Teaching cases of chest pathology, differential diagnosis, interpretation of chest case, CXR and CT , reference textbook of teaching files ( Chest)

1. ALPINE SKI HOUSE
TEACHING FILES
CHEST
Case 11 to 20
Maw Maw Oo

2. ALPINE SKI HOUSE
A 47-year-old woman with progressive shortness of breath, undergoing radiography and computed tomography
 Differential Diagnosis
 Emphysema
 Asthma
 Bronchiolitis in infants
 Bronchiolitis obliterans
 Pulmonary arterial hypertension
 Kyphosis
 Bilateral mastectomy
 Overexposed chest radiograph
Hyperlucency of both
lungs, which is most
noticeable in the peripheral
lung regions and lower lung
zones, and hyperinflation
with flattening of the
diaphragm. The patient
was a 47-year-old woman
with panacinar emphysema
due to α1-antitrypsin
deficiency

3. ALPINE SKI HOUSE
In the same patient, coronal, reformatted, high-resolution
CT shows extensive areas of decreased attenuation mainly in
the lower lobes, which is consistent with panacinar
emphysema.
Several bullae and upper lobe centrilobular emphysema can
be seen.

4. ALPINE SKI HOUSE
Posteroanterior chest radiograph shows hyperlucency of
both lungs, a marked decrease in the peripheral vascular
markings, and increased lung volumes. The patient was a 44-
year-old man with severe bronchiolitis obliterans after
bilateral lung transplantation.

5. ALPINE SKI HOUSE
Coronal, reformatted, high-resolution CT
shows extensive areas of decreased
attenuation and vascularity and areas of
slightly increased attenuation and vascularity,
resulting in a mosaic pattern of attenuation
and perfusion. Extensive bronchiectasis
can be seen. The patient was a 20-year-old
woman with severe bronchiolitis obliterans
after bilateral lung transplantation

6. ALPINE SKI HOUSE
A 76-year-old man with progressive shortness of breath, undergoing chest radiography and computed tomography
• Differential Diagnosis
• Pulmonary edema
• Interstitial pulmonary fibrosis: Idiopathic
pulmonary fibrosis (IPF), nonspecific
interstitial pneumonia (NSIP), asbestosis-
related, hypersensitivity pneumonitis
(chronic), sarcoidosis
• Pulmonary Langerhans histiocytosis
• Lymphangioleiomyomatosis
Posteroanterior chest
radiograph shows
extensive bilateral
reticular pattern, which
is worse in the lower
lung zones,
and reduced lung
volumes in a 76-year-old
man with idiopathic
pulmonary fibrosis

7. ALPINE SKI HOUSE
In the same patient, coronal reformation, high-resolution CT image shows bilateral,
irregular, linear opacities and honeycombing involving mainly the subpleural lung regions
of the lower lobes, resulting in a reticular pattern on the chest radiograph

8. ALPINE SKI HOUSE
Posteroanterior chest radiograph shows a diffuse, fine
reticular pattern and normal lung volumes in a 45-year-old
woman with long-standing lymphangioleiomyomatosis
In the same patient, coronal reformation, high-
resolution CT image shows bilateral, numerous, thin-
walled cysts consistent with long-standing
lymphangioleiomyomatosis

9. ALPINE SKI HOUSE
A 73-year-old woman with shortness of breath, undergoing computed tomography
 Differential Diagnosis
 Idiopathic pulmonary fibrosis
 nonspecific interstitial
pneumonia (NSIP)
 interstitial fibrosis associated
with connective tissue disease
 Asbestosis
 Chronic hypersensitivity
pneumonitis
 Sarcoidosis
 Drug reaction
In a 73-year-old woman with
idiopathic pulmonary
fibrosis, high-resolution CT at
the level of bronchus
intermedius shows a reticular
pattern caused by intralobular
linear opacities Involving mainly
the peripheral lung regions.
Notice the associated
architectural distortion.

10. ALPINE SKI HOUSE
In a 73-year-old woman with idiopathic pulmonary
fibrosis, high-resolution CT at the level of lung bases
shows reticular pattern caused by intralobular linear
opacities involving mainly the peripheral lung regions.
Notice the associated architectural distortion

11. ALPINE SKI HOUSE
Coronal reformation image shows that the reticular pattern
Involves mainly the peripheral lung regions and lower lung
zones in a 73-year-old woman with idiopathic pulmonary
fibrosis.
Reticular pattern on high-resolution computed tomography

12. ALPINE SKI HOUSE
A 39-year-old woman with shortness of breath, undergoing computed tomography
High-resolution CT
image shows bilateral,
thin-walled
cysts surrounded by
normal lung
parenchyma in a 39-
year-old woman with
lymphangioleiomyomat
osis
 Differential Diagnosis
 Lymphangioleiomyomatosis
 Pulmonary Langerhans cell histiocytosis
 Birt-Hogg-Dubé syndrome
 Honeycombing in end-stage fibrosis
 Lymphoid interstitial pneumonia (LIP)
 Hypersensitivity pneumonitis
 Pneumocystis jiroveci pneumonia

13. ALPINE SKI HOUSE
High-resolution CT image shows bilateral, peripheral
honeycombing and associated reticulation in a 67-year-old
man with idiopathic pulmonary fibrosis
Cystic pattern on high-resolution
computed tomography

14. ALPINE SKI HOUSE
A 46-year-old woman who is human immunodeficiency virus (HIV) positive and has fever and shortness of breath,
undergoing computed tomography
High-resolution CT image
shows extensive, bilateral
ground-glass opacities in a 46-
year-old, HIV-positive woman
with Pneumocystis jiroveci
pneumonia
 Differential Diagnosis
 Pneumocystis jiroveci pneumonia
 Cytomegalovirus pneumonia
 Acute respiratory distress
syndrome (ARDS)
 Acute interstitial pneumonia (AIP)
 Focal or diffuse pulmonary
hemorrhage
 Aspiration

15. ALPINE SKI HOUSE
Coronal re-formation image shows extensive,
bilateral ground-glass opacities involving mainly
the upper and middle lung regions in a 38-year-
old man with diffuse pulmonary hemorrhage
resulting from angiosarcoma

16. ALPINE SKI HOUSE
High-resolution CT image shows bilateral, central
ground-glass opacities in a 34-year-old man with
pulmonary hemorrhage resulting from Goodpasture
syndrome

17. ALPINE SKI HOUSE
Coronal reformation image shows extensive,
bilateral ground-glass opacities in a 46-year-old,
HIV-positive woman with Pneumocystis jiroveci
pneumonia

18. ALPINE SKI HOUSE
A 65-year-old, immunocompetent woman with progressive dyspnea and dry cough, undergoing computed
tomography
High-resolution CT
image shows
extensive, bilateral
ground-glass opacities
and lobular areas of
decreased attenuation
and vascularity in a 65-
year-old woman who
was a bird breeder
with subacute
hypersensitivity
pneumonitis
 Differential Diagnosis
 Hypersensitivity pneumonitis (HP)
 Nonspecific interstitial pneumonia
(NSIP)
 Connective tissue disease
 Drug reaction
 Respiratory bronchiolitis–interstitial
lung disease(RBILD)
 Desquamative interstitial
pneumonia (DIP)
 Lymphoid interstitial pneumonia
(LIP)
 Alveolar proteinosis
 Bronchioloalveolar cell carcinoma
Ground-glass pattern in chronic lung disease

19. ALPINE SKI HOUSE
Coronal reformation image shows extensive, bilateral
ground-glass opacities and lobular areas of decreased
attenuation and vascularity in a 65-year-old woman who was
a bird breeder with subacute hypersensitivity pneumonitis

20. ALPINE SKI HOUSE
High-resolution CT image shows diffuse, bilateral
ground-glass opacities and mild superimposed reticulation in
a 60-year-old woman with nonspecific interstitial pneumonia.
The bronchi within the areas of ground-glass opacities are
dilated and distorted bronchi (i.e., traction bronchiectasis;
arrows).

21. ALPINE SKI HOUSE
Coronal reformation image shows diffuse, bilateral
ground-glass opacities involving mainly the lower lung
zones in a 60-year-old woman with nonspecific
interstitial pneumonia. Findings of fibrosis include
reticulation, traction bronchiectasis, and subpleural
honeycombing

22. ALPINE SKI HOUSE
A 55-year-old man with slowly progressive shortness of breath, undergoing computed tomography
High-resolution CT image
shows bilateral ground-
glass opacities with
superimposed smooth
septal lines and
intralobular lines,
resulting in a crazy paving
pattern. The patient was a
55-year-old man with
alveolar proteinosis
 Differential Diagnosis
 Alveolar proteinosis
 Pneumocystis pneumonia
 Bacterial pneumonia
 Acute respiratory distress
syndrome (ARDS)
 Acute interstitial pneumonia
(AIP)
 Acute eosinophilic
pneumonia
 Pulmonary hemorrhage
 Pulmonary edema
 Nonspecific interstitial
pneumonia (NSIP)
 Lipoid pneumonia
 Bronchioloalveolar cell
carcinoma
 Radiation pneumonitis

23. ALPINE SKI HOUSE
High-resolution CT image shows the crazy paving pattern
in the right upper lobe, characterized by thickened
interlobular septa and intralobular lines superimposed on a
background of ground-glass opacity. Notice presence of
blood in the right main bronchus (arrow). The patient was a
51-year-old man with pulmonary hemorrhage who presented
with hemoptysis

24. ALPINE SKI HOUSE
A 75-year-old woman with progressive shortness of breath, undergoing computed tomography
Coronal reformation CT image
shows areas of decreased
attenuation and vascularity
and areas of increased
attenuation and vascularity
(mosaic attenuation/perfusion
pattern) in 75-year-old woman
with chronic thromboembolic
pulmonary hypertension
 Differential Diagnosis
 Bronchiolitis obliterans
 Asthma
 Chronic thromboembolic
pulmonary hypertension
 Primary hypertension
 Hypersensitivity pneumonitis
 Respiratory bronchiolitis–
interstitial lung disease
(RBILD)
 Pneumocystis pneumonia
(AIDS)

25. ALPINE SKI HOUSE
High-resolution CT image shows
bilateral ground-glass opacities
in a geographic distribution and
areas of normal intervening
lung resulting in a mosaic
attenuation pattern. The
patient was a 50-year-old
woman with Pneumocystis
pneumonia

26. ALPINE SKI HOUSE
Mosaic attenuation (perfusion) pattern occurred
after bilateral lung transplantation in a 20-year-old
woman with obliterative bronchiolitis. High-
resolution CT image shows areas of decreased
attenuation and vascularity and areas of normal or
increased attenuation and vascularity. Notice
bronchiectasis within the areas of decreased
attenuation.

27. ALPINE SKI HOUSE
A 55-year-old woman with progressive shortness of breath 1 year after stem cell transplantation
Expiratory CT image shows extensive air
trapping in a
55-year-old woman with bronchiolitis obliterans
after stem cell transplantation for multiple
myeloma
Inspiratory CT image in a 55-year-old woman with
bronchiolitis obliterans after stem cell transplantation for
multiple myeloma shows no definite abnormality

28. ALPINE SKI HOUSE
Inspiratory CT image of air trapping in a 54-year-old
woman with severe asthma shows a mosaic
attenuation pattern

29. ALPINE SKI HOUSE
Expiratory, high-resolution CT of a 41-year-old man
shows air trapping (arrows) in a few pulmonary lobules in
the lower lobes. The patient was an asymptomatic, lifelong
nonsmoker.
Some air trapping is common in normal individuals

30. ALPINE SKI HOUSE
A 24-year-old woman, progressive exertional dyspnea
Posteroanterior chest
radiograph shows numerous
nodules measuring between 1
and 5 mm in diameter
throughout both lungs, most
profuse in the lower lobes. The
patient was a 24-yearold
woman with metastatic thyroid
carcinoma
 Differential Diagnosis
 Infection: tuberculosis,
fungi, viral pneumonia
 Neoplasms: metastases,
bronchioloalveolar
carcinoma
 Inhalational diseases:
silicosis, coalworker’s
pneumoconiosis
 Miscellaneous conditions:
sarcoidosis, talcosis in
intravenous drug users

31. ALPINE SKI HOUSE
Chest radiograph shows numerous nodules, 1 to 2 mm
in diameter, throughout both lungs (miliary pattern).
The patient was a 50-year-old man with miliary tuberculosis

32. ALPINE SKI HOUSE
Posteroanterior chest radiograph shows numerous nodules
involving mainly the middle and upper lung zones. Also
Noted is increased opacity in the right paratracheal region
consistent with lymphadenopathy. The patient was a 45-year-
old woman with sarcoidosis

33. ALPINE SKI HOUSE
Chest radiograph shows small nodular opacities in the
upper lobes. The patient was a 48-year-old man with silicosis

34. ALPINE SKI HOUSE
Wish you all to be healthy in COVID crisis