CT Emphysema, Paraseptal Emphysematous Changes Bilateral Lower Lobes 65-year-old male with emphysema of the lungs presents with a cough, fever and leukocytosis. CT in the axial plane shows bibasilar paraseptal emphysematous changes and centrilobular changes in the lingula and RUL. Hyperinflation with resultant small heart is noted. Ashley Davidoff MD TheCommonVein.net 259Lu 117504
bleb
Axial CT – Lady Windermere Syndrome 61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough. Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome Ashley Davidoff MD TheCommonVein.net 250Lu 135876
Axial CT – Lady Windermere Syndrome 61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough. Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome Ashley Davidoff MD TheCommonVein.net 250Lu 135876
bronchiectasis
136598c
Fibrotic NSIP 59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD Upper Image Axial CT shows bibasilar ground glass, bronchiectasis, and bronchiolectasis with volume loss and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing. Note air-fluid level in the distended esophagus. The lower image focuses on the peripheral sparing. The spared secondary lobules have also undergone enlargement secondary to the fibrotic process Ashley Davidoff MD TheCommonVein.net 110Lu 136598c01
136598c
Fibrotic NSIP 59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD Upper Image Axial CT shows bibasilar peripheral reticular changes, ground glass, bronchiectasis, and bronchiolectasis with volume and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing posteriorly. Note air-fluid level in the distended esophagus. Lower Image The lower image focuses on the traction bronchiectasis caused by the fibrotic process Ashley Davidoff MD TheCommonVein.net 110Lu 136598c
bronchiolectasis
Chest CT above shows bronchiolitis which is characterized by peribronchial thickening which is thickening of the small airways of lung (yellow arrows)Ashley Davidoff MD TheCommonVein.net 81F-bronchiolitis-infection-inflammation-004
Chest CT above shows bronchiolitis which is characterized by peribronchial thickening which is thickening of the small airways of lung (yellow arrows)Ashley Davidoff MD TheCommonVein.net 81F-bronchiolitis-infection-inflammation-004
bronchiolitis
Frontal and Lateral CXR shows follicular bronchiolitis which is characterized by a coarsened nodular interstitial pattern. Ashley Davidoff MD TheCommonVein.net 132Lu 136650c B.A
Frontal and Lateral CXR shows follicular bronchiolitis which is characterized by a coarsened nodular interstitial pattern. Ashley Davidoff MD TheCommonVein.net 132Lu 136650c B.A
bronchiolitis (CXR)
Finger in Glove Sign 19 year old female with cystic fibrosis and bronchiectasis CT scan through the upper lung fields shows mucin filled subsegmental bronchi of the right upper lobe with morphology reminiscent of the “finger in glove” sign Courtesy Priscilla Slanetz MD MPH TheCommonVein.net 31966 B.A
Finger in Glove Sign
19 year old female with cystic fibrosis and bronchiectasis
CT scan through the upper lung fields shows mucin filled subsegmental bronchi of the right upper lobe with morphology reminiscent of the “finger in glove” sign (point to by yellow arrows)
Courtesy Priscilla Slanetz MD MPH TheCommonVein.net31966cl B.A
bronchocelebronchocentricbronchocentric
CT in the axial plane shows a bilobed calcified broncholith in the lateral segment of the middle lobe (c, d white arrowheads) with post obstructive atelectasis (c, blue arrowhead) Ashley Davidoff MD TheCommonVein.net 136585cL B.A
1
CT in the axial plane shows a bilobed calcified broncholith in the lateral segment of the middle lobe (c, d white arrowheads) with post obstructive atelectasis (c, blue arrowhead) Ashley Davidoff MD TheCommonVein.net 136585cL B.A
broncholith
CT Scan Bilateral Apical Builla Centrilobular Emphysema CT scan in the axial plane shows bilateral apical bullous lung disease, most commonly seen in emphysema Ashley Davidoff MD TheCommonVein.Net 136440 B.A
CT Scan Bilateral Apical Builla Centrilobular Emphysema CT scan in the axial plane shows bilateral apical bullous lung disease, most commonly seen in emphysema Ashley Davidoff MD TheCommonVein.Net 136440 B.A
bulla
CT Scan Bilateral Apical Bulla Centrilobular Emphysema CT scan in the coronal plane shows bilateral apical bullous lung disease, magnified in the lower image Ashley Davidoff MD TheCommonVein.Net 136439c B.A CT scan in the coronal plane of shows bilateral apical bullous lung disease, magnified in the lower image Ashley Davidoff MD TheCommonVein.Net 136439c B.A
bullous emphysema
Coronal and sagittal CT reconstructions show a cavitating mass in the superior segment of the right lower lobe (upper images) correlated with axial images (lower panel) Ashley Davidoff MD TheCommonVein.net 176Lu 136737 B.A Coronal and sagittal CT reconstructions show a cavitating mass in the superior segment of the right lower lobe (upper images) correlated with axial images (lower panel) Ashley Davidoff MD TheCommonVein.net 176Lu 136737 B.A
cavity (lungs)
132575.8bL
CT above shows a secondary lobule which is the smallest identifiable unit of the lung (made up of around 30 a0cni supplied by a common distal bronchiole and pulmonary artery)and its boundaries can be visualized by assessing the interlobular speta (red arrows)Ashley Davidoff MD TheCommonVein.net B.A
CT above shows a secondary lobule which is the smallest identifiable unit of the lung (made up of around 30 a0cni supplied by a common distal bronchiole and pulmonary artery)and its boundaries can be visualized by assessing the interlobular speta (red arrows)Ashley Davidoff MD TheCommonVein.net B.Acentrilobular (secondary lobule)
Centrilobular Emphysema in the Upper Lobes of the Lungs Axial CT (a) with magnified view of the upper lobes of a 66year female with centrilobular emphysema shows an expanded lobule with a centrilobular vessel in the middle characteristic of centrilobular emphysema Ashley Davidoff MD TheCommonvein.net RnD B.ACentrilobular Emphysema in the Upper Lobes of the Lungs Axial CT (a) with magnified view of the upper lobes of a 66year female with centrilobular emphysema shows an expanded lobule with a centrilobular vessel in the middle characteristic of centrilobular emphysema Ashley Davidoff MD TheCommonvein.net RnD B.A
centrilobular emphysema
Lingular Pneumonia 52 year old male presents with a cough and fever CT scan in the axial plane shows a lingular consolidation with air bronchograms and a positive silhouette sign. Both the superior and inferior lingular segments are involved Ashley Davidoff MD TheCommonVein.net135190 B.ALingular Pneumonia 52 year old male presents with a cough and fever CT scan in the axial plane shows a lingular consolidation with air bronchograms and a positive silhouette sign. Both the superior and inferior lingular segments are involved Ashley Davidoff MD TheCommonVein.net135190 B.A
consolidation in the lungs
CT shows alveolar proteinosis- central distribution which is characterized by diffuse bilateral ground-glass opacities involving both the upper and lower lobes Ashley Davidoff TheCommonVein.net117513 B.ACT shows alveolar proteinosis- central distribution which is characterized by diffuse bilateral ground-glass opacities involving both the upper and lower lobes Ashley Davidoff TheCommonVein.net117513 B.A
consolidation in the lungs
CT above shows the pathologic cryptogenic organizing pneumonia (COP) which is characterized by bilateral and asymmetrical ground-glass opacities and areas of consolidation that can overlap with the ground glass opacities Ashley Davidoff MD TheCommonVein.netlungs-COP-005-path-52f-CT B.ACT above shows the pathologic cryptogenic organizing pneumonia (COP) which is characterized by bilateral and asymmetrical ground-glass opacities and areas of consolidation that can overlap with the ground glass opacities Ashley Davidoff MD TheCommonVein.netlungs-COP-005-path-52f-CT B.A
cryptogenic organizing pneumonia (COP)
A 62-year-old female patient with Sjögren?s syndrome. Axial high-resolution computed tomography scan of the chest (A) and coronal reformatting (B). In A, diffuse thickening of the bronchial walls (closed arrows), some ground-glass opacities and thin-walled cysts of varying sizes, with a diffuse, bilateral distribution (open arrows). In B, distribution predominantly in the lower fields. Daniel Simões Oliveira et al Radiologia Brasileira 51 (5): 321?327. web-lungs-0013.jpg B.AA 62-year-old female patient with Sjögren?s syndrome. Axial high-resolution computed tomography scan of the chest (A) and coronal reformatting (B). In A, diffuse thickening of the bronchial walls (closed arrows), some ground-glass opacities and thin-walled cysts of varying sizes, with a diffuse, bilateral distribution (open arrows). In B, distribution predominantly in the lower fields. Daniel Simões Oliveira et alweb-lungs-0013.jpg B.A
cyst in the lungs
Axial CT through the lower lung fields at the level of the left atrium shows desquamative interstitial pneumonia (DIP) which is characterized by diffuse ground glass changes with more prominent heterogeneity (b and c). Some of secondary lobules are expanded, with some with slightly thickened septa and prominent centrilobular nodules likely indicating small airway involvement (c, white ring). Ashley Davidoff MD TheCommonVein.net 253Lu 136008 B.A
Axial CT through the lower lung fields at the level of the left atrium shows desquamative interstitial pneumonia (DIP) which is characterized by diffuse ground glass changes with more prominent heterogeneity (b and c). Some of secondary lobules are expanded, with some with slightly thickened septa and prominent centrilobular nodules likely indicating small airway involvement (c, white ring).
Ashley Davidoff MD TheCommonVein.net 253Lu 136008 B.A desquamative interstitial pneumonia (DIP)
CHF – Alveolar Edema CT scan shows Diffuse ground glass pattern with thickening of the interlobular septa and manifesting as crazy paving pattern Ashley Davidoff MD TheCommonVein.net 131742 B.A
CHF – Alveolar Edema
CT scan shows Diffuse ground glass pattern with thickening of the interlobular septa and manifesting as crazy paving pattern
Ashley Davidoff MD TheCommonVein.net 131742cL B.Adiffuse alveolar damage (DAD)
Position of Disease Subpleural Sparing Ashley Davidoff MD TheCommonvein.net lungs-0775 0775-lo res subpleural sparing
diffuse lung changes
CXR Emphysema and Small Heart 58-year-old male presents with dyspnea. The lungs are hyperinflated with flattening of the diaphragms and increase in the retrosternal space on the lateral examination. The person also has an asthenic build with a relatively straight back and narrow A-P dimension. Frontal CXR shows a small heart with structures of the heart visualized to the right of the midline caused by compression of the low-pressure right atrium. The increased in the retrosternal airspace also compresses the relatively low pressure anteriorly positioned right ventricle. The heart is also lifted off the diaphragm (band c white arrowheads) and results in juxtaphrenic lung markings and peaks below the heart (d, arrowheads) Ashley Davidoff MD TheCommonVein.net 136232c01L B.ACXR Emphysema and Small Heart 58-year-old male presents with dyspnea. The lungs are hyperinflated with flattening of the diaphragms and increase in the retrosternal space on the lateral examination. The person also has an asthenic build with a relatively straight back and narrow A-P dimension. Frontal CXR shows a small heart with structures of the heart visualized to the right of the midline caused by compression of the low-pressure right atrium. The increased in the retrosternal airspace also compresses the relatively low pressure anteriorly positioned right ventricle. The heart is also lifted off the diaphragm (band c white arrowheads) and results in juxtaphrenic lung markings and peaks below the heart (d, arrowheads) Ashley Davidoff MD TheCommonVein.net 136232c01L B.A
emphysema
Axial CT scan with contrast shows bilateral complex and loculated effusions with thickened enhancing pleura. Ashley Davidoff MD TheCommonVein.net 135684 B.A
Axial CT scan with contrast shows bilateral complex and loculated effusions with thickened enhancing pleura.
Ashley Davidoff MD TheCommonVein.net 135684cL B.Aempyema
CT in the axial plane shows an obstructing lesion in the left mainstem bronchus of the lung (green arrowhead) with post obstructive atelectasis of the lingula (black arrowhead) and a small portion of left upper lobe anteriorly (white arrowhead). The major fissure is displaced anteriorly. Ashley Davidoff MD TheCommonVein.net 257Lu 136110cL B.ACT in the axial plane shows an obstructing lesion in the left mainstem bronchus of the lung (green arrowhead) with post obstructive atelectasis of the lingula (black arrowhead) and a small portion of left upper lobe anteriorly (white arrowhead). The major fissure is displaced anteriorly. Ashley Davidoff MD TheCommonVein.net 257Lu 136110cL B.A
endobronchial finding
CT Extra-Pleural Fat Sign CT shows extra fat sign which is characterized by focal subsegmental area of atelectasis in the right lower lobe abutting the diaphragm associated with extra pleural fat proliferation secondary to the parenchymal infiltrate. Ashley Davidoff MD TheCommonVein.net 136036c B.ACT Extra-Pleural Fat Sign CT shows extra fat sign which is characterized by focal subsegmental area of atelectasis in the right lower lobe abutting the diaphragm associated with extra pleural fat proliferation secondary to the parenchymal infiltrate. Ashley Davidoff MD TheCommonVein.net 136036c B.A
extrapleural finding (fat sign)
CT Miliary Tuberculosis 60-year-old female presents with a cough and weight loss. Axial CT shows miliary nodules throughout both lung fields. Some of these nodules are are centrilobular or distributed along the bronchovascular bundles (b, maroon arrowheads) and others are fissural based (b, pink arrowheads). She responded well to treatment and final diagnosis was mycobacterium tuberculosis. Ashley Davidoff MD TheCommonVein.net 265Lu 136201cL This CT shows fissural nodules which are usually benign round nodules with well-defined margins that usually appear within fissural lines (yellow arrowheads) Ashley Davidoff MD TheCommonVein.net136201cL01 B.A
Axial CT of the chest at the level of the aortic arch shows follicular bronchiolitis (BALT) which is characterized by centrilobular nodules, ground-glass opacities and bronchial wall thickening. Ashley Davidoff MD TheCommonVein.net 132Lu 136652 B.A
Axial CT of the chest at the level of the aortic arch shows follicular bronchiolitis (BALT) which is characterized by centrilobular nodules, ground-glass opacities and bronchial wall thickening. Ashley Davidoff MD TheCommonVein.net 132Lu 136652 B.A
This CT shows a ground glass nodule in the lung which is characterized by a small round hazy opacity that are usually less than 3cm in size (yellow arrows)Ashley Davidoff MD TheCommonVein.net29787L B.A
This CT shows a ground glass nodule in the lung which is characterized by a small round hazy opacity that are usually less than 3cm in size (yellow arrows)Ashley Davidoff MD TheCommonVein.net 29787cL B.A
ground glass nodule in the lungs
This CT shows diffuse ground glass opacities involving the upper lobes and lower lobes. A finding commonly seen in patients with sarcoidosis Ashley Davidoff MD TheCommonVein.net 029Lu 29064a002.8 B.A. CT shows diffuse ground glass opacities involving the upper lobes and lower lobes. A finding commonly seen in patients with sarcoidosis Ashley Davidoff MD TheCommonVein.net 029Lu 29064a002.8 B.A
ground glass opacity (GGO)
“This X-ray depicts what a normal CXR should look like. Ashley Davidoff MD TheCommonVein.net 028-M-Normal-CXR-001L B.Ahilum
This CT shows a dominant pattern of extensive honeycombing in the lower lobes. Honeycombing is described as small well-defined clustered cystic spaces that look like a honeycomb with thickened walls. Also present above are reticular patterns which signal the fibrosis that often accompanies honeycombing Ashley Davidoff MD thecommonvein.net 134902-lungs UIP B.A
CT scan of a 74 year old febrile female above shows a wedge shaped right upper lobe infiltrate consisting of a combination of consolidation and ground glass components along a bronchovascular distribution consistent with bronchopneumonia. An enlarged right hilar lymph node is present Ashley Davidoff TheCommonVein.net RnD Image First program 135180.bronchopneumoniacB.A
CT scan of a 74 year old febrile female above shows a wedge shaped right upper lobe infiltrate consisting of a combination of consolidation and ground glass components along a bronchovascular distribution consistent with bronchopneumonia. An enlarged right hilar lymph node is present Ashley Davidoff TheCommonVein.net RnD Image 135180
infiltrate lungs (see opacity)
CT scan of the chest shows mosaic attenuation peripheral pulmonary lobules best exemplified in the posterior aspects of the superior segments of the lower lobes bilaterally A lobular bronchiole is overlaid in teal in c, while the accompanying lobular arteriole is seen in royal blue entering the lobule and then branching. The peripheral venules (red) in the interlobular septa join to form the lobular vein. The accompanying lymphatics (yellow) accompany the venules in the interlobular septa. These are not visualized but are implied In this remarkable CT we were able to identify a few secondary lobules at the periphery of the lung that have a rectangular shape in this instance. The branching structure that enters the lobule (blue in c), is characterised as an arteriole for two reasons. Firstly, it is paired with a tubular airway seen in (b) in its most proximal portion as a lucent tubule, and subsequently interpolated in light blue in c. Secondly it branches in the center of the lobule. It is distinct from the border forming interlobular septum which surrounds it. A second relatively large vessel colored in red receives a branch from the interlobular septum and by virtue of its size and position it has to be a pulmonary venule. We know that the lymphatic vessel accompanies the venule, and so the yellow lymphatic has been implied but not visualised. We also know that connective tissue surrounds these two structures. In this instance the matrix of the lobule that consists of the alveoli is less dense than it should be and is surrounded by normal lung parenchyma. Lucency, or mosaic attenuation implies either small vessel disease or small airway disease. In the latter instance air trapping from small airway disease is implied. Ashley Davidoff MD TheCommonVein.net 47152c02 RnD CT scan of the chest shows mosaic attenuation peripheral pulmonary lobules best exemplified in the posterior aspects of the superior segments of the lower lobes bilaterallyAshley Davidoff MD TheCommonVein.net47152c01e B.A
interlobular septuminterstitial fibrosis (combined with UIP, ILD)
interstitial lung diseaseinterstitium
left paratracheal stripe
CT chest above shows poorly-diffentiated adenocarincoma. Poorly-diffentiated adenocarincomas on CT are characterizedr by irregular or spiculated masses that are lobulated in shape as seen above. Usually they are located in the periphery Ashley Davidoff MD TheCommonVein.net B.A
lobulation
CT above shows reveals bulky conglomerate lymphadenopathy with central hypodensity in right levels IV, VI, supraclavicular region and partially visualized within the upper mediastinum. Ashley Davidoff MD TheCommonVein.net Lymphsadenopathy-low-demsity-TB-04-CT-5-years-ago B.A
CT above shows reveals bulky conglomerate lymphadenopathy with central hypodensity in right levels IV, VI, supraclavicular region and partially visualized within the upper mediastinum. Ashley Davidoff MD TheCommonVein.net Lymphsadenopathy-low-demsity-TB-04-CT-5-years-agoL B.Alow density lymphadenopathy (LAD) lymph nodes of the chest: superior mediastinal nodes lymph nodes of the chest: aortic nodes lymph nodes of the chest: inferior mediastinal nodes
lymphadenopathy in the chest (LAD)
53 year old male with history of smoking presents with a cough CXR shows a large mass in the left apex Diagnosis adenocarcinoma of the lung with extensive necrosis of the tumor Ashley Davidoff MD The CommonVein.net B.A
53 year old male with history of smoking presents with a cough CXR shows a large mass in the left apex
Diagnosis adenocarcinoma of the lung with extensive necrosis of the tumor (yellow arrow)
Ashley Davidoff MD The CommonVein.net lungs-large-adenocarcinoma-necrosis-001-53m-CXRcL B.Amass in the lungAshley Davidoff MD The CommonVein.netheart-membranous-VSD-000b-37F-CXR-normal_L BA
The ski slopes of Mount Mediastinum Start with the left slope at the apex of the left lung. After you get off the ski-lift, follow the signs to the ?Subclavian Steel? which is painted in dark maroon ? just like blood. You will gain speed very quickly off this slope which starts with the subclavian artery. This is the most dangerous of the slopes since you are almost upside down as you start. As you gather speed come across the bump of the aorta. This trail is called the ?Aortic Notch? and its sign is colored in bright red. ? This trail holds the biggest mogul. A shallow mogul of the MPA (?Lung Artree? dark blue) comes next, and then a concave in pink for the left atrial appendage. ?Pretty Pendage? (short lived) After that it is a great mild and long slope of the orange LV (?Smooth Elvee?) until you pass alongside the triangular fat pad of the LV. The second slope on the right starts near the apex of the right lung and is marked with a bright green sign called ?vein cave? As you step off the lift ? there is a ninety degree drop, and if you look to your left you will see the red cells in the superior vena cava traveling much slower than you. After the ?vein cave? route, the gentle curve around the right atrium (purple) takes over and you are brought to an almost negligible slope of the right ventricle. (teal) The right and left slope meet at the bottom by the ski house. Ashley Davidoff MD TheCommonVein.net 42260bb01 BA
Frontal CXR – Miliary TB 60-year-old immunocompromise female presents with a cough and weight loss CXR shows a diffuse miliary pattern. Final diagnosis was mycobacterium tuberculosis. Associated findings include healed right sided rib fractures and surgical clips in the left axilla Ashley Davidoff MD TheCommonVein.net 265Lu 136197 B.A Frontal CXR – Miliary TB 60-year-old immunocompromise female presents with a cough and weight loss CXR shows a diffuse miliary pattern. Final diagnosis was mycobacterium tuberculosis. Associated findings include healed right sided rib fractures and surgical clips in the left axilla Ashley Davidoff MD TheCommonVein.net 265Lu 136197 B.A
Mosaic attenuation pattern. CT scan through lower lobes shows the indirect sign of constrictive obliterative bronchiolitis, in this case the sequel to a severe viral lower respiratory tract infection. https://pubs.rsna.org/doi/full/10.1148/radiol.13120908 B.A
40 year old female with SLE and congestive-cardiomyopathy. Axial CT (top row) shows a focal nodule that was connected to a bronchiole. Bronchiectasis with mucoid impaction and ABPA were radiological considerations. T2 weighted MRI (bottom row) shows T2 brightness confirming the fluid or proteinaceous nature of the nodule likely from mucoid impaction. Note surrounding mosaic attenuation suggesting associated small airway obstruction. Ashley Davidoff MD TheCommonVein.net 002-CT-mucoid-impaction
CT scan at the level of the aortic arch shows a mass in the anterior segment of the right upper lobe of the lung characterised by a c shaped or crescent shaped anterior rim of air with ball of soft tissue, reminiscent of the crescent sign most characteristic of an aspergillus infection of a cavity and resulting in an aspergilloma. Ashley Davidoff TheCommonVein.net20760cB.A
20760cmycetoma fungal mass
NODULAR PATTERN ON CXR IN ILD Frontal view exemplifies a diffuse nodular pattern of ILD such as is seen in silicosis and sarcoidosis Courtesy You Tube on ILD. web-lungs-0161b
NSIP 71-year-old female presents with a history of scleroderma, ILD, hypothyroidism and dcSSc CT in the coronal plane shows bibasilar ground glass changes, with bronchovascular thickening traction bronchiectasis, and bronciolectasis Ashley Davidoff MD TheCommonVein.net 196Lu 136607 B.A
136607Lnonspecific interstitial pneumonia (NSIP)
Scleroderma with predominant cellular NSIP pattern characterised by predominant ground glass pattern and peripheral distribution. Bronchiectasis is not a prominent feature. Peripheral sparing is noted Ashley Davidoff MD TheCommonVein.net scleroderma NSIP 006 B.A
60-M-scleroderma-NSIP-006Lnonspecific interstitial pneumonia (NSIP) cellular form
CT Scleroderma Obliterative Bronchiolitis vs Cellular NSIP 39-year-old-male with a history of scleroderma associated with ILD and digital vasculopathy with ulcers. Axial CT shows thickening of the segmental, subsegmental and small airways supplying the posterior basal segment of the right lower lobe. In addition there is a background poorly defined ground glass changes and mild reticulation. In this clinical setting obliterative bronchiolitis (aka bronchiolitis obliterans aka constrictive bronchiolitis) is suggested. Cellular NSIP is also a radiological consideration. Ashley Davidoff MD TheCommonVein.net 132Lu 136669c B.A CT Scleroderma Obliterative Bronchiolitis 39-year-old-male with a history of scleroderma associated with ILD and digital vasculopathy with ulcers. Coronal CT shows thickening of the segmental and subsegmental airway supplying the lateral basal segment of the left lower lobe. In addition there is a background of peripheral ground glass changes poorly defined ground glass centrilobular nodules and mild reticulation. In this clinical setting obliterative bronchiolitis (aka bronchiolitis obliterans aka constrictive bronchiolitis) is suggested. Cellular NSIP is also a radiological consideration. Ashley Davidoff MD TheCommonVein.net 132Lu 136669c B.A
obliterative bronchiolitis
Westermark sign. Frontal radiograph (A) and an enhanced CT of the chest (B) demonstrate lucency within the right upper lobe representing oligemia secondary to pulmonary embolus. Source Signs in Thoracic Imaging Journal of Thoracic Imaging 21(1):76-90, March 2006.web-lungs-0074
Panlobular Emphysema CT scan of a 78 year old male with history of alpha-1 antitrypsin deficiency with extensive and severe emphysematous change uncharacteristically more prominent in the upper and midlung regions. Associated complex right pleural effusion with compressive atelectasis Ashley Davidoff TheCommonVein.net RnD116533.panlobular-emphysema-alpha-1-antitrypsinB.A
PLEURAL BASED NODULE (red arrow) and FISSURAL NODULES (green arrow) – SARCOIDOSIS – CHARACTERISTIC NODULES 51-year-old male with history of sarcoidosis The frontal CXR shows subtle nodular changes in the right upper peripheral lung field (red circles) and the lateral examination shows 3 regions of nodular changes (red arrowheads) The CT examination scout film confirms 3 major regions of nodular change in the posterior and superior segment of the RUL along the confluence of the right major and minor fissure and in the posterior segment of the left upper lobe peripherally. The axial images show a variety of characteristic changes including; Ground glass opacity Stellate or flame shaped nodules Semisolid nodules Fissural based nodules Subpleural nodules Micronodules along the lymphovascular and bronchovascular bundles of the secondary lobule Calcified nodule some of which are surrounded by soft tissue of the granuloma There are small calcified nodes in the mediastinum, but no significant pathological adenopathy No obvious cardiac nor splenic involvement is noted Ashley Davidoff MD132135.8L. B.A
pleura-based finding
136550c_effusion
CXR Small Pleural Effusion 50-year-old man presents with dyspnea. PA and lateral view shows blunting of the right costophrenic angle in the P-A view (above) and confirmed on the lateral view (below) Courtesy Ashley Davidoff MD TheCommonVein.net 136550cB.A
pleural effusion
Chest X-ray Asbestos Related Disease 76-year-old former pipe fitter, presents with a cough. CXR in the frontal and lateral projections show evidence of asbestos related disease characterized by pleural thickening and calcified pleural plaques. Ashley Davidoff MD TheCommonVein.net 42016c01B.A Chest X-ray Asbestos Related Disease 76-year-old former pipe fitter, presents with a cough. CXR in the frontal and lateral projections show evidence of asbestos related disease characterized by pleural thickening and calcified pleural plaques (ringed in white). Ashley Davidoff MD TheCommonVein.net 42016c01L
pleural plaque
pleural tag (CT)
chest-lungs-pneumomedistinum-001-CXR-trauma_c
chest-lungs-pneumomedistinum-001-CXR-trauma_cL
pneumomediastinum
PNEUMONIA IN THE SUPERIOR SEGMENT OF THE RLL Ashley Davidoff MD TheCommonVein.net130900c.8B.A
REVERSED HALO SIGN CAUSED BY PE AND PROBABLE HEMORRHAGIC INFARCTION 32 year old male presents with acute PE and reversed halo sign indicative most likely of a hemorrhagic pulmonary infarction Ashley Davidoff MD131475.8
High-resolution CT in respiratory bronchiolitis-associated interstitial lung disease. Bronchiolocentric interstitial ground-glass opacifications, accentuated in the upper part of the lung. Smoking-Related Interstitial Lung Disease Ashley Davidoff MD TheCommonVein.netJanuary 2015Deutsches Ärzteblatt International 112(4):43-50 web-lungs-298 Hagmeyer L et al B.A
High-resolution CT in respiratory bronchiolitis-associated interstitial lung disease. Bronchiolocentric interstitial ground-glass opacifications, accentuated in the upper part of the lung (in blue square)
Ashley Davidoff MD TheCommonVein.netSmoking-Related Interstitial Lung Diseaseweb-lungs-298cL B.A
respiratory bronchiolitis ILD
CXR Alveolar Septal Amyloidosis 56 -year-old female with a history of amyloidosis (AL) presents for follow up following a pulmonary embolus. Frontal view of the chest shows diffuse reticular process best appreciated at the left base suggesting Kerley b lines (magnified in the lower panels). In the appropriate clinical setting these findings are compatible with the diagnosis of alveolar septal amyloidosis. Note the air fluid level in the stomach in this patient with known amyloidosis of the stomach with delayed gastric emptying Ashley Davidoff MD TheCommonVein.net 244 Lu 135741c05cB.A CXR Alveolar Septal Amyloidosis 56 -year-old female with a history of amyloidosis (AL) presents for follow up following a pulmonary embolus. Frontal view of the chest shows diffuse reticular process best appreciated at the left base suggesting Kerley b lines (magnified in the lower panels). In the appropriate clinical setting these findings are compatible with the diagnosis of alveolar septal amyloidosis. Note the air fluid level in the stomach in this patient with known amyloidosis of the stomach with delayed gastric emptying. Ashley Davidoff MD TheCommonVein.net 244 Lu 135741c05cB.A
reticular pattern lungs
LANGERHANS HISTIOCYTOSIS RETICULONODULAR PATTERN 53-year-old female with nicotine dependence presents with dyspnea and cough CXR (PA and Lateral) shows bilateral and extensive reticular nodular changes slightly more prominent in the upper lung zones CT scan from 16 months prior showed multiple relatively thick-walled cysts predominantly in the upper lobes. The cysts are round and air filled large and are between 5mm-8mm CT scan 9 months later shows improvement in the thickened walls of the cysts but maintenance of diffuse cystic changes predominantly in the upper lobes A CT scan done 2 years later shows no significant change in the diffuse bilateral cystic changes, dominant in the upper lobes and consistent with Langerhans histiocytosis Ashley Davidoff MD131990.B.A
reticulonodular pattern lungs
28-M-Normal-CXR-001L03
28-M-Normal-CXR-001L03
right paratracheal stripe
118433c
Rounded Atelectasis (aka Folded Lung Syndrome) and Asbestos Related disease 72-year-old male with a history of asbestos exposure presents with a cough. Axial CTscan using lung windows, shows a pleural based nodule (purple arrowhead b) with a subtending curvilinear comet tail formed by a trailing bronchovascular bundle (teal blue b). There is associated pleural thickening and pleural based calcification (black arrowheads ,b), reminiscent of asbestos related disease. Ashley Davidoff MD TheCommonVein.net 118433cL 240Lu B.A
Secondary Lobule The top image (a) shows an anatomic drawing of a secondary lobule of the lung subtended by a lobular bronchiole (lb) and arteriole (pa). The interlobular septum contains the venule (red) lymphatic (yellow) and septum (maroon) The anatomical specimen of the lung (b) shows normal intralobular parenchyma while image c shows the centrilobular arteriole (navy blue) and centrilobular bronchiole (teal) and interlobular venule (red) and lymphatics (yellow) The interlobular septum is slightly thickened Ashley Davidoff TheCommonVein.netlungs-0785-lo-res-secondary-lobule.jpgB.A
secondary lobule
Anatomy of the Bronchial Segments of the Right and Left lobes of the Lung Ashley Davidoff TheCommonvein.net 32686b05L segmental bronchi.8
segment of lung
Rounded Atelectasis (aka Folded Lung Syndrome) and Asbestos Related disease 72-year-old male with a history of asbestos exposure presents with a cough. Axial CTscan using lung windows, shows a pleural based nodule with a subtending curvilinear comet tail formed by a trailing bronchovascular bundle. There is associated pleural thickening and pleural based calcification reminiscent of asbestos related disease. Ashley Davidoff MD TheCommonVein.net 118433c 240LuB.A
53 year old male with history of smoking presents with a cough CXR shows a large mass in the left apex Diagnosis adenocarcinoma of the lung with extensive necrosis of the tumor Ashley Davidoff MD The CommonVein.netungs-large-adenocarcinoma-necrosis-001-53m-CXRB.A
lungs-large-adenocarcinoma-necrosis-001-53m-CXRcLsolid lung mass
Tension Pneumothorax Spontaneous rupture tension pneumothorax, total collapse. Ashley Davidoff MD TheCommonVein.net 42106b Tension Pneumothorax In the upper images the forces of the mediastinum overcome the forces of the lung which are at low pressure. In tension pneumothorax the pressures in this case, in the left thorax, keep on increasing as more air builds up, and eventually exceed the forces of the mediastinum The mediastinum gets compressed, preventing blood return and resulting in poor cardiac output Ashley Davidoff MD TheCommonVein.net 42106c04
CT ?Reactivation TB – Left Upper Lobe Airway Disease Segmental Subsegmental and Small Airway Involvement CT scan in the coronal plane of the left upper lobe of a 28-year-old immigrant with cough shows a thickening of the walls of the segmental, (blue circle) and subsegmental airway disease (teal circle ) as well as small airways disease characterised by tree in bud changes (ringed in whit)e These findings indicate transbronchial spread. Lab tests confirmed a diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis. Ashley Davidoff MD TheCommonVein.net 255Lu 136079cL
tree-in-bud appearance (CT)
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CT Emphysema, Paraseptal Emphysematous Changes Bilateral Lower Lobes65-year-old male with emphysema of the lungs presents with a cough, fever and leukocytosis. CT in the axial plane shows bibasilar paraseptal emphysematous changes and centrilobular changes in the lingula and RUL. Hyperinflation with resultant small heart is noted.Ashley Davidoff MD TheCommonVein.net 259Lu 117504
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Axial CT – Lady Windermere Syndrome61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndromeAshley Davidoff MD TheCommonVein.net 250Lu 135876
Axial CT – Lady Windermere Syndrome61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndromeAshley Davidoff MD TheCommonVein.net 250Lu 135876
bronchiectasis
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Fibrotic NSIP59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILDUpper ImageAxial CT shows bibasilar ground glass, bronchiectasis, and bronchiolectasis with volume loss and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing. Note air-fluid level in the distended esophagus.The lower image focuses on the peripheral sparing. The spared secondary lobules have also undergone enlargement secondary to the fibrotic processAshley Davidoff MD TheCommonVein.net 110Lu 136598c01
136598c
Fibrotic NSIP59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILDUpper ImageAxial CT shows bibasilar peripheral reticular changes, ground glass, bronchiectasis, and bronchiolectasis with volume and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing posteriorly. Note air-fluid level in the distended esophagus.Lower ImageThe lower image focuses on the traction bronchiectasis caused by the fibrotic processAshley Davidoff MD TheCommonVein.net 110Lu 136598c
bronchiolectasis
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CT Emphysema, Paraseptal Emphysematous Changes Bilateral Lower Lobes65-year-old male with emphysema of the lungs presents with a cough, fever and leukocytosis. CT in the axial plane shows bibasilar paraseptal emphysematous changes and centrilobular changes in the lingula and RUL. Hyperinflation with resultant small heart is noted.Ashley Davidoff MD TheCommonVein.net 259Lu 117504
bleb
Axial CT – Lady Windermere Syndrome61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndromeAshley Davidoff MD TheCommonVein.net 250Lu 135876
Axial CT – Lady Windermere Syndrome61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndromeAshley Davidoff MD TheCommonVein.net 250Lu 135876
bronchiectasis
136598c
Fibrotic NSIP59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILDUpper ImageAxial CT shows bibasilar ground glass, bronchiectasis, and bronchiolectasis with volume loss and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing. Note air-fluid level in the distended esophagus.The lower image focuses on the peripheral sparing. The spared secondary lobules have also undergone enlargement secondary to the fibrotic processAshley Davidoff MD TheCommonVein.net 110Lu 136598c01
136598c
Fibrotic NSIP59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILDUpper ImageAxial CT shows bibasilar peripheral reticular changes, ground glass, bronchiectasis, and bronchiolectasis with volume and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing posteriorly. Note air-fluid level in the distended esophagus.Lower ImageThe lower image focuses on the traction bronchiectasis caused by the fibrotic processAshley Davidoff MD TheCommonVein.net 110Lu 136598c
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Fibrotic NSIP59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILDUpper ImageAxial CT shows bibasilar peripheral reticular changes, ground glass, bronchiectasis, and bronchiolectasis with volume and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing posteriorly. Note air-fluid level in the distended esophagus.Lower ImageThe lower image focuses on the traction bronchiectasis caused by the fibrotic processAshley Davidoff MD TheCommonVein.net 110Lu 136598c
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Fibrotic NSIP59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILDUpper ImageAxial CT shows bibasilar peripheral reticular changes, ground glass, bronchiectasis, and bronchiolectasis with volume and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing posteriorly. Note air-fluid level in the distended esophagus.Lower ImageThe lower image focuses on the traction bronchiectasis caused by the fibrotic processAshley Davidoff MD TheCommonVein.net 110Lu 136598c
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Fibrotic NSIP59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILDUpper ImageAxial CT shows bibasilar ground glass, bronchiectasis, and bronchiolectasis with volume loss and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing. Note air-fluid level in the distended esophagus.The lower image focuses on the peripheral sparing. The spared secondary lobules have also undergone enlargement secondary to the fibrotic processAshley Davidoff MD TheCommonVein.net 110Lu 136598c01
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Fibrotic NSIP59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILDUpper ImageAxial CT shows bibasilar ground glass, bronchiectasis, and bronchiolectasis with volume loss and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing. Note air-fluid level in the distended esophagus.The lower image focuses on the peripheral sparing. The spared secondary lobules have also undergone enlargement secondary to the fibrotic processAshley Davidoff MD TheCommonVein.net 110Lu 136598c01
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Axial CT – Lady Windermere Syndrome61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndromeAshley Davidoff MD TheCommonVein.net 250Lu 135876
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Axial CT – Lady Windermere Syndrome61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndromeAshley Davidoff MD TheCommonVein.net 250Lu 135876
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Axial CT – Lady Windermere Syndrome61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndromeAshley Davidoff MD TheCommonVein.net 250Lu 135876
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Axial CT – Lady Windermere Syndrome61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough.Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndromeAshley Davidoff MD TheCommonVein.net 250Lu 135876
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CT Emphysema, Paraseptal Emphysematous Changes Bilateral Lower Lobes65-year-old male with emphysema of the lungs presents with a cough, fever and leukocytosis. CT in the axial plane shows bibasilar paraseptal emphysematous changes and centrilobular changes in the lingula and RUL. Hyperinflation with resultant small heart is noted.Ashley Davidoff MD TheCommonVein.net 259Lu 117504
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CT Emphysema, Paraseptal Emphysematous Changes Bilateral Lower Lobes65-year-old male with emphysema of the lungs presents with a cough, fever and leukocytosis. CT in the axial plane shows bibasilar paraseptal emphysematous changes and centrilobular changes in the lingula and RUL. Hyperinflation with resultant small heart is noted.Ashley Davidoff MD TheCommonVein.net 259Lu 117504
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CT above shows a secondary lobule which is the smallest identifiable unit of the lung (made up of around 30 a0cni supplied by a common distal bronchiole and pulmonary artery)and its boundaries can be visualized by assessing the interlobular speta (red arrows)Ashley Davidoff MD TheCommonVein.net B.Acentrilobular (secondary lobule)
Axial CT through the lower lung fields at the level of the left atrium shows desquamative interstitial pneumonia (DIP) which is characterized by diffuse ground glass changes with more prominent heterogeneity (b and c). Some of secondary lobules are expanded, with some with slightly thickened septa and prominent centrilobular nodules likely indicating small airway involvement (c, white ring).
CHF – Alveolar Edema
53 year old male with history of smoking presents with a cough CXR shows a large mass in the left apex
Ashley Davidoff MD The CommonVein.netheart-membranous-VSD-000b-37F-CXR-normal_L BA
Ashley Davidoff MD TheCommonVein.net131745.8LB.A
Ashley Davidoff MD TheCommonVein.net131745.8L02 B.Amicronodules lungs
heart-SLE-congestive-cardiomyopathy-mitral-regurgitation-002-CT-mucoid-impaction-40F_L mucoid impaction lungs multifocal lung finding
nodular pattern in the lungs
72-m-lung-screen-ca-02-currentc
72-m-lung-screen-ca-02-currentcLnodule lung nodules interlobular septum lungs (CT)
136607Lnonspecific interstitial pneumonia (NSIP)
60-M-scleroderma-NSIP-006Lnonspecific interstitial pneumonia (NSIP) cellular form
lung-COVID-Organizing-pneumonia-53M-013_OP
136202cL_02perilymphatic
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lung-72-M-saber-trachea-001L
bronchus-segmental-normal
bronchus-segmental-normalLsegmental bronchi
132089.8L
132089.8cLsubpleural changes (nodules)
tracheobronchomalacia_insp_exp
