- •Chest Imaging
- •Foreword
- •Preface
- •Educational Support and Funding
- •Acknowledgments
- •Contents
- •Fundamentals > Chest Primer Presentation
- •Chest X-Ray Interpretation Self-Study Instructions
- •Using the RoboChest Website
- •Decision Tree Algorithms to Help Solidify Concepts
- •References
- •Comprehensive Review of Search Patterns
- •Search Pattern Mnemonic
- •Interpretive Approach to CXR
- •Applying the Mnemonic to the Search Pattern
- •Chest Primer Presentation
- •References
- •Introduction and Terminology
- •Chest Imaging Terminology
- •Mach Effect on CXR
- •Trachea and Lungs on CXR
- •Mediastinal Anatomy on CXR
- •The Hilum (Plural: Hila)
- •Pulmonary Arteries and Veins
- •Normal Lung Markings
- •Vessel Size
- •Quiz Yourself: Mediastinum Lines, Edges
- •Shoulder Anatomy
- •Reference
- •Abnormal Lung Parenchyma
- •Mass
- •Mass Considerations
- •Size
- •Mass Characteristics
- •Malignancy
- •Case 4.1
- •Metastatic
- •Case 4.2
- •Bronchial Carcinoid
- •Radiological Signs
- •Case 4.3
- •Granulomatous Disease
- •Infectious Granulomatous Disease
- •Case 4.4
- •Non-infectious Granulomatous Disease
- •Benign Neoplasm
- •Hamartoma
- •Case 4.6
- •Congenital Abnormality
- •Pulmonary Arteriovenous Malformations
- •Case 4.7
- •Consolidation
- •Consolidative Radiological Findings/Distribution
- •Consolidative Model
- •Blood (Hemorrhage)
- •Case 4.8
- •Pus (Exudate)
- •Case 4.9
- •Case 4.10
- •Water (Transudate)
- •Pulmonary Edema
- •Case 4.11
- •Case 4.12
- •Protein (Secretions)
- •Case 4.13 (see Figs. 4.38 and 4.39)
- •Cells (Malignancy)
- •Interstitial
- •Radiological Signs
- •Linear Form: Lines
- •Case 4.14
- •Nodular Form: Dots
- •Case 4.15
- •Reticulo-Nodular Form
- •Pneumoconiosis
- •Case 4.16
- •Case 4.17
- •Destructive Fibrotic Lung
- •Case 4.18
- •Langerhans Cell Histiocytosis
- •Case 4.19
- •Vascular Pattern
- •Normal Pulmonary Vascular Anatomic Review
- •Radiological Signs in the Vascular Pattern
- •Mechanism
- •Vascular Examples
- •Pulmonary Arterial Hypertension (PAH)
- •Case 4.20
- •Pulmonary Venous Congestion
- •Pulmonary Venous Congestion: Edema
- •Emphysema
- •Airway (Bronchial) Patterns
- •Complete Obstruction
- •Lobar Atelectasis (Collapse)
- •Signs
- •Lobar Atelectasis Patterns
- •Complete Obstruction: Case Study
- •Partial Obstruction
- •Radiological Signs
- •Bronchial Wall Thickening
- •Bronchial Wall Thickening Causes
- •Bronchial Wall Thickening Model
- •Bronchiolar
- •Case 4.21
- •References
- •Pleural Effusion
- •Case 5.1
- •Technique and Positioning Revisited
- •Case 5.2
- •Comparison of Effusions over Time
- •Loculated Fluid/Pseudotumor
- •Case 5.3
- •Case 5.4
- •Thickening
- •Pneumothorax
- •Fluid and Air
- •Analogous Model
- •References
- •Anterior Mediastinal Mass
- •Case 6.1
- •Middle Mediastinal Mass
- •Posterior Mediastinal Mass
- •Case 6.2
- •Mediastinal Enlargement
- •Case 6.3
- •Reference
- •Case 7.1
- •Lines and Tubes
- •References
- •Appendix
- •Appendix 1: Glossary and Abbreviations
- •Appendix 2: Sources and Additional References
- •Text Sources
- •Image Sources
- •Additional References
- •Chest Imaging References
- •Chest Imaging Online References
- •Index
38 |
4 Abnormal Lung Patterns |
Fig. 4.6 PA showing multiple nodules on left (all less than 3 cm) and nodules and one mass on the right (3.4 cm)
Case 4.2
This case (Figs. 4.6 – 4.8) depicts multiple metastatic masses.
Findings: Multiple well-rounded opacities in the left lung.
Pattern: Mass (and nodules), multiple, bilateral.
Differential Diagnosis
•Malignancy
•Granulomatous disease
•Inflammation
•Benign neoplasm
•Congenital
Since there are multiple masses, malignancy (metastatic), granulomatous, and congenital become higher on the differential. Given a history of adrenal cortical carcinoma, metastatic is the primary diagnosis. Metastatic is the highest on the differential.
Bronchial Carcinoid
Bronchial Carcinoid lesions are classified from low grade (typical) to high grade (atypical). Both extremes have similar imaging features, with the majority of lesions being centrally located, well-defined, and round-to-ovoid in shape.
Mass |
39 |
Fig. 4.7 Lateral demonstrating the mass overlying the hilum and multiple nodules
Fig. 4.8 CXR with arrows indicating the multiple nodules (small arrows) and mass (large arrow)
40 |
4 Abnormal Lung Patterns |
Fig. 4.9 PA showing large masses on right
Radiological Signs
Approximately 20% of bronchial carcinoids arise peripherally, distal to the segmental bronchi. The majority of these neoplasms are of the atypical subtype. Both typical and atypical subtypes can be associated with hilar and mediastinal lymphadenopathy; hyperplasia results from repeated post-obstructive infections or metastasis. Local nodal metastasis is more common in atypical carcinoids.
Case 4.3
Figures 4.9–4.12 show multiple large masses.
Findings: Widening of mediastinum superiorly on the right. Opacity in the retrosternal clear space seen on the lateral, heterogeneously enhancing perihilar mass post IV contrast on CT.
Pattern: Mass.
Differential Diagnosis
•Malignancy
•Granulomatous
•Inflammation, other
Mass |
41 |
Fig. 4.10 Lateral demonstrating large perihilar masses
Fig. 4.11 Axial CT at level of carina (C) showing large heterogeneously enhancing mass (M) anteriolateral to ascending aorta (A) representing a bronchial carcinoid. There is also a pleural effusing noted on CT (Eff). Note also the descending aorta (DA), the left pulmonary artery (LPA)