HRCT DILD Lubljana 2009

HRCT in Diffuse Interstitial Lung DiseaseHRCT in Diffuse Interstitial Lung DiseaseSteps in High Resolution CT Diagnosis• Pattern of abnormality• Distribution of disease• Associated findings• Clinical historyTomás Franquet MDHospital de Sant Pau. BarcelonaWhat is the diagnosis?HRCT in Diffuse Interstitial Lung DiseaseSecondary Pulmonary LobuleHRCT in Diffuse Interstitial Lung DiseaseHRCT Basic Pattern of AbnormalityAnatomic structuresCentrilobular bronchioleCentrilobular arteryInterlobular septumCourtesy of Harumi Itoh MD, Fukui (Japan)• Nodular• Septal• Reticular• Cystic• Ground-glass opacity• ConsolidationHRCT in Diffuse Interstitial Lung DiseaseSmall Nodules (1-10mm)Anatomic distribution• Perilymphatic• Centrilobular• RandomHRCT in Diffuse Interstitial Lung DiseasePerilymphatic NodulesWhere are the lymphatics?• Along vessels• Along bronchi• Along pleura• Interlobar fissures1

HRCT in Diffuse Interstitial Lung DiseasePerilymphatic Nodules1. Sarcoidosis2. Lymphangitic spread of tumor3. Silicosis4. Coalworkers’ pneumoconiosis5. Lymphocytic interstitial pneumoniaHRCT in Diffuse Interstitial Lung DiseaseSarcoidosisNodular thickening of• Bronchi• Vessels• Interlobar fissures• Subpleural lungPerihilar predominanceUpper & Mid lungHRCT in Diffuse Interstitial Lung DiseaseNodules (Centrilobular)HRCT in Diffuse Interstitial Lung DiseaseCentrilobular Nodules1. Hypersensitivity pneumonitis2. Respiratory Bronchiolitis3. RB-Interstitial lung disease4. Silicosis5. Coalworkers’ pneumoconiosisHRCT in Diffuse Interstitial Lung DiseaseHypersensitivity pneumonitisHRCT in Diffuse Interstitial Lung DiseaseSmall Nodules (Random)• Nodules• Poorly defined• Centrilobular• ClustersA few mm from pleuraAway from fissures & vessels2

HRCT in Diffuse Interstitial Lung DiseaseSmall Nodules (Random)1. Miliary TBHRCT in Diffuse Interstitial Lung DiseaseSeptal PatternInterlobular septal thickening2. Hematogenous metastases3. Sarcoidosis4. Pneumoconiosis (Talcosis, Silicosis)HRCT in Diffuse Interstitial Lung DiseaseSeptal PatternHRCT in Diffuse Interstitial Lung DiseasePulmonary edema1. Pulmonary edema2. Lymphangitic carcinomatosis3. Lymphoma4. Lymphocytic interstitial pneumoniaHRCT in Diffuse Interstitial Lung DiseaseLymphangitic carcinomatosisHRCT in Diffuse Interstitial Lung DiseaseLymphangitic carcinomatosisFromn Webb RW. Thin-section CT of the Seconadry Pulmonary Lobule: The 2004 Fleischner Lecture. Radiology, 20063

HRCT in Diffuse Interstitial Lung DiseaseReticular PatternIntralobular lines (intralobular interstitium)HRCT in Diffuse Interstitial Lung DiseaseIntralobular interstitial thickeningDef n : very fine network of lines within visible lobulesCaused by:• IPF/UIP• NSIP• H. pneumonitis (chronic)• Pulmonary edema• ARDSHansell DM et al. Fleischner Society: Glossary of terms for Thoracic Imaging. Radiology 2008HRCT in Diffuse Interstitial Lung DiseaseReticular PatternHRCT in Diffuse Interstitial Lung DiseaseNiemann-Pick DiseaseReticular PatternHRCT in Diffuse Interstitial Lung DiseaseCystic airspacesDef n :enlarged foci of air-containing lung surrounded by awall of variable thickness and composition 1HRCT in Diffuse Interstitial Lung DiseaseHoneycombingDef n :cluster or row of small cysts (3-10 mm in Ø)Typically seen in:• IPF/UIP• NSIP (fibrotic)• H. pneumonitis (chronic)• Asbestosis• ARDSHansell DM et al. Fleischner Society: Glossary of terms for Thoracic Imaging. Radiology 2008Hansell DM et al. Fleischner Society: Glossary of terms for Thoracic Imaging. Radiology 20084

HRCT in Diffuse Interstitial Lung DiseaseCystic Lung DiseaseHRCT in Diffuse Interstitial Lung DiseasePulmonary Langerhans histiocytosis• Honeycombing• Pulmonary Langerhans’ histiocytosis• Lymphangioleiomyomatosis• Lymphocytic interstitial pneumonia• Hypersensitivity pneumonitis• Nodules: smooth, irregular• Cysts: often bizarre shapes• Random or diffuse distribution• Upper and midle lung zones• Relative sparing of lung basesHRCT in Diffuse Interstitial Lung DiseasePulmonary Langerhans histiocytosisHRCT in Diffuse Interstitial Lung DiseaseLymphangioleiomyomatosis• Muscle proliferation• Along airways• Along lymphatics• Along blood vesselsHRCT in Diffuse Interstitial Lung DiseaseLymphangioleiomyomatosisJournal of Computer Assisted Tomography 2003; 27(4):475–478• Thin walled cysts• Diffuse• Parenchyma betweencysts typically normal5

HRCT in Diffuse Interstitial Lung DiseaseGround-glass opacityDef n : Hazy increased attenuation of thelung, but with preservation of bronchialand vascular markingsHRCT in Diffuse Interstitial Lung DiseaseGround glass opacity• Subacute hypersensitivity pneumonitis• Nonspecific interstitial pneumonia• Collagen vascular disease• Lymphocytic interstitial pneumonia• Drug reactionHansell DM et al. Fleischner Society: Glossary of terms forThoracic Imaging. Radiology 2008HRCT in Diffuse Interstitial Lung DiseaseNon-specific Interstitial Pneumonia (NSIP)HRCT in Diffuse Interstitial Lung Disease“Crazy-paving” patternDef n :A network of asmooth linear patternsuperimposed on anarea of ground-glassopacityHansell DM et al. Fleischner Society: Glossary of terms for Thoracic Imaging. Radiology 2008HRCT in Diffuse Interstitial Lung DiseaseCrazy-paving pattern (Alveolar proteinosis)HRCT in Diffuse Interstitial Lung DiseaseAir-space consolidationDef n : Increased attenuationof the lung, caused by fillingof air spaces by fluid, cells,or other material “…Predominant lesion in 4 chronicdiseases:• Cryptogenic organizing pneumonia• Chronic eosinophilic pneumonia• Bronchoalveolar cell carcinoma• Parenchymal lymphomaHansell DM et al. Fleischner Society: Glossary of terms for Thoracic Imaging. Radiology 20086