- •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
Interstitial |
63 |
Fig. 4.38 Portable CXR done in ICU demonstrating diffuse patchy airspace opacities. Additionally there are the following tubes/lines: ET tube in trachea above carina, feeding tube in stomach, two left chest tubes, PICC line at junction of left brachycephalic and SVC
Fig. 4.39 CT of same patient demonstrating “crazy paving” in RML and RLL (thin arrows on patient’s right) and bronchiectasis within consolidated LLL (wide arrow on patient’s left)
Cells (Malignancy)
Bronchoalveolar cell carcinoma (BAC), Kaposi’s sarcoma, and lymphoma can display as a consolidative pseudo-mass.
Figure 4.40 demonstrate perihilar consolidations in a child with Kaposi’s sarcoma.
Interstitial
Chest X-Rays showing interstitial markings include a large variety of abnormal processes including edema, inflammation, disease, and environmental exposure.
64
Fig. 4.40 (a) PA and (b) lateral CXR demonstrating irregular perihilar patchy consolidations partially obliterating vasculature and right heart border in this patient with Kaposi’s sarcoma
a
b
4 Abnormal Lung Patterns
Interstitial |
65 |
Fig. 4.41 End-stage “Honeycomb” lung (Image courtesy of Ed Uthman, M.D.)
Interstitial markings appear on CXR and CT due to changes affecting the interstitium of the lung.
The composition of the pulmonary interstitium includes the:
•Alveolar walls, septi, and the connective tissue surrounding bronchi and vessels (peribronchial and perivascular spaces).
Mechanisms of infiltration include:
•Thickening of lung interstices
•Architectural destruction of interstitium (honeycomb or “end-stage” lung)
Interstitial pattern includes lines, dots, and/or holes (any combination of the three) as opposed to the fluffy opacities seen with consolidation. Keep in mind there can be mixed patterns with consolidation, airway, mass, or vascular. On CT, ground glass is another finding in interstitial pattern.
An example of a disease that would produce an interstitial pattern, in this case, lines and holes (honeycomb pattern). Figure 4.41 is a gross specimen lung from a patient who had end-stage lung disease.