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Cystic lung diseases
This document discusses various cystic lung lesions and patterns of lung disease visible on CT scans. It describes findings such as honeycombing seen in usual interstitial pneumonia, thin-walled cysts in lymphangioleiomyomatosis, and small nodules and cysts in Langerhans cell histiocytosis. Differential diagnoses are discussed for different cystic and reticular radiographic lung patterns. HRCT features of various interstitial lung diseases and emphysema types are also outlined.
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Cystic lung diseases
- 2. Cystic Lung Lesions By GamalRabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University
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- 4. Lung Cysts Pulmonary fibrosis(Honeycombing) Lymphangiomyomatosis Langerhanscell histiocytosis Lymphocytic Interstitial Pneumonia (LIP) Differential Diagnosis
- 5. Rough Reticular FineReticular Traction Bronchiectasis and Interface sign Honey combing UIP UIP or NSIP
- 6. Usual Interstitial PneumoniaUIP HRCT Findings Reticular opacities, thickened intra- and interlobular septa Irregular interfaces Honey combing and parenchymal distorsion Ground glass opacities (never prominent) Basal and subpleural predominance
- 7. Basal and subpleuraldistribution UIP
- 8. The Many ‘HRCTFaces’ of NSIP Honeycombing not a prominent feature !!!!
- 9. Lymphangioleiomyomatosis (LAM) HRCT Morphology Thin-walledcysts (2mm - 5cm) Uniform in size / rarely confluent Homogeneous distribution Chylous pleural effusion Lymphadenopathy in young women
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- 15. Langerhans Cell Histiocytosis HRCTFindings Small peribronchiolar nodules (1-5mm) Thin-walled cysts (< 1cm), Bizarre and confluent Ground glass opacities Late signs: irreversible / parenchymal fibrosis Honey comb lung, septal thickening, bronchiectasis
- 16. 1 year later PeribronchiolarNodules Cavitating nodules and cysts Langerhans Cell Histiocytosis
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- 18. Langerhans Cell Histiozytosis KeyFeatures Upper lobe predominance Combination of cysts and noduli Characteristic stages Increased Lung volume Sparing of costophrenic angle S M O K I N G
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- 20. Langerhans Cell Histiocytosis DifferentialDiagnosis Only small nodules Sarkoidosis, Silikosis Only cysts idiopathic Fibrosis LAM Destruktive emphysema
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- 22. .......after cessation ofsmoking
- 23. Benign lymphoproliferative disorder Diffuseinterstitial infiltration of mononuclear cells Not limited to the air ways as in follicular Bronchiolitis LIP = Lymphocytic Interstitial Pneumonia
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- 25. LIP = Lymphocytic InterstitialPneumonia Rarely idiopathic In association with: Sjögren‟s syndrome Immune deficiency syndromes, AIDS Primary biliary cirrhosis Multicentric Castlemean‟s disease
- 26. Sjoegren disease Dry eyeand dry mouth Fibrosis, bronchitis and bronchiolitis LIP Overlap Sarcoid, DM/PM, MXCT SLE, RA (pleural effusion) Up to 40 x increased risk for lymphoma (mediastinal adenopathy) and 2 x times increased risk for neoplasma
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- 28. Young woman Drymouth Smoker LAM LIP Histiocytosis
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- 32. Emphysema histopathological definition …..permanent abnormalenlargement of airspaces distal to the bronchioles terminales and …...destruction of the walls of the involved airspaces
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- 35. CLE and PLEin one Patient
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- 37. What is YourDiagnosis ? Cystic Changes and Decreased Density Quiz
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- 42. Emphysema Emphysema typically presentsas areas of low attenuation without visible walls as a result of parenchymal destruction.
- 43. EMPHYSEMA Permanent, abnormal enlargementof air spaces distal to the terminal bronchiole and accompanied by the destruction of the walls of the involved air spaces. 43
- 44. Centrilobular emphysema Most commontype Irreversible destruction of alveolar walls in the centrilobular portion of the lobule Upper lobe predominance and uneven distribution Strongly associated with smoking.
- 45. Centrilobular (proximal or centriacinar)emphysema Found most commonly in the upper lobes 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. 45
- 46. Centrilobular emphysema dueto smoking. The periphery of the lung is spared (blue arrows). Centrilobular artery (yellow arrows) is seen in the center of the hypodense area.
- 47. Panlobular emphysema Affects thewhole secondary lobule Lower lobe predominance In alpha-1-antitrypsin deficiency, but also seen in smokers with advanced emphysema
- 48. PANLOBULAR EMPHYSEMA Affects theentire secondary pulmonary lobule and is more pronounced in the lower zones Complete destruction of the entire pulmonary lobule. Results in an overall decrease in lung attenuation and a reduction in size of pulmonary vessels 48
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- 51. Paraseptal (distal acinar) emphysema Affectsthe peripheral parts of the secondary pulmonary lobule Produces subpleural lucencies. 51
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- 53. Cystic lung disease Lungcysts are defined as radiolucent areas with a wall thickness of less than 4mm.
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- 55. Lymphangiomyomatosis complicated bypneumothorax
- 56. Bronchiectasis Bronchiectasis is definedas 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 associated atelectasis and sometimes air trapping
- 57. ABPA: glove-finger shadowdue to mucoid impaction in central bronchiectasis in a patient with asthma.
- 58. Signet-Ring Sign A signet-ringsign represents an axial cut of a dilated bronchus (ring) with its accompanying small artery (signet).
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- 61. Bronchial dilation withlack of tapering .
- 62. HONEYCOMBING 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. 62
- 63. Honeycombing Honeycombing is definedby the presence of small cystic spaces with irregularly thickened walls composed of fibrous tissue.
- 64. 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 stageARDS 64
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- 66. Honeycombing and tractionbronchiectasis in UIP.
- 67. Typical UIP withhoneycombing and traction bronchiectasis in a patient with idiopathic pulmonary fibrosis (IPF)
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