Part 2 book “High-Resolution CT of the lung” has contents: Pulmonary edema and acute respiratory distress syndrome, emphysema and chronic obstructive pulmonary disease, cystic lung diseases, airways diseases, pulmonary hypertension and pulmonary vascular disease, drug-induced lung diseases and radiation pneumonitis,… and other contents.
13 Pneumoconiosis, Occupational, and Environmental Lung Disease I M P O R T A N T T O P I C S ASBESTOSIS AND ASBESTOS-RELATED DISEASE 342 BERYLLIUM DISEASE (BERYLLIOSIS) 369 SILICOSIS 358 INERT DUST PNEUMONCONIOSIS 370 COAL WORKER’S PNEUMOCONIOSIS 365 WELDER’S PNEUMOCONIOSIS (SIDEROSIS) 370 GRAPHITE WORKER’S PNEUMOCONIOSIS 366 INDIUM EXPOSURE 371 MIXED DUST PNEUMONOCONIOSIS 366 FLOCK WORKER’S LUNG 371 TALCOSIS 366 ALUMINUM DUST PNEUMOCONIOSIS 368 CHEMICAL PNEUMONITIS AND SMOKE INHALATION 371 HARD METAL PNEUMOCONIOSIS 369 BIOMASS FUEL EXPOSURE 372 Abbreviations Used in This Chapter Al BAL CWP DAD DLCO DPT FEV1 FVC FWL HU ILD ILO IPF NSIP PAP PFT PMF TLC UIP aluminum bronchoalveolar lavage coal worker’s pneumoconiosis diffuse alveolar damage carbon monoxide diffusing capacity diffuse pleural thickening forced expiratory volume in second forced vital capacity flock worker’s lung Hounsfield units interstitial lung disease International Labor Organization idiopathic pulmonary fibrosis nonspecific interstitial pneumonia primary alveolar proteinosis pulmonary function test progressive massive fibrosis total lung capacity usual interstitial pneumonia Pneumoconiosis and occupation lung disease remains a significant problem Even with safety standards issued by the Occupational Safety and Health Administration and other organizations, such as the National Institute of Occupational Safety and Health, occupational lung disease continues to be one of the most common work-related injuries (1,2) The term pneumoconiosis refers to the presence of lung disease related to dust inhalation (3,4) Many pneumoconioses are related to occupational exposure (5) Some inhaled dusts lead to lung fibrosis and significant clinical disability; such pneumoconioses are classified as fibrotic Examples of fibrotic pneumoconiosis include asbestosis, silicosis, coal worker’s pneumoconiosis (CWP), berylliosis, and talcosis Other dusts are relatively inert and result in accumulation of particle-laden macrophages, but little pulmonary fibrosis or disability Such nonfibrotic pneumoconioses include siderosis or welder’s pneumoconiosis, stannosis, and baritosis High-resolution computed tomography (HRCT) has been shown to be more sensitive and specific than chest radiographs in the diagnosis of a number of pneumoconioses (3,4,6) Although a variety of abnormal findings may be observed on HRCT in patients with pneumoconioses, HRCT abnormalities generally relate to (a) the presence of peribronchiolar dust accumulation with or without associated fibrosis, usually visible as small nodular opacities; (b) aggregation of small nodular opacities into large nodules or masses; or (c) more diffuse lung inflammation or fibrosis resulting in ground-glass opacity, reticulation, traction bronchiectasis, and, in some cases, honeycombing ASBESTOSIS AND ASBESTOS-RELATED DISEASE Asbestos is a group of heterogeneous, naturally occurring fibrous silicate minerals, known since antiquity for their heat-resistant properties It has been used across industries and manufacturing, and can be found in brake linings and pads, tiles, bricks, insulation material, and linings of furnaces and ovens (1) 342 #152201 Cust: LWW Au: Webb Pg No 342 DESIGN SERVICES OF C hapter 13 Pneumoconiosis, Occupational, and Environmental Lung Disease Asbestos exposure in the workplace, and to a lesser degree in the general population, is a major public health concern in the United States Inhalation of asbestos fibers has been known to cause pulmonary and pleural fibrosis for more than 80 years Asbestos-related abnormalities include asbestosis, asbestos-related rounded atelectasis, and asbestos-related pleural disease 343 TABLE 13-1 Criteria for a Clinical Diagnosis of Asbestosis Reliable history of exposure to asbestos Appropriate time interval between exposure and detection Chest radiographic evidence of ILO types s, t, or u (small irregular) opacities with a profusion (severity) of 1/1 or greater Restrictive lung impairment with a FVC below the lower limit of normal Asbestosis The lung disease associated with asbestos fiber inhalation is known as asbestosis (4,7,8) Histologically, asbestosis is defined as interstitial pulmonary fibrosis associated with the presence of intrapulmonary asbestos bodies or asbestos fibers (9,10) After inhalation, asbestos fibers are first deposited in the respiratory bronchioles and alveolar ducts, but with longer and more extensive exposure they also accumulate in a subpleural location (9–12) In patients who have asbestosis, the earliest changes of fibrosis occur in the peribronchiolar region of the lobular core (6,11–13) As the fibrosis progresses, it involves alveolar walls throughout the lobule and, eventually, the lobular periphery and interlobular septa Honeycombing can be seen in advanced cases Visceral pleural thickening often overlies areas of parenchymal fibrosis In asbestosis, abnormalities are usually most severe in the lower and posterior lungs and in a subpleural location (12) Yamamoto et al (14) classified the lung fibrosis of asbestosis as two types: honeycombing predominant fibrosis, seen in approximately 40% of cases and indistinguishable from that of usual interstitial pneumonia (UIP), and atelectatic induration predominant fibrosis, seen in the remainder and unlike that seen in UIP It is uncommon, in clinical practice, to obtain histologic proof of asbestosis; this diagnosis is usually presumptive and based on indirect evidence (9,15–17) The expression “clinical diagnosis of asbestosis” has been adopted by the American Thoracic Society (ATS) to refer to a diagnosis based on a combination of chest radiographic abnormalities, restrictive abnormalities on pulmonary function tests (PFTs), appropriate physical findings, and known exposure to asbestos (Table 13-1) (16–18) Although none of these clinical or radiographic criteria is specific, the presence of multiple abnormal findings in an individual with significant asbestos exposure is taken as presumptive evidence of asbestosis A diagnosis of asbestosis is difficult to make and is probably inappropriate when only a few physical or functional abnormalities are present Limitations in the accuracy of these criteria have been pointed out, and interstitial fibrosis in asbestos-exposed patients does not always reflect asbestosis; in one study, 5% of patients who had biopsy-proven interstitial lung disease and asbestos exposure had a disease other than asbestosis on lung biopsy (19) Symptoms and physical findings are present in only a small minority of patients who have asbestosis, unless the disease is relatively advanced (7,9,16) Similarly, reductions in lung volumes and diffusing capacity, which #152201 Cust: LWW Au: Webb Pg No 343 Diffusing capacity below the lower limit of normal Bilateral late or pan inspiratory crackles at the posterior lung base, not cleared by coughing Modified from Schwartz A, Rockoff SD, Christiani D, et al A clinical diagnostic model for the assessment of asbestosis: a new algorithmic approach J Thorac Imaging 1988;3:29–35; McLoud TC The use of CT in the examination of asbestos-exposed persons [Editorial] Radiology 1988;169:862–863; American Thoracic Society The diagnosis of nonmalignant diseases related to asbestos Am Rev Respir Dis 1986;134:363–368 are typical of restrictive lung disease, are insensitive for detecting early or mild degrees of dysfunction in patients who have asbestosis The chest radiograph is often relied on to help in diagnosis, but it is quite limited in its ability to detect early disease Clinical symptoms and radiographic findings of asbestosis are not usually detected until 10 years after exposure, and this latent period is sometimes as long as 40 years (9,16,18) Gallium scintigraphy can be of value in patients who have early disease (13,20) Plain Radiographic Diagnosis of Asbestosis The International Labor Organization (ILO) classification of pneumoconiosis radiographs provides a method for objectively recording and quantitating the parenchymal and pleural abnormalities seen in patients who have asbestos-related diseases (16,17,21,22) Although certain ILO abnormalities (Table 13-1) are often assumed to be diagnostic of asbestosis in patients who have been exposed to asbestos, numerous authors have stressed the limitations of chest radiographs in detecting or making a confident diagnosis of this disease (9,16,17,21–26) Chest radiographs are relatively insensitive in detecting the presence of asbestosis In a study performed by Epler et al (27), of 58 patients who had asbestosis diagnosed on lung biopsy, (10%) had normal chest radiographs according to ILO standards Kipen et al (24) found that 25 of 138 (18%) asbestos-exposed patients who had histologic proof of pulmonary fibrosis had no radiographic findings of this disease Furthermore, 80% of the cases that were graded as less than 1/0 according to ILO standards had moderate or severe histologic grades of fibrosis It is also clear that the ILO classification of radiographs lacks specificity for diagnosing asbestosis (21,22); there are no plain radiographic findings that are pathognomonic of this disease Epstein et al (28) found that 36 of 200 (18%) screening chest radiographs showed small opacities that were consistent with pneumoconiosis using the ILO classification system; of these, 22 (61%) had no known DESIGN SERVICES OF 344 s e c t i o n III High-Resolution CT Diagnosis of Diffuse Lung Diseases occupational exposure to asbestos In other studies, it has been suggested that cigarette smoking results in radiographic abnormalities indistinguishable from those produced by asbestosis, but this is controversial (17,21,29) HRCT Techniques in Asbestos-Exposed Subjects In patients who have asbestos exposure, it has been recommended that scans should be obtained both supine and prone at each level (9,15,30) or in the prone position only (8,31) It is particularly important to scan asbestos-exposed individuals in the prone position because the posterior lung is typically involved earlier and to a greater degree than the anterior lung (8) Unless prone scans are obtained, it may be impossible to distinguish normal dependent atelectasis from early fibrosis in the posterior lung (Fig 13-1) In evaluating patients who have asbestos exposure, several authors have indicated that a limited number of scans should be sufficient for the diagnosis of lung disease (8,9,15,25,30,31) Because of the typical basal distribution of asbestosis, obtaining four or five scans near the lung bases with the most cephalad scan obtained at the level of the carina should be sufficient for detection of an abnormality Indeed, this approach has proven to have good sensitivity in patients who have suspected asbestosis and would be appropriate for screening groups of asbestos-exposed individuals (32) In an individual patient with asbestos exposure and suspected lung disease, however, the most appropriate protocol is to obtain HRCT at 2-cm intervals, both prone and supine This technique allows a more complete assessment of abnormal findings, including lung masses, emphysema, and pleural abnormalities (8), allows a more accurate diagnosis of the type of lung disease present, and is more accurate in distinguishing fibrotic lung disease from emphysema, which can have similar symptoms Low-dose spiral CT with 5-mm-thick image reconstruction has also been shown to be accurate in demonstrating pleural and pulmonary abnormalities in asbestos-exposed individuals (33) HRCT Findings of Asbestosis On HRCT, asbestosis can result in a variety of findings, depending on the severity of the disease (6,8,9,11,15,17,25,30,34–36) A very characteristic finding in patients with asbestosis is a basal predominance of pulmonary abnormalities Akira et al (37) found predominant lower lung zone involvement in 78 of 80 (98%) patients with asbestosis, while only patients had predominant upper lobe disease It is also characteristic for lung abnormalities to be most severe in the posterior lung and subpleural regions The earliest abnormal findings recognizable on HRCT in patients who have asbestosis reflect the presence of centrilobular, peribronchiolar fibrosis (Table 13-2) (11,35,38) In one study (11), dotlike opacities were visible in the subpleural lung in patients who had early asbestosis, forming clusters and subpleural curvilinear opacities when confluent; these correlated with the presence of peribronchiolar A TABLE 13-2 HRCT Findings in Asbestosis Findings of fibrosis (i.e., traction bronchiectasis or bronchiolectasis, intralobular interstitial thickening, irregular interlobular septal thickening, irregular interfaces)a Honeycombing in advanced disease Subpleural dotlike opacities in early disease (peribronchiolar fibrosis)a Subpleural linesa Parietal pleural thickening or plaquesa,b Parenchymal bands, particularly in association with pleural thickeninga,b B FIGU RE 13-1 Dependent lung opacity (atelectasis) in a patient with asbestos exposure A: In the supine position, ill-defined areas of increased opacity are visible posteriorly Irregularity of the costal pleural surfaces reflects pleural thickening and plaques B: In the prone position, the lungs are normal in appearance There is no evidence of reticulation and fibrosis The pleural irregularity, particularly within the posterior lung, remains visible #152201 Cust: LWW Au: Webb Pg No 344 Earliest abnormalities posterior and basal Ground-glass opacity a b Most common finding(s) Finding(s) most helpful in differential diagnosis DESIGN SERVICES OF C hapter 13 Pneumoconiosis, Occupational, and Environmental Lung Disease 345 B A FIGU RE 13-2 Subpleural dotlike opacities in asbestosis Radiographic (A) and histologic (B) sections of an inflation-fixed lung obtained from a patient with early asbestosis Small nodular opacities (arrows) are visible in the subpleural lung regions, representing peribronchiolar fibrosis (From Akira M, Yokoyama K, Yamamoto S, et al Early asbestosis: evaluation with high-resolution CT Radiology 1991;178:409–416, with permission.) fibrosis extending to involve the contiguous airspaces and alveolar interstitium (Fig. 13-2) In a subsequent study (35), subpleural nodular opacities or “dots” were visible in 21 of 23 patients who had early asbestosis, reflecting peribronchiolar fibrosis These nodular opacities are typically visible several millimeters from the pleural surface and may be associated with fine reticulation (Figs 13-3 to 13-5) In a subsequent review of 80 patients with asbestosis, Akira et al (37) found subpleural dotlike or branching opacities in 81% The presence of peribronchiolar fibrosis can also result in an abnormal prominence of the centrilobular arteries, giving rise to an increased reticulation in the peripheral lung (11,15) As pulmonary fibrosis extends from the peribronchiolar regions to involve the remainder of the pulmonary lobule, other findings of fibrosis can be recognized Intralobular interstitial thickening (intralobular lines) (Fig. 13-5), irregular reticular opacities, thickening of interlobular septa or fibrosis in the periphery of pulmonary lobules (i.e., a perilobular pattern) (Fig 13-6), B A FIGU RE 13-3 Early fibrosis in asbestosis with dotlike opacities and a subpleural line A: Prone HRCT shows an irregular subpleural line in the posterior right lung (small arrows) and a parenchymal band (long arrow) The posterior left lung is only minimally abnormal B: A targeted image of the posterior right lung shows a number of small dotlike opacities in the peripheral lung These are quite similar to the subpleural opacities, reported by Akira et al (35), and reflect the presence of peribronchiolar fibrosis #152201 Cust: LWW Au: Webb Pg No 345 DESIGN SERVICES OF 346 s e c t i o n III High-Resolution CT Diagnosis of Diffuse Lung Diseases FIGU RE 13-4 Early fibrosis in asbestosis On a prone scan, small dots and a fine reticular pattern are visible in the posterior subpleural lung (arrows) Although this appearance is nonspecific, it is consistent with asbestosis A A B FIGU RE 13-6 Centrilobular and perilobular fibrosis in asbestosis B FIGU RE 13-5 Fibrosis in asbestosis A: HRCT shows bilateral pleural thickening typical of asbestos-related pleural disease (arrows) The thickened pleura is visible internal to ribs and separated from them by extrapleural fat Pleural thickening is also visible in the paravertebral regions Several regions of thickened pleura are calcified B: HRCT shows dotlike opacities (arrows) in the subpleural lung associated with intralobular interstitial thickening #152201 Cust: LWW Au: Webb Pg No 346 A: HRCT shows a reticular pattern in the lung periphery corresponding to thickened interlobular septa or fibrosis in the periphery of lobules Several regions of thickened pleura are calcified B: Lung slice in a patient with asbestosis Centrilobular nodules (small arrows) associated with peribronchiolar fibrosis are visible in the lung periphery Patchy fibrosis of interlobular septa (large arrows) is also seen Longer linear scars represent parenchymal bands (Courtesy of Martha Warnock, MD.) DESIGN SERVICES OF C hapter 13 Pneumoconiosis, Occupational, and Environmental Lung Disease 347 B A FIGU RE 13-7 A–C: Supine and prone HRCT in an 81-year-old man with significant occupational exposure to asbestos, dyspnea, and an abnormal chest radiograph Images show subpleural reticulation predominantly representing intralobular interstitial thickening and perilobular fibrosis Early honeycombing (C, arrow) and traction bronchiectasis are visible at the lung base C traction bronchiectasis or bronchiolectasis, architectural distortion, and findings of honeycombing (Figs 13-7 to 13-9) can all be seen in patients who have asbestosis, depending on the severity of their disease (9,11,15,25,37) Fibrosis in the periphery of lobules and interlobular septal thickening are common in early disease (9,30,39), but may be difficult to recognize in patients with advanced disease and honeycombing (40) Akira et al (37) found B C A FIGU RE 13-8 Asbestosis with honeycombing in a 66-year-old man A: Calcified pleural plaques are visible, typical of asbestos exposure B and C: HRCT at two levels through the lung bases shows intralobular lines, thickening of interlobular septa, and parenchymal bands D: A targeted image shows septal thickening and early subpleural honeycombing, which forms a subpleural line #152201 Cust: LWW Au: Webb Pg No 347 DESIGN SERVICES OF 348 s e c t i o n III High-Resolution CT Diagnosis of Diffuse Lung Diseases D FIGU RE 13-8 (Continued) intralobular interstitial thickening in 69% of 80 patients with asbestosis, and irregular interlobular septal thickening was seen in 89% Honeycombing was visible in 34% of 80 patients with asbestosis studied by Akira et al (37), and typically predominates in the peripheral and posterior lung (Figs. 13-7 to 13-9) In a study of patients who had advanced lung disease (40), subpleural honeycombing was present in 100% of those with asbestosis Parenchymal bands are common in patients who have asbestosis (Figs 13-6 and 13-8 to 13-12) (6,9,11,15,31,39), and may reflect thickening of interlobular septa, fibrosis along bronchovascular sheaths (11), coarse scars, or areas of atelectasis adjacent to pleural plaques or areas of visceral pleural thickening (41) (Fig 13-11C) Several bands occurring in the same location may give the appearance of a “crow’s foot.” Often in patients who have asbestosrelated disease, parenchymal bands are associated with areas of thickened pleura and have a basal predominance (Fig 13-12) (9,42) Akira et al (37) found that in patients with asbestosis, parenchymal bands occurred significantly more often (53%) in patients with pleural disease than in those without (21%) In one study, parenchymal bands were found to be unilateral in 69% of cases (41) Gevenois et al (41) considered parenchymal bands to be related to visceral pleural fibrosis and to be distinct from findings of pulmonary fibrosis—namely, septal lines, intralobular lines, and honeycombing Parenchymal bands can be seen in a number of fibrotic diseases, but are particularly common in patients who have asbestosis In one study, multiple parenchymal bands were seen in 66% of asbestos-exposed patients, whereas parenchymal bands A B FIGU RE 13-9 Asbestosis with honeycombing A: HRCT in a patient with asbestos exposure with pleural thickening and calcification shows extensive honeycombing at the lung bases B: Lung slice in a different patient with asbestosis shows fibrosis and honeycombing (arrows) in the periphery of the lower lobe This distribution is typical (Courtesy of Martha Warnock, MD.) #152201 Cust: LWW Au: Webb Pg No 348 FIGU RE 13-10 Interlobular septal thickening and parenchymal bands in a patient with early asbestosis View of the posterior lower lobe on a prone scan shows interlobular septal thickening (small arrows) and a thicker parenchymal band (large arrows) DESIGN SERVICES OF C hapter 13 Pneumoconiosis, Occupational, and Environmental Lung Disease 349 B A FIGU RE 13-11 A and B: HRCT in a 58-year-old man with a history of asbestos exposure and pleural thickening Parenchymal bands and interlobular septal thickening are associated with pleural thickening This finding does not necessarily indicate the presence of asbestosis but may reflect atelectasis or coarse scars C: Histologic section in a patient with asbestosis (trichrome stain) shows fibrotic parenchymal bands (small arrows) bridging several lobules Peribronchovascular fibrosis is also visible (large arrow) (Courtesy of Martha Warnock, MD.) C were much less frequent in a control group of patients who did not have asbestos exposure (9) In another study, it was found that parenchymal bands were present in 79% of patients who had asbestosis, as compared with only 11% of patients who had idiopathic pulmonary fibrosis (IPF) (43) In a study of patients who had histologically proven asbestosis (39), parenchymal bands were visible on HRCT in 76% Subpleural lines can reflect early fibrosis occurring in patients who have asbestosis (Figs 13-3 and 13-13) A B FIGU RE 13-12 DPT and parenchymal bands in asbestosis A: On a prone scan, extensive pleural thickening is visible bilaterally (arrows) B and C: Prone (B) and supine (C) HRCT show bilateral parenchymal bands, occurring in relation to the thickened pleura A focal fibrotic mass or region of rounded atelectasis is visible in the posterior lung C #152201 Cust: LWW Au: Webb Pg No 349 DESIGN SERVICES OF 350 s e c t i o n III High-Resolution CT Diagnosis of Diffuse Lung Diseases FIGU RE 13-13 Subpleural line in asbestosis On a prone scan, early lung fibrosis with intralobular interstitial thickening is associated with a subpleural line (arrow) (11,44); this finding has been associated with the presence of peribronchiolar and associated lung fibrosis, resulting in collapse and flattening of alveoli (6,11) Akira et al (37) found subpleural lines in 69% of 80 patients with asbestosis In patients who have more severe fibrosis, a subpleural line can reflect honeycombing (Fig 13-8) Subpleural lines can also reflect atelectasis; in asbestosexposed individuals, subpleural lines representing atelectasis have a propensity to occur adjacent to plaques (Fig. 13-14) (31) Ground-glass opacity is uncommon as an isolated abnormality in patients who have asbestosis (43) When present, this finding is usually seen in association with reticular opacities, traction bronchiectasis, and honeycombing, and reflects fibrosis When seen in isolation, it correlates with the presence of mild alveolar wall and interlobular septal fibrosis or edema (11) This finding is much more frequent in association with other causes of interstitial pneumonia than it is in patients who have asbestosis (43) It should be kept in mind that patients who have asbestosis usually show a number of HRCT findings indicative of lung fibrosis, and the abnormalities are usually bilateral and often somewhat symmetric (41) The presence of focal or unilateral HRCT abnormalities should not be considered sufficient for making this diagnosis In fact, FIGU RE 13-14 Subpleural line associated with pleural plaques and pleural thickening Several subpleural lines (arrows) are visible bilaterally, occurring adjacent to pleural plaques and regions of pleural thickening #152201 Cust: LWW Au: Webb Pg No 350 in one study, three abnormal findings indicative of interstitial disease were required before a definite diagnosis could be made (39) Furthermore, although asbestosis can be present in the absence of visible pleural plaques, a diagnosis of asbestosis should be considered questionable unless pleural thickening is visible on HRCT Although the presence of typical asbestos-related pleural thickening or plaques (described in a subsequent section) in association with findings of lung fibrosis may be used to suggest the diagnosis of asbestosis, it should be kept in mind that not all patients with asbestosis show pleural abnormalities Pleural disease was found in 66 of 80 (83%) patients with asbestosis studied by Akira et al (37) and 78% of 74 patients with asbestosis studied by Copley et al (45) Scoring systems for use with HRCT, analogous to the ILO system for chest radiographic interpretation, have been proposed by Gamsu et al (39), Al-Jarad et al (46), Kraus et al (47,48), Huuskonen et al (49), and Kusaka et al (50), one of which involves the use of 28 additional symbols In a study by Al-Jarad et al (46), the HRCT scoring system was found to have better interobserver repeatability than the ILO system, although both HRCT and the ILO system scores correlated to a similar degree with impairment of lung function Kraus et al (47,48) found their system practical and reproducible Gamsu et al (39) assessed the relative accuracy of a subjective semiquantitative scoring system for HRCT and a relatively simple method of scoring based on the cumulative number of HRCT findings present in patients who have proven asbestosis; similar results were found for both scoring systems Huuskonen et al (49) also reported a simple HRCT scoring system they believed to be reliable and reproducible for classifying lung fibrosis and diagnosing asbestosis in large populations with occupational exposure Although these systems may provide a method for quantification, they may lack sensitivity Silva et al (51) evaluated changes over time, after cessation of exposure, in the pattern and extent of parenchymal abnormalities in asbestos-exposed workers, and compared three semiquantitative HRCT techniques They found that the majority of patients with previous asbestos exposure show evidence of progression on CT at to years followup, but that this progression is not usually detected using the three assessed scoring schemes The study included 52 male asbestos workers (mean age 62.2 years) who had baseline HRCT after cessation of exposure and follow-up HRCT to years later Two thoracic radiologists independently quantified the findings according to the scoring systems proposed by Gamsu et al (39), Huuskonen et al (49), and Sette et al (52) There was no significant difference in the prevalence of the two most common parenchymal abnormalities (centrilobular small dotlike or branching opacities and interstitial lines) between the initial and follow-up CT scans Honeycombing (20%) and traction bronchiectasis and bronchiolectasis (50%) were seen more commonly on the follow-up CT than on the initial examination (10% and 33%, respectively) DESIGN SERVICES OF C hapter 13 Pneumoconiosis, Occupational, and Environmental Lung Disease (p = 0.01) An increased extent of parenchymal abnormalities was evident on side-by-side comparison of the HRCT studies in 42 (81%) patients, but this resulted in an increase in score in at least one semiquantitative system in only 16 (31%) patients (all p > 0.01) (51) On the other hand, a study by Bar-Shai et al (53) assessed changes in PFTs and chest CT over a 15-year period after cessation of asbestos exposure in a group of workers at an Israeli power plant The mean length of their exposure was 30 ± 10 years (range 7–43 years) Comparison of the initial and follow-up CT findings revealed a similar prevalence of pleural plaques, but a significant increase in the frequency of calcification (from 37% to 66%, p = 0.008), no change in the prevalence of pulmonary fibrosis (37%), and a deterioration in PFT results (p = 0.04) Functional Significance of High-Resolution Computed Tomography Abnormalities in Asbestosis Sette et al (52) evaluated the relationship between HRCT abnormalities and impairment of pulmonary gas exchange at rest and during moderate exercise in workers exposed to asbestos A significant correlation was found between extent of interstitial lung disease (ILD) on HRCT and impairment of gas exchange (p < 0.01) Logistic regression analysis demonstrated significant association of parenchymal bands (odds ratio, 6.20; 95% CI: 1.99, 19.22) and subpleural nodules (odds ratio, 3.83; 95% CI: 1.23, 11.89) with functional impairment In smoking asbestos-exposed workers, the presence of smoking-related pulmonary emphysema, pleural disease, and lung fibrosis can all contribute to disability Copley et al (54) studied 133 individuals who had been exposed to asbestos in an attempt to develop an HRCT system for assessing the relative contribution of asbestos-induced pleural and pulmonary disease, and smoking-related emphysema, to functional impairment The extent of asbestos-induced pleural disease, pulmonary disease, and emphysema measured using HRCT correlated significantly with various parameters of physiologic impairment (p < 0.001) When predictive equations related to HRCT findings were applied to an additional group of asbestos-exposed individuals, total lung capacity (TLC) (r = 0.75, p < 0.001) and carbon monoxide diffusing capacity (DLCO) (r = 0.64, p < 0.001) correlated strongly with the HRCT score Another study (55) also attempted to determine the HRCT findings associated with impairment of lung function and DLCO in smoking asbestos-exposed workers, and the results suggest that emphysema is the most important factor Marked impairment of DLCO was associated with combined fibrosis and emphysema but not with pleural disease or pulmonary fibrosis alone For the subjects with combined fibrosis and emphysema, the mean fibrosis score did not differ between those with normal, slightly reduced, or markedly reduced DLCO, but the emphysema score was significantly higher for the patients with marked impairment than for those with normal DLCO (p < 0.01) #152201 Cust: LWW Au: Webb Pg No 351 351 Utility of High-Resolution Computed Tomography in the Diagnosis of Asbestosis In patients who have significant asbestos exposure but no evidence of asbestosis on chest radiographs, it has been reported that as many as 20% to 30% will have some abnormal HRCT findings consistent with this disease (i.e., findings of pulmonary fibrosis) (15,23) However, other studies report the percentage of asbestos-exposed patients who have normal chest radiographs and abnormal HRCT studies to be as low as 5% (31,56) Although the precise figures may vary depending on the population studied, it is universally conceded that HRCT is more sensitive than chest radiographs in detecting this disease As stated previously, 10% to 20% of patients who have asbestosis diagnosed histologically have normal chest radiographs (24,27) Certainly, chest films underestimate the presence of histologic asbestosis (24,27), but what is the significance of HRCT abnormalities in asbestos-exposed patients who have normal or near-normal chest radiographs? This question was addressed in a study of 169 asbestos- exposed workers with normal chest radiographs (ILO, 0/0 or 0/1) who also had HRCT (23) In this group, HRCT scans were read as normal or nearly normal in 76 (45%), abnormal and suggestive of asbestosis in 57 (34%), or abnormal but not suggestive of pulmonary fibrosis in 36 (21%) Comparing the two groups in whom HRCT was interpreted as normal or suggestive of asbestosis, the group considered to be abnormal on HRCT had significantly lower vital capacity (percent predicted) and DLCO (percent predicted) than did the normal group; these are functional findings typically associated with asbestosis (23) However, there was no difference between the groups in a number of other clinical and functional parameters, including smoking history and measures of airway obstruction Thus, based on this study, it appears as if HRCT is able to discriminate between groups of patients who have normal and abnormal lung function and indicates the significance of the abnormalities identified on HRCT In another study, Harkin et al (57) studied 37 a sbestosexposed individuals who had normal or near-normal chest radiographs using HRCT, PFTs, and bronchoalveolar lavage (BAL) A normal HRCT proved to be an excellent predictor of normality, with PFT values close to 100% predicted for forced vital capacity (FVC), forced expiratory volume in second (FEV1), TLC, DLCO, and normal BAL However, abnormal HRCT findings were associated with reduced FEV1/FVC ratio, reduced DLCO, and BAL findings consistent with asbestosis Bergin et al (58) emphasized the nonspecific nature of the HRCT findings used to diagnose mild degrees of asbestosis In a study of 157 patients who did not have evidence of asbestos exposure (58), HRCT showed dependent subpleural lines in 32 (20%), nondependent subpleural lines in 19 (12%), parenchymal bands in 47 (30%), thickened septal lines in dependent areas in 93 (59%), septal lines in nondependent areas in 67 (43%), and honeycomb lung DESIGN SERVICES OF 718 s e c t i o n I V High-Resolution CT Review TUBERCULOSIS HRCT Findings (See pages 429–437.) Tuberculosis can result in a variety of findings, including pneumonia, cavitary consolidations or masses, endobronchial spread of infection resulting in centrilobular nodules or tree-in-bud, and miliary (random) nodules Patchy unilateral or bilateral airspace consolidation Cavitation, thin or thick walled Scattered centrilobular nodules, tree-in-bud Small, well-defined nodules, random distribution Pleural effusion Low-density hilar/mediastinal lymph nodes Patchy bilateral consolidation (primary tuberculosis) Endobronchial spread of infection with centrilobular nodules Cavitary lesion with centrilobular nodules and tree-in-bud (arrows) Miliary TB with diffuse small nodules involving the pleural surface (open arrow), small vessels (curved arrows), and septa (small arrows) C h a p t e r 24 Appearances and Characteristics of Common Diseases 719 USUAL INTERSTITIAL PNEUMONIA HRCT Findings (See pages 210–220.) Usual interstitial pneumonia (UIP) is a histologic pattern characterized by heterogeneous lung involvement and honeycombing It is the most common interstitial pneumonia Idiopathic UIP is idiopathic pulmonary fibrosis (IPF) The differential diagnosis of UIP includes collagen-vascular diseases, asbestosis, drug reactions, and end-stage hypersensitivity pneumonitis See also Idiopathic Pulmonary Fibrosis Findings are also those of IPF Irregular reticular opacities Traction bronchiectasis Honeycombing in 70% Peripheral, subpleural, lower lung zone, posterior predominance Ground-glass opacity unusual except in areas showing fibrosis Patchy subpleural honeycombing Subpleural, lower lobe honeycombing Peripheral, subpleural, lower lung zone, posterior predominance of abnormalities Subpleural intralobular interstitial thickening in early disease 720 s e c t i o n I V High-Resolution CT Review VIRAL (CYTOMEGALOVIRUS) PNEUMONIA HRCT Findings (See pages 456–458.) Cytomegalovirus pneumonia is an important cause of morbidity and mortality among immunosuppressed patients It is illustrated as an example of HRCT findings seen in viral infections Patchy bilateral ground-glass opacity, consolidation, or both Reticulation (resolving disease) Crazy paving Centrilobular ground-glass opacity nodules Patchy ground-glass opacity Crazy paving: patchy ground-glass opacity with septal thickening (arrow) Patchy ground-glass opacity Index NOTE: Page numbers followed by f and t indicate figures and tables A ABPA See Allergic bronchopulmonary aspergillosis (ABPA) Acinar nodules, 107, 660 Acinus, 660 relative to secondary pulmonary lobule, pulmonary, 660f Acquired immunodeficiency syndrome (AIDS) See also HIV/AIDS acute Pneumocystis jirovecii (carinii) pneumonia in patient with, 453f extensive Kaposi sarcoma in patient with, 295f HRCT levels in patient with Pneumocystis jirovecii pneumonia associated with, 142f lymphoid interstitial pneumonia in patient with, 114f, 248f, 249–250f, 299f, 607f patient with fungal pneumonia, 178f, 179f patient with pulmonary hypertension, 16f -related bronchiectasis, 593f -related lymphoma, 304 Active tuberculosis, HRCT findings in, 431t Acute eosinophilic pneumonia, 391 Acute interstitial pneumonia (AIP), 239–242, 240f, 241f, 242t, 679 acute respiratory distress syndrome secondary to, 487f and ARDS with developing fibrosis, 489f Acute lung injury, ground-glass opacity associated with, 142f Acute Pneumocystis jirovecii (carinii) pneumonia, in AIDS patients, 453f Acute respiratory distress syndrome (ARDS), 398, 710 with developing lung fibrosis, 489f and diffuse alveolar damage, 485–490, 486f, 486t exudative stage of, 486f, 487f with lung fibrosis, 490f pulmonary fibrosis following, 490f secondary to acute interstitial pneumonia, 487f Acute silicosis, 358, 358f Acute tracheobronchitis, 467–468 Adaptive statistical iterative reconstruction (ASIR), 23 Adenocarcinoma invasive mucinous, 288–294, 289f, 290f, 291f, 292f, 293f, 695 with lepidic growth, 287f pulmonary, 149f, 288–294, 289f, 290f, 291f, 292f, 293f Adult T-cell leukemia-lymphoma (ATLL), 307–308 AIDS See Acquired immunodeficiency syndrome (AIDS) AILD See Angioimmunoblastic lymphadenopathy (AILD) AIP See Acute interstitial pneumonia (AIP) Air bronchogram, 660–661 Air crescent sign, 661, 661f Air-filled cystic lesions, 165–184 algorithmic approach to diagnosis of, 183–184, 183f, 184f bronchiectasis, 180–183 bullae emphysema, 173, 175, 177 bullous emphysema, 173, 175, 177 cavitary nodules, 179–180, 179f emphysema, 173–178 honeycombing, 166 lung cysts, 165–166 pneumatocele, 178 Air trapping, 661–662 on expiratory HRCT, 65–66, 191–203 in normals, 198–199 in patient with asthma, 195f in patient with bronchiolitis obliterans, 195f in patient with chronic airway infection and bronchiolitis, 194f in patient with idiopathic scoliosis, 25f in patient with normal inspiratory scans, 199 in patient with postinfectious bronchiolitis obliterans, 662f quantitative assessment of, 202–203 sarcoidosis with mosaic perfusion and, 324f, 325f Airspace, 661 consolidation, 661, 661f cystic, 666 enlargement, irregular, 529, 669 nodules, 108f, 661, 661f Airway anatomy, 54f, 596f diameter to wall thickness, relation of, 50t infection, 123f, 126f, 194f invasive pulmonary aspergillosis, 466f, 467, 468f morphology during expiration, changes in, 67–68 -predominant COPD, 530–532, 531f segmentation, automated, 568f small, 674 wall thickening diffuse, due to Crohn disease, 592f with ulcerative colitis, 591–592f Airway diseases, 36, 36t, 323f, 324f, 552–613 extent and severity of, estimating, 535–538, 537–539f mosaic perfusion due to, 189 small, in COPD, 532 extent and severity of, estimating, 538–539 Algorithm, kV(p), and mA on image noise, effect of, 6f Aliasing, 39 Allergic bronchopulmonary aspergillosis (ABPA), 123, 563f, 578f, 579f, 580f, 584–586, 585t, 680 Alpha-1-antiprotease deficiency, panlobular emphysema due to, 523f, 524f Alpha-1-antitrypsin deficiency, 588 Aluminum dust pneumoconiosis, 368–369 Alveolar damage, diffuse See Diffuse alveolar damage (DAD) Alveolar microlithiasis, 159–160, 160f Alveolar proteinosis, 19f, 77f, 79, 681 Amiodarone, 399f, 401–402 lung, 403–404f, 462f pulmonary toxicity, 160, 160f Amyloid, lymphoid interstitial pneumonia and, 251f Amyloidosis, 419–423, 420t, 423f B-cell lymphoma with, 421f diffuse alveolar septal, 421f focal (primary), 422f lung nodules in, 135 with multiple myeloma, 420f, 421f with perilymphatic nodules, 114f Anemia, sickle-cell, 637, 637f Angioimmune proliferative lesion, 305–306 Angioimmunoblastic lymphadenopathy (AILD), 299–300, 300f Angioinvasive aspergillosis, 463–467 Angulation, gantry, 32 Ankylosing spondylitis, 274–276, 275f, 275t Anorectic drugs, pulmonary hypertension associated with use of, 631f Antineoplastic agents, 402, 404 Antineutrophilic cytoplasmic antibody, small vessel vasculitis associated with, 646–649 Architectural distortion, 662 ARDS See Acute respiratory distress syndrome (ARDS) Arteries large bronchi and, 48–51 in lobes, 48f normal appearance of large bronchi and, 49f Arterobronchus ratio, 559 Artifacts bronchiectasis, 40f double fissure, 40f motion-related, 39–40 reduction of cardiac motion, 31–32 streak, 39 Asbestos exposure, 135, 344f, 347f, 349f, 354f, 355f, 356f parenchymal bands in patient with, 97 -related disease, 342–358, 682 pleural disease, 353–358 Asbestosis, 343–353, 682 centrilobular and perilobular fibrosis in, 346f criteria for clinical diagnosis of, 343t diffuse pleural thickening and parenchymal bands in, 349f early fibrosis in, 345f fibrosis in, 346f functional significance of HRCT abnormalities in, 351 with honeycombing, 347–348f HRCT findings, 344–351, 344t HRCT techniques in asbestos-exposed subjects, 344 versus idiopathic pulmonary fibrosis, 352–353, 352t lung nodules in, 124 parenchymal bands in patient with, 97f patient with early, 348f plain radiographic diagnosis of, 343–344 subpleural curvilinear line in patient with, 99f subpleural dotlike opacities in, 345f subpleural line in, 350f utility of HRCT in diagnosis of, 351–352 Asian panbronchiolitis, bronchiolar abnormalities in, 123f ASIR See Adaptive statistical iterative reconstruction (ASIR) Aspergilloma, 462, 462f developing, 463f Aspergillosis See also Invasive pulmonary aspergillosis (IPA) airway invasive pulmonary, 466f, 467, 468f 721 #152201 Cust: LWW Au: Webb Pg No 721 DESIGN SERVICES OF 722 Index Aspergillosis See also Invasive pulmonary aspergillosis (IPA) (continued) allergic bronchopulmonary, 123, 563f, 578f, 579f, 580f, 584–586, 585t, 680 angioinvasive, 463–467 chronic necrotizing (semi-invasive), 462, 463f fungal infections other than, 468–471 invasive pulmonary, 462–463, 463t, 464f, 465f, 467f, 468f Aspergillus bronchopneumonia, 467 Aspergillus-related lung disease, 461–468 Aspergilloma, cavitary tuberculosis associated with, 437f Aspiration, 124 organizing pneumonia associated with, 149f Asthma, 123, 195f, 577f, 582–584 Atelectasis, 344f, 353, 354f, 569, 662 rounded, 135 ATLL See Adult T-cell leukemia-lymphoma (ATLL) Atoll sign, 662, 673 consolidation and, 154–156, 156f, 157f Autoimmune pulmonary alveolar proteinosis, 411 Automated airway segmentation, 568f Azoospermia, obstructive, 589 B B-cell lymphoma with amyloidosis, 421f HRCT findings in low-grade, 301t B/A See Bronchoarterial (B/A) ratio BAC See Bronchioloalveolar carcinoma (BAC) Bacille Calmette-Guérin after immunotherapy, for bladder carcinoma, 446f Bacterial bronchopneumonia, 450f BAL See Bronchoalveolar lavage (BAL) BALT See Bronchus-associated lymphoid tissue (BALT) BALToma, 301t BD See Behỗet disease (BD) Beaded septal thickening, 78f, 79–82 Beaded septum sign, 662, 662f Behỗet disease (BD), 624, 644, 645f, 646t Berylliosis, 369370, 370f Beryllium disease, 369–370 BHD See Birt-Hogg-Dubé syndrome (BHD) Bilateral lung transplantation and normal lung function, 202f Bilateral subpleural curvilinear lines, in patient with idiopathic pulmonary fibrosis, 99f Biomass fuel exposure, 372 Bird fancier lung, 377f, 378f, 379f, 380f, 381f, 382f, 383f, 387f Birt-Hogg-Dubé syndrome (BHD), 171f, 172 clinical findings, 510, 513 HRCT findings, 513–514, 513f, 514t Bladder carcinoma, bacille Calmette-Guérin after immunotherapy for, 446f Blebs, 662 bullae and, 175, 177 Bleomycin, 401 nonspecific interstitial pneumonia in man treated with, 400f BO See Bronchiolitis obliterans (BO) Bone marrow transplant recipient with bronchiolitis obliterans, HRCT in, 188f Bone marrow transplantation, constrictive bronchiolitis associated with, 613 BOOP See Bronchiolitis obliterans organizing pneumonia (BOOP) Bowel disease, inflammatory See Inflammatory bowel disease Breast carcinoma, 76f, 281f, 407f, 408f Breath, 212f, 227f, 283f Bronchi and arteries, 48–51, 48f, 49f window mean and width on visibility of, 34–35f Bronchial artery enlargement, in bronchiectasis, 566f Bronchial diameter, 48–50 Bronchial dilatation, 558 Bronchial tapering, 559–560 Bronchial wall thickening, 50–51, 50f, 560–561, 560f reversible, associated with inflammation, 561f Bronchiectasis, 122, 122f, 123f, 180–183, 180f, 181f, 553–593, 662–663, 663f AIDS-related, 593f artifacts, 40f associated conditions and possible mechanisms, 553t associated with systemic diseases, 589–593 bronchial artery enlargement in, 566f and bronchiolitis, 564f and bronchiolitis obliterans, 589f clinical correlation, 556–557 due to Crohn disease, 592f CT phenotypes associated with, 540–541 cylindrical, 181, 182f, 554f cystic, 180–181, 182f, 555–556f differentiation of peribronchovascular interstitial thickening and, 95f, 96f diseases associated with, 572–593, 572f allergic bronchopulmonary aspergillosis, 584–586 alpha-1-antitrypsin deficiency, 588 asthma, 582–584 bronchiectasis associated with systemic diseases, 589–593 cystic fibrosis, 182f, 574–582, 575f dyskinetic cilia syndrome, 586–587 familial congenital bronchiectasis, 588 Kartagener syndrome, 586–587, 587f tracheobronchomegaly, 587–588, 587f Williams-Campbell syndrome, 588 yellow nails and lymphedema, 589 Young syndrome, 589 extensive, in Mounier-Kuhn syndrome, 557f gantry angulation in patient with right middle lobe, 32f HRCT findings in, 558t visual interpretation, 557–566 imaging techniques in, 566–567, 567f in immune deficiency, 593f in man with IPF, 213f morphologic types of, 182f mosaic perfusion and air trapping, 562–565, 564f mucoid impaction, 561–562, 561f, 562f pitfalls in diagnosis of, 569–571, 570f, 570t, 571f pseudobronchiectasis, 180f, 570 quantitative HRCT airway evaluation, 567–569 radiographic findings, 557 reversible, 569, 570f in rheumatoid arteritis, 260f sarcoidosis with, 329f sarcoidosis with peribronchovascular fibrosis associated with traction, 133f scoring systems, 569t with signet ring sign, 96f and small airway infection by pseudomonas, 123f traction, 133f, 181, 183, 183f, 347f, 571f, 675, 675f types of, 180–181, 182f with ulcerative colitis, 591–592f utility of HRCT for diagnosis of, 571–572 varicose, 180, 182f, 554–555f Williams-Campbell syndrome with, 588f Bronchiolar abnormalities in Asian panbronchiolitis, 123f Bronchiolar diseases, 119–120, 595t, 596t Bronchiole, 663 respiratory, 673 terminal, 675 Bronchiolectasis, 663, 663f in man with IPF, 213f traction, 675 Bronchiolitis, 593–613, 663 cellular, 594 with centrilobular nodules, follicular, 125f clinical and etiologic classification of, 595 constrictive, 594–595, 606–613, 609f, 610f diffuse panbronchiolitis, 600–602, 601f, 601t, 602f diseases associated with, 606–613 follicular, 124–125, 125f, 297–298, 297f, 298f, 605–606, 606f histologic classification of, 594–595, 594t, 595–596f HRCT classification of, 595–613 infectious, 597f, 598f, 599f, 600 mosaic perfusion and, 194f mosaic perfusion in bronchiectasis and, 564f noninfectious, 600 panbronchiolitis, 122–123, 123f #152201 Cust: LWW Au: Webb Pg No 722 respiratory, 603–604, 603f tree-in-bud, 597–602, 597f, 598f, 599f viral, 122f Bronchiolitis obliterans (BO), 124, 594–595, 606, 684 air trapping in patient with postinfectious, 662f expiratory air trapping in patient with, 195f HRCT findings in, 608t HRCT in bone marrow transplant recipient with, 188f HRCT in boy with postinfectious, 188f inspiratory and expiratory postinfectious, 194f inspiratory and postexpiratory HRCT inpatient with, 200f MD-HRCT image in patient with, 20f postexpiratory air trapping in patient with, 195f related to rheumatoid arthritis, 188f rheumatoid arthritis with bronchiectasis and, 589f from smoke inhalation, dynamic expiratory HRCT in patient with, 29f Bronchiolitis obliterans organizing pneumonia (BOOP), 153f, 233–239, 399–400 Bronchioloalveolar carcinoma (BAC), diffuse, 293t Bronchitis See Tracheobronchitis, acute Bronchoalveolar lavage (BAL) alveolar proteinosis before and after, 415f Bronchoarterial (B/A) ratio, 48–50, 49f, 50f, 558–559 normal and abnormal, 559f Bronchocentric, 663 Bronchocentric granulomatosis, 394–395 Bronchopneumonia, 108f, 118f, 121, 121f, 127f, 448–450, 449f Aspergillus, 467 bacterial, 450f due to Haemophilus influenzae infection, 449f due to Pseudomonas infection, 449f Bronchopulmonary aspergillosis, allergic, 123, 563f, 578f, 579f, 580f, 584–586, 585t, 680 Bronchovascular bundle, 663 Bronchus, subacute hypersensitivity pneumonitis in woman of right upper lobar, 381f Bronchus-associated lymphoid tissue (BALT), 296 Bronchus intermedius, dynamic expiratory HRCT showing stenosis of, 27f Bullae, 526f, 528f, 663, 664f Bullae emphysema, 173, 175, 177, 177f Bullectomy, for emphysema, 543 Bullous emphysema, 173, 175, 177, 526–529, 527f, 690 C Calcification, 159f, 364f Candida, 468–469 Capillaritis, diffuse pulmonary hemorrhage with, 650f Carcinoma adenocarcinoma invasive mucinous, 695 with lepidic growth, 287f pulmonary, 149f, 288–294, 289f, 290f, 291f, 292f, 293f bladder, 446f breast, 76f, 281f, 407f, 408f bronchioloalveolar, 293t HRCT findings in lymphangitic spread of, 283t HRCT in patient who had partial left pneumonectomy for lung, 284f interlobular septal thickening in patients with lymphangitic spread of, 76f interlobular septal thickening with lymphangitic spread of breast, 76f lung, 284f, 407f, 408f lymphangitic metastatic, 703 lymphangitic spread of, 111, 113f, 114f, 281t, 283t breast, 281f thyroid, 114f metastatic hematogenous, 702 lymphangitic, 703 organizing pneumonia and radiation for right breast, 408f DESIGN SERVICES OF Index rectal carcinoma, hematogenous metastases from, 116f testicular hematogenous metastases and, 288f organizing pneumonia and, 399f thyroid carcinoma, lymphangitic spread of, 114f Cardiac motion artifacts, reduction of, 31–32 Cardiac sarcoidosis, 334f Cardiogenic pulmonary edema, 483f Cardiomyopathy, hydrostatic pulmonary edema in patient with, 481–482f Cardiovascular abnormalities and pulmonary hypertension, 627 Cavitary masses, Wegener granulomatosis with, 647f Cavitary nodules, 179–180, 179f, 497f Cavitary sarcoidosis, 328–329 Cavitary tuberculosis, 433f, 437f Cavity, 663–664 CB See Constrictive bronchiolitis (CB) Cellular bronchiolitis, 593 Central or medullary lung, 60 Centriacinar (centrilobular) emphysema, 519f Centrilobular anatomy in isolated lung, 58f Centrilobular and perilobular fibrosis in asbestosis, 346f Centrilobular bronchiolar abnormality, 123f Centrilobular emphysema (CLE), 173, 174f, 175f, 176f, 177f, 519, 519f, 520f, 520t, 521f, 522f, 664, 664f, 687 confluent, 522f distinguished from lung cysts, 178 minimum and maximum-intensity projection imaging in, 534–535f Centrilobular interstitial thickening, 664, 672 Centrilobular interstitium, 664–665 Centrilobular nodules, 116–129, 602–606, 603f, 605f, 627 follicular bronchiolitis with, 125f of ground-glass opacity in patient with hypersensitivity pneumonitis, 123f HRCT appearance of, 117f in hypersensitivity pneumonitis, 605f in infection, 118f invasive mucinous adenocarcinoma with, 125f, 290f, 291f in patient with bronchopneumonia, 118f, 119f in patient with chronic airways disease and bronchopneumonia, 118f in patient with hypersensitivity pneumonitis, 117f, 664f and rosettes in patient with endobronchial spread of tuberculosis, 120f in sarcoidosis, 318f soft-tissue attenuation, 130–131, 130t and tree-in-bud in patient with tuberculosis, 120f Centrilobular opacities, 627 Centrilobular region, 58–59 Centrilobular rosettes and tree-in-bud in patient with endobronchial spread of tuberculosis, 120f Centrilobular structures, 58–59, 664 CEP See Chronic eosinophilic pneumonia (CEP) CF See Cystic fibrosis (CF) Chemical pneumonitis and smoke inhalation, 371–372 Chest wall parietal pleura and, 61f pleural surfaces and, 61f Chronic airways disease and bronchopneumonia, centrilobular nodules in patient with, 118f Chronic bronchiectasis and small airway infection by pseudomonas, 123f Chronic eosinophilic pneumonia (CEP), 389–391, 389f, 390f, 390t, 683 Chronic hypersensitivity pneumonitis, 377f in bird fancier, 383–384f with fibrosis and curing of sausages, 385f with fibrosis in bird fancier, 385f in patient in exposed to feathers in fly fishing, 384f Chronic mineral oil aspiration, lipoid pneumonia from, 417f, 418f Chronic myelogenous leukemia, HRCT in man with, 402f Chronic necrotizing (semi-invasive) aspergilloma, 462, 463f Chronic obstructive pulmonary disease (COPD), 529–547 airway-predominant, 530–532, 531f, 536–538, 537–539f on CT, visually defined patterns of, 530t CT image assessment in, 533–541 emphysema-predominant, 529–530, 530f, 533–535, 534–535f, 536f endoscopic approaches to, 546–547 patients, CT imaging techniques for, 532 phenotypes in, 529–532 small airway disease in, 532, 538–539 Chronic pulmonary embolism, 625f, 626f, 635–636, 636f Chronic pulmonary thromboembolism (CPTE), 635–636 HRCT findings in, 636t Chronic renal failure and metastatic calcification, 159f Churg-Strauss syndrome (CSS), 134–135, 391–394, 392f, 393f, 393t, 394f, 648, 649f Cicatricial emphysema, 529 Cigarette smoking, 496f Cirrhosis, hepatopulmonary syndrome in patient with, 642f CLE See Centrilobular emphysema (CLE) CMV See Cytomegalovirus (CMV) Coal macule, histologic appearance of, 365f Coal worker’s pneumoconiosis (CWP), 361t, 365–366, 365f, 716 perilymphatic nodules in patient with, 110–111, 113f Coalescent nodules, 318–321, 320f Cocaine overdose, diffuse alveolar damage due to, 399f Coccidioidomycosis, miliary, 115f Collagen-vascular diseases (CVDs), 256–276, 589–590, 652 ankylosing spondylitis, 274–276 mixed connective tissue disease, 270–272 polymyositis-dermatomyositis, 268–270 progressive systemic sclerosis, 261–266 relative frequency of patterns of abnormality in, 257t rheumatoid arthritis, 257–261 scleroderma, 261–266 Sjögren syndrome, 272–274 systemic lupus erythematosus, 266–268 Collimation on resolution, effect of, 4f Common variable immune deficiency (CVID), 593 Computed tomography See HRCT (high-resolution computed tomography) Confluent centrilobular emphysema, 522f Congenital pulmonary alveolar proteinosis, 411 Conglomerate masses, 132f, 665, 665f Consolidation, 152–158, 665, 665f algorithmic approach to diagnosis of, 156–158, 157f atoll sign and, 154–156, 156f, 157f differential diagnosis of, 150–151, 155t halo sign and, 153–154, 154f invasive mucinous adenocarcinoma with, 290f, 291f Constrictive bronchiolitis (CB), 594–595, 606–613, 608t, 610f, 684 associated with bone marrow transplantation, 613 associated with heart-lung or lung transplantation, 611–613 associated with rheumatoid arthritis, 610–611 idiopathic, 608–610 after lung transplantation, 610f, 611f postinfectious, 608 Contrast agents, use of, 32 COP See Cryptogenic organizing pneumonia (COP) COPD See Chronic obstructive pulmonary disease (COPD) COPDGene study, technical recommendations for, 533 Cortical and medullary lung, concept of, 59–60 Cortical lung, peripheral or, 59–60 Corticomedullary differentiation in lung, 60f Cough and shortness of breath, HRCT in man who has, 283f CPTE See Chronic pulmonary thromboembolism (CPTE) #152201 Cust: LWW Au: Webb Pg No 723 723 Crazy paving, 144f, 146–147f, 147–150, 148f, 149f, 149t, 413f, 414f, 415f, 665, 665f Crohn disease, diffuse airway wall thickening and bronchiectasis due to, 592f Cross-sectional lung area changes in, during expiration, 66–67 Cryptococcus, 469–470 Cryptogenic organizing pneumonia (COP), 232–239, 233f, 233t, 234f, 235f, 236f, 237f, 706 airspace nodules in patient with, 108f CSS See Churg-Strauss syndrome (CSS) CVDs See Collagen-vascular diseases (CVDs) CVID See Common variable immune deficiency (CVID) CWP See Coal worker’s pneumoconiosis (CWP) Cyclophosphamide, 401 Cylindrical bronchiectasis, 180, 182f, 554f Cystic airspace, 666 Cystic bronchiectasis, 180–181, 182f, 555–556f Cystic disease, sarcoidosis with, 328–329, 329f Cystic fibrosis (CF), 122, 122f, 182f, 188f, 196f, 574–582, 574f, 575f, 576f, 581t, 685 Cystic lung disease, 166–172, 168–171f, 492–514 Birt-Hogg-Dubé syndrome, 510, 513–514, 513f, 514t differential diagnosis of, 167t extensive, 171f lymphangiomyomatosis, 500–510 lymphoid interstitial pneumonia, 510, 511f, 512f pulmonary Langerhans cell histiocytosis, 492–500 typical of Langerhans histiocytosis, HRCT in patient with, 168f Cysts, 665–666 honeycombing with large lung, 166f in hypersensitivity pneumonitis, 383f incidental lung, 172–173 Langerhans cell histiocytosis with lung, 168–169f lung See Lung cysts in patient who has lymphangiomyomatosis, lung, 666f pulmonary Langerhans cell histiocytosis with, 496f in woman with lymphoid interstitial pneumonia, lung, 170f in woman with Sjögren syndrome, lung, 170f Cytarabine, hypersensitive pneumonitis and, 399f Cytomegalovirus (CMV) pneumonia, 456–458, 457f, 457t, 458f, 720 viral pneumonias other than, 458–461 D DAD See Diffuse alveolar damage (DAD) DCS See Dyskinetic cilia syndrome (DCS) Decreased lung attenuation, 187–203 air trapping on expiratory HRCT, 191–203 ground-glass opacity versus mosaic perfusion, 190–191 mixed disease and headcheese sign, 191 mosaic perfusion, 187–190 Density, transient dependent, 9f Dependent opacity, 666, 666f Desquamative interstitial pneumonia (DIP), 245– 248, 245f, 246f, 246t, 247f, 500f, 686 Diffuse alveolar damage (DAD), 398, 399f, 485–490, 486f, 486t, 649–654 with capillaritis, 650f HRCT findings in, 650, 651t pulmonary edema without, 484 unassociated with pulmonary capillaritis, 650t Diffuse alveolar septal amyloidosis, 421f Diffuse bronchioloalveolar carcinoma See Invasive mucinous adenocarcinoma Diffuse lung disease, 37t Diffuse panbronchiolitis (DPB), 600–602, 601f, 602f, 707 Diffuse pleural thickening (DPT), and parenchymal bands in asbestosis, 349f Diffuse pulmonary neoplasms, 280–308 hematogenous metastases, 285–288 Kaposi sarcoma, 294–296 lymphoproliferative disorders, lymphoma, and leukemia, 296–308 pulmonary lymphangitic carcinomatosis, 280–285 DESIGN SERVICES OF 724 Index Diffuse sarcoidosis with random distribution of nodules, 116f Diffuse thin-walled lung cysts, causes of, 493t DIP See Desquamative interstitial pneumonia (DIP) Diseases airways, 323f, 324f, 552–613 bronchiectasis, 553–593 bronchiolitis, 593–613 diseases associated with bronchiectasis, 572–593 diseases associated with bronchiolitis, 606–613 asbestos-related, 353–358 Aspergillus-related lung, 461–468 associated with bronchiectasis, 572–593 allergic bronchopulmonary aspergillosis, 584–586 alpha-1-antitrypsin deficiency, 588 asthma, 582–584 bronchiectasis associated with systemic diseases, 589–593 cystic fibrosis, 574–582 dyskinetic cilia syndrome, 586–587 familial congenital bronchiectasis, 588 Kartagener syndrome, 586–587, 587f tracheobronchomegaly, 587–588, 587f Williams-Campbell syndrome, 588 yellow nails and lymphedema, 589 Young syndrome, 589 associated with bronchiolitis, 606–613 beryllium, 369–370 bronchiectasis associated with systemic, 589–593 bronchiolar, 594t, 595t collagen-vascular, 589–590 drug-related, 394 fungal, 394 inflammatory bowel, 590 miscellaneous infiltrative lung, 411–426 amyloidosis, 419–423, 420f, 420t, 421f, 422f, 423f exogenous lipoid pneumonia, 416–419, 416t, 417f, 418f light chain deposition disease, 423–424, 424f pulmonary alveolar microlithiasis, 424–426, 426f pulmonary alveolar proteinosis, 411–416, 412f, 413f, 414f, 415f, 416f musculoskeletal, 332f obstructive lung, 36, 36t utility of HRCT in diagnosing asbestos-related pleural, 356–357 Disseminated pulmonary ossification, 161 Distal acinar emphysema, 666 Dosages for asbestos screening, 24 radiation, 20–24, 21t Double fissure artifacts, 40f DPB See Diffuse panbronchiolitis (DPB) DPT See Diffuse pleural thickening (DPT) Drug abuse, 367f, 368t Drug and toxin-induced pulmonary arterial hypertension, 629, 631f Drug-induced lung disease, 397–405 acute respiratory distress syndrome, 398 bronchiolitis obliterans organizing pneumonia, 399–400 diffuse alveolar damage, 398 eosinophilic pneumonia, 400 HRCT findings in, 398t hypersensitivity pneumonitis, 399 nonspecific interstitial pneumonia, 400–401 organizing pneumonia, 399–400 and radiation pneumonitis, 397–409 reaction to specific drugs, 401–405 Drug-related diseases, 394 Drugs anorectic, 631f reaction to specific, 401–405 Dual energy, use of, 32–33 Dust pneumoconiosis, aluminum, 368–369 Dynamic expiratory HRCT, 25–29, 26f, 28f, 29f, 666 Dyskinetic cilia syndrome (DCS), 586–587 Dyspnea, nonspecific interstitial pneumonia in man who had, 222f E ECG gated MD-HRCT, 31f Edema interlobular septal thickening resulting from pulmonary, 75f, 76f mixed, 484–485 postpartum pulmonary, 485f pulmonary, 481–485 Eggshell calcification in silicosis, 364f Eisenmenger syndrome, pulmonary hypertension in patient with, 623f Electrocardiographically triggered HRCT, 31–32 Embolism chronic pulmonary, 625f, 626f, 635–636, 636f fat, 638–639 of foreign material, 639 of parasites, 639–670 pulmonary artery tumor, 637–638 Emphysema, 173–178, 517–529, 666, 667f airways disease, or obstructive lung disease, 36t bullae, 173, 175, 177, 177f bullous, 173, 175, 177, 526–529, 527f, 690 centrilobular, 173, 174f, 175f, 176f, 177f, 519f, 520f, 521f, 534–535f, 664, 664f, 687 centrilobular emphysema with extensive paraseptal, 522f cicatricial, 529 classification of, 518 confluent centrilobular, 522f CT quantitation of, 178 distal acinar, 666 extent and severity of, estimating, 533–535, 534–535f, 536f giant bullous, 528f and honeycombing, 541f honeycombing versus paraseptal, 177–178, 177f HRCT findings in, 519–529, 520t left lung transplantation for panlobular, 203f lung cysts versus centrilobular, 178 panlobular, 173, 175f, 176f, 203f, 519–523, 523f, 524f, 525t, 671, 671f, 688 paraseptal, 84f, 85t, 177–178, 177f, 521f, 522f, 523, 525–526, 525f, 526f, 534–535f, 671, 672f, 689 pathogenesis of, 517–518 -predominant COPD, 529–530, 530f radiographic findings, 518–519 with small focal lucencies, 520f End-stage lung, 666 End-stage sarcoidosis, 714 Endobronchial spread of neoplasm, lung nodules in, 125 nontuberculous mycobacterial infection with, 120–121, 121f of tuberculosis, 120–121, 120f, 121f, 432f Endoscopic approaches to COPD, 546–547 Environmental lung disease, occupational and, 342–372 aluminum dust pneumoconiosis, 368–369 asbestosis and asbestos-related disease, 342–358 berylliosis, 369–370 beryllium disease, 369–370 biomass fuel exposure, 372 chemical pneumonitis and smoke inhalation, 371–372 coal worker’s pneumoconiosis, 365–366 flock worker’s lung, 371 graphite worker’s pneumoconiosis, 366 hard metal pneumoconiosis, 369 indium exposure, 371 inert dust pneumoconiosis, 370 mixed dust pneumoconiosis, 366 siderosis, 370–371 silicosis, 358–365 talcosis, 366–368 welder’s pneumoconiosis, 370–371 Eosinophilia, single pulmonary, 388–389 Eosinophilic lung diseases, 388–394 hypersensitivity pneumonitis and, 376–395 Eosinophilic pneumonia, 153f, 389–391, 400, 400f acute, 391 chronic, 389–391, 389f, 390f, 390t, 683 #152201 Cust: LWW Au: Webb Pg No 724 Epoprostenol failure or response, pulmonary arterial hypertension and, 634t Essential cryoglobulinemia, 654 Exogenous lipoid pneumonia, 416–419, 416t from chronic mineral oil aspiration, 417f, 418f Expiratory air trapping in patient with bronchiolitis obliterans, 195f Expiratory HRCT, 24–30, 63f, 64f, 667 air trapping on, 191–203 dynamic, 25–29, 26f, 29f, 66f, 196f helical, normal low-dose dynamic, 28f normal, 62–68 Expiratory scans and diagnosis of mixed disease, 200–202 and diagnosis of mosaic attenuation, 199–200 F Familial congenital bronchiectasis, 588 Farmer, subacute hypersensitivity pneumonitis in, 381f Fat embolism, 638–639 FBP See Filtered back projection (FBP) Feathers in fly fishing, chronic hypersensitivity pneumonitis in patient exposed to, 384f Fibrosis acute respiratory distress syndrome with developing lung, 489f, 490f AIP and ARDS with developing, 489f in asbestosis, 346f centrilobular and perilobular, 346f early, 345f, 346f in bird fancier, chronic hypersensitivity pneumonitis with, 385f and curing of sausages, chronic hypersensitivity pneumonitis with, 385f interstitial, 141f lung, 143f mixed connective tissue disease with pulmonary, 271f in patient with scleroderma, findings of, 263f parenchymal, 325–326 peribronchovascular, 133f perivascular, 640f persistent opacity in posterior lung inpatient with pulmonary, 9f pulmonary sarcoidosis and findings of pulmonary, 327f, 328f sarcoidosis with, 327f, 328–329f scleroderma and mild interstitial, 263f in silicosis, conglomerate masses of, 133f due to silicosis, progressive massive, 362f, 363f Fibrotic masses, focal, 353 Fibrotic nonspecific interstitial pneumonia, 90f Fibrotic sarcoidosis, HRCT findings in, 325t Filtered back projection (FBP), 23 Flock worker’s lung (FWL), 371 Fly fishing, chronic hypersensitivity pneumonitis in patient in exposed to feathers in, 384f Focal fibrosis in patient with asbestos exposure and pleural thickening, atelectasis or, 135 Focal fibrotic masses, 353, 354f Focal lymphoid hyperplasia, 296–297, 297f Follicular bronchiolitis, 124–125, 125f, 297–298, 297f, 298f, 605–606, 606f Foreign material, embolism of, 639 Fuel exposure, biomass, 372 Fungal disease, 394 Fungal infections other than aspergillosis, 468–471 Fungal pneumonia, cavitary nodules in AIDS patient with, 178f, 179f Fungus, subacute hypersensitivity pneumonitis in woman exposed to, 379f FWL See Flock worker’s lung (FWL) G Gantry angulation, 32, 32f GGO See Ground-glass opacities (GGO) Giant bullous emphysema, 528f Giant cell (temporal) vasculitis, 643 Glossary of high-resolution computed tomography terms, illustrated, 660–676 Goodpasture syndrome, 141f, 650–651, 652f DESIGN SERVICES OF Index GPA See Granulomatosis with polyangiitis (GPA) Granulomas, sarcoidosis with conglomerate mass of, 320f Granulomatosis, 305–306, 640f bronchocentric, 394–395 Wegener, 134, 134f Granulomatosis with polyangiitis (GPA) See Wegener granulomatosis Graphite worker’s pneumoconiosis, 366 Ground-glass attenuation, 667 Ground-glass opacities (GGO), 129–130, 130t, 140–152, 234f, 236f, 237f, 321, 667, 667f algorithmic approach to diagnosis of, 150–151, 151f associated with acute lung injury, 142f associated with interstitial fibrosis, 141f associated with lung fibrosis, 143f in boy with Goodpasture syndrome and pulmonary hemorrhage, 141f crazy-paving pattern, 147–150, 148f, 149t diagnostic pitfalls, 151–152 differential diagnosis of, 143–145, 144t, 151t distinguished from mosaic perfusion, 190–191 eosinophilic pneumonia and, 153f histologic abnormalities associated with, 145–146, 147t inspiratory and postexpiratory HRCT inpatient with and, 199f and interlobular septal thickening, 149f invasive mucinous adenocarcinoma with, 290f, 291f mycoplasma pneumonia with patchy, 447f organizing pneumonia with patchy areas of consolidation and, 152f in patient with hypersensitivity pneumonitis, 123f, 142f in patient with nonspecific interstitial pneumonia, 143f Pneumocystis carinii with, 142 pulmonary alveolar proteinosis, 413f, 414f, 415f sarcoidosis with, 321f, 322f, 324f significance of, 142–143 H Haemophilus influenzae, 121f infection, bronchopneumonia due to, 449f Halo sign, 667 consolidation and, 153–154, 154f reversed, 154–156, 156f, 157f, 673 tuberculosis with reversed, 434f Hard metal pneumoconiosis, 369, 369f Headcheese sign, 191, 192f, 193f, 667, 668f hypersensitivity pneumonitis, 201f Heart, scans of, 31f Heart-lung transplantation, bronchiolitis obliterans associated with, 611–613 Heavy metal pneumoconiosis, 161 Helical HRCT, normal low-dose dynamic expiratory, 28f Hematogenous metastases, 116f, 285–288, 286f, 287f, 288f, 288t, 702 Hemoptysis, 37, 37t Hemorrhage, 141f, 148f, 199f, 691 associated with idiopathic pulmonary hemosiderosis, 652f associated with systemic lupus erythematosus, 653f associated with thrombotic thrombocytopenic purpura, 651f crazy paving in, 651f findings of, 627 with intralobular interstitial thickening and intralobular lines, 670f lung nodules in, 126 microscopic polyangiitis with, 649f Wegener granulomatosis with, 648f Henoch-Schönlein purpura, 653–654 Hepatitis C, sarcoid-like reaction in patient with, 337f Hepatopulmonary syndrome (HPS), 640–642, 641f, 641t Heritable pulmonary arterial hypertension, 629 Herpes simplex virus pneumonia, 461 Hilar pulmonary edema, in patient with renal failure, 484f Histiocytosis, HRCT in man with Langerhans, 168f in woman with Langerhans, 168f HIV/AIDS, 590–593 See also Acquired immunodeficiency syndrome (AIDS) HIV-positive patient nontuberculous mycobacterial infection in, 445–446 tuberculosis in, 437–439 Hodgkin lymphoma, 303t Honeycombing, 668 air-filled cystic lesions, 166 diagnosis variability in, 88–89 differential diagnosis of, 86t distinguished from paraseptal emphysema, 177–178, 177f emphysema and, 541f in idiopathic pulmonary fibrosis, 83f, 86–88, 166f, 213–214f, 668f with large lung cysts, 166f in nonspecific interstitial pneumonia, 224f in paraseptal emphysema, 84f, 85t in rheumatoid lung disease, 84f sarcoidosis with, 329f in usual interstitial pneumonia, 86–88, 87f, 87t, 88t Hot tub lung, 444f HP See Hypersensitivity pneumonitis (HP) HPS See Hepatopulmonary syndrome (HPS) HRCT (high-resolution computed tomography), 2, 667 See also MD-HRCT appearance of centrilobular nodules, 117f appearance of increased lung opacity, 141f appearance of perilymphatic nodules, 316f appearances and decreased attenuation, 165f appearances of large bronchi and arteries in lobes, 48f appearances of trachea, 67f in bone marrow transplant recipient with bronchiolitis obliterans, 188f in boy with postinfectious bronchiolitis obliterans, 188f bronchiectasis scoring systems, 569t comparison of 1.25-mm spaced axial, 10f, 11f dynamic expiratory, 25–29, 26f, 66f, 666 inspiratory and expiratory, 63f inspiratory and postexpiratory, 64f, 65f levels in patient with Pneumocystis jirovecii pneumonia associated with AIDS, 142f linear and reticular opacities visible on, 75f lobular anatomy, 57f in man who has cough and shortness of breath, 283f in man with chronic myelogenous leukemia, 402f in man with Langerhans histiocytosis, 168f normal expiratory, 62–68 normal low-dose dynamic expiratory helical, 28f normal postexpiratory, 194f -pathological correlation in man with ChurgStrauss syndrome, 393f in patient who had partial left pneumonectomy for lung carcinoma, 284f in patient with alveolar microlithiasis with lung and soft-tissue windows, 160f in patient with bilateral lung transplantation, dynamic expiratory, 27f in patient with bronchiolitis obliterans from smoke inhalation, 29f in patient with centrilobular emphysema, 177f in patient with cystic lung disease typical of Langerhans histiocytosis, 168f in patient with mixed connective tissue disease, 270–272, 271f, 272f in patient with paraseptal emphysema, 177f in patient with pulmonary hemorrhage and ground-glass opacity, 199f in patient with pulmonary hypertension, 632f in patient with tuberous sclerosis and lymphangiomyomatosis, 169f sarcoidosis showing perilymphatic distribution of nodules on, 110–111f showing stenosis of bronchus intermedius, 27f technical aspects of, 2–40, 3t additional technical modifications, 31–33 expiratory HRCT, 24–30 #152201 Cust: LWW Au: Webb Pg No 725 725 fundamental techniques, 2–10 HRCT artifacts, 39–40 HRCT protocols, 36–38 image display, 33–36 radiation dose, 20–24 spaced axial scans versus volumetric scanning, 10–20 spatial resolution of HRCT, 38–39 techniques of scan acquisition, 10–20 terms, illustrated glossary of, 660–676 in woman with Langerhans histiocytosis, 168f in woman with lymphangiomyomatosis, 169f in woman with mixed connective tissue disease, 271f in woman with systemic lupus erythematosus, 268f HRCT (high-resolution computed tomography) findings, 2, 667 abnormalities clinical findings of, 72–73 combinations and patterns of, 71–72 distribution of, 72 in active tuberculosis, 431t in acute interstitial pneumonia, 239–242, 242t, 679 in acute respiratory distress syndrome, 486–490, 487t in adult, cystic fibrosis, 581t air trapping on expiratory, 191–203 in allergic bronchopulmonary aspergillosis, 585–586, 585t, 680 in alveolar proteinosis, 681 in amiodarone pulmonary toxicity, 160f in amyloidosis, 419–422, 420f, 420t, 421f in angioinvasive aspergillosis, 464–465 in ankylosing spondylitis, 274–276, 275t in asbestos-related disease, 682 in asbestosis, 344t, 352t, 682 in asthma, 583584 in Behỗet disease, 646t in Birt-Hogg-Dubé syndrome, 513–514, 513f, 514t in bronchiectasis, 557–566, 558t in bronchiolitis, 595–613 in bronchiolitis obliterans, 608t, 684 in bronchocentric granulomatosis, 394–395 in bullous emphysema, 690 in centrilobular emphysema, 520t, 687 in chronic eosinophilic pneumonia, 683 in chronic hypersensitivity pneumonitis, 389–391, 390t, 693 in chronic pulmonary thromboembolism, 636t in Churg-Strauss syndrome, 393t in coal worker’s pneumoconiosis, 361t, 716 in constrictive bronchiolitis, 608, 608t, 684 in cryptogenic organizing pneumonia, 233–239, 233t, 706 in cystic fibrosis, 579–581, 685 in cytomegalovirus pneumonia, 457t, 720 in desquamative interstitial pneumonia, 246t, 686 in diffuse alveolar damage, 486–490, 487t in diffuse bronchioloalveolar carcinoma, 293t in diffuse panbronchiolitis, 601t, 707 in diffuse pulmonary hemorrhage with, 650, 651t in drug-induced lung disease, 398t in early or active sarcoidosis, 317t in end-stage sarcoidosis, 714 in exogenous lipoid pneumonia, 416–419, 416t, 417f, 418f expiratory, 667 in fibrotic sarcoidosis, 325t in hematogenous metastatic carcinoma, 288t, 702 in hemorrhage, 691 in hepatopulmonary syndrome, 641t in hypersensitive pneumonitis, 379t in idiopathic pulmonary arterial hypertension, 629t in idiopathic pulmonary fibrosis, 212t, 352t, 694 in invasive mucinous adenocarcinoma, 695 in Kaposi sarcoma, 294–296, 296t, 696 in Langerhans cell histiocytosis, 697 in lipoid pneumonia, 698 low-dose, 670 in low-grade B-cell lymphoma, 301t in lung disease, 74–102 in lymphangiomyomatosis, 503–508, 506t, 699 DESIGN SERVICES OF 726 Index HRCT (high-resolution computed tomography) findings (continued) in lymphangitic metastatic carcinoma, 703 in lymphangitic spread of carcinoma, 283t in lymphoid interstitial pneumonia, 248–252, 249t, 299t, 700 in lymphoma, 701 in mixed connective tissue disease, 272t in mosaic perfusion, 625–627 in Mycobacterium avium-intracellulare complex, 704 in mycoplasma pneumonia, 447–448, 447t in non-Hodgkin lymphoma, 303t in nonspecific interstitial pneumonia, 221t, 705 in nontuberculous mycobacterial infections, 440–444, 443t in HIV-positive patients, 445–446 normal low-dose dynamic expiratory helical, 28f normal postexpiratory, 194f in panlobular emphysema, 525t, 688 in paraseptal emphysema, 526t, 689 of pleural thickening, 354–356 in pleuroparenchymal fibroelastosis, 252–253, 252t in Pneumocystis carinii pneumonia, 451–455, 451t, 709 in pneumonia, 293t in polymyositis-dermatomyositis, 268–270, 269t in posttransplantation lymphoproliferative disorder, 305t in progressive systemic sclerosis, 261–266, 263t in pulmonary adenocarcinoma, 289–294, 292f, 293t in pulmonary alveolar microlithiasis, 425–426 in pulmonary alveolar proteinosis, 412–414, 412t in pulmonary arterial hypertension, 708 in pulmonary aspergillosis, 463t in pulmonary capillary hemangiomatosis, 634t in pulmonary edema, 483t, 710 in pulmonary Hodgkin lymphoma, 303t in pulmonary Langerhans cell histiocytosis, 495–498, 497t in pulmonary lymphangitic carcinomatosis, 281–285 of pulmonary vascular disease, 622–627 in pulmonary veno-occlusive disease, 633t in radiation pneumonitis, 406t in respiratory bronchiolitis-interstitial lung disease, 244t, 711 in rheumatoid arthritis, 259t, 712 in sarcoidosis, 713 in scleroderma, 715 in septic embolism and infarction, 471t in silicosis, 361t, 716 in Sjögren syndrome, 273t in subacute hypersensitivity pneumonitis, 692 in systemic lupus erythematosus, 267t, 717 in talcosis secondary to intravenous drug abuse, 368t in tuberculosis, 718 in usual interstitial pneumonia, 719 in Wegener granulomatosis, 646t Hughes-Stovin syndrome, 624 Human meta pneumovirus, 461 Hydrostatic edema, 710 Hydrostatic pulmonary edema, 481–484 Hypereosinophilic syndrome, 391, 392f Hyperplasia, focal lymphoid, 296–297, 297f Hyperplasia, micronodular pneumocyte, 506–507f Hypersensitivity pneumonitis (HP), 123, 376–388, 399, 604–605, 605f, 606f in bird fancier, 378f, 379f, 380f, 381f, 382f, 383f centrilobular nodules in patient with, 117f, 664f centrilobular nodules of ground-glass opacity in patient with, 123f chronic, 377f, 693 consolidation in patient with, 154f cysts in, 383f cytarabine and, 399f and eosinophilic lung diseases, 376–395 in farmer, 381f with fibrosis and curing of sausages, 385f with fibrosis in bird fancier, 385f ground-glass opacity in patient with, 142f with headcheese sign, 201f HRCT findings, 377–386, 379t in patient in exposed to feathers in fly fishing, 384f progression of, 385f subacute, 377f, 378f, 383f, 692 utility of HRCT, 386–388 in woman exposed to fungus, 379f in woman of right upper lobar bronchus, subacute, 381f Hypoxemia, 17f pulmonary hemorrhage associated with, 635 I Idiopathic constrictive bronchiolitis, 608–610 Idiopathic eosinophilic lung disease, 388–394 acute eosinophilic pneumonia, 391 chronic eosinophilic pneumonia, 389–391 Churg-Strauss syndrome, 391–394 hypereosinophilic syndrome, 391 single pulmonary eosinophilia, 388–389 Idiopathic interstitial pneumonias (IIPs), 208–228, 232–253 acute interstitial pneumonia, 239–242 clinical and pathological features of, 209t cryptogenic organizing pneumonia, 232–239 desquamative interstitial pneumonia, 245–248 lymphoid interstitial pneumonia, 248–252 nonspecific interstitial pneumonia, 220–226 RB and respiratory bronchiolitis-interstitial lung disease, 242–245 UIP and idiopathic pulmonary fibrosis, 210–220 Idiopathic pulmonary alveolar proteinosis, 411 Idiopathic pulmonary arterial hypertension (IPAH), 629t, 634t Idiopathic pulmonary fibrosis (IPF), 211f, 212f, 213f, 694 asbestosis versus, 352–353 bilateral subpleural curvilinear lines in patient with, 99f bronchiectasis and bronchiolectasis in man with, 213f ground-glass opacities with, 213f honeycombing in, 83f, 84f, 86–88, 166f, 213–214f, 668f HRCT findings in, 211t HRCT findings in asbestosis and, 352t intralobular interstitial thickening in inflated lung from patient with, 89f intralobular interstitial thickening inpatient with, 90f irregular surfaces with mild, 213f lung cancer in, 216f patchy, peripheral and basal distribution of, 215f progression of, 217f and progressive shortness of breath, 212f pulmonary ossification and, 216f reticular opacities in patient with, 211f, 212f traction bronchiectasis in patient with, 183f usual interstitial pneumonia and, 210–220 women with acute exacerbation of, 218f Idiopathic pulmonary hemosiderosis (IPH), 651–652 Idiopathic pulmonary hypertension with plexogenic arteriopathy, 629, 630f Idiopathic scoliosis, postexpiratory air trapping in patient with, 25f IIPs See Idiopathic interstitial pneumonias (IIPs) ILD See Interstitial lung disease (ILD) Image interpolation and pixel size, 33f Image noise, 6f Immune complex small vessel vasculitis, 652–654 Immune deficiency bronchiectasis in, 593f syndromes, 590–593 Immune reconstitution syndrome, 439f Impaction, mucous, 561–562, 561f, 562f Incidental lung cysts, 172–173 Indium exposure, 371 Inert dust pneumoconiosis, 370 Infarction HRCT findings in septic embolism and, 471t septic embolism and, 471–472 Infections, 429–472 Aspergillus-related lung disease, 461–468 bronchopneumonia, 448–450 cavitary tuberculosis with endobronchial spread of, 433f centrilobular nodules in, 118f with endobronchial spread, 120–121, 121f #152201 Cust: LWW Au: Webb Pg No 726 fungal infections other than aspergillosis, 468–471 in HIV-positive patient, 445–446 HRCT findings in nontuberculous mycobacterial, 443t miliary bacille Calmette-Guérin, 446–447 Mycobacterium avium complex, 441f, 442f, 443f, 444f, 573f Mycoplasma pneumoniae pneumonia, 447–448 nontuberculous mycobacterial infection, 439–444 nontuberculous mycobacterial infection in HIV-positive patient, 445–446 opportunistic, 450–461 respiratory syncytial virus, 461f septic embolism and infarction, 471–472 tree-in-bud in patient with airway, 126f tree-in-bud in patient with Mycobacterium avium complex, 128f tuberculosis, 429–437 tuberculosis in HIV-positive patient, 437–439 Infectious bronchiolitis, 121, 122f, 597f, 598f, 599f, 600 Infestations, parasitic, 394 Infiltrative lung diseases, miscellaneous, 411–426 amyloidosis, 419–423, 420f, 420t, 421f, 422f, 423f exogenous lipoid pneumonia, 416–419, 416t, 417f, 418f light chain deposition disease, 423–424, 424f pulmonary alveolar microlithiasis, 424–426, 426f pulmonary alveolar proteinosis, 411–416, 412f, 413f, 414f, 415f, 416f Inflammatory bowel disease, 590 Influenza, 459–460 Influenza virus pneumonia, 459f, 460f Inhalation, smoke, 371–372 Inspiratory and postexpiratory lung transplantation for panlobular emphysema, 203f Inspiratory HRCT, 63f, 64f, 65f, 199f, 200f Inspiratory scans, air trapping in patients with normal, 199 Intercostal stripe and paravertebral line, 61f Interface sign, 92–93, 93f, 668, 669f Interlobular septa, 55–58, 56f, 669f Interlobular septal thickening, 74–82, 668, 668f in alveolar proteinosis, 77f, 79 associated with pulmonary alveolar proteinosis, 415f, 416f cardiogenic pulmonary edema and, 483f, 484f in child with lymphangiomyomatosis, 77f differential diagnosis of, 81t hydrostatic pulmonary edema with, 483f with lymphangitic spread of breast carcinoma, 76f and parenchymal bands, 348f patchy areas of ground-glass opacity and, 149f resulting from pulmonary edema, 75f, 76f sarcoidosis with, 318f Interstitial fibrosis, 141f, 263f Interstitial lung disease (ILD) CT phenotypes associated with, 541 in rheumatoid arthritis, 260f Interstitial nodules, 107f, 668, 669f Interstitial pneumonia, 15f, 679 acute, 239–242, 240f, 241f, 242t, 487f, 489f, 679 desquamative, 245–248, 245f, 246f, 246t, 247f, 500f, 686 idiopathic See Idiopathic interstitial pneumonias (IIPs) lymphoid See Lymphoid interstitial pneumonia nonspecific See Nonspecific interstitial pneumonia (NSIP) usual, 86–88, 87f, 87t, 88t, 210–220, 210f, 257f, 258f, 719 Interstitial pulmonary edema, lobular anatomy and, 57f, 58f Interstitial thickening, 89–92 Interstitium, 669 centrilobular, 664–665 intralobular, 669 peribronchovascular, 673 subpleural, 60, 674 Intralobular interstitial thickening, 89–92, 89f, 90f, 91t, 669, 669f, 670f Intralobular interstitium, 669 Intralobular lines, 89–92, 669, 669f, 670f Intraparenchymal cystic airspaces, algorithmic approach to, 184f Intravascular tumor emboli, 638f DESIGN SERVICES OF Index Intravenous drug abuse, 367f, 368t Invasive mucinous adenocarcinoma, 288–294, 289f, 290f, 291f, 292f, 293f, 293t, 695 with centrilobular nodules, 125f Invasive pulmonary aspergillosis (IPA), 462–463, 463t, 464f, 465f, 467f, 468f IPA See Invasive pulmonary aspergillosis (IPA) IPAH See Idiopathic pulmonary arterial hypertension (IPAH) IPF See Idiopathic pulmonary fibrosis (IPF) IPH See Idiopathic pulmonary hemosiderosis (IPH) Irregular airspace enlargement, 669 Irregular linear opacity, 669 Isolated pauci-immune pulmonary vasculitis, 649 J Juvenile rheumatoid arthritis, 297f K Kaposi sarcoma (KS), 294–296, 294–295f, 296t, 696 Kartagener syndrome, 586–587, 587f, 598f KS See Kaposi sarcoma (KS) kV(p) and mA on image noise effect of algorithm, 6f use of, 32–33 L LAM See Lymphangiomyomatosis (LAM) Langerhans cell histiocytosis (LCH), 697 and cigarette smoking, 496f with lung cysts, 168–169f nodular, 497f with small nodular opacities, 499f with small nodules, 116f Langerhans histiocytosis, 123–124, 168f, 172 Large vessel vasculitis, 643–646 LCDD See Light chain deposition disease (LCDD) LCH See Langerhans cell histiocytosis (LCH) Left lung transplantation, panlobular emphysema in patient with, 523f Left mid-lung show localized perilymphatic nodules, 317f Lesion, angioimmune proliferative, 305–306 Leukemia, 306–307, 307f HRCT in man with chronic myelogenous, 402f lymphoma, and lymphoproliferative disorders, 296–308 adult T-cell leukemia-lymphoma, 307–308 AIDS-related lymphoma, 304 angioimmune proliferative lesion, 305–306 angioimmunoblastic lymphadenopathy, 299–300 focal lymphoid hyperplasia, 296–297 follicular bronchiolitis, 297–298 leukemia, 306–307 lymphoid interstitial pneumonia, 298–299 lymphomatoid granulomatosis, 305–306 posttransplantation lymphoproliferative disorder, 304–305 primary pulmonary lymphoma, 300–301 Pneumocystis jirovecii pneumonia in patient with, 148f secondary pulmonary lymphoma, 301–303 Light chain deposition disease (LCDD), 171f, 423–424, 424f Linear and reticular opacities visible on HRCT, 75f Linear opacities, 74–102, 669 algorithms honeycombing, 85 intralobular lines, 92 honeycombing, 82–89 interface sign, 92–93 interlobular septal thickening, 74–82 intralobular interstitial thickening, 89–92 intralobular lines, 89–92 irregular, 669 parenchymal bands, 97–98, 98t peribronchovascular interstitial thickening, 94–98 perilobular pattern, 82 subpleural curvilinear line, 98–100 Lipoid pneumonia, 698 exogenous, 416–419, 416t from chronic mineral oil aspiration, 417f, 418f Lobar bronchus, subacute hypersensitivity pneumonitis in woman of right upper, 381f Lobe bronchiectasis, gantry angulation in patient with right middle, 32f Lobe predominance, Langerhans histiocytosis with upper, 169f Lobes air crescent signs in left upper, 661f HRCT appearances of large bronchi and arteries in, 48f Lobular anatomy and interstitial pulmonary edema, 57f, 58f Lobular core, 669–670 structures of, 670 Lobular (lung) parenchyma and lung acini, 59 Lobular pneumonia, 119f Lobular structures, dimensions of secondary, 53f Lobules, 670 according to Willis, pulmonary, 54f and components, anatomy of secondary, 54–59 and lung acinus, secondary pulmonary, 51–54 Miller’s, 55f primary pulmonary, 55f pulmonary, 673 pulmonary acinus relative to secondary pulmonary, 660f Reid’s, 55f secondary pulmonary, 52f, 53f, 55f, 674 Low-dose HRCT, 670 Low-grade B-cell lymphoma, HRCT findings in, 301t Lung acini, lobular (lung) parenchyma and, 59 Lung acinus, secondary pulmonary lobule and, 51–54 Lung anatomy, normal, 67–68 anatomy of secondary lobule and components, 54–59 concept of cortical and medullary lung, 59–60 large bronchi and arteries, 48–51 lung interstitium, 47–48 normal expiratory HRCT, 62–68 normal lung attenuation, 61–62 secondary pulmonary lobule and lung acinus, 51–54 subpleural interstitium and pleural surfaces, 60–61 Lung and Pneumocystis jirovecii (carinii) pneumonia, right, 454f Lung and soft-tissue windows, HRCT in patient with alveolar microlithiasis with, 160f Lung attenuation bronchiolar diseases associated with decreased, 606–613 changes with expiration, 62–65 normal, 61–62 in patients with pulmonary embolism, 189f Lung calcification and high-attenuation opacities, 158–161, 158t Lung cancer, in idiopathic pulmonary fibrosis, 216f Lung carcinoma, 284f, 407f, 408f Lung cysts, 165–166, 670 defined, 165–166 differential diagnosis of, 167t distinguished from centrilobular emphysema, 178 honeycombing with large, 166f incidental, 172–173 in patient who has lymphangiomyomatosis, 666f in woman with lymphoid interstitial pneumonia, 170f in woman with Sjögren syndrome, 170f Lung diseases Aspergillus-related, 461–468 cystic Birt-Hogg-Dubé syndrome, 510, 513–514, 513f, 514t lymphangiomyomatosis, 500–510 lymphoid interstitial pneumonia, 510, 511f, 512f pulmonary Langerhans cell histiocytosis, 492–500, 494f, 495f, 496f, 497t, 498f differential diagnosis of cystic, 167t drug-induced, 397–405 eosinophilic lung disease, 388 of specific etiology, 394–395 extensive cystic, 171f honeycombing in rheumatoid, 84f #152201 Cust: LWW Au: Webb Pg No 727 727 HRCT findings in drug-induced, 398t hypersensitivity pneumonitis, 376–388 idiopathic eosinophilic, 388–394 miscellaneous infiltrative, 411–426 amyloidosis, 419–423, 420f, 420t, 421f, 422f, 423f exogenous lipoid pneumonia, 416–419, 416t, 417f, 418f light chain deposition disease, 423–424, 424f pulmonary alveolar microlithiasis, 424–426, 426f pulmonary alveolar proteinosis, 411–416, 412f, 413f, 414f, 415f, 416f obstructive, 36, 36t occupational and environmental, 342–372 aluminum dust pneumoconiosis, 368–369 asbestosis and asbestos-related disease, 342–358 berylliosis, 369–370 beryllium disease, 369–370 biomass fuel exposure, 372 chemical pneumonitis and smoke inhalation, 371–372 coal worker’s pneumoconiosis, 365–366 flock worker’s lung, 371 graphite worker’s pneumoconiosis, 366 hard metal pneumoconiosis, 369 indium exposure, 371 inert dust pneumoconiosis, 370 mixed dust pneumoconiosis, 366 siderosis, 370–371 silicosis, 358–365 talcosis, 366–368 welder’s pneumoconiosis, 370–371 in patient with sarcoidosis, 158f pulmonary hemorrhage associated with, 635 radiation-induced, 405–409 CT and HRCT findings, 406–409 utility of CT and HRCT, 409 and radiation pneumonitis, drug-induced, 397–409 restrictive or fibrotic, 37, 37t rheumatoid arthritis and, 258f of unknown type, diffuse, 37, 37t Lung diseases, HRCT findings of, 71, 74–102 air trapping on expiration, 191–203 algorithm cystic airspaces, 183–184, 183f, 184f ground-glass opacity, 150–151, 151f inhomogeneous lung opacity, 191f, 200f interlobular septal thickening, 81f multinodular lung disease, 130f linear and reticular opacities, 74–102 mosaic perfusion and mosaic attenuation, 187–190 nodules and nodular opacities, 106–135 parenchymal opacification, 140–161 Lung fibrosis, 143f, 489f, 490f Lung function, bilateral lung transplantation and normal, 202f Lung injury, ground-glass opacity associated with acute, 142f Lung interstitium, 47–48, 47f Lung involvement, 303f, 319f, 321f Lung nodules in amyloidosis, 135 in Churg-Strauss syndrome, 134–135 MIP image and patient with small, 18f simple silicosis and man shows, 360f in Wegener granulomatosis, 134, 134f Lung opacity, 10f, 141f, 344f Lung parenchyma, normal, 19f Lung slice in patient with lymphangitic spread of tumor, 113f Lung transplantation constrictive bronchiolitis after, 612f constrictive bronchiolitis associated with, 611–613 dynamic expiratory HRCT in patient with bilateral, 27f for emphysema, 543–544 lymphangiomyomatosis before and after, 507–508f lymphoid interstitial pneumonia in man who underwent, 251f and normal lung function, bilateral, 202f for panlobular emphysema, 203f DESIGN SERVICES OF 728 Index Lung transplantation (continued) panlobular emphysema in patient with left, 523f patient with bronchopneumonia, 108f posttransplantation lymphoproliferative lung disorder after double, 305f Lung volume reduction surgery (LVRS) for emphysema, 544–546 patient inclusion and exclusion criteria, 544t Lungs See also Flock worker’s lung (FWL) amiodarone, 402f, 403–404f, 403f bird fancier’s, 377f, 383f central or medullary, 60 centrilobular anatomy in isolated, 58f concept of cortical and medullary, 59–60 contiguous 1-mm reconstruction through right, 316f corticomedullary differentiation in, 60f hot tub, 444f interlobular septa in isolated, 56f medullary, 60 parenchymal band in patients with normal, 97f in patient with pulmonary fibrosis, 9f peripheral or cortical, 59–60 LVRS See Lung volume reduction surgery (LVRS) Lymph node abnormalities in sarcoidosis, 327, 330f Lymphadenopathy, tuberculous, 434f Lymphangioleiomyomatosis See Lymphangiomyomatosis (LAM) Lymphangiomyomatosis (LAM), 172, 500–510, 501f, 503f, 504f, 699 before and after lung transplantation, 507–508f clinical findings, 502–503 differential diagnosis, 509t, 510 HRCT findings, 503–508, 506t in patient with tuberous sclerosis and, 169f in woman with, 169f interlobular septal thickening in child with, 77f lung cysts in patient who has, 666f MD-HRCT in patients with, 18f open-lung biopsy and, 501f pathology, 501–502 radiographic findings, 503 tuberous sclerosis with, 505–506f, 505f utility of HRCT, 508–509 Lymphangitic carcinomatosis See Pulmonary lymphangitic carcinomatosis (PLC) Lymphangitic metastatic carcinoma, 703 Lymphangitic spread of breast carcinoma, 76f, 281f of carcinoma, 76f, 111–112, 113f, 114f, 281f, 283t HRCT findings of, 283t nodular interlobular septal thickening in, 281f of thyroid carcinoma, 114f Lymphedema, yellow nails and, 589 Lymphoid interstitial pneumonia, 114f, 170f, 172, 248–252, 248f, 249f, 251f, 298–299, 299f, 299t, 510, 511f, 512f, 607f, 700 and amyloid, 251f in boy who has AIDS, 248f HRCT findings in, 248–252, 249t in man who underwent lung transplant, 251f in Sjögren syndrome, 273f in woman who has AIDS, 249–250f Lymphoid hyperplasia, focal, 296–297, 297f Lymphoma, 701 See also Adult T-cell leukemialymphoma (ATLL) AIDS-related, 304 angioimmunoblastic lymphadenopathy-like, 299, 300f high-grade T-cell, 302f HRCT findings in low-grade B-cell, 301t non-Hodgkin, 301f, 303t, 304f leukemia, and lymphoproliferative disorders, 296–308 adult T-cell leukemia-lymphoma, 307–308 AIDS-related lymphoma, 304 angioimmune proliferative lesion, 305–306 angioimmunoblastic lymphadenopathy, 299–300 focal lymphoid hyperplasia, 296–297, 297f follicular bronchiolitis, 297–298, 297f, 298f leukemia, 306–307 lymphoid interstitial pneumonia, 298–299 lymphomatoid granulomatosis, 305–306 posttransplantation lymphoproliferative disorder, 304–305 primary pulmonary lymphoma, 300–301 secondary pulmonary lymphoma, 301–303 primary pulmonary, 300–301 recurrent, 302f with secondary lung involvement, 303f secondary pulmonary, 301–303 Lymphomatoid granulomatosis, 305–306 Lymphoproliferative disorders, lymphoma, and leukemia, 296–308 M mA on image noise effect of algorithm, kV(p), and, 6f effect of kV(p), and, 6f MAC See Mycobacterium avium complex (MAC) infection MacLeod syndrome, 610f MALT See Mucosa-associated lymphoid tissue (MALT) MALToma, 300f, 301t in Sjögren syndrome, 274f Mass(es), 670 in organizing pneumonia, irregular, 134f Mastectomy, radiation pneumonitis in patient with left, 407f MCTD See Mixed connective tissue disease (MCTD) MD-HRCT (multidetector helical HRCT) in AIDS patient with pulmonary hypertension, 16f ECG gated, 31f image in patient with bronchiolitis obliterans, 20f in patient with lymphangiomyomatosis, 18f in patient with mixed connective tissue disease, 13–14f in patient with nonspecific interstitial pneumonia, reconstructed, 13–14f in women with hypoxemia, 17f MDP See Mixed dust pneumoconiosis (MDP) Medium size vessel vasculitis, 646 Medullary lung, 60 Meta pneumovirus, human, 461 Metastases, hematogenous, 285–288, 286f, 287f, 288f Metastatic calcification, 158–159 chronic renal failure and, 159f lung nodules in, 126 Metastatic carcinoma hematogenous, 702 lymphangitic, 703 Methotrexate, 401, 402f Micronodular pneumocyte hyperplasia, 506–507f Micronodule, 670 Microscopic polyangiitis (MPA), 648–649 with pulmonary hemorrhage, 649f Mid-lung show localized perilymphatic nodules, left, 317f Mid-lung window, 670 Mid-lung zones, perilymphatic nodules primarily involving, 317f Middle lobe atelectasis, 570f Miliary bacille Calmette-Guérin, 446–447 Miliary coccidioidomycosis, 115f Miliary tuberculosis, 433f Miller’s lobule, 55f Mineral oil aspiration, lipoid pneumonia from chronic, 417f, 418f Mixed connective tissue disease (MCTD), 13–14f, 270–272, 271f, 272f, 272t Mixed disease and headcheese sign, 191 Mixed dust pneumoconiosis (MDP), 366 Mixed edema, 484–485 Mosaic attenuation expiratory scans and diagnosis of, 199–200 pattern, 670 Mosaic oligemia See Mosaic perfusion Mosaic perfusion, 187–190, 670, 671f and air trapping, sarcoidosis with, 324f, 325f and air trapping in patient with chronic airway infection and bronchiolitis, 194f due to airways disease, 189 bronchiectasis with, 564f in bronchiolitis, 564f distinguished from ground-glass opacity, 190–191 with patchy lung attenuation in patients with pulmonary embolism, 189f in patients with cystic fibrosis, 188f #152201 Cust: LWW Au: Webb Pg No 728 pattern, 190–191 pulmonary hypertension and, 624–627, 626f due to vascular disease, 189–190 Motion-related artifacts, 39–40 Mounier-Kuhn syndrome, 587 extensive bronchiectasis in, 557f MPA See Microscopic polyangiitis (MPA) Mucormycosis, 469 Mucosa-associated lymphoid tissue (MALT), 296 Mucous impaction, 561–562 in allergic bronchopulmonary aspergillosis, 563f bronchiectasis with, 561f, 562f focal, 562f, 563f Multinodular lung disease, 130f Multiple myeloma, nodular calcification in patient with, 420f, 421f Multiple nodules, invasive mucinous adenocarcinoma with, 293f Muscles, transversus thoracis and subcostalis, 357f Musculoskeletal disease, 332f Mycobacterium avium complex (MAC) infection, 128f, 441f, 442f, 443f, 444f, 573f Mycobacterium avium-intracellulare complex, 704 Mycoplasma pneumoniae pneumonia, 447–448 Myelogenous leukemia, HRCT in man with chronic, 402f N Nails, yellow, 589 NHL See Non-Hodgkin lymphoma (NHL) Nitrofurantoin, nonspecific interstitial pneumonia in man treated with, 401f Nodular Langerhans cell histiocytosis, 497f Nodular opacities Langerhans cell histiocytosis with small, 499f nodules and, 106–135 accuracy of HRCT in determining nodule distribution, 131 algorithmic approach to nodule pattern and diagnosis, 129–131 large nodules and masses, 131–135 nodule appearance, 106–107 nodule attenuation, 106–107 nodule distribution and pattern, 107–129 nodule margins, 107t nodule size, 106 tree-in-bud, 126–129 Nodular pattern, 107–129, 670 Nodular pulmonary Langerhans cell histiocytosis, 494f Nodular septal thickening, 78f, 79–82 Nodules, 670, 671f acinar, 107, 660 airspace, 661, 661f in amyloidosis, 135 with perilymphatic, 114f appearance of small, 115f cavitary, 179–180, 179f centrilobular, 116–129, 118f, 119f, 120f, 123f, 125f, 318f, 602–606, 603f, 664, 664f and opacities, 627 in Churg-Strauss syndrome, 134–135 coalescent, 318–321, 320f differential diagnoses and characteristics of small, 109t diffuse sarcoidosis with random distribution of, 116f on HRCT, sarcoidosis showing perilymphatic distribution of, 110–111f HRCT appearance of centrilobular, 117f HRCT appearance of perilymphatic, 316f interstitial, 107f, 668, 669f Langerhans cell histiocytosis with small, 116f left mid-lung show localized perilymphatic, 317f lung in amyloidosis, 135 in Churg-Strauss syndrome, 134–135 MIP image and patient with small, 18f simple silicosis and man shows, 360f in Wegener granulomatosis, 134, 134f and masses, 131–135, 132t micronodule, 670 MIP image and patient with small lung, 18f and nodular opacities, 106–135 DESIGN SERVICES OF Index accuracy of HRCT in determining nodule distribution, 131 algorithmic approach to nodule pattern and diagnosis, 129–131 large nodules and masses, 131–135 nodule appearance, 106–107 nodule attenuation, 106–107 nodule distribution and pattern, 107–129 nodule margins, 107t nodule size, 106 tree-in-bud, 126–129 in patient with sarcoidosis, 132f peribronchovascular, 315f perilymphatic distribution of, 109f, 111f, 114f, 315–318, 316f, 317f, 672f pulmonary Langerhans cell histiocytosis with cavitary, 497f random distribution of, 112, 115–116, 673 in sarcoidosis, 319f with perilymphatic distribution of, 110–111f silicotic, 359f simple silicosis and, 360f small, 109t, 115f in Wegener granulomatosis, 134, 134f Non-Hodgkin lymphoma (NHL), 301f, 303t, 304f Noninfectious bronchiolitis, 600 Nonspecific interstitial pneumonia (NSIP), 10f, 220–226, 221f, 222f, 400–401, 705 basal predominance of, 224f fatal acute exacerbation in woman with biopsy proven, 227f ground-glass opacity in patient with, 143f honeycombing in, 224f HRCT findings in, 221–227, 223t improved with treatment, 225f in man treated with bleomycin, 400f with nitrofurantoin, 401f in man who had dyspnea, 222f pattern in polymyositis, 269f progression of fibrosis, 225f in progressive systemic sclerosis, 262f prone scans in patient with fibrotic, 90f reconstructed MD-HRCT in patient with, 13–14f in rheumatoid arthritis, 259f and shortness of breath, 227f in Sjögren syndrome, 273f subpleural curvilinear lines in patient with scleroderma who likely has, 100f subpleural line in patient with, 100f in systemic lupus erythematosus, 267f utility of HRCT, 227–228 Nonthromboembolic pulmonary embolism, 637–640 Nontuberculous mycobacterial (NTMB) infections, 120–121, 121f, 439–444, 443t in HIV-positive patient, 445–446 Normal lung anatomy, 47–68 NSIP See Nonspecific interstitial pneumonia (NSIP) NTMB See Nontuberculous mycobacterial (NTMB) infections O Obliterate bronchiolitis in RA, bronchiectasis and, 260f Obstructive azoospermia, 589 Obstructive lung disease, 36t Occupational and environmental lung disease, 342–372 aluminum dust pneumoconiosis, 368–369 asbestosis and asbestos-related disease, 342–358 berylliosis, 369–370 beryllium disease, 369–370 biomass fuel exposure, 372 chemical pneumonitis and smoke inhalation, 371–372 coal worker’s pneumoconiosis, 365–366 flock worker’s lung, 371 graphite worker’s pneumoconiosis, 366 hard metal pneumoconiosis, 369 indium exposure, 371 inert dust pneumoconiosis, 370 mixed dust pneumoconiosis, 366 siderosis, 370–371 silicosis, 358–365 talcosis, 366–368 welder’s pneumoconiosis, 370–371 OP See Organizing pneumonia (OP) Opacification, 671 See also Parenchymal opacification Opacities, 74–102, 671 algorithms honeycombing, 85 intralobular lines, 92 centrilobular, 627 dependent, 666, 666f ground-glass See Ground-glass opacities honeycombing, 82–89 interface sign, 92–93 interlobular septal thickening, 74–82 intralobular interstitial thickening, 89–92 intralobular lines, 89–92 linear See Linear opacities lung, 10f, 141f, 344f parenchymal bands, 97–98, 98t peribronchovascular interstitial thickening, 94–98 perilobular pattern, 82 in posterior lung in patient with pulmonary fibrosis, 9f reticular See Reticular opacities subpleural curvilinear line, 98–100 subpleural interstitial thickening, 98 visible on HRCT, linear and reticular, 75f Open-lung biopsy and lymphangiomyomatosis, 501f Opportunistic infections, 450–461 Oral phenytoin, eosinophilic pneumonia in man treated with, 400f Organizing pneumonia (OP), 124, 399–400 airspace consolidation in, 661f airspace nodules in, 108f associated with aspiration, 149f cryptogenic, 706 irregular masses in, 134, 134f in man with ulcerative colitis, 400f with patchy areas of consolidation and groundglass opacity, 152f and radiation for right breast carcinoma, 408f reversed halo sign or atoll sign in, 673, 673f and testicular carcinoma, 399f Orthodeoxia, hepatopulmonary syndrome in patient with, 642f P PAH See Pulmonary arterial hypertension (PAH) PAM See Pulmonary alveolar microlithiasis (PAM) PAN See Polyarteritis nodosa (PAN) Panacinar emphysema See Panlobular emphysema Panbronchiolitis, 122–123, 123f diffuse, 600–602, 601f, 601t, 602f Panlobular emphysema (PLE), 173, 175f, 176f, 203f, 519–523, 523f, 525t, 671, 671f, 688 PAP See Pulmonary alveolar proteinosis (PAP) Papillomatosis, cavitary nodules in patient with tracheobronchial, 179f Paracoccidioidomycosis, 470–471 Parahilar ground-glass opacity, hydrostatic pulmonary edema with patchy, 483f Parahilar pulmonary edema, in patient with renal failure, 484f Paraseptal emphysema, 177f, 521f, 523, 525–526, 525f, 526f, 526t, 671, 672f, 689 distinguished from honeycombing, 177–178, 177f honeycombing in, 84f, 85t minimum and maximum-intensity projection imaging in, 534–535f Parasites, embolism of, 639–670 Parasitic infestations, 394 Paravertebral line, 61f intercostal stripe and, 61f Parenchyma, normal lung, 19f Parenchymal bands, 97–98, 97f, 98t, 348f, 349f, 672, 672f Parenchymal involvement, sarcoidosis with minimal, 316f Parenchymal opacification, 140–161, 672 algorithm - consolidation, 156–158, 157f algorithmic approach to diagnosis of consolidation, 156–158, 157f algorithmic approach to diagnosis of ground-glass opacity, 150–151, 151f #152201 Cust: LWW Au: Webb Pg No 729 729 consolidation, 152–158 differential diagnosis, 150–151 ground-glass opacity, 140–152 lung calcification and high-attenuation opacities, 158–161, 158t Parietal pleura, 60–61, 61f thickening, differential diagnosis and mimics of, 356–357 Partial volume artifact, 39 Patient size, relationship of noise to, 7f PCH See Pulmonary capillary hemangiomatosis (PCH) PCP See Pneumocystis jirovecii (carinii) pneumonia (PCP) Parenchymal fibrosis, 325–326 Peribronchovascular interstitium, sarcoidosis with minimal involvement of, 315f Peribronchiolar diseases, 119–120 Peribronchovascular fibrosis associated with traction bronchiectasis, sarcoidosis with, 133f Peribronchovascular interstitial thickening, 94–98, 94t, 95f, 96f, 672, 672f Peribronchovascular interstitium, 673 Peribronchovascular nodules, 315f in patient with sarcoidosis, large, 112f Perilobular distribution, 673 Perilobular fibrosis in asbestosis, centrilobular and, 346f Perilobular pattern, 82 Perilymphatic distribution, 673 of nodules, 108–114, 108f, 110–111f, 316f Perilymphatic nodules, 114f, 315–318, 672f in AIDS patient with lymphoid interstitial pneumonia, 114f amyloidosis with, 114f HRCT appearance of, 316f left mid-lung show localized, 317f in patient with coal worker’s pneumoconiosis, 110–111, 113f in patient with silicosis, 110–111, 113f primarily involving mid-lung zones, 317f in sarcoidosis, 314f Peripheral airways anatomy of, 54f visibility of, 560 Peripheral distribution, 673 eosinophilic pneumonia with consolidation having, 153f Peripheral or cortical lung, 59–60 Perivascular diseases, lung nodules in, 125–126 Perivascular fibrosis, 640f Permeability edema, increased, 710 PH See Pulmonary hypertension (PH) Phenytoin, oral, 400f Photon starvation, 39 Pixel size, image interpolation and, 33f PLC See Pulmonary lymphangitic carcinomatosis (PLC) PLCH See Pulmonary Langerhans cell histiocytosis (PLCH) PLE See Panlobular emphysema (PLE) Pleura, parietal, 60–61, 61f Pleural disease asbestos-related, 353–358 utility of HRCT in diagnosing asbestos-related, 356–357 Pleural plaques in patient with asbestos exposure, 356f subpleural line associated with, 350f Pleural surfaces, subpleural interstitium and, 60–61 Pleural thickening asbestos exposure and, 349f, 354f, 355f diffuse, 349f HRCT findings of, 353–358 and parenchymal bands in asbestosis, 349f parietal, 356–357 in patient with pulmonary fibrosis, 357f pleural plaques and subpleural line associated with, 350f visceral, 357f Pleuroparenchymal fibroelastosis (PPFE), 252–253 Plexogenic arteriopathy, idiopathic pulmonary hypertension with, 630f PM-DM See Polymyositis-dermatomyositis (PM-DM) Pneumatocele, 178, 673 Pneumocystis jirovecii pneumonia associated with, 178f, 179f DESIGN SERVICES OF 730 Index Pneumoconiosis, 342–372 aluminum dust, 368–369 asbestosis and asbestos-related disease, 342–358 berylliosis, 369–370 beryllium disease, 369–370 biomass fuel exposure, 372 chemical pneumonitis and smoke inhalation, 371–372 coal worker’s, 110–111, 113f, 361t, 365–366, 365f, 716 flock worker’s lung, 371 graphite worker’s, 366 hard metal, 369, 369f heavy metal, 161 indium exposure, 371 inert dust, 370 lung nodules in, 124 mixed dust, 366 siderosis, 370–371 silicosis, 358–365 talcosis, 366–368 welder’s, 370–371 Pneumocystis jirovecii (carinii) pneumonia (PCP), 142, 143f, 148f, 178f, 179f, 450–456, 451f, 451t, 452f, 453f, 454f, 455f, 709 Pneumocyte hyperplasia, micronodular, 506–507f Pneumonectomy for lung carcinoma, HRCT in patient who had partial left, 284f Pneumonia acute eosinophilic, 391 airspace nodules in patient with cryptogenic organizing, 108f associated with AIDS, 142f associated with pneumatoceles and pneumothorax, 179f bronchopneumonia See Bronchopneumonia cavitary nodules in AIDS patient with fungal, 179f cytomegalovirus, 456–458, 457f, 458f, 720 eosinophilic, 153f, 389–391, 400, 400f exogenous lipoid, 416–419, 416t, 417f, 418f HRCT findings in, 293t influenza virus, 459f, 460f interstitial, 15f, 679 acute, 239–242, 240f, 241f, 242t, 487f, 489f, 679 desquamative, 245–248, 245f, 246f, 246t, 247f, 500f, 686 idiopathic See Idiopathic interstitial pneumonias (IIPs) lymphoid See Lymphoid interstitial pneumonia nonspecific See Nonspecific interstitial pneumonia (NSIP) usual, 86–88, 87f, 87t, 88t, 210–220, 210f, 257f, 258f, 719 lipoid, 698 lung opacity on prone scans in patient with scleroderma and interstitial, 10f Mycoplasma pneumoniae, 447f, 447–448, 447t, 448f organizing See Organizing pneumonia in patient with leukemia, 148f Pneumocystis carinii, 709 reconstructed images in patient with interstitial, 15f due to respiratory syncytial virus, 148f viral, 458–461 Pneumonitis, 123f, 142f, 371–372 drug-induced lung diseases and radiation, 397–409 hypersensitivity, 399, 604–605, 605f, 606f radiation, 406t, 407f Pneumothorax, Pneumocystis jirovecii pneumonia associated with pneumatoceles and, 179f Pneumovirus See Meta pneumovirus, human Polymyositis, NSIP pattern in, 269f Polyarteritis nodosa (PAN), 646 Polymyositis-dermatomyositis (PM-DM), 268–270, 269t Posterior lung, 9f, 10f Postexpiratory air trapping, 25f, 195f Postexpiratory HRCT, 25, 64f, 65f, 194f, 199f, 200f Postinfectious bronchiolitis obliterans, 188f, 194f, 662f Postinfectious constrictive bronchiolitis, 608 Postpartum pulmonary edema, 485f with crazy paving, 485f Posttransplantation lymphoproliferative disorder (PTLD), 304–305, 305t after double lung transplant, 305f PPFE See Pleuroparenchymal fibroelastosis (PPFE) Primary pulmonary lobule, 55f Primary pulmonary lymphoma, 300–301 Progressive systemic sclerosis (PSS), 261–266, 263t, 265f, 715 nonspecific interstitial pneumonia in, 262f Prone scans, 9f, 10f Proteinosis, 19f, 77f, 79 pulmonary alveolar, 411–416, 412f, 413f, 414f, 415f, 416f Pseudobronchiectasis, 180f, 570 Pseudomonas, 123f infection, bronchopneumonia due to, 449f Pseudoplaques, 673 PTLD See Posttransplantation lymphoproliferative disorder (PTLD) Pulmonary acinus relative to secondary pulmonary lobule, 660f Pulmonary adenocarcinoma, 149f Pulmonary alveolar microlithiasis (PAM), 424–426, 426f Pulmonary alveolar proteinosis (PAP), 146–147f, 411–416, 412f, 413f, 414f, 415f, 416f, 681 acute silicosis as cause of, 412f associated with interlobular septal thickening, 415f, 416f before and after bronchoalveolar lavage, 415f congenital, 411 crazy paving in, 665f idiopathic/autoimmune, 411 secondary, 411 Pulmonary amiodarone toxicity, HRCT in, 160f Pulmonary arterial hypertension (PAH), 628–629, 634, 634t, 708 drug and toxin-induced, 629, 631f heritable, 629 idiopathic, 629, 629t, 630f, 634t plexiform arteriopathy in, 629f Pulmonary artery abnormalities, HRCT findings of, 622–624 Pulmonary artery diameter decreased, 624 increased, 623–624 Pulmonary artery tumor embolism, 637–638 Pulmonary aspergillosis allergic bronchopulmonary aspergillosis, 123, 563f, 578f, 579f, 580f, 584–586, 585t, 680 invasive pulmonary aspergillosis, 462–463, 463t, 464f, 465f, 467f, 468f Pulmonary capillary hemangiomatosis (PCH), 632–634, 633f, 634t Pulmonary edema, 481–485, 710 with crazy paving, 483f without diffuse alveolar damage, 484 findings of, 627 HRCT findings in, 483t hydrostatic, 481–484 and interlobular septal thickening, 75f, 76f, 483f, 484f lobular anatomy and interstitial, 58f lung nodules in, 125 mixed edema, 484–485 with patchy parahilar ground-glass opacity, 483f in patient with cardiomyopathy, 481–482f in patient with renal failure, 482f, 484f postpartum, 485f and right-sided thoracentesis, 484f Pulmonary emboli, septic, 471f, 472f Pulmonary embolism, 189f, 625f, 626f chronic, 636f Pulmonary eosinophilia, single, 388–389 Pulmonary fibrosis following acute respiratory distress syndrome, 490f mixed connective tissue disease with, 271f persistent opacity in posterior lung in patient with, 9f pulmonary sarcoidosis and findings of, 327f, 328f due to sarcoidosis, 328f visceral pleural thickening in patient with, 357f Pulmonary hemorrhage, 141f, 148f, 199f associated with idiopathic pulmonary hemosiderosis, 652f systemic lupus erythematosus, 653f thrombotic thrombocytopenic purpura, 651f crazy paving in, 651f findings of, 627 with intralobular interstitial thickening and intralobular lines, 670f #152201 Cust: LWW Au: Webb Pg No 730 lung nodules in, 126 microscopic polyangiitis with, 649f Wegener granulomatosis with, 648f Pulmonary hemosiderosis, idiopathic, 651–652 Pulmonary hypertension (PH), 627–640 associated with end-stage sarcoidosis, 635f associated with use of anorectic drugs, 631f cardiovascular abnormalities and, 627 clinical classification of, 628t CT phenotypes associated with, 540 HRCT in patient with, 634f lung nodules in, 126 MD-HRCT in AIDS patient with, 16f and mosaic perfusion, 624–627, 626f in patient with Eisenmenger syndrome, 623f primary, 628 secondary, 628 sickle-cell anemia with, 637f Pulmonary Langerhans cell histiocytosis (PLCH), 492–500, 494f, 495f, 496f, 496t, 497f, 498f, 697 clinical findings, 494–495 differential diagnosis, 499–500 HRCT findings, 495–498, 497t pathology, 493–494 radiographic findings, 495 utility of HRCT, 499 Pulmonary lobular anatomy, 51f Pulmonary lobules, 52f, 55f, 660f, 673 and acinus, 54f lung acinus, secondary, 51–54 Pulmonary lymphangitic carcinomatosis (PLC), 280–285, 282f Pulmonary lymphoma primary, 300–301 secondary, 301–303 Pulmonary lymphoproliferative diseases, 280–308 hematogenous metastases, 285–288 Kaposi sarcoma, 294–298 lymphoproliferative disorders, lymphoma, and leukemia, 296–308 pulmonary lymphangitic carcinomatosis, 280–285 Pulmonary neoplasms, diffuse See Diffuse pulmonary neoplasms Pulmonary sarcoidosis, 327f, 328f Pulmonary tuberculosis with patchy consolidation, 431f Pulmonary vascular disease (PVD) HRCT findings of, 622–627 suspected, 37, 38t Pulmonary vasculitis, 642–649 classification of, 643t immune complex small vessel vasculitis, 652–654 large vessel vasculitis, 643–646 medium size vessel vasculitis, 646 small vessel vasculitis associated with antineutrophilic cytoplasmic antibody, 646–649 Pulmonary veno-occlusive disease (PVOD), 631–632, 632f, 633t PVD See Pulmonary vascular disease (PVD) PVOD See Pulmonary veno-occlusive disease (PVOD) Q QCT See Quantitative computed tomography (QCT) Quantitative computed tomography (QCT), 30–31 emphysema studies, 532t of airway disease, 536–538, 537–539f of bronchiectasis, 540–541 clinical utility, 541–547 of emphysema-predominant COPD, 533–535, 534–535f, 536f of interstitial lung disease, 541 phenotypes, visual identification of, 539–540 of pulmonary hypertension, 540 of small airway disease, 538–539 R RA See Rheumatoid arthritis (RA) Radiation dose, 20–24 for chest imaging techniques, 21t DESIGN SERVICES OF Index Radiation pneumonitis, 406t, 407f drug-induced lung diseases and, 397–409 Radiographic findings in amyloidosis, 419 in asthma, 583 in bronchiectasis, 557 in cystic fibrosis, 577 in emphysema, 518–519 in lymphangiomyomatosis, 503 in pulmonary alveolar microlithiasis, 424 in pulmonary alveolar proteinosis, 412 in sarcoidosis, 313 Random distribution of nodules, 112, 115–116, 673 RB See Respiratory bronchiolitis (RB) RB-ILD See Respiratory bronchiolitis-interstitial lung disease (RB-ILD) Reactivation tuberculosis with cavitation, 431f Reconstitution syndrome, immune, 439f Reconstruction algorithm on resolution, 5f, 6f on spatial resolution, 5f Reconstruction on resolution, effect of targeted, 8f Reconstruction on spatial resolution, effect of targeted, 8f Rectal carcinoma, hematogenous metastases from, 116f Reid’s lobule, 55f Renal failure chronic, 159f hydrostatic pulmonary edema in patient with, 482f parahilar pulmonary edema in patient with, 484f Resolution, 4f, 5f, 6f, 8f Respiratory bronchiole, 673 Respiratory bronchiolitis (RB), 124, 242–245, 242f, 243f, 603–604, 603f Respiratory bronchiolitis-interstitial lung disease (RB-ILD), 244f, 244t, 245f, 603–604, 604f, 711 Respiratory distress syndrome, acute See Acute respiratory distress syndrome Respiratory syncytial virus (RSV), 148f, 460, 461f Reticular opacities, 74–102 algorithms honeycombing, 85 intralobular lines, 92 honeycombing, 82–89 interface sign, 92–93 interlobular septal thickening, 74–82 intralobular interstitial thickening, 89–92 intralobular lines, 89–92 parenchymal bands, 97–98, 98t peribronchovascular interstitial thickening, 94–98 perilobular pattern, 82 pulmonary alveolar proteinosis, 413f subpleural curvilinear line, 98–100 subpleural interstitial thickening, 98 visible on HRCT, 75f Reticular pattern See Reticulation Reticulation, 673 Reversed halo sign, in organizing pneumonia, 673, 673f Rheumatoid arthritis (RA), 257–261, 712 bronchiectasis and obliterate bronchiolitis in, 260f, 589f bronchiolitis obliterans associated with, 188f constrictive bronchiolitis associated with, 610–611 and end-stage usual interstitial pneumonia, 258f HRCT findings in, 257–261, 259t interstitial lung disease in, 260f juvenile, 297f and lung disease, 80f, 258f nonspecific interstitial pneumonia in, 259f usual interstitial pneumonia and, 257f utility of HRCT, 261 Rheumatoid lung disease, honeycombing in, 84f Rheumatologic disorders, biologic agents for, 405 Right breast carcinoma, organizing pneumonia and radiation for, 408f Right lung, 316f, 454f Right-sided thoracentesis, pulmonary edema and, 484f Ring artifacts, 39 Rosettes in patient with endobronchial spread of tuberculosis, centrilobular nodules and, 120f Rounded atelectasis, 353, 354f RSV See Respiratory syncytial virus (RSV) S Sandblaster, acute silicosis in man who worked as, 358f Sarcoid-like reaction (SLR), 337f Sarcoid spleen, 332f Sarcoidosis, 312–339, 713 associated conditions and sarcoid-like reactions, 337–338 calcification within nodular lung disease in patient with, 158f cardiac, 334f centrilobular nodules in, 318f coalescent nodules in, 320f with conglomerate mass of granulomas, 320f conglomerate masses of nodules in patient with, 132f CT-guided biopsy in, 336f with cystic disease, bronchiectasis, or honeycombing, 329f differential diagnosis, 338–339 with diffuse lung involvement, 319f end-stage, 714 extrapulmonary extranodal manifestations of, 332–333 with fibrosis, 327f, 328–329f with ground-glass opacity, 321f, 322f, 324f HRCT findings in, 315–318 air trapping, 323–325 airway abnormalities, 321–323 coalescent nodules, 318–321 in early or active, 317t extrapulmonary extranodal manifestations of sarcoidosis, 332–333 in fibrotic, 325t ground-glass opacity, 321 lymph node abnormalities, 327 mosaic perfusion, 323–325 parenchymal fibrosis, 325–326 perilymphatic nodules, 315–318 thoracic complications, 327–332 with interlobular septal thickening, 318f large peribronchovascular nodules in patient with, 112f lymph node abnormalities in, 327, 330f with minimal involvement of peribrochonvascular interstitium, 315f with minimal parenchymal involvement, 316f with mosaic perfusion and air trapping, 324f, 325f nodular peribronchovascular interstitial thickening in patient with, 96f nodular septal thickening in patient with, 78f with patchy lung involvement, 321f pathological findings, 313 with peribronchovascular fibrosis associated with traction bronchiectasis, 133f with perilymphatic distribution of nodules, 110–111f perilymphatic nodules in, 314f prone HRCT in patient who has end-stage, 330f pulmonary, 327f, 328f pulmonary fibrosis due to, 328f pulmonary hypertension associated with end-stage, 635f radiographic findings, 313 with random distribution of nodules, 116f scattered nodules in, 319f showing perilymphatic distribution of nodules on HRCT, 110–111f before and after treatment, 326f unusual distribution in, 317f utility of HRCT, 333–337 Sarcoma, Kaposi See Kaposi sarcoma Scan(s/ing) protocols, 37t, 38t spaced axial scans versus volumetric, 10–20 spatial and prone, 9f Scan acquisition, techniques of, 10–20 Scleroderma, 261–266, 715 findings of fibrosis in patient with, 263f and mild interstitial fibrosis, 263f subpleural curvilinear lines in patient with, 99f #152201 Cust: LWW Au: Webb Pg No 731 731 subpleural ground-glass opacity in patient with, 262f, 263f Secondary lobular structures, dimensions of, 53f Secondary lobule and components, anatomy of, 54–59 centrilobular region and structures, 58–59 interlobular septa, 55–58 lobular parenchyma and lung acini, 59 Secondary lung involvement, lymphoma with, 303f Secondary pulmonary alveolar proteinosis, 411 Secondary pulmonary lobule, 51–54, 52f, 53f, 55f, 674 Secondary pulmonary lymphoma, 301–303 Segmentation, automated airway, 568f Segmented reconstruction, of scan data, 32 Septal amyloidosis, diffuse alveolar, 421f Septal line, 674 Septal thickening, 281f, 453f, 674 beaded, 78f, 79–82 interlobular, 74–82, 668, 668f nodular, 78f, 79–82 Septic embolism and infarction, 471–472, 471t Septic pulmonary emboli, 471f, 472f Septum, 674 Septum sign, beaded, 662, 662f Shortness of breath, HRCT in man who has cough and, 283f Sickle-cell anemia, 637 with pulmonary hypertension, 637f Siderosis, 370–371 Sign air crescent, 661, 661f atoll, 154–156, 156f, 157f, 662, 673 beaded septum, 662, 662f halo, 667 consolidation and, 153–154, 154f reversed, 154–156, 156f, 157f, 673 tuberculosis with reversed, 434f headcheese, 191 interface, 92–93, 93f, 668, 669f signet ring, 96f, 674, 674f Signet ring sign, 96f, 674, 674f Silica exposure, 360f, 361f Silicoproteinosis, 358 Silicosis, 358–365, 716 acute (silicoproteinosis), 358, 358f acute, as cause of pulmonary alveolar proteinosis, 412f classic, 359 and coal worker’s pneumoconiosis, 361t complicated, 362f computed tomography and HRCT findings, 359–365 conglomerate masses of fibrosis in, 132f eggshell calcification in, 364f and man shows lung nodules, 360f and nodules, 360f in patient with long-term silica exposure, 360f perilymphatic nodules in patient with, 110–111, 113f progressive massive fibrosis due to, 362f, 363f silicotic nodules in simple, 359f simple, 360f in stone mason with long silica exposure, 361–362f Silicotic nodules, in simple silicosis, 359f Silicotuberculosis, 363f Single pulmonary eosinophilia, 388–389 Sjögren syndrome (SS), 170f, 272–274, 273f, 273t, 274f, 298f, 422f, 423f SLE See Systemic lupus erythematosus (SLE) SLR See Sarcoid-like reaction (SLR) Small airway anatomy, 596f Small airways disease, 674 in COPD, 532 extent and severity of, estimating, 538–539 Small lung nodules, MIP image and patient with, 18f Small nodules, 109t, 115f Small vessel vasculitis associated with antineutrophilic cytoplasmic antibody, 646–649 Smoke inhalation, 29f, 371–372 Smokers, 242f centrilobular emphysema in, 520f Soft-tissue attenuation centrilobular nodules, 130–131, 130t Spaced axial HRCT, comparison of 1.25-mm, 10f, 11f DESIGN SERVICES OF 732 Index Spaced axial scans versus volumetric scanning, 10–20 reconstruction techniques with volumetric HRCT, 15–20 spaced axial scans, 10–12 volumetric HRCT, 12–15 Spatial and prone scans, 9f Spatial resolution, 5f, 8f Spirometrically Triggered Expiratory HRCT, 29 Spleen, sarcoid, 332f SS See Sjögren syndrome (SS) Stair-step artifacts, 39 Stannosis in tin miner, 370f Streak artifacts, 39 Structures relative to their size, shape, and orientation, resolution of, 38f Subacute hypersensitivity pneumonitis, 377f, 378f, 383f in bird fancier, 378f, 379f, 380f, 381f, 382f in farmer, 381f in woman exposed to fungus, 379f in woman of right upper lobar bronchus, 381f Subacute Pneumocystis jirovecii (carinii) pneumonia with septal thickening, 453f Subcostalis muscles, transversus thoracis and, 357f Subpleural, 674 Subpleural bulla, paraseptal emphysema with large, 526f Subpleural curvilinear lines, 98–100, 675, 675f in asbestosis, 350f associated with pleural plaques and pleural thickening, 350f in patient with asbestosis, 99f in patient with idiopathic pulmonary fibrosis, 99f in patient with NSIP, 100f in patient with scleroderma, 99f Subpleural distribution, eosinophilic pneumonia with consolidation having peripheral and, 153f Subpleural dotlike opacities in asbestosis, 345f Subpleural ground-glass opacity in patient with scleroderma, 262f, 263f Subpleural interstitial thickening, 98, 674, 674f Subpleural interstitium, 674 and pleural surfaces, 60–61 and visceral pleura, 60 Subpleural lung, algorithmic approach to cystic airspaces in, 183f Surgery, lung volume reduction See Lung volume reduction surgery (LVRS) Swyer-James syndrome, 608, 610f Syndrome acquired immunodeficiency See Acquired immunodeficiency syndrome (AIDS) acute respiratory distress, 398, 710 Birt-Hogg-Dubé, 171f, 172, 513–514, 513f, 514t Churg-Strauss, 134–135, 391–394, 392f, 393f, 393t, 394f, 648, 649f dyskinetic cilia, 586–587 Eisenmenger, 623f Goodpasture, 141f, 650–651, 652f hepatopulmonary, 640–642, 641f, 641t Hughes-Stovin, 624 hypereosinophilic, 391, 392f immune deficiency, 590–593 immune reconstitution, 439f Kartagener, 586–587, 587f, 598f MacLeod, 610f Mounier-Kuhn, 557f, 587 Sjögren, 170f, 272–274, 273f, 273t, 274f, 298f, 422f, 423f Williams-Campbell, 588, 588f Young, 589 Systemic diseases, bronchiectasis associated with, 589–593 Systemic lupus erythematosus (SLE), 266–268, 267f, 267t, 268f, 590, 717 pulmonary hemorrhage associated with, 653f T T-cell lymphoma, high-grade, 302f Takayasu arteritis, 643–644, 644f Talcosis, 160–161, 366–368, 368f associated with intravenous drug abuse, 367f HRCT findings, 367–368 secondary to intravenous drug abuse, 368t Targeted reconstruction, of CT image, 675 TB See Tuberculosis (TB) Terminal bronchiole, 675 Testicular carcinoma hematogenous metastases and, 288f organizing pneumonia and, 399f Thoracentesis, pulmonary edema and right-sided, 484f Thrombotic thrombocytopenic purpura, pulmonary hemorrhage associated with, 651f Thyroid carcinoma, lymphangitic spread of, 114f Tin miner, stannosis in, 370f Toxicity, HRCT in pulmonary amiodarone, 160f Trachea, HRCT appearances of, 67f Tracheobronchial disease, 422f Tracheobronchial papillomatosis, cavitary nodules in patient with, 179f Tracheobronchitis, acute, 467–468 Tracheobronchomegaly, 587–588, 587f Traction bronchiectasis, 133f, 181, 183, 183f, 347f, 571f, 675, 675f Traction bronchiolectasis, 675 Transient dependent density, 9f Transversus thoracis and subcostalis muscles, 357f Tree-in-bud, 119f, 126–129, 675–676, 675f bronchiolitis, 597–602, 597f, 598f, 599f in bronchopneumonia, 127f in patient with airway infection, 126f in patient with cystic fibrosis, 122f in patient with endobronchial spread of tuberculosis, 120f in patient with Mycobacterium avium complex infection, 128f in patient with tuberculosis, 120f in patient with yellow nails, 122f Tuberculosis (TB), 429–437, 718 cavitary, 433f, 437f centrilobular nodules and rosettes in patient with endobronchial spread of, 120f centrilobular nodules and tree-in-bud in patient with, 120f centrilobular rosettes and tree-in-bud in patient with endobronchial spread of, 120f endobronchial spread of, 432f in HIV-positive patient, 437–439 HRCT findings in active, 430–435, 431t miliary, 433f primary and postprimary, 430 pulmonary, 431f with reversed halo sign, 434f utility of HRCT, 435–437 Tuberculous lymphadenopathy, 434f Tuberous sclerosis complex, 500–510, 504f with lymphangiomyomatosis, 505f with lymphangiomyomatosis, 169f, 505–506f Tumor emboli, intravascular, 638f lung slice in patient with lymphangitic spread of, 113f #152201 Cust: LWW Au: Webb Pg No 732 U UIP See Usual interstitial pneumonia (UIP) Ulcerative colitis bronchiectasis and airway wall thickening associated with, 591–592f organizing pneumonia in man with, 400f Usual interstitial pneumonia (UIP), 210f, 719 honeycombing in, 86–88, 87f, 87t, 88t and idiopathic pulmonary fibrosis, 210–220 and rheumatoid arthritis, 257f, 258f V Varicella zoster infection, 461 Varicose bronchiectasis, 180, 182f, 554–555f Vascular diseases collagen, 589–590 lung nodules in, 125–126 mosaic perfusion due to, 189–190 Vasculitis, lung nodules in, 125–126 Viral bronchiolitis, 122f Viral pneumonia, 720 influenza, 459f, 460f other than cytomegalovirus, 458–461 Viruses cytomegalovirus, 456–458, 457f, 458f, 720 human meta pneumovirus, 461 pneumonia due to respiratory syncytial, 148f respiratory syncytial, 148f, 460, 461f Visceral pleura, subpleural interstitium and, 60 Visceral pleural thickening in patient with pulmonary fibrosis, 357f Volumetric expiratory computed tomography, 29–30 Volumetric scanning, spaced axial scans versus, 10–20 W Wall thickness, relation of airway diameter to, 50t Wegener granulomatosis, 646–648, 647f with cavitary masses, 647f HRCT findings in, 646t lung nodules in, 134, 134f with pulmonary hemorrhage, 648f Welder’s pneumoconiosis, 370–371 Whole-lung lavage (WLL), 412, 415 Williams-Campbell syndrome, 588, 588f Willis, pulmonary lobules according to, 54f Windmill artifacts, 39 Window mean and width on visibility of bronchi, 34–35f Window settings, 33–36 WLL See Whole-lung lavage (WLL) Workstations, use of, 33 Y Yellow nails, 122f, 589 Young syndrome, 589 Z Zebra artifact, 39 Zygomycosis, 469 DESIGN SERVICES OF ... Small lung nodules are associated with distortion of lung architecture because of lung fibrosis and the development of larger nodules and regions of emphysema in the lung periphery #1 522 01 Cust:... Roentgenol 20 10;194:W20–W26 Akira M High-resolution CT in the evaluation of occupational and environmental disease Radiol Clin North Am 20 02; 40:43–59 Becklake MR Asbestos-related diseases of the lungs... so-called #1 522 01 Cust: LWW Au: Webb Pg No 3 52 end-stage lung, characterized by the presence of fibrosis, alveolar dissolution, bronchiolectasis, and disruption of normal lung architecture For