- •Preface
- •Contents
- •Pattern Approach for Lung Imaging
- •1: Nodule
- •Solitary Pulmonary Nodule (SPN), Solid
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Lung Cancer (Solid Adenocarcinoma)
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Carcinoid or Atypical Carcinoid
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •BALT Lymphoma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Tuberculoma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Hamartoma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Sclerosing Hemangioma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Ground-Glass Opacity Nodule
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Atypical Adenomatous Hyperplasia (AAH)
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Adenocarcinoma in Situ (AIS)
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Minimally Invasive Adenocarcinoma (MIA)
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •2: Mass
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Pulmonary Sarcoma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Progressive Massive Fibrosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Actinomycosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •3: Consolidation
- •Lobar Consolidation
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Lobar Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Invasive Mucinous Adenocarcinoma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Infarction
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Patchy and Nodular Consolidation
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Airway-Invasive Pulmonary Aspergillosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Cryptococcosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •IgG4-Related Lung Disease
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Lymphomatoid Granulomatosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •4: Beaded Septum Sign
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •References
- •5: Comet Tail Sign
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •Rounded Atelectasis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •6: CT Halo Sign
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •Angioinvasive Pulmonary Aspergillosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Metastatic Hemorrhagic Tumors
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Endometriosis with Catamenial Hemorrhage
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •7: Galaxy Sign
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •Galaxy Sign in Pulmonary Tuberculosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •8: Reversed Halo Sign
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Mucormycosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Lymphomatoid Granulomatosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •9: Tree-in-Bud Sign
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •Aspiration Bronchiolitis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Foreign-Body-Induced Pulmonary Vasculitis (Cellulose and Talc Granulomatosis)
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •Bronchial Atresia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Bronchial Tuberculosis and Mucoid Impaction
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Foreign-Body Aspiration
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Allergic Bronchopulmonary Aspergillosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •11: Lobar Atelectasis Sign
- •Disease Causing the Sign
- •Distribution
- •Clinical Considerations
- •Right Upper Lobar Atelectasis
- •Left Upper Lobar Atelectasis
- •Right Middle Lobar Atelectasis
- •Lower Lobar Atelectasis
- •References
- •Cavity
- •Diseases Causing the Cavity
- •Distribution
- •Clinical Considerations
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Langerhans Cell Histiocytosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Septic Pulmonary Embolism
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Cavitary Pulmonary Tuberculosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Paragonimiasis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Cyst
- •Diseases Causing the Cyst
- •Distribution
- •Clinical Considerations
- •Blebs and Bullae
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Sequestration
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Intrapulmonary Bronchogenic Cyst
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Traumatic Lung Cysts
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •References
- •Mosaic Attenuation
- •Diseases Causing the Mosaic Attenuation Pattern
- •Distribution
- •Clinical Considerations
- •Cystic Fibrosis
- •Pathology and Pathogenesis
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Constrictive Bronchiolitis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Chronic Pulmonary Thromboembolism
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Idiopathic Pulmonary Arterial Hypertension
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Airway Disease (Bronchiectasis and Bronchiolectasis)
- •Distribution
- •Clinical Considerations
- •Swyer-James-MacLeod Syndrome
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Dyskinetic Cilia Syndrome
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •14: Air-Crescent Sign
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •Aspergilloma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Rasmussen’s Aneurysm
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •15: Signet Ring Sign
- •Diseases Causing the Sign
- •Distribution
- •Clinical Considerations
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •16: Interlobular Septal Thickening
- •Smooth Septal Thickening
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Pulmonary Edema
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Niemann–Pick Disease
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •Nodular Septal Thickening
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Pulmonary Lymphangitic Carcinomatosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT-Pathology Comparisons
- •Patient Prognosis
- •References
- •17: Honeycombing
- •Honeycombing with Subpleural or Basal Predominance
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Asbestosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Honeycombing with Upper Lung Zone Predominance
- •Diseases Causing the Pattern and Distribution
- •Distribution
- •Clinical Considerations
- •Idiopathic Familial Pulmonary Fibrosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Chronic Hypersensitivity Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •End-stage Fibrotic Pulmonary Sarcoidosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •18: Small Nodules
- •Small Nodules with Centrilobular Distribution
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Mycoplasma Pneumoniae Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Diffuse Panbronchiolitis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Follicular Bronchiolitis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Tumor Embolism
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Pneumoconiosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Sarcoidosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Alveoloseptal Amyloidosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Small Nodules with Random (Miliary) Distribution
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Miliary Tuberculosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Miliary Metastasis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •19: Multiple Nodular or Mass(-like) Pattern
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Pulmonary Metastasis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Lymphoma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Amyloidomas
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •ANCA-Associated Granulomatous Vasculitis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •Ground-Glass Opacity with Reticulation and Fibrosis
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Ground-Glass Opacity with Reticulation, but without Fibrosis (Crazy-Paving Appearance)
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Pneumocystis jirovecii Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Lipoid Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pulmonary Alveolar Proteinosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Mucinous Adenocarcinoma or Adenocarcinoma in Situ, Diffuse Form
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Desquamative Interstitial Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Ground-Glass Opacity without Reticulation, with Small Nodules
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Subacute Hypersensitivity Pneumonitis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Cytomegalovirus Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Diffuse Alveolar Hemorrhage
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Ground-Glass Opacity without Reticulation, Diffuse Distribution
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Acute Hypersensitivity Pneumonitis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Acute Eosinophilic Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •22: Consolidation
- •Consolidation with Subpleural or Patchy Distribution
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Cryptogenic Organizing Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Chronic Eosinophilic Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Churg–Strauss Syndrome
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Radiation Pneumonitis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Consolidation with Diffuse Distribution
- •Diseases Causing the Pattern
- •Distribution
- •Clinical Considerations
- •Viral Pneumonias
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Acute Interstitial Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Diffuse Alveolar Hemorrhage
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •23: Decreased Opacity with Cystic Walls
- •Cavities
- •Diseases Causing Cavities
- •Distribution
- •Clinical Considerations
- •Rheumatoid Lung Nodules
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Cavitary Metastasis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Cysts
- •Diseases Causing Multiple Cysts
- •Distribution
- •Clinical Considerations
- •Lymphangioleiomyomatosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Lymphocytic Interstitial Pneumonia
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •Emphysema
- •Distribution
- •Clinical Considerations
- •Centrilobular Emphysema
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •Patient Prognosis
- •Paraseptal Emphysema
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •Patient Prognosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •Patient Prognosis
- •References
- •24: Decreased Opacity without Cystic Walls
- •Mosaic Attenuation, Vascular
- •Distribution
- •Clinical Considerations
- •Airway Diseases Causing Mosaic Attenuation
- •Distribution
- •Clinical Considerations
- •Asthma
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •Distribution
- •Clinical Considerations
- •Cystic Fibrosis
- •Pathology and Pathogenesis
- •Symptoms and Signs
- •CT Findings
- •CT–Pathology Comparisons
- •Patient Prognosis
- •References
- •26: Pneumonia
- •Lobar Pneumonia
- •Bronchopneumonia
- •Interstitial Pneumonia
- •27: Drug-Induced Lung Disease
- •Interstitial Pneumonitis and Fibrosis
- •Eosinophilic Pneumonia
- •Cryptogenic Organizing Pneumonia
- •Diffuse Alveolar Damage
- •Hypersensitivity Pneumonia
- •References
- •Systemic Lupus Erythematosus (SLE)
- •Rheumatoid Arthritis (RA)
- •Progressive Systemic Sclerosis (PSS)
- •Sjögren’s Syndrome
- •Mixed Connective Tissue Disease
- •Ankylosing Spondylitis
- •References
Multiple Nodular or Mass(-like) Pattern |
19 |
|
Definition |
a |
|
When the lesions of lung opaciÞcation appear with discrete margin, we call them multiple nodules or masses (please also note section ÒPatchy and Nodular ConsolidationÓ in Chap. 3) (Figs. 19.1 and 19.2).
Diseases Causing the Pattern
Pulmonary metastases (Fig. 19.2) are the most common cause of multiple nodules or masses. Lymphoproliferative diseases (Fig. 19.3), particularly in the secondary involvement of the lungs in Hodgkin lymphoma or non-Hodg- kin lymphoma, may also manifest multiple nodules or
masses [1]. Pulmonary epithelioid hemangioendothelioma
b
(Fig. 19.4), which is a lowto intermediate-grade vascular neoplasm, can manifest multiple nodules. Rheumatoid nodules, amyloidomas (Fig. 19.5), sarcoidosis, pulmonary vasculitis including ANCA-associated granulomatous vasculitis (former WegnerÕs granulomatosis) (Fig. 19.6), fungal infection (Fig. 19.7) or nocardiosis, and septic emboli are the benign inßammatory or infectious causes of multiple pulmonary nodules. Pulmonary Langerhans cell histiocytosis (eosinophilic granuloma) also manifests multiple variablesized cavitating or noncavitating nodules with cystic lung lesions.
Distribution
Lesions in abovementioned diseases show random distribution.
Clinical Considerations
The presence of multiple nodules or masses in both lungs in a patient with extrathoracic malignancy or primary lung cancer suggests the diagnosis of pulmonary metastases or
Fig. 19.1 Marginal zone B-cell lymphoma manifesting as multiple masses in both lungs in a 73-year-old woman. (a, b) Lung window images of CT scans (2.5-mm section thickness) obtained at levels of distal main bronchi (a) and right middle lobar bronchus (b), respectively, show multiple masses in both lungs. Mass contain internal CT air-bronchogram sign (arrows). Also note thin-walled air-Þlled cyst in bottom of right upper lobe. Histopathologic evaluation of ore biopsy obtained from a mass suggested extranodal marginal zone lymphoma or lymphoplasmacytic lymphoma
K.S. Lee et al., Radiology Illustrated: Chest Radiology, Radiology Illustrated, |
183 |
DOI 10.1007/978-3-642-37096-0_19, © Springer-Verlag Berlin Heidelberg 2014 |
|
184 |
19 Multiple Nodular or Mass(-like) Pattern |
|
|
a |
b |
c
Fig. 19.2 Pulmonary metastases from a breast cancer in a 62-year-old man. (a) Lung window of CT scan (5.0-mm section thickness) obtained at level of aortic arch shows multiple variable-sized poorly deÞned nodules in both upper lobes. Also note left pleural effusion (open arrow). (b) Low-magniÞcation (×40) photomicrograph of pathologic specimen
obtained from right upper lobe with wedge resection demonstrates a predominant nodule (arrows) and surrounding malignant satellite nodules. (c) High-magniÞcation (×100) photomicrograph discloses ductforming adenocarcinoma (arrows) with lymphangitic tumor spread. Also note pulmonary arterial invasion (arrowheads)
lung-to-lung metastases. Pulmonary nodules in a patient with rheumatoid arthritis may favor the diagnosis of necrobiotic nodules (rheumatoid nodules). Approximately 15Ð20 % of patients with pulmonary epithelioid hemangioendothelioma (EH) have a hepatic involvement. Pulmonary EH manifesting as multiple nodules have a relatively good prognosis, whereas the disease manifesting as reticulonodular lesions or diffuse inÞltrative pleural thickening have aggressive clinical courses. Lung nodules in a patient with chronic inßammatory disease (e.g., SjšgrenÕs syndrome) or systemic lymphoproliferative disorders and plasma cell dyscrasias (e.g., multiple myeloma) may suggest the presence of amyloidomas [2]. Nocardiosis is a disease in patients with underlying diabetes or chronic kidney disease [3]. Common predisposing factors
for septic embolism include tricuspid valve endocarditis with or without IV drug addiction, alcoholism, skin infection, and peripheral septic thrombophlebitis [4]. Airway invasive pulmonary aspergillosis is a disease in immunocompromised patients (those who have hematologic malignancy and who underwent hematopoietic stem cell transplantation) particularly whose peripheral blood absolute neutrophil count is <500 cells/μL (neutropenia). Cryptococcosis is an indolent lung infection in mildly immunocompromised patients [5]. Generalized symptoms and signs, such as diffuse alveolar hemorrhage, acute glomerulonephritis, chronic refractory sinusitis or rhinorrhea, imaging Þndings of nodules or cavities, and multisystemic disease, precede typical imaging Þndings in pulmonary vasculitis [6].
Clinical Considerations |
185 |
|
|
a |
b |
c
d
H & E stain |
CD20 |
Fig. 19.3 Diffuse large B-cell lymphoma involving lung parenchyma in a 48-year-old man who is complaining of febrile sense, cough, and dyspnea. (aÐc) Lung window images of CT scans (2.5-mm section thickness) obtained at levels of aortic arch (a), main bronchi (b), and bronchus intermedius (c), respectively, show multiple variable-sized nodules and masses in both lungs. Lesions typically have
bronchovascular distribution. Also note CT air-bronchogram signs (arrows) within mass lesions. (d) Photomicrographs of H & E staining (left) and immunohistochemical staining of CD20 (right), respectively, disclose atypical, pleomorphic, and large lymphoid cells and reactive to CD20. These Þndings are compatible with large B-cell lineage lymphoma
186 |
19 Multiple Nodular or Mass(-like) Pattern |
|
|
a |
b |
c |
d |
e
Fig. 19.4 Epithelioid hemangioendothelioma appearing as multiple innumerable pulmonary nodules in both lungs in a 22-year- old man. (aÐc) Lung window images of CT scans (2.5-mm section thickness) obtained at levels of right middle lobar bronchus (a), cardiac ventricle (b), and suprahepatic inferior vena cava (c), respectively, show multiple variable-sized small nodules in both lungs. Nodules show random distribution. Also note surrounding ground-glass opacity (arrows) in some nodules, suggestive of asso-
ciated hemorrhage. (d) Low-magniÞcation (×40) photomicrograph exhibits multiple nodules having central sclerotic and peripheral mild cellular (epithelioid endothelial proliferation) components. Nodules are distributed randomly. (e) High-magniÞcation (×200) photomicrograph discloses abundant eosinophilic stroma and tumor cells containing prominent cytoplasmic vacuoles or intracytoplasmic lumina (arrows). Inset: positive staining for CD31 indicating endothelial origin of tumor cells
Clinical Considerations |
187 |
|
|
a |
b |
Fig. 19.5 Biopsy-proven (surgical lung biopsy using video-assisted thoracoscopic surgery) amyloidomas presenting as multiple variablesized nodules in a 62-year-old man. (a, b) Lung window images of thin-section (1.5-mm section thickness) CT scans obtained at levels of
bronchus intermedius (a) and suprahepatic inferior vena cava (b), respectively, show multiple lung nodules of different size. Also note accompanying emphysema and bullae in both lungs
a |
c |
b
Fig. 19.6 Antineutrophil cytoplasmic antibody (ANCA)-associated granulomatous vasculitis displaying multiple masses in a 64-year-old man. (a, b) Lung window images of thin-section (1.5-mm section thickness) CT scans obtained at levels of right upper lobar bronchus (a) and cardiac ventricle (b), respectively, show multiple variable-sized nodules and masses in both lungs. Lesions are typically located along
bronchovascular bundles or subpleural lungs. Also note relatively extensive pulmonary emphysema. (c) Coronal reformatted CT image (5.0-mm section thickness) demonstrates nodules or mass (arrows) of diverse size in both lungs, which are distributed along bronchovascular bundles. Also note extensive emphysema in both lungs
188 |
19 Multiple Nodular or Mass(-like) Pattern |
|
|
a |
b |
c
Fig. 19.7 Pulmonary cryptococcosis manifesting as multiple variablesized nodules in both lungs in a 72-year-old man. (aÐc) Lung window images of CT scans (2.5-mm section thickness) obtained at levels of aortic arch (a), main bronchi (b), and cardiac ventricle (c), respectively,
show multiple variable-sized nodules and masses in both lungs. Lesions are located along bronchovascular bundles or subpleural lung. Core biopsy from right upper lobe nodule discloses cryptococcal organisms
Key Points for Differential Diagnosis
|
Distribution |
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Zones |
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Clinical presentations |
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Diseases |
U |
M |
L |
SP C |
R |
BV |
R |
Acute |
Subacute |
Chronic |
Others |
Pulmonary metastasis |
|
+ |
+ |
+ |
+ |
|
+ |
|
|
+ |
Variable-sized nodules |
Lymphoproliferative disease |
|
|
+ |
+ |
|
+ |
|
|
+ |
+ |
|
Pulmonary epithelioid |
+ |
+ |
+ |
|
+ |
|
+ |
|
|
+ |
Most are less than 1 cm, little |
hemangioendothelioma |
|
|
|
|
|
|
|
|
|
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or no growth on serial exam |
Rheumatoid nodules |
+ |
+ |
|
+ |
+ |
|
+ |
|
|
+ |
Variable in size, may cavitate, |
|
|
|
|
|
|
|
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|
|
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unpredictable natural course |
Amyloidomas |
|
|
+ |
+ |
|
|
+ |
|
|
+ |
Internal calciÞcations (50 %) |
Sarcoidosis |
+ |
+ |
|
+ |
|
+ |
|
|
|
+ |
Cavitation may occur; mediastinal |
|
|
|
|
|
|
|
|
|
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or hilar LN enlargement, female |
|
|
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|
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|
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predominance, African Americans |
ANCA-associated |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
|
+ |
+ |
Large necrotic area on enhanced |
granulomatous vasculitis |
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|
|
|
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|
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|
scans |
Fungal infection or |
+ |
+ |
+ |
+ |
+ |
|
+ |
+ |
+ |
|
|
nocardiosis |
|
|
|
|
|
|
|
|
|
|
|
Septic lung |
+ |
+ |
+ |
+ |
+ |
|
+ |
|
|
|
Feeding vessel sign, cavitation |
Note: ANCA antineutrophil cytoplasmic antibody, U upper, M middle, L lower, SP subpleural, C central, R random, BV bronchovascular, LN lymph node