lung hrct patterns

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  • Unit of lung (0.5-3 cm)
    Irregularly polyhedral متعدد السطوح
    Supplied by a group of terminal bronchioles and accompanying pulmonary arterioles surrounded by lymph vessels
    Demarcated by “interlobular septa”
    pulmonary veins
    pulmonary lymphatics
    connective tissue stroma
  • Unit of lung (0.5-3 cm)
    Irregularly polyhedral متعدد السطوح
    Supplied by a group of terminal bronchioles and accompanying pulmonary arterioles surrounded by lymph vessels
    Demarcated by “interlobular septa”
    pulmonary veins
    pulmonary lymphatics
    connective tissue stroma
  • Unit of lung (0.5-3 cm)
    Irregularly polyhedral متعدد السطوح
    Supplied by a group of terminal bronchioles and accompanying pulmonary arterioles surrounded by lymph vessels
    Demarcated by “interlobular septa”
    pulmonary veins
    pulmonary lymphatics
    connective tissue stroma
  • Unit of lung (0.5-3 cm)
    Irregularly polyhedral متعدد السطوح
    Supplied by a group of terminal bronchioles and accompanying pulmonary arterioles surrounded by lymph vessels
    Demarcated by “interlobular septa”
    pulmonary veins
    pulmonary lymphatics
    connective tissue stroma
  • Unit of lung (0.5-3 cm)
    Irregularly polyhedral متعدد السطوح
    Supplied by a group of terminal bronchioles and accompanying pulmonary arterioles surrounded by lymph vessels
    Demarcated by “interlobular septa”
    pulmonary veins
    pulmonary lymphatics
    connective tissue stroma
  • Unit of lung (0.5-3 cm)
    Irregularly polyhedral متعدد السطوح
    Supplied by a group of terminal bronchioles and accompanying pulmonary arterioles surrounded by lymph vessels
    Demarcated by “interlobular septa”
    pulmonary veins
    pulmonary lymphatics
    connective tissue stroma
  • Unit of lung (1 cm to 1 inch)
    Irregularly polyhedral
    Supplied by a group of terminal bronchioles and accompanying pulmonary arterioles surrounded by lymph vessels
    Demarcated by “interlobular septa”
    pulmonary veins
    pulmonary lymphatics
    connective tissue stroma
  • The yellow arrows indicates the pulmonary vessels
  • lung hrct patterns

    1. 1. HRCT PATTERNS
    2. 2. Secondary lobule • It is the basic anatomic unit of pulmonary structure and function. • It is the smallest lung unit that is surrounded by connective tissue septa.
    3. 3. 1-2 cm and is made up of 5- 15 pulmonary acini Supplied by a small bronchiole (terminal bronchiole) in the center, that is parallelled by the centrilobular artery. Pulmonary veins and lymphatics run in the periphery  Two lymphatic systems:  central network  peripheral network
    4. 4. Raoof, S. , CHEST 2006; 129:805
    5. 5. 6
    6. 6. terminal bronchioles 7
    7. 7. Accompanying pulmonary arterioles 8
    8. 8. Surrounded by lymph vessels 9
    9. 9. Pulmonary veins 10
    10. 10. Pulmonary lymphatics 11
    11. 11. 12 Connective Tissue StromaConnective Tissue Stroma
    12. 12. Increased attenuation Decreased attenuation
    13. 13. interlobular septal thickening Irregular smooth nodular Lung distortion Honey lymphangitic tumor Combing DDs sarcoidosis Sarcoidosis,asbestosis
    14. 14. smooth Thick septa predominant ground glass predominant Lymphangitic tumor crazy paving DDs Pulm oedema Haemorrhage Amyloid(rare)
    15. 15. Peribronchovascular interstitial thickening Lymphangitic spread of carcinoma Lymphoma Leukaemia LIP Interstitial edema Sarcoidosis
    16. 16. Interlobular septal thickening
    17. 17. Focal septal thickening in lymphangitic carcinomatosis
    18. 18. Septal thickening and ground-glass opacity with a gravitational distribution in a patient with cardiogenic pulmonary edema.
    19. 19. Notice the nodules along the fissures indicating a perilymphatic distribution (red arrows). The majority of nodules located along the bronchovascular bundle (yellow arrow).
    20. 20. Nodular septal thickening
    21. 21. Parenchymal bands Non tapering reticular opacity,1-3 mm in tickness and 2 to 5 cm in length Often peripheral and contacts the pleural surface Represent contiguous thickened interlobulsr septa,peribronchovascular fibrosis,scars or atelectasis
    22. 22. DD’S Asbestosis Sarcoidosis Silicosis TB
    23. 23. Subpleural line Curvilinear opacity,few mm or les in thickness,prallelling the pleura and less than 1 cm from the pleural surface. Represent fibrosis / localized alveolar collapse / atelectasis. Commonly seen in asbestosis
    24. 24. Size, Distribution, Appearance Nodules and Nodular Opacities 28 SizeSize Small Nodules: <10 mm Micro - <3 mmSmall Nodules: <10 mm Micro - <3 mm Large Nodules: >10 mm Masses - >3 cmsLarge Nodules: >10 mm Masses - >3 cms AppearanceAppearance Interstitial opacity:  Well-defined, homogenous, Soft-tissue density Obscures the edges of vessels or adjacent structure Interstitial opacity:  Well-defined, homogenous, Soft-tissue density Obscures the edges of vessels or adjacent structure Air space: Ill-defined, inhomogeneous. Less dense than adjacent vessel – GGO small nodule is difficult to identify Air space: Ill-defined, inhomogeneous. Less dense than adjacent vessel – GGO small nodule is difficult to identify
    25. 25. Based on distribution Perilymphatic Centrilobular Random
    26. 26. Sarcoidosis The majority of nodules located along the bronchovascular bundle (yellow arrow).
    27. 27. Centrilobular nodules 5 to 10mm away from the pleural surface Evenly spaced Associated with pumonary artery branches If air filled centrilobular bronchiole----lucency within the nodule
    28. 28. Causes Bronchiolar and peribronchiolar Vascular and perivascular
    29. 29. Bronchiolar and peribronchiolar Endobronchiolar spread HSP Bronchiolitis obliterans Respiratory bronchiolitis Cystic fibrosis Bronchiectasis
    30. 30. Vascular and perivascular Pulmonary edema Vasculitis Pulmonary hemorrhage Pulm HTN
    31. 31. Tree-in-bud 44  Centrilobular nodules m/b further characterized by presence or absence of ‘‘tree-in-bud.’’  Tree-in-bud -- Impaction of centrilobular bronchus with mucous, pus, or fluid, resulting in dilation of the bronchus, with associated peribronchiolar inflammation .  Dilated, impacted bronchi produce Y- or V-shaped structures  This finding is almost always seen with pulmonary infections.
    32. 32. Tree-in-bud
    33. 33. Typical Tree-in-bud appearance in a patient with active TB.
    34. 34. Random nodules Hematogenous mets Miliary TB Miliary fungal infections Sarcoidosis ( extensive) LCH
    35. 35. Langerhans cell histiocytosis: early nodular stage before the typical cysts appear.
    36. 36. Parenchymal opacification GGO Consolidation Lung calcification and high attenuation opacities
    37. 37. Ground glass opacity Hazy increase in lung opacity not associated with obscuration of underlying vessels or bronchial margins
    38. 38. Significance of GGO Acute symptoms---asociation with active disease Subaute or chronic---active disease / fibrosis
    39. 39. Crazy paving pattern Superimposition of reticular pattern on GGO PAP Acute silicosis Pulmonary edema Pulmonary haemorrhage ARDS P.Carnii pneumonias
    40. 40. Consolidation Increased lung attenuation with obscuration of underlying vessels
    41. 41. Lung calcification and high attenuation opacities Multifocal calcification (often with nodules) T.B, Histoplasmosis, varicella pneumonia, sarcoidosis Diffuse and dense calcification Metastatic calcification (due to hypercalcemia ,in patients with CRF, Hyperparathyroidism) – calcification mainly interstitial. Disseminated pulmonary ossification Alveolar microlithiasis (posterior and lower lobe predominance
    42. 42. Low attenuation Lung cysts,emphysema and bronchiectasis
    43. 43. Honey combing Lung cysts Emphysema Bullae Pneumatocoeles Cavitary nodules Bronchiectasis
    44. 44. HONEYCOMBING 67 Defined as - small cystic spaces with irregularly thickened walls composed of fibrous tissue. Predominate in the peripheral and subpleural lung regions Subpleural honeycomb cysts typically occur in several contiguous layers. D/D- paraseptal emphysema in which subpleural cysts usually occur in a single layer.
    45. 45. Honey combing Air filled cystic spaces Several mm to cms in diameter Peripheral and subpleural Definable walls,1 to 3 mm in thickness Associated with findings of lung fibrosis
    46. 46. 69 Causes Lower lobe predominance : 1. UIP or interstitial fibrosis 2. Connective tissue disorders 3. Hypersensitivity pneumonitis 4. Asbestosis 5. NSIP (rare) Upper lobe predominance : 1. End stage sarcodosis 2. Radiation 3. Hypersensitivity Pneumonitis 4. End stage ARDS
    47. 47. Honeycombing Typical UIP pattern with in a patient with idiopathic pulmonary fibrosis
    48. 48. Lung cysts Well defined rounded or circumscribed lesion with a wall that may be uniform or varied in thickness ( < 2- 3 mm)
    49. 49. LAM LCH LIP Bullae Pneumatocoeles Honeycombing Cystic bronchiectasis
    50. 50. Langerhans cell histiocytosis
    51. 51. HRCT Appearances LAM Numerous thin-walled cysts, surrounded by normal parenchyma.  Round in shape and more or less uniform. Mediastinal or hilar adenopathy . Chylous Pleural effusions (40%). Recurrent pneumothorax (40%)
    52. 52. Multiple thin-walled cysts of roughly uniform size. Unlike LCH, the cysts in LAM tend to be rounded and uniformly distributed throughout the parenchyma with no regional sparing. There is a conspicuous absence of nodules.
    53. 53. Lymphangiomyomatosis complicated by pneumothorax
    54. 54. Emphysema Permanent abnormal enlargement of air spaces distal to terminal bronchiole accompanied by destruction of walls of involved air spaces
    55. 55. Centrilobular Paraseptal Panlobular Irregular / cicatrical Bullous
    56. 56. Centrilobular emphysema Most common type Upper lobe predominance Strongly associated with smoking.
    57. 57. Centrilobular emphysema 81 Manifests as multiple small areas of low attenuation without a perceptible wall, producing a punched-out appearance. Often the centrilobular artery is visible within the centre of these lucencies.
    58. 58. Centrilobular emphysema due to smoking. The periphery of the lung is spared (blue arrows). Centrilobular artery (yellow arrows) is seen in the center of the hypodense area.
    59. 59. Panlobular emphysema Affects the whole secondary lobule Lower lobe predominance In alpha-1-antitrypsin deficiency, but also seen in smokers with advanced emphysema
    60. 60. PANLOBULAR EMPHYSEMA 84
    61. 61. Panlobular emphysema
    62. 62. Paraseptal (distal acinar) emphysema 86 Affects the peripheral parts of the secondary pulmonary lobule Produces subpleural lucencies.
    63. 63. Paraseptal emphysema
    64. 64. Paraseptal emphysema v/s honeycombing
    65. 65. Centrilobular emphysema and lung cysts
    66. 66. Bullae and blebs Bulla : sharply demarcated area of emphysema measuring 1cm or more in diameter with a wall that is < 1 mm. Bleb: focal thin walled lucency contigous with pleura usually at lung apex
    67. 67. Pneumatocoele Thin walled gas filled space within the lung,usually assosciated with pneumonia Appearance similar to cyst or bulla and cannot be differentiated
    68. 68. Cavitary nodules • Thicker and irregular walls than cysts • LCH • TB • Fungal infections • Sarcoidosis • Rheumatoid lung disease • Mets • wegeners
    69. 69. Bronchiectasis Localized irrevesible bronchial dilatation with thickening of the bronchial wall. Cylindrical Varicose Cystic Traction
    70. 70. • localized bronchial dilatation. (signet-ring sign) bronchial wall thickening lack of normal tapering with visibility of airways in the peripheral lung mucus retention in the broncial lumen
    71. 71. ABPA: glove-finger shadow due to mucoid impaction in central bronchiectasis in a patient with asthma.
    72. 72. Signet-Ring Sign A signet-ring sign represents an axial cut of a dilated bronchus (ring) with its accompanying small artery (signet).
    73. 73. Tram Tracks
    74. 74. Mosaic perfusion and attenuation Due to airway disease Due to vascular disease Infiltrative process adjacent to normal lung
    75. 75. Inhomogenous lung opacity Decreased vessel size Uniform sized vessels Some regions too lucent Some regions too dense No reticulation Associated reticulation, No Nodules Nodules Mosaic perfusion Ground glass opacity
    76. 76. Inhomogenous lung opacity Decreased size of vessels uniform sized vessels (suspect mosaic perfusion) (suspect GGO) No air trapping air trapping no air trapping Vascular disease obstructive disease infiltrative disease Chronic PE small airways disease GGO DD’s large airways disease
    77. 77. Air trapping on expiration Diagnosis of air trapping in obstructive lung disease Diagnosis of airway diseases with normal inspiratory scan Distinguishing mosaic perfusion from GGO Allowing the diagnosis of mixed infiltrative and obstructive diseases
    78. 78. Nodular pattern 1.Hypersensitivity pneumonitis: 2.Miliary TB: random nodules 3.Sarcoidosis
    79. 79. Low Attenuation pattern Lymphangiomyomatosis (LAM) LCH Honeycombing Centrilobular emphysema
    80. 80. Thank you
    81. 81. Mosaic perfusion Pulmonary hypertension Abnormal airways Large areas of lucency Lobular lucencies Vascular disease Obstructive disease Chronic PE small airways disease lareg airways disease

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