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Hrct in diagnosis of diffuse lung diseases

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the lecture explains the different patterns of HRCT and how they can diagnose different interstitial lung diseases.

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Hrct in diagnosis of diffuse lung diseases

  1. 1. HRCT in diagnosis ofdiffuse Lung Diseases Dr/Ahmed Bahnassy Assistant Professor of Radiology Qassim University
  2. 2. Technique and anatomy Very thin 1mm slices for chest with 10-20 mm intervals aiming at visualizing the lung interstitium.
  3. 3. Road map to diagnosis1. Recognize the abnormality pattern.2. Locate it in relation to the lung and to the SPL3. Evaluate its effects on lung parenchyma
  4. 4. HRCT patterns Reticular pattern Nodular pattern. Increased lung opacity. Decreased lung opacity and cystic changes
  5. 5. I-Reticular opacities Interlobular septal thickening: Causes :1. Lymphangitic spread of tumour (asymmetrical or symmetrical)2. Pulmonary edema.3. Amyloidosis
  6. 6. Honeycombing – Causes:1. IPF2. Collagen vascular diseases (Rh.A. - scleroderma)3. Drug related fibrosis4. End stage Hypersensitivity pneumonitis5. End Stage Sarcoidosis6. Radiation.7. End stage ARDS
  7. 7. Traction Bronchiectasis Causes :  Corkscrewed bronchi1. Non specific in IPF intersitial pneumonia.2. UIP3. Sarcoidosis.4. Hypersensitivity pneumonitis.5. Radiation.6. End stage ARDS
  8. 8. I :Lymphangitic spread of tumour
  9. 9. II-Scleroderma
  10. 10. III-IPF Posterior lung cysts  Prone scan
  11. 11. IV-Rheumatoid arthritis-Dilated bronchi=fibrosis
  12. 12. II-Nodules Perilymphatic. Centrilobular. Random
  13. 13. A-Perilymphatic nodules Causes :1. Sarcoidosis.2. Silicosis.3. Lymphangitic spread of tumour.4. Amyloidosis.5. Lymphocytic interstitial pneumonitis
  14. 14. I -Sarcoidosis
  15. 15. II-Lymphangitis carcinomatosis
  16. 16. B-Random nodulescauses :1. Miliary infection2. Haematogenous metastasis.3. Sarcoidosis
  17. 17. I-Miliary TB
  18. 18. II-Miliary mets
  19. 19. C-Centrilobular nodules causes :1. Endobronchial spread of infection (Bacteria, virus, TB, mycobacterium, fungus)2. Endobronchial spread of tumor (BAC)3. Hypersensitivity pneumonitis.4. BOOP5. Silicosis and coal miner pneumoconiosis
  20. 20. Centrilobular nodulesI-Bronchopneumonia
  21. 21. II-Hypersensitivity pneumonitis
  22. 22. Tree – in – bud appearance Causes :1. Endobronchial spread of infection(bacteria,TB ,fungi)2. Airway disease with infection(CF ,bronchiectasis)3. Mucous plugging(asthma ,ABPA)4. BAC .
  23. 23. I-Cystic fibrosis
  24. 24. II-Air way infection
  25. 25. III-Pseudomonasbronchopneumonia
  26. 26. III-Increased lung opacity Consolidation. Ground Glass opacification
  27. 27. Consolidation causes. Acute Symptoms:  Chronic Symptoms : – Pneumonia – Chronic eosinophilic – Pulmonary edema,He. pneumonia – ARDS – BOOP – Interstitial pneumonia – Lipoid pneumonia. – BAC
  28. 28. Consolidation-I-Chronic eosinophilic pneumonia:multifocal,patchy subpleural areas of consolidation
  29. 29. II-BOOP:patchy GG opacity inperibronchial distribution. (Here posttransplant graft versus host disease)
  30. 30. Ground Glass Opacity causes Acute Symptoms :  Chronic Symptoms : – Pulmonary edema, – NSIP He. – UIP – Pneumonia. – DIP – DAD – Hypersensitivity – AIP pneumonitis. – Acute Hypersensitivity – Alveolar proteinosis. pneumonitis. – Sarcoidosis. – Lipoid pneumonia. – BAC
  31. 31. I-Pulmonary edema
  32. 32. II-CMV infection:GG opacities with centrilobular nodules
  33. 33. III-Pneumocystis carinii infection
  34. 34. IV-Hypersensitivity pneumonitis
  35. 35. Crazy-paving pattern Combination of GG opacity with interlobular septal thickening. Non specific. Causes : PCP , viral pneumonia ,edema , hemorrhage ,ARDS . If chronic lung disease it is often :alveolar proteinosis
  36. 36. Alveolar Proteinosis Fine reticular pattern + GG opacity
  37. 37. IV-Decreased lung opacity and cystic lesions .1. Emphysema (centrilobular ,panlobular ,paraseptal )2. Mosaic perfusion.3. Air trapping .4. Lung cysts .
  38. 38. I-Centrilobular Emphysema
  39. 39. II-Panlobular Emphysema
  40. 40. III-Paraseptal Emphysema
  41. 41. Lung cysts –causes  Uncommon: Common  Lymphangioleio causes : myomatosis. – Bullae – Honeycombing.  LCH – Pneumatocekes.  TS – Cystic  Sjogren bronchiectasis. syndrome. – Cysts in  LIP hypersensitivty pneumonitis  Papillomatosis
  42. 42. I-Lymphangiomyomatosis
  43. 43. II-LCH
  44. 44. Mosaic appearance causes : Airway Disease: – Large air way (CF ,Bronchiectasis) – Small air way (BOOP ,small air way infection ,mucous plugging) Vascular diseases : – Chronic PE – vasculitis
  45. 45. Common Interstitial lung diseases
  46. 46. UIP/IPF
  47. 47. Reticular opacities, traction bronchiectasis + HC
  48. 48. NSIP=GG opacities +reticulations
  49. 49. COP- Peribronchial consolidations- GG opacity
  50. 50. COP=Irregular nodular opacities
  51. 51. DIP
  52. 52. LIP
  53. 53. Golden rules for HRCT interpretation. Honeycombing with a basal and subpleural redominance is highly suggestive of UIP.Lung biopsy is rarely performed when HRCT shows these findings. Concentric lower lobe GG opaity without honeycombing suggests NSIP.In a patient with collagen vascular disease ,biopsy is uncommoly performed. Patchy or noular subpleural or peribronchial consolidation is typical of COP. Cystic air spaces or GG opacity may represent LIP.LIP is usually associated with other diseases. Diffuse or centrilobular GG opacity in a smoker is typical of DIP or RB-ILD
  54. 54. References 1 - HOGG JH. Chronic interstitial lung disease of unknown cause: a new classification based on pathogenesis. A J R 1991; 156: 225-233. 2 - BERGIN C, ROGGLI V, COBLENTZ C, CHILES C. The secondary pulmonary lobule: normal and abnormal CT appearances. AJR 1988; 151:21-25. 3 - WEBB WR, STEIN MG, FINKBEINER WE,JUNG GI I et coll. Normal and diseased isolated lungs: high-resolution CT. Radiology 1988; 166: 81-87. 4 - MURATA K, ITOH H, TODO G, KANAOKA M, NOMA S et coll. Centrilobular lesions of the lungs: demonstration by high-resolution CT and pathologic correlation. Radiology 1986; 161: 641- 645. 5 - REMY-JARDIN M, REMY J, GIRAUD F, WATTINNE L, GOSSELIN B. Computed tomography assessment of ground glass opacity : Semiology and significance. J Thorac Imaging 1993; 8 : 249-264. 6 - BRAUNER MW, GRENIER Ph, MOMPOINT D, LENOIR S, De CREMOUX H. Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology 1989; 172: 467-471. 7 - MULLER NL, MILLER RR, WEBB WR, EWANS KG, OSTROW DN. Fibrosing alveolitis: Pathologic-CT correlation. Radiology 1986; 160: 585-588. 8 - WESTCOTT JL, COLE SR. Traction bronchiectasis in end-stage pulmonary fibrosis. Radiology 1986; 161: 665-669. 9 - MUNK PL, MULLER NL, MILLER RR, OSTROW DN. Pulmonary lymphangitic carcinomatosis: CT and pathologic findings. Radiology 1988; 166: 705-709. 10 - HANSELL DM, MOSKOVIC. High resolution computed tomography in extrinsic allergic alveolitis. Clin Radiol 1991; 43: 8-12. 11 - MULLER NL, MILLER RR. State-of-the art: Computed tomography of chronic diffuse infiltrative lung diseaseI Am Rev Respir Dis 1990; 142: 1206-1215.

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