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Non infectious lung diseases
- 2. Kaposi sarcoma Lymphocytic interstitial Pneumonitis Lymphoma
- 3. Most common AIDS-associated malignancy Herpes virus Mostly in homosexual or bisexual men and their partners Western countries and Africa
- 5. Parenchymal nodular or reticular opacities with predilection towards perihilar mid to lower zones Pleural effusion Mediastinal and/or hilar lymphadenopathy
- 6. ill-defined parenchymal nodules Surrounded by a small area of ground-glass density. Bilateral perihilar pulmonary infiltrates Interlobular septal thickening Lymphadenopathy (50%)
- 7. Multiple poorly defined radio opaque pulmonary lesion in patient with bronchial and cutaneous Kaposi's sarcoma.
- 8. Chest X-rays of three patients with pulmonary KS showing bilateral paracardiac infiltration. Confluent lesions are most evident in C.
- 9. HRCT scans of patient with pulmonary KS showing peribronchovascular thickening and irregular narrowing of the bronchial lumen.
- 13. Seen most frequently in the non-AIDS Association with Sjogren’s syndrome and Systemic lupus erythematosus (SLE) When occurring in the AIDS population it is most frequent in children
- 15. Most commonly a mid and lower zone reticular or reticulonodular infiltrate. Neither pleural nor lymph node enlargement is associated with LIP. Radiographically indistinguishable from opportunistic infection, slow progression of radiological change is suggestive of the diagnosis
- 16. features can be non specific ◦ Mid & lower-zone predominant, reticular or reticulonodular infiltrate ◦ chronic bilateral airspace opacification
- 17. Features generally tend to be diffuse with mid lower lobe predominance Thickening of bronchovascular bundles Intersitital thickening along lymph channels Small but variably sized pulmonary nodules (can be centrilobular or subpleural, and often ill defined) Ground-glass Scattered thin walled cysts
- 23. Lymphoma occurs with increased frequency in AIDS patients. Mediastinal nodal enlargement Pleural or pericardial effusions Pulmonary infiltrate or single, multiple pulmonary masses
- 26. Non-Hodgkin's Lymphoma (NHL) accounts for 90% Well-defined solitary or multiple parenchymal nodules are common. Demonstrate a very short doubling time of between 4 and 6 weeks mimicking infection. Unlike KS, they are often peripheral
- 30. commonest Iymphoma neoplasm of young adults The disease usually arises in lymph nodes, hilar or mediastinal lymph node enlargement is seen on the chest X-ray lymphadenopathy is frequently bilateral it is often asymmetrical and involves anterior mediastinum. Retrosternal nodes may erode the sternum.
- 33. Involvement of lung parenchyma is seen in about 30% Spread of disease from hilar lymph nodes The resulting pulmonary infiltrate may resemble lymphangitis carcinomatosa. The pulmonary infiltrate may also appear as solitary areas of consolidation. May appear as larger confluent areas or miliary nodules. The pulmonary opacities may have an air bronchogram Involvement of the bronchial wall Pleural effusion
- 34. Malignant proliferation of a specific lymphoreticular cell Grading systems Majority arises within lymph glands (or the thymus)
- 35. Radiographic manifestations of non-Hodgkin and Hodgkin's lymphomas are similar.
- 37. No convincing evidence showing a significant rise. It occurs in smokers Male preponderance and patients often present at a younger age and at a later stage. Tumors are frequently poorly differentiated or predominantly adenocarcinomas. Radiographic appearances are similar to ordinary lung cancer, except that lesions tend to be more peripheral, with over 90% in the upper lobes.
- 40. Pulmonary lymphoma. CT shows an irregular soft-tissue mass with an air bronchogram.
- 41. Histiocytic lymphoma. Chest X-ray shows mediastinal adenopathy, multiple ill-defined pulmonary nodules and a right pleural effusion.
- 42. Lymphocytic lymphoma. Chest X-ray shows a large left pleural effusion, a small right pleural effusion and right paratracheal adenopathy.
- 44. Pulmonary parenchymal lymphoma (A) Chest radiograph reveals multiple poorly defined pulmonary nodules without lymphadenopathy. (B) CT image through the lower lobes shows an air bronchogram in the largest mass (arrow).
- 46. LIP:Chest X-ray showing bilateral reticulonodular interstitial infiltrates.
- 47. Lymphocytic interstitial pneumonia -Chest radiograph shows diffuse, fine nodular changes, seen in the lower lobes.
- 49. HRCT of a patient with pulmonary KS at the level of the main bronchi shows ground-glass attenuation areas in the posterior regions of both lungs, which correspond to pulmonary hemorrhage. Peribronchovascular thickening is observed in the right lung, as well as bilateral pleural effusion.
Editor's Notes
- The incidence now appears to be falling due to the widespread use of antiherpes virus drugs and combination antiretroviral therapy
- Pulmonary KS occurs in patients with known cutaneous KS Pulmonary KS is rare in the absence of cutaneous visceral involvement. mesenchymal tumour that involves the lymphovascular system Kaposi's sarcoma is a multicentric disease that frequently involves the skin, lymph nodes, gastrointestinal tract, and lungs. Pulmonary KS in the absence of mucocutaneous involvement is uncommon. The CD4 cell count in patients with pulmonary KS is usually <100 cells/mm3
- Pulmonary KS can affect the lung parenchyma, pleura or trachea, bronchial tree. When there is pulmonary involvement, disease is usually evident bronchoscopically as distinctive raised erythematous plaques within the airways. If these plaques become sufficiently enlarged they may occlude segmental bronchi resulting in atelectasis.
- has two major patterns linear interstitial nodules fluffy ill-defined nodules
- symmetrical perilymphatic Peribronchovascular distribution (1-2 mm). lymphadenopathy is typically of high attenuation The most frequent chest CT findings are thickening of the peribronchovascular interstitium, particularly in the axial portions; irregular and poorly defined nodules; and interlobular septal thickening. The presence of these findings in patients with AIDS is highly suggestive of KS
- A and B.
- Pulmonary KS in a 45-year-old man. (a) Chest radiograph shows multiple bilateral ill-defined nodules (arrowheads indicate nodules on the right side). Two indistinct masses (arrows) are identified in the left hemithorax. (b) High-resolution lung CT scan demonstrates two irregular flame-shaped nodules (white arrows) in the right apex and an ill-defined mass (black arrows) in the left apex. The diagnosis was confirmed with fine-needle aspiration biopsy of the left upper lobe mass.
- Thoracic AIDS-related KS in a 45-year-old man. (a) Chest radiograph demonstrates multiple bilateral 3–5-mm micronodules in a peribronchovascular distribution. (b) High-resolution lung CT scan shows innumerable bilateral, poorly defined peribronchovascular micronodules, some of which exhibit coalescence. (c) CT scan (soft-tissue windowing) depicts enlarged lymph nodes in the axillae and mediastinum (thin arrows). Note also the bilateral pleural fluid collections as well as some nodularity (thick arrows). Skin compromise is also identified in the left hemithorax (arrowhead). Histopathologic findings were consistent with KS.
- Disseminated AIDS-related KS in a 36-year-old man with thoracic involvement. (a)Chest radiograph shows ill-defined nodular confluent opacities in the left upper lobe. (b) Chest CT scan demonstrates multiple nodules around the bronchus for the apicoposterior segment of the left upper lobe (black arrow). Other small nodules are also identified in the posterior segment of the right upper lobe (white arrows).
- (B, C). CT scans of two different patients demonstrating multiple poorly defined pulmonary nodules with a mid and lower zone and peribronchovascular predominance.
- benign lymphoproliferative disorder characterised by lymphocyte predominant infiltration of the lungs although adult cases are regularly encountered. subtype of interstitial lung disease
- Although it is Bronchiectasis may occasionally occur.
- but may include
- The following features may be seen with LIP on HRCT, but the findings are not exclusive to its diagnosis. Cysts are usually deep within the lung parenchyma- perivascular or sub pleural- typically a cyst abuts a vessel; size range from 1-30 mm (useful for differentiation between lymphoma or the lung ) Mediastinal lymphadenopathy
- Lymphocytic interstitial pneumonia in a 76-year-old woman with Sjögren syndrome. Thin-section (1.5-mm-collimation) CT scan demonstrates several thin-walled cystic airspaces (straight arrows) in the right middle and lower lobes. Thickened bronchovascular bundles (curved arrows). Thin-section (1-mm-collimation) CT scan through the left upper lobe demonstrates numerous thickened interlobular septa (arrows)
- Lymphocytic interstitial pneumonitis. (A) Chest X-ray demonstrating bilateral mid and lower zone 2-5-mm nodules. (B) Three years later there is an extensive mid and lower zone pulmonary infiltrate. HRCT scan demonstrating the bronchovascular distribution of confluent infiltrate with more peripheral discrete nodules. Transbronchial biopsy confirmed the diagnosis of lymphocytic interstitial pneumonitis.
- 58-year-old woman with Sojgren syndrome, persistent dyspnea, and biopsy-proven lymphoid interstitial pneumonia. Unenhanced axial CT image through mid lungs reveals centrilobular ground-glass nodules, finding that develops as consequence of peribronchiolar interstitial inflammation.
- 71-year-old woman with Sojgren syndrome, chest pain, cough, dyspnea, and biopsy-proven lymphoid interstitial pneumonia (LIP). Contrast-enhanced axial CT image shows both perivascular cysts and lower lobe ground-glass opacities, combination of findings that strongly supports diagnosis of LIP.
- 73-year-old woman with Sojgren syndrome symptoms, including dyspnea and arthralgias, and biopsy-proven lymphoid interstitial pneumonia (LIP). Contrast-enhanced coronal reformatted image through lungs shows numerous thin-walled cysts mostly located adjacent to blood vessels. These perivascular cysts are identified in most patients with LIP.
- Lymphoma, rarely confined to the thorax, is well described in AIDS patients. probably as a consequence of B-lymphocyte proliferation due to long-term stimulation by the HIV virus, and Epstein-Barr virus infection There may be atypical mediastinal nodal enlargement
- possibly due to the longer life expectancy coupled with the longer latency period required for the development of neoplasms. and the majority of cases are associated with Epstein-Barr virus. NHL is typically extranodal and usually disseminated at the time of diagnosis. Thoracic involvement is reported in up to 40%, although subclinical involvement is probably higher. cavitation is unusual
- Lymphoma. Chest X-ray (CXR) on a human immunodeficiency virus patient that presented with multiple lung masses, which grew rapidly mimicking infection. Note that there is no associated lymphadenopathy. Well-defined solitary or multiple parenchymal nodules CXR are common. A percutaneous biopsy revealed a non-Hodgkin's lymphoma
- AIDS-related lymphoma. There is a well-defined mass in the left mid zone. Percutaneous needle biopsy was undertaken to confirm the diagnosis.
- AIDS-related lymphoma causing extensive consolidation in the right upper lobe. Infiltration of the left lower lobe in association with a pleural effusion is also evident.
- with a peak incidence at 25-29 years of age, and a second, smaller peak at 70-74 years. It is distinguished from other lymphomas by the presence of Reed-Sternberg cells CT may identify nodal disease not apparent on the chest X-ray. particularly in the retrosternal and paraspinal regions. Following treatment by radiotherapy or chemotherapy, lymph node calcification may occur. CT may identify nodal disease not apparent on the chest X-ray. particularly in the retro-sternal and paraspinal regions.
- Hodgkin's disease. Chest X-ray (A) shows right hilar lymphadenopathy and the lateral film (B) shows a large anterior mediastinal lymph node mass.
- Hodgkin's disease. CT shows extensive calcification in mediastinal lymph nodes in a patient previously treated for Hodgkin's disease.
- Pulmonary involvement may also occur. Usually by direct extension from mediastinal lymph nodes across the pleura. Lung involvement in the absence of lymphadenopathy is rare if the patient has not already been treated. Pleural involvement by the disease itself is less common, but is a cause of pleural plaques and effusion. and may cavitate. It is usually due to spread of disease from hilar lymph nodes along the peribronchial connective tissue space.
- Grading systems that relate the morphology of the tumour to prognosis (i.e. going from less to more aggressive: low grade, intermediate grade and high grade) Tumour architecture (i.e. follicular (or nodular) and diffuse lymphomas). Mucosa-associated lymphoid tissue (MALT) within the lung may also give rise to primary non-Hodgkin's lymphoma. These are usually low-grade B-cell lymphomas and manifest as one or more areas of pulmonary consolidation with or without associated adenopathy. Classification of these tumours is constantly being revised. line will give rise to a B-cell, T cell or histiocytic lymphoma.
- Progression of disease in the non-hodgkin's group is less orderly with pulmonary and pleural involvement often preceding mediastinal disease. There is also a greater tendency for the pulmonary infiltrates to travel along fissures and involve the pleura
- There is no correlation between stage of disease and CD4 count. Extensive pleural disease as the sole radiographic manifestation of lung cancer has also been reported .
- Lymphoma-Hodgkin's disease Chest X-ray shows bilateral hilar adenopathy, mediastinal adenopathy, right upper lobe pulmonary shadowing and a right pleural effusion. (B) Contrast-enhanced CT shows massive anterior mediastinal adenopathy, with direct infiltration of the right upper lobe and a large pleural effusion.
- Pulmonary lymphoma. CT shows an irregular soft-tissue mass with an air bronchogram.
- Histiocytic lymphoma. Chest X-ray shows mediastinal adenopathy, multiple ill-defined pulmonary nodules and a right pleural effusion.
- Lymphocytic lymphoma. Chest X-ray shows a large left pleural effusion, a small right pleural effusion and right paratracheal adenopathy.
- NHL in a 23-year-old human immunodeficiency virus female. The chest radiograph shows multiple well-defined lung nodules within the left lung associated with mediastinal lymphadenopathy. Lymphadenopathy is a less common feature in acquired immunodeficiency disease-related NHL and nodes are rarely significant according to size criteria unlike as in the case shown here, where there is significant lymphadenopathy as confirmed by computed tomography (right upper frame). Magnetic resonance imaging is the imaging of choice to detect vascular encasement
- Pulmonary parenchymal lymphoma in a 41-year-old HIV-positive man. He presented with worsening shortness of breath and dry cough. (A) Chest radiograph reveals multiple poorly defined pulmonary nodules without lymphadenopathy. (B) CT image through the lower lobes shows an air bronchogram in the largest mass (arrow). CT-guided biopsy showed malignant large cell lymphoma
- AIDS-related lymphoma presenting as lymphadenopathy. (A) Contrast-enhanced CT image at the level of the left and right main pulmonary arteries shows a large mass involving the anterior and middle mediastinal compartments. The mass results in obstruction of the superior vena cava and encasement of the right pulmonary artery.
- Lymphocytic interstitial pneumonitis in a human immunodeficiency virus patient. Chest X-ray showing bilateral reticulonodular interstitial infiltrates. Diagnosis was confirmed by a transbronchial biopsy
- Lymphocytic interstitial pneumonia (LIP) in a 31-year-old man, CD4 cell count 337 cells/mm3 . He presented with a 1-month history of slurred speech but no respiratory symptoms. Chest radiograph shows diffuse, fine nodular changes, best seen in the lower lobes. Surgical biopsy of the right lower lobe showed a bronchiolocentric lymphoid infiltrate accompanied by lymphocytic infiltrates in the interstitium representing a mixture of B and T cells.
- Lung carcinoma in a 46-year-old HIV-positive man, CD4 cell count 343 cells/mm3. He had a history of cigarette smoking. The chest radiograph shows a large, well-defined mass in the right upper lobe, as well as extensive emphysematous changes. Biopsy revealed focally necrotic non-small-cell carcinoma.
- High-resolution CT scan of a patient with pulmonary KS at the level of the main bronchi shows ground-glass attenuation areas in the posterior regions of both lungs, which correspond to pulmonary hemorrhage. Peribronchovascular thickening is observed in the right lung, as well as bilateral pleural effusion.
- Pneumocystis carinii pneumonia (PCP) in a 31-year-old HIV-positive woman with underlying emphysema. (A) Posteroanterior chest radiograph shows a symmetric, bilateral, perihilar, and basilar distribution of ground-glass opacities and consolidation. The symmetrical distribution is typical of PCP. (B) High-resolution CT (HRCT) image at the level of the bronchus intermedius shows a relatively symmetric distribution of ground-glass opacities, with some areas of more confluent consolidation in the lower lobes. Note extensive underlying emphysema with predominantly paraseptal features.