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![Panlobular Emphysema
– Most commonly associated with α-1-antitrypsin
deficiency
– Rarely associated with intravenous drug abuse
(e.g., methylphenidate [Ritalin])
– Predominates in basal portions of lungs](https://image.slidesharecdn.com/bilateralhyperlucenthemithorax-180125201217/85/Bilateral-hyperlucent-hemithorax-12-320.jpg)
Uploaded byHisham Khatib
Bilateral hyperlucent hemithorax
The document outlines key differential diagnoses for bilateral hyperlucent hemithorax, emphasizing both pulmonary and extrapulmonary causes, along with technical considerations. It details common conditions like centrilobular and panlobular emphysema, bronchiectasis, and bronchiolitis, while also addressing less common and rare conditions such as constrictive bronchiolitis and pulmonary atresia. Diagnostic imaging characteristics are provided for various conditions to aid in accurate identification.
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Bilateral hyperlucent hemithorax
- 1. Bilateral Hyperlucent Hemithorax Hisham AlKhatib,M.D. Consultant Radiologist
- 2. •اله وعلى هللارسول على والسالم والصالة هلل الحمد اجمعين مّلوس وصحبه •، علما وزدني ينفعني بما وعلمني علمتني بما انفعني اللهم الحكيم العليم انك • Praise be to Allah and prayers be upon the Messenger of Allah and his family and companions. • Oh God, give me the benefit of what you have taught me and teach me what benefits me.
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- 4. Key Differential DiagnosisIssues • Pulmonary causes – Usually related to airways disease – Pulmonary vascular causes much less common • Extrapulmonary causes – Congenital or developmental lack of chest wall soft tissue – Bilateral mastectomy
- 5. Key Differential DiagnosisIssues • Technical – Overexposure • Uncommon with digital radiography – Incorrect window and level settings on CT
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- 7. Common Causes • CentrilobularEmphysema • Panlobular Emphysema • Bronchiectasis • Bronchiolitis
- 8. Helpful Clues forCommon Diagnoses
- 9. Centrilobular Emphysema – Mostcommon type of emphysema – Almost always smoking related – Predominates in upper lobes and superior segments of lower lobes – Radiography: Hyperinflation, attenuation of vessels in affected areas – CT: Centrilobular foci of low attenuation without perceptible walls – Bulla: Emphysematous space > 1 cm
- 12. Panlobular Emphysema – Mostcommonly associated with α-1-antitrypsin deficiency – Rarely associated with intravenous drug abuse (e.g., methylphenidate [Ritalin]) – Predominates in basal portions of lungs
- 13. Panlobular Emphysema – Radiography •Hyperinflation • Attenuation of vessels in affected areas, particularly lower lung zones – CT • Hyperinflation, particularly of lower lobes • Diffusely decreased attenuation of affected lung parenchyma with small vessels
- 16. Bronchiectasis – Hyperinflation andair-trapping from associated small airways disease – Related to chronic or recurrent infection • Rarely result of congenital cartilage abnormality (Williams-Campbell syndrome)
- 17. Bronchiectasis – Radiography • Pulmonaryhyperinflation • Dilated bronchi • “Tram-tracking”: Parallel lines representing nontapering walls of ectatic bronchi seen in profile • Mucoid impaction may be present
- 18. Bronchiectasis – CT • Bronchialabnormalities clearly shown • Diffuse low attenuation and small vessels often present in parenchyma supplied by dilated and inflamed bronchi • Extensive air-trapping may be apparent on expiratory CT
- 21. Bronchiolitis – Usually infectious •Viral • Mycoplasma – Radiography: Hyperinflation, small lung nodules – CT: Centrilobular nodules, tree in bud opacities
- 23. Less Common Causes •Constrictive Bronchiolitis • Asthma • Pulmonary Langerhans Cell Histiocytosis • Lymphangiomyomatosis
- 24. Helpful Clues forLess Common Diagnoses
- 25. Constrictive Bronchiolitis – Submucosaland peribronchial fibrosis resulting in luminal narrowing or occlusion – Numerous causes • Infection: Viral (adenovirus and respiratory syncytial virus), Mycoplasma, Pneumocystis • Connective tissue diseases, especially rheumatoid arthritis and Sjögren syndrome • Drug reaction • Inhalational injury (toxic fumes, smoke) • Transplant: Lung and blood stem cell
- 26. Constrictive Bronchiolitis – Radiography:Normal lung volume to hyperinflation – CT: Heterogeneity of lung with smaller vessels in areas of low attenuation • Expiratory imaging confirms presence of air-trapping
- 28. Asthma – Chronic airwayinflammation with remodeling – Radiography • Most patients have normal or near normal radiographs • Bronchial wall thickening may be evident • Pulmonary hyperinflation in severe cases
- 29. Asthma – CT • Bronchialwall thickening • Bronchial luminal narrowing • Air-trapping (expiratory CT) • Allergic bronchopulmonary aspergillosis should be considered with central bronchiectasis and mucoid impaction
- 31. Pulmonary Langerhans Cell Histiocytosis –Nearly all patients are smokers – Radiography • Hyperinflation • Reticular or reticulonodular abnormality sparing costophrenic sulci
- 32. Pulmonary Langerhans Cell Histiocytosis –CT • Upper lobe predominant cysts: Vary in size and shape • Small nodules ± central lucency progressing to cysts over time • Ground-glass opacity – Spontaneous pneumothorax in < 10%
- 35. Lymphangiomyomatosis – Occurs exclusivelyin women of child-bearing age or patients with tuberous sclerosis – Radiography • Hyperinflation • Diffuse reticular abnormality (from superimposition of cysts) • Pleural effusion (chylous)
- 36. Lymphangiomyomatosis – CT • Diffuselung cysts ranging 2-20 mm with thin, smooth walls • Associated findings: Renal angiomyolipomas, retroperitoneal and mediastinal lymphangiomas, chylous pleural effusion – Patients may present with recurrent or chronic pneumothoraces
- 39. Rare but Important •Pulmonary Atresia
- 40. Helpful Clues forRare Diagnoses
- 41. Pulmonary Atresia – Presentsin neonatal period: Cyanosis – Associated with other congenital cardiac malformations (e.g., tetralogy of Fallot) – Radiography • Cardiomegaly • Concave pulmonary artery segment • Pulmonary oligemia – Diagnosis usually confirmed by echocardiography or cardiac MR
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