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1、Pulmonary HRCTHistology of Normal LungInterstitial Compartments of the Lung Bronchovascular interstitium (surrounds the bronchovascular bundle) Centrilobular interstitium (surrounds the distal bronchiolovascular bundle) Interlobular septal interstitium (often seen as lines perpendicular to the pleur
2、a) Pleural interstitium unilateral lymphangitic spread of tumorBasic HRCT PatternsLinesNodulesConsolidationGround-glass OpacityCystsLinearabnormalitiesinclude:a)thickenedinterlobularsepta(image1)b)bronchovascularinterstitialthickening(image1)c)reticularchange(image2).Location of Nodules:centrilobula
3、r, random interstitialTree-in-bud PatternHistologic Section of Bronchopneumonianodules represent centrilobular interstitial tumor cut in cross-sectionCausesofnodulesTumor infectious and non-infectious granulomasPneumoconioses mucous plugsendobronchial disease and hypersensitivity pneumonia. Ground-g
4、lass Opacity caused by influenzal pneumoniaCausesofGround-glass Opacitypulmonary edema; ARDS; viral, mycoplasmal, and pneumocystis pneumonias; hypersensitivity pneumonia; pulmonary hemorrhage;other diffuse interstitial lung diseases. cysts represent multiple dilated bronchi (known as cystic bronchie
5、ctasis)Causesofcystscystic bronchiectasis multiple cysts confined to the subpleural lung are usually indicative of honeycombing, which results from chronic interstitial fibrosis.Langerhans cell histiocytosis lymphangioleiomyomatosisDiagnosticsteps1. What are the major abnormalities in this case? a)
6、Nodulesb) Linear opacitiesc) Consolidationd) Ground-glass opacity2. What is the distribution of the lesions? a) Bronchovascular interstitiumb) Interlobular septac) Centrilobular regiond) PleuraDiffuse bronchitis/bronchiolitis on HRCT:Diffuse well- and poorly-defined centrilobular nodules Tree-in-bud
7、 pattern Thickening of bronchial walls Patchy pneumonic consolidation Diagnostic features of endobronchial tuberculosis on HRCT:Tree-in-bud pattern Clustered centrilobular nodules Mass-like areas of consolidation Cavitation in larger nodules or masses Diagnostic features of bronchiectasis, bronchiti
8、s, and bronchiolitis on HRCTBronchial dilation and wall thickening Tree-in-bud pattern Centrilobular nodules Mosaic perfusion of air trapping (more later) numerous hematogenous metastatic nodules on HRCT:Usually random distribution Often smooth, well-defined Varying size common Diagnostic features o
9、f miliary tuberculosis on HRCTRandom nodules Diffuse distribution throughout lung Uniform size, upper lung Reticular change Traction bronchiectasis Focal lung sparing Diagnostic features of usual interstitial pneumonia on HRCTSubpleural reticular opacities at the lung bases, early Associated cystic
10、air spaces, 2 to 20 mm in diameter (honeycombing) Traction bronchiectasis Patchy ground-glass opacities Architectural distortion in relation to normal lung Basal, subpleural predominance Diagnostic features of Langerhans cell histiocytosis on HRCT Irregularly-shaped cysts with variable wall thicknes
11、s Small centrilobular nodules less than 5 mm in diameter Middle and upper lung zone predominance of cysts and nodules Diagnostic features of lymphangioleiomyomatosis on HRCTNumerous round, thin-walled cysts (in women of child-bearing age) Even and diffuse distribution, bilaterally End-expirationEnd-
12、inspirationDiagnostic features of bronchiolitis obliterans on HRCT EarlyInhomogeneousmosaicperfusiondiscoveredoraccentuatedonexpiratoryimagesLateBronchiectasisEnd-expiratoryimageshelptodeterminewhethermosaicperfusioniscausedbyair-trappingorprimaryvasculardisease.Note: The contrast between light and
13、dark is accentuated on the expiratory image. Note: The contrast between light and dark is not accentuated on the expiratory image. Causes of Mosaic or Inhomogeneous PerfusionSmall airway disease with a physiologic decrease in perfusion in regions of air-trapping Primary stenosing vascular disease Diagnostic features of pulmonary hypertension on HRCTMosaic perfusion pattern or normal lung Central pulmonary artery enlargement
