Chest radiology teaching files, text book of imaging radiology, diagnosis , differential diagnosis of chest cases

2. A 42-year-old man with shortness of breath, undergoing
computed tomography
Patients may be asymptomatic or have
nonspecific symptoms of dry cough and
shortness of breath.
Small perilymphatic nodules are located mainly along the
bronchi, vessels, interlobar fissures, and subpleural lung
regions

3. PERILYMPHATIC NODULAR PATTERN ON HIGH-RESOLUTION
DIFFERENTIAL DIAGNOSIS
• Sarcoidosis
• Lymphatic spread of tumor (lymphangitis carcinomatosis, lymphoma)
• Silicosis
• Coalworker’s pneumoconiosis
• Lymphoid interstitial pneumonia
• Lymphoid hyperplasia
• Amyloidosis

4. A 50-year-old man with progressive shortness of breath,
undergoing computed tomography
hypersensitivity pneumonitis.
centrilobular nodular opacities in a symmetric
distribution.
bird breeder and developed subacute hypersensitivity
pneumonitis.

5. sarcoidosis, high-resolution CT at the level of the upper lobes shows numerous small,
perilymphatic nodules located mainly along the interlobular septa (arrowheads),
centrilobular regions (long white arrows), and subpleural regions (short black arrows).

6. A 50-year-old man with progressive shortness of breath,
undergoing computed tomography
1. asymptomatic (e.g., respiratory bronchiolitis),
2. present with acute fever and cough (e.g., infectious
3. bronchiolitis),
4. more indolent course with fever and cough (e.g., tuberculosis),
5. Progressive shortness of breath (e.g., hypersensitivity
pneumonitis).
• Differential Diagnosis
• Infectious bronchiolitis due to viral,
mycoplasmal, bacterial, or fungal infection
• Panbronchiolitis
• Aspiration bronchiolitis
• Hypersensitivity pneumonitis
• Pneumoconiosis: silicosis or coal worker’s
pneumoconiosis
• Respiratory bronchiolitis
• Respiratory bronchiolitis–interstitial lung
disease (RBILD)
• Severe pulmonary arterial hypertension
• Pulmonary capillary hemangiomatosis
• Intravascular metastases
Centrilobular nodules

7. aspiration bronchiolitis resulting from a closed head injury,
bilateral, poorly defined, centrilobular nodular opacities and
lobular areas of ground-glass opacity. Notice the bronchi filled
with secretions (white arrows) adjacent to the accompanying
pulmonary arteries (black arrows) in the left lower lobe
diffuse, poorly defined,centrilobular nodular
opacities in a 50-year-old man who was a bird
breeder and developed subacute hypersensitivity
pneumonitis. centrilobular opacities typically are
a few millimeters away from the pleura,
interlobular septa, and large vessels and bronchi.

8. A 57-year-old man with fever and cough, undergoing
computed tomography
tree-in-bud pattern
• fever and cough in infectious
bronchiolitis and
endobronchial spread of
tuberculosis;
• chronic cough in patients with
mucoid impaction associated
with bronchiectasis;
• worsening of symptoms of
asthma in patients with allergic
bronchopulmonary
aspergillosis;
• history of impaired
consciousness or esophageal
motility disorder in aspiration
bronchiolitis; and
• Dyspnea and weight loss in
patients with intravascular
metastases
Differential diagnosis
 Infectious bronchiolitis
 Endobronchial spread of Tb or MAI
 Mucoid impaction distal to
bronchiectasis
 Allergic bronchopulmonary
aspergillosis
 Aspiration bronchiolitis
 Bronchiolitis due to inhalation of
gases and fumes
 Intravascular metastases

9. endobronchial spread of tuberculosis,
centrilobular branching nodular and linear
opacities, resulting in a tree-in-bud
appearance in the left lower lobe, and a
cavitated nodule (arrow).
right middle lobe bronchus shows bilateral
centrilobular branching nodular and linear
opacities, resulting in a tree-in-bud
appearance (infectious bronchiolitis)

10. A 74-year-old man with progressive shortness of breath,
undergoing computed tomography
Small nodules occur with a random distribution
• Acute presentation
includes fever and
shortness of breath -
miliary infection (e.g.,
tuberculosis,
histoplasmosis,
coccidioidomycosis).
• Asymptomatic or, less
commonly, progressive
shortness of breath -
hematogenous spread
of metastases
Differential diagnosis
 Miliary tuberculosis
 Miliary fungal infection
(coccidioidomycosis, cryptococcosis,
histoplasmosis)
 Pulmonary metastases
 Septic embolism

11. numerous, small, well defined nodules that
can be seen in relation to interlobular
septa, small vessels, and pleural surfaces,
Miliary Tuberculosis
numerous, bilateral , well-defined,
small nodules in a random
distribution, Metastatic pulmonary
carcinoma

12. A 57-year-old man with fever and neutropenia after
hematopoietic stem cell transplantation, undergoing
computed tomography
Single or multiple nodules or masses are surrounded by
a rim of ground-glass opacity
• pulmonary adenocarcinoma
-asymptomatic smokers.
• angioinvasive aspergillosis -
severe neutropenia, most
commonly in leukemia,
chemotherapy, or stem cell
transplantation
Differential Diagnosis
 Infection ( aspergillosis, candidiasis,
mucormycosis,cytomegalovirus,
herpes simplex
 Neoplasm( pulmonary
adenocarcinoma, metastatic
angiosarcoma, metastatic
mucinous adenocarcinoma, Kaposi
sarcoma, lymphoma)
 Vasculitis ( wegener
granulomatosis)
 Organizing pneumonia (
bronchiolitis obliterans organizing
pneumonia BOOP)

13. bilateral nodules surrounded by a rim of ground-glass attenuation (i.e., CT halo sign)
in angioinvasive aspergillosis and severe neutropenia after hematopoietic stem cell
transplantation
small nodule surrounded by a rim of
ground-glass attenuation (i.e., CT halo
sign) in pulmonary adenocarcinoma

14. A 47-year-old man, hemoptysis thin-walled cystic lesion
Differential diagnosis
 Fungus ball( aspergilloma, rarely candida)
 Active infection ( angioinvasive
aspergillosis,candida,hydatid,paragonimiasis abscess , lung
gangrene)
 Blood clot in cavity, bullae or bronchiectasis
 Neoplasm –pulmonary carcinoma , metastasis

15. previous tuberculosis and right upper lobe intracavitary aspergilloma

16. with leukemia and angioinvasive aspergillosis.

17. A 79-year-old man, cough, low-grade fever cavitary nodule
• cavitary nodule or mass may
have smooth, lobulated, or
spiculated, well-defined or ill-
defined margins
• The inner wall may be smooth,
irregular, or nodular.
Differential diagnosis
 Infection ( TB, fungal, lung
abscess)
 Neoplasm ( pul: Ca, solitary
metastasis)
 Congenital abnl(bronchogenic
cyst , cystic adenomatoid
malformation)
 Inflammatory processes
( Wegener, RA nodule)
 Trauma-pulmonary
laceration(post traumatic
pneumatocele)

18. demonstrates cavity in the
right middle lobe, focal areas of
consolidation in the right middle
and lower lobes and lingula, and
centrilobular nodular opacities
in the right middle lobe and
lingula. pulmonary tuberculosis
thin-walled cavity in the
right upper lobe.
coccidioidomycosis
large cavitating mass with
speculated margins and
nodular inner walls in the
left upper lobe. pulmonary
adenocarcinoma.

19. 79-year-old man, weight loss, malaise, cough multiple lung nodules
• circular opacities of various sizes
may have smooth, lobulated or
spiculated, well-defined or illdefined
margins.
• Surrounding halo of ground-glass
opacity may be seen in patients with
hemorrhagic nodules or nodules
associated with inflammatory
reaction or mucus production
Differential diagnosis
 Pulmonary metastases
 Lymphoma
 Infection ( TB, fungal, septic
embolism)
 Congenital abnl( AVM)
 Inflammatory ( Wegener, RA)
 Trauma-post traumatic
haematomas

20. metastatic adenocarcinoma
leukemia, severe neutropenia,
and angioinvasive aspergillosis.

21. A 36-year-old man who is an intravenous drug user with
fever, undergoing computed tomography
multiple cavitary lung nodules
Multiple cavitated nodules caused by
hematogenous dissemination
of infection (i.e., septic embolism) or
tumor (i.e., metastases) tend to involve
mainly the peripheral regions of the
lower lobes. Cavities in tuberculosis and
nontuberculous mycobacterial
infections tend to involve mainly the
upper lobes and superior segments of
the lower lobes.
Differential diagnosis
 Infection ( TB, fungal, septic
embolism)
 Neoplasm( metastatic SCC)
 Congenital abnl( congenital cystic
adenomatoid malformation)
 Inflammatory ( Wegener, RA)
 Trauma- pulmonary laceration ( post
traumatic pneumatocele)

22. Metastasis SCC
multiple, bilateral, cavitated nodules
focal consolidation in the right middle lobe
and ground-glass opacities in the right lung
multiple, bilateral, peripheral nodules, most
of which are cavitated. The patient had
septic emboli caused by Staphylococcus
aureus.

23. An 82-year-old woman with recurrent hemoptysis, undergoing
radiography and computed tomography
focal convexity with downward bulge
(short arrow) in the medial portion
of the displaced minor fissure and
concave appearance of the lateral
aspect of the minor fissure (long
arrow), resulting in a reverse S
configuration known as the S sign
atelectatic right upper lobe as a soft
tissue density lying against the
mediastinum and outlined laterally
by the minor fissure (long arrows)
that is displaced superiorly and
medially. Anterior and superior
displacement of the major fissure
(curved arrow) and a right hilar mass
(short arrows) associated with the
focal convexity
right upper lobe atelectasis
(long arrows) and a central
tumor (short arrows) a
bronchogenic carcinoma.
right paratracheal lymph
node enlargement.
DDx- consolidation in right upper lobe