Concept #2
Abnormalities have 2 Important Imaging
Clues:
1. Morphology/pattern of disease
2. Distribution of disease: location, location,
location!
Patterns
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Consolidation
Ground Glass
Lines
Reticulation
Cysts
Nodules
–Tree-in-Bud/Budding Tree opacities
Patterns
• *Infiltrate is not one of these patterns*
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Consolidation
Ground Glass
Lines
Reticulation
Cysts
Nodules
– Tree-in-Bud/Budding Tree opacities
Patterns
• Consolidation
• Ground Glass
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Lines
Reticulation
Cysts
Nodules
– Tree-in-Bud/Budding Tree opacities
Distribution of Disease
• Focal (or multifocal) versus diffuse
• Dependent distribution (varies with position!)
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Upper lobe
Bronchovascular
Peripheral
Random
We can do better
• “Infiltrate”: A vague term at best, used to
describe any abnormality. Avoid it!
• Lung “fields”: Fields are for cows! They are
lungs or lobes
• “Poor inspiratory effort”: Low lung volumes
is at least more appropriate
• “Nonspecific”: Earn your paycheck
Acute Consolidation
Increased Ill-Defined Opacity Completely Obscuring
The Vessels
• Pneumonia: Bacterial, Mycoplasma,
Aspiration
• Pulmonary Edema: Hydrostatic and Capillary
leak
• Pulmonary Hemorrhage: Contusion,
Pulmonary embolus, pulmonary-renal
diseases.
Acute?
Think blood, pus or water
Normal versus consolidation
Acute Ground Glass
Increased Ill-Defined Opacity Partially Obscuring
The Vessels
• Pneumonia: PCP, CMV, evolving or resolving
bacterial pneumonia
• Pulmonary Edema: Capillary leak >
hydrostatic edema
• Pulmonary Hemorrhage
• Hyaline Membrane Disease: Premature
infants only
Normal
Ground Glass
17 yo Male: Sudden Onset Dyspnea
Acute Ground Glass Opacity (2 Weeks of
symptoms) & Upper Lobe Distribution
Consolidation versus Ground Glass
• Increased ill-defined
opacity completely
obscuring vessels
Consolidation
• Increased opacity, but
you can still see some
vessels through it
Consolidation versus Ground Glass
• Increased ill-defined
opacity completely
obscuring vessels
Consolidation
• Increased opacity, but
you can still see some
vessels through it
Ground Glass (GGO)
Consolidation versus Ground Glass
• Increased ill-defined
opacity completely
obscuring vessels
Consolidation
• Increased opacity, but
you can still see some
vessels through it
Ground Glass (GGO)
Normal
Diffuse GGO versus focal consolidation
Aside –
Atelectasis is tough, and common
Smooth Margins, Radiate from Hilum
Kerley A and B Lines =
Septal Thickening
• Pulmonary Edema: Usually Hydrostatic
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• Lymphangitic Spread of Tumor:
Adenocarcinoma or Lymphoma most likely.
• Pneumonia: Typical viral pneumonia
• Acute Eosinophilic Pneumonia
Interlobular Septal Lines
Diffuse Septal Thickening:
Hydrostatic Edema
Septal thickening, vascular
indistinctness
Peripheral Lace-Like Reticular Opacities
• Usual Interstitial Pneumonitis (UIP)
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Idiopathic pulmonary fibrosis (IPF)
Collagen Vascular Diseases: Rheumatoid and
Scleroderma most common
Drug toxicity
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E.g. Bleomycin
Honeycombing
Cystic Pattern
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Diffuse/Central Bronchiectasis
Severe Emphysema
Langerhans Cell Histiocytosis (EG)
PCP
Lymphangioleiomyomatosis (LAM)
– Tuberous Sclerosis
• Lymphocytic interstitial pneumonitis (LIP)
Cystic Bronchiectasis
Nodular Opacities
• Metastasis: Any Tumor (Different Sizes)
• Granulomatous Diseases: Sarcoidosis, TB,
Fungal, (Similar Size)
• Inhalational Diseases/Lymphatic:
Hypersensitivity pneumonitis, EG (PLCH),
Silicosis and Coal Workers pneumoconiosis.
(Upper Lobes)
• Miliary Nodules: TB/Fungal, Sarcoid,
Metastasis
Most Likely Diagnosis?
Miliary Nodule: < 3mm in Size
Tree in bud pattern
• Suggests small airways
disease
• Seen in things like
aspiration, non-tb
mycobacterial infection,
viral pneumonia