How read chest ct 2
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1) Ground-glass opacity and consolidation are the main patterns of increased lung attenuation seen on chest CT. 2) Ground-glass opacity indicates mild decrease in airspace or mild increase in soft tissue and is potentially treatable, while consolidation obscures vessels/airways and indicates more severe disease. 3) The distribution, associated patterns, and clinical context can help determine if an interstitial lung disease is acute/potentially treatable versus chronic/not treatable.
How read chest ct 2
- 1. HOW READ CHEST CT -2 ANAS SAHLE ,MD
- 2. Basic elements Appearance pattern Distribution Patient data pattern Ct interpretation
- 3. Normal HRCT Findings airways Normal airways are visible only to within 3 cm of the pleura. The centrilobular bronchiole, with a diameter of 1 mm and a wall thickness of 0.15 mm, is not normally visible on HRCT.
- 4. Normal HRCT Findings small pulmonary arteries and veins More peripherally, numerous small "dots" and a few branching lines represent small pulmonary arteries and veins. Throughout, arteries branch at acute angles, and veins branch at 90° angles Centrilobular arteries (1 mm in diameter) are V- or Y-shaped structures on HRCT seen within 5 to 10 mm of the pleural surface. Pulmonary veins (0.5 cm) are occasionally seen as linear or dotlike structures within 1 to 2 cm of the pleura and, when visible, indicate the locations of interlobular septa
- 5. FIGURE 17.3. HRCT Findings in Interstitial Lung Disease 1- Interlobular (Septal) Lines 2-Intralobular Lines 3-Thickened Fissures 4-Thickened bronchovascular structures Dot lik 5-Centrilobular (Lobular tree-in-bud Core) Abnormalities lldefined 6- Subpleural lines 7-Parenchymal bands 8-Honeycombing 9-Thin-walled cysts 10-Irregularity of Lung Interfaces 11-Ground-Glass or Hazy Increased Density 12-Architectural Distortion and Traction Bronchiectasis 13-Conglomerate Masses 14-Consolidation
- 6. Appearance pattern Increased Decreased Nodular Linear lung lung opacities opacities attenuation attenuation
- 7. Increased lung attenuation Ground-glass opacity Consolidation
- 8. Ground-glass opacity(GGO) • GGO: • hazy increase in lung density, • with preservation of airway vessel margins. • The density of the intra-bronchial air appears darker as the air in the surrounding alveoli. This is called the 'dark bronchus' sign • Occurs when: • there is mild decrease in the amount of air in air- spaces(Air space disease ) • when there is mild increase in size andor amount of soft tissue structures (Interstitial lung disease ). • two phenomena that often occur simultaneously.
- 9. High Attenuation pattern 1. Ground-glass- opacity (GGO) 2. Consolidation High Attenuation
- 13. WHAT IS DOMINANT PATTERN ?
- 14. Ground-glass opacity Treatable or not treatable?
- 15. Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern 60-80% Active Treatable 2. Ground-glass of cases pathology opacity 1. Taction 20-40% Chronic not Bronchiectasis of cases pathology treatable 2. Honeycombing 3. Cysts
- 16. Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern 60-80% Potentially Active of cases treatable 2. Ground-glass pathology opacity 1. Taction 20-40% Chronic not Bronchiectasis of cases pathology treatable 2. Honeycombing 3. Cysts
- 17. Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern 60-80% Potentially Active of cases treatable 2. Ground-glass pathology opacity 1. Taction 20-40% Chronic not Bronchiectasis of cases pathology treatable 2. Honeycombing 3. Cysts
- 18. Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern 60-80% Potentially Active of cases treatable 2. Ground-glass pathology opacity 1. Taction 20-40% Chronic not Bronchiectasis of cases pathology treatable 2. Honeycombing 3. Cysts
- 19. Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern 60-80% Potentially Active of cases treatable 2. Ground-glass pathology opacity 1. Taction 20-40% Chronic Not Bronchiectasis of cases pathology treatable 2. Honeycombing 3. Cysts
- 20. Ground-glass opacity Treatable or not treatable ? Acute / 1. Reticular Pattern 60-80% Potentially Active of cases treatable 2. Ground-glass pathology opacity 1. Taction 20-40% Chronic Not Bronchiectasis of cases pathology treatable 2. Honeycombing 3. Cysts
- 21. Ground-glass opacity Treatable or not treatable? • Potentially treatable lung disease
- 22. Ground-glass opacity Treatable or not treatable? • Radiological Findings of fibrosis: • Traction bronchiectasis • Honeycombing
- 23. Ground-glass opacity Treatable or not treatable? • Traction Bronchiectasis • Honeycombing Non specific interstitial pneumonitis (NSIP)
- 24. Crazy Paving
- 25. Crazy Paving in a patient with Alveolar proteinosis Linear Crazy- GGO pattern paving • Crazy Paving is a combination of ground glass opacity with superimposed septal thickening
- 26. Consolidation • Defined as: • Increased in lung density • with obscuration of underlying vessels and airway walls, – an air-bronchogram may be present. • Air-space nodules, focal area of GGO are often seen in association with consolidation.
- 27. Increased lung attenuation Preservation of B-V Obscuration of vascular marking=GGO marking=consolidation Symptoms course Symptoms course (acute,sub-acute,chronic) (acute,sub-acute,chronic) Centri-lobular Linear pattern sub-pleural Other pattern No linear pattern superimposed patchy diffuse also lobar Centri-lobular DD for other CRAZY PAVING Sub-pleural pattern Patchy,diffuse
- 28. Increased lung attenuation Appearance pattern GGO Cosolidation Patient data(symptoms course) Acute Sub-acute Chronic Distribution patternother pattern Centri-lobular Sub-pleural Patchy Diffuse Lobar Regional lung distribution Upper lowerdiffuse Central peripheral
- 29. Acute GGOconsolidationcrazy-paving Pulmonary infection Pulmonary edema Pulmonary hemorrhage ARDS Acute intrstitial pneumonia Eosinophilic pnrumonia Radiation pneumonia
- 30. Sub-acutechronic course GGO Hyper-sensitivity pneumonitis Smoking related paranchymal disease UIPIPF NSIP Lymphocytic interstitial pneumoniaLIP Alveolar proteinosis Asbestosis Vasculitis(churg-strauss syn) Eosinophylic pneumonia(chronic) COP Bronchoalveolar CA Lipoid pneumonia Sarcoidosis
- 31. Sub-acutechronic course cosolidation COP Bronchoalveloar CA UIPIPF NSIP Lymphocytic interstitial pneumoniaLIP Lymphoma Vasculitis(churg-strauss syn) Eosinophylic pneumonia(chronic) Hyper-sensitivity pneumonitis Lipoid pneumonia Sarcoidosis
- 32. Sub-acutechronic course crazy-paving UIPIPF NSIP Lymphangitic spread of tumor Alveolar proteinosis Vasculitis(churg-strauss syn) Eosinophylic pneumonia(chronic) COP Bronchoalveolar CA Lipoid pneumonia Sarcoidosis
- 33. Centri-lobular nodular GGO Hyper-sensitivity pneumonitis Organizing pneumonia Pulmonary infection Pulmonary edema Pulmonary hemorrhage vasculitis Metastatic calcification Lymphocytic interstitial pneumonia(sjogren,AIDS)
- 34. Centri-lobular nodular consolidation • Hyper-sensitivity pneumonitis • Organizing pneumonia • Pulmonary infection • Pulmonary edema • Pulmonary hemorrhage • Bronchoalveolar carcinoma • Aspiration • vasculitis • Lymphocytic interstitial pneumonia(sjogren,AIDS)
- 35. Sub-pleural GGO UIPIPF Organizing pneumonia Eosinophylic pneumonia Asbestosis
- 36. Sub-pleural consolidation • Eosinophylic pneumonia • Organizing pneumonia • UIPIPF
- 37. Patchy GGO Hyper-sensitivity pneumonitis NSIP DIP Alveolar proteinosis Pulmonary hemorrhage vasculitis Sarcoidosis
- 38. Patchy consolidation • Hyper-sensitivity pneumonitis • NSIP • DIP • Pulmonary hemorrhage • vasculitis • Sarcoidosis
- 39. Diffuse GGO Hyper-sensitivity pneumonitis Smoking related lung diseases Pulmonary infection Pulmonary edema Pulmonary hemorrhage Alveolar proteinosis Acute interstitial pneumonia(AIP) ARDS NSIP
- 40. Diffuse consolidation • Hyper-sensitivity pneumonitis • Pulmonary infection • Pulmonary edema • Pulmonary hemorrhage • Alveolar proteinosis • AIP • ARDS • NSIP
- 41. Lobar consolidation • Pulmonary infection • Bronchoalveolar carcinoma • Organising pneumonia • Lymphoma
- 42. Regional distribution Upperlowerdiffuse Centralperipherial Posterioranterior zone zone zone
- 43. Regional distribution Upper zone Lower zone diffuse zone • Sarcoidosis • oedema • Hyper-sensetivity • Tuberculosis • UIP pneumonitis • Chronic • NSIP • Diffuse eosinophylic • DIP pneumonia pneumonia. • COP • Lymphangitic • Lipoid pneumonia spread of tumor • Alveolar • Sarcoidosis hemorrhage
- 44. Regional distribution Central zone Peripheral zone • Sarcoidosis • Asbestosis • Lymphagitic spread of tumor • UIP • Alveolar proteinosis. • NSIP • DIP • COP • Chronic eosinophylic pneumonia • Hyper-sensitivity pneumonitis. • Acute interstitial pneumonia. • Septic emboli • Pulmonary embolisem.
- 45. Regional distribution Posterior • oedema • ARDS • UIP • NSIP • Asbestosis • Sarcoidosis • Hyper-sensitivity pneumonitis • Lipoid pneumonia
- 46. High Attenuation