Patterns of Pulmonary

Disease
 Pattern recognition

• group abnormal findings into

“patterns”
• ie:
– interstitial
• net-like, fine linear shadows
• bilateral, well-defined
– air-space
• fluffy, cloudy consolidation shadows
• unilateral, ill-defined
Atelectasis-CS1
• Compressive: Intrapulmonary masses
compressing adjacent normal tissue
– Pulmonary mass
• Obstructive: airway obstruction
– Foreign bodies
– Tumors
• Cicatrizing
– Infections (TB, histoplasmosis)
Chest wall lesion- CS2
• abscess- painful, red subcutaneous mass
• *hematoma- history of trauma
• pleural fluid- free or loculated transudate
• *rib fracture- offset of rib cortices
• rib tumor- expansile tumors (ie,
enchondroma, osteoblastomas, multiple
myeloma, mets etc.)
• soft tissue body wall neoplasms
Chest wall mass & missing rib (malignant)
Malignant tumor of the chest wall on CT
Healing rib fracture
Pancoast tumor of right lung apex
 Diaphragmatic abn.- CS3
• depressed
– emphysema (bilat)
– bullae
– large pleural effusion
– pneumothorax
• Elevated
– congenital eventration, atelectasis,
phrenic nerve paralysis
– poor inspiratory effort, ascites,
gastric air bubble, pregnancy,
obesity
– hiatal hernia
– pneumoperitoneum
R

Pneumoperitoneum
Pneumoperitoneum
Emphysema
Pleural effusion
Pneumoperitoneum
Pneumonia:
alveolar
(airspace)
pattern of dz
Pneumonia
Pulmonary
edema

How is this
bilateral
pattern of
consolidation
sometimes
described?
Diffuse interstitial - CS6
• acute
– infection- viral, not bacterial
– pulmonary edema- (i.e., CHF)
– lymphangitic mets- often unilateral
• chronic
– connective tissue- (ie, rheumatoid, SLE)
– pneumoconioses-asbestosis
– sarcoidosis- stage 4
– idiopathic-
Interstitial lung disease
Interstitial disease
Interstitial lung disease
Enlarged hilum - CS7

• bronchogenic carcinoma-
unilateral
• mets- unilateral or bilateral
• granulomas- small, often calcified (ie, TB,
histoplasmosis)
• lymphoma- often mediastinal involvement
• pulmonary embolism- acute clinical onset
• sarcoidosis- stage 1 and 2
Interstitial lung disease
 Enlarged hilum
Normal
(brochogenic
carcinoma)
 Enlarged hilum
(brochogenic carcinoma)
Sarcoidosis
Focal radiolucent lesion - CS8

• cavities- thick walls

– Infections- chronic
– Tumor- bronchogenic
carcinoma
– Septic embolism-
• cysts- thin walls
– bronchogenic- congenital, past films
– bulla/bleb- emphysema
– rheumatoid- patient has arthritis
Cavity in right lung field
Cavity in left lung field with internal fungal ball
Lung cyst
Lung cyst
Intrathoracic calcifications - CS9

• cardiovascular- valve, artery

• pulmonary-*granuloma,
hamartoma
• hilar/mediastinal- *granuloma,
teratoma, silicosis
• pleural- emphysema, hemothorax,
*pneumoconioses
•
 Mediastinal lesions - CS10
• anterior
– teratoma, thymoma, substernal
thyroid, Hodgkin’s disease, aortic
aneurysm
• middle
– aortic aneurysm, hiatal hernia,
lymphadenopathy
• posterior
– aortic aneurysm, extramedullary
hematopoiesis, *neurogenic
neoplasm
Mediastinal mass
Posterior mediastinal
mass
Pleural effusion - CS11

• *CHF- large heart, transient,

pulmonary edema
• empyema- purulent effusion
• *malignancy- lymphoma, bronchogenic,
mesothelioma, mets
• collagen disease- SLE, rheumatoid
• abdominal disease- pancreatitis,
hepatitis, abscesses
Mult. masses & nodules - CS14

• *mets- history of primary

tumor, weight loss, middle aged
or older, rarely calcified, small or
large size
• granuloma- small and calcified
• lymphoma- mediastinal involvement
• sarcoidosis- black females, rare, hilar and
paratracheal lymph node enlargement
Solitary pulmonary nodule (SPN)
Pulmonary granulomas
 Adult Respiratory Distress Syndrome

This CXR shows diffuse bilateral alveolar

infiltrates similar to acute pulmonary edema
of cardiac origin, except that the cardiac
silhouette is usually normal.
CXR changes often lag many hours behind
functional changes and the hypoxemia may
seem disproportionately severe compared
to the edema observed by CXR.
 This common medical emergency is precipitated by a variety
of acute processes that directly or indirectly injure the lung,
e.g., primary bacterial or viral pneumonias, aspiration of
gastric contents, direct chest trauma, prolonged or profound
shock, burns, fat embolism, near-drowning, massive blood
transfusion, cardiopulmonary bypass, oxygen toxicity, or acute
hemorrhagic pancreatitis.
 The incidence of ARDS is estimated to be over 30% following
the "sepsis syndrome" characterized by leukocytosis or
leukopenia, fever, hypotension, and a known potential source
of systemic infection, whether or not blood cultures are
positive for a bacterial pathogen.
 Patients usually have not had previous lung disease.
 It usually develops within 24-48 hours after the initial injury or
illness. Dyspnea occurs first, usually accompanied by rapid,
shallow respiration. Intercostal and suprasternal retraction
may be present on inspiration. The skin may appear cyanotic
or mottled,, and may not improve with oxygen administration
Cardiomyopathy
 This is a 25 year old female with a diagnosis of endstage
idiopathic cardiomyopathy.
 The PA CXR shows four chamber enlargement and a
grossly globular heart, often termed a "water bottle"
heart. One can see the marked splaying of the carina
with prominent left atrium and ventricles on lateral view.
 The differential diagnosis would include postpartum
cardiomyopathy, ischemic cardiomyopathy, alcoholic
cardiomyopathy, and viral myocarditis.
 A pericardial effusion would also look like this on CXR,
and an echocardiogram would have to be performed to
differentiate the two.