) structures in the nondependent subpleural
parenchyma. On the left, there is a suggestion of subpleural
honeycombing (curved arrow). The interlobar fissures are
thickened, and there is serration of the lung-pleural
interface at sites of interstitial fibrosis, changes indicative of
visceral pleural fibrosis.89

10. • Fig C 47-8 Asbestosis. Scan through the right middle lobe shows an
irregular mass with aerated lung interposed between it and the adjacent
pleural thickening. A focal band of soft tissue can be seen in contact with
the pleura. The mass was stable on serial radiographs and thus was
considered to represent a variant of round atelectasis.89

11. • Fig C 47-9 Asbestosis. Moderate bilateral
paraspinous and costal pleural thickening.
Scattered calcifications are visible in the right
anterior costal plaque (arrows).89

12. • Fig C 47-10 Silicosis. Upper lobe distribution of
small nodules.90

13. • Fig C 47-11 Extrinsic allergic alveolitis. Bird-breeder's
lung. Scan at the level of the right hemidiaphragm
shows patchy areas of hazy interstitial density
(“ground-glass” density; arrows) that typically do not
obscure the underlying vascular markings.87

14. • Fig C 47-12 Pulmonary Langerhans cell histiocytosis.
Scan through the right lower lung zone shows cystic air
spaces with thin walls. Characteristically the tip of the
middle lobe (arrow) is spared.87

15. • Fig C 47-13 Lymphangiomyomatosis. Scan through the right upper lobe
shows numerous thin-walled cystic air spaces of various sizes. The patient
also had pneumomediastinum and extensive subcutaneous emphysema.5

16. • Fig C 47-14 Radiation fibrosis. HRCT performed 1 year after
radiation therapy for lung carcinoma demonstrates a
reticular pattern and ground-glass opacity in the medial
aspect of the right upper lobe. Note the traction
bronchiectasis due to fibrosis and the sharp demarcation
between normal and irradiated lung.88