Case 1: Question. 1.1 What is the main pattern of this HRCT? 1. Intralobular line 2. Groundglass opacity 3. Perilymphatic nodule
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1 HRCT WORK SHOP
2 Case 1
3
4 Case 1: Question 1.1 What is the main pattern of this HRCT? 1. Intralobular line 2. Groundglass opacity 3. Perilymphatic nodule
5 Case 1: Question 1.2 What is the diagnosis? 1. Hypersensitivity pneumonitis 2. Silicosis 3. Alveolar proteinosis 4. Miliary tuberculosis
6 Case 2
7
8 Case 2 : Question 2.1 What is the main pattern of this HRCT? 1. Nodule 2. Groundglass opacity 3. Reticular line
9 Case 2 : Question 2.2 What is the intralobular distribution? 1. Centrilobular 2. Perilymphatic 3. Random
10 Case 2 : Question 2.3 What is the diagnosis? 1. Hypersensitivity pneumonitis 2. Silicosis 3. Lymphangitic carcinomatosis 4. Miliary tuberculosis
11 Case 3
12
13 Case 3 : Question 3.1 What about the lung volume? 1. Increase 2. Normal 3. Decrease
14 Case 3 : Question 3.2 What is the intralobular distribution? 1. Centrilobular 2. Perilymphatic 3. Random
15 Case 4
16
17 Case 4: Question 4.1 What is the intralobular distribution? 1. Centrilobular 2. Perilymphatic 3. Random
18 Case 4: Question 4.2 What is the associated finding? 1. Bronchiectasis 2. Lymphadenopathy 3. Pleural effusion
19 Case 4: Question 4.3 What is the diagnosis? 1. Bronchial spreading tuberculosis 2. Miliary tuberculosis 3. Lymphangitic carcinomatosis
20 Case 5
21
22 Case 5: Question 5.1 What is the main pattern of this HRCT? 1. Micronodule 2. Line 3. Both 1 and 2
23 Case 5: Question 5.2 What is the intralobular distribution? 1. Centrilobular 2. Perilymphatic 3. Random
24 Case 6
25
26 Case 6: Question 6.1 What is this CT sign? 1. Crazy paving 2. Mosaic pattern
27 Case 7
28
29 Case 7: Question 7.1 What is the craniocaudal distribution? 1. Upper + middle 2. Lower + middle 3. Diffuse
30 Case 7: Question 7.2 What is the diagnosis? 1. Emphysema 2. Langerhans cell histocytosis (LCH) 3. Lymphangiomyomatosis (LAM)
31 Case 8
32
33 Case 8: Question 8.1 What is the main pattern of this HRCT? 1. Honeycomb 2. Groundglass opacity 3. Consolidation
34 Case 9
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36 Case 9: Question 9.1 What is the diagnosis? 1. Emphysema 2. Langerhans cell histocytosis(lch) 3. Lymphangiomyomatosis (LAM)
37 Case 10
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39 Case 10: Question 10.1 What is the main pattern of this HRCT? 1. Smooth septal thickening 2. Nodular septal thickening 3. Centrilobular nodule
40 Case 10: Question 10.2 What is the associated finding? 1. Pleural effusion 2. Pulmonary arterial hypertension 3. Lymphadenopathy
41 Case 11
42
43 Case 11: Question 11.1 What is the main pattern of this HRCT? 1. Smooth interlobular septal thickening 2. Nodule 3. Ground glass opacity
44 Case 11: Question 11.2 What is the pattern of disease spreading? 1. Perilymphatic spreading 2. Bronchial spreading
45 Case 11: Question 11.3 What is the associated finding? 1. Pleural effusion 2. Enlarged lymph node 3. 1 and 2
46 Case 11: Question 11.4 What is the diagnosis? 1. PAP 2. Hypersensitivity pneumonitis 3. Lymphangitic carcinomatosis
47 Case11 : Question 11.5 What is the best further investigation? 1. Surgical Bx 2. Thoracoscopic Bx 3. Bronchoscopic BX
48 Case 12
49
50 Case12 : Question 12.1 What is the main pattern of this HRCT? 1. Interlobular line 2. Intralobular line 3. GGO
51 Case 12 : Question 12.2 What is the axial distribution? 1. Peripheral 2. Central 3. Diffuse
52 Case 12 : Question 12.3 What is the intralobular distribution? 1. Perilobular 2. Centrilobular 3. Panlobular
53 Case 13
54
55 Case 13 : Question 13.1 What about the lung volume? 1. Increase 2. Normal 3. Decrease
56 Case 13 : Question 13.2 What is the main pattern of this HRCT? 1. Reticulation 2. Nodule 3. Honeycombing
57 Case 13 : Question 13.3 What is the craniocaudal distribution? 1. Upper 2. Diffuse 3. Lower
58 Case 13 : Question 13.4 What is the axial distribution? 1. Peripheral 2. Diffuse 3. Central
59 Case 13 : Question 13.5 What is the intralobular distribution? 1. Perilobular 2. Centrilobular 3. Panlobular
60 Case 14
61
62 Case 14 : Question 14.1 What is the main pattern of this HRCT? 1. Reticulation 2. Groundglass opacity 3. Honeycombing
63 Case 14 : Question 14.2 What is the craniocaudal distribution? 1. Upper 2. Diffuse 3. Lower
64 Case 14 : Question 14.3 What is the axial distribution? 1. Peripheral 2. Diffuse 3. Central
65 Case 14 : Question 14.4 What is the intralobular distribution? 1. Panlobular 2. Centrilobular 3. Perilobular
66 Case 14 : Question 14.5 A patient known to have systemic sclerosis for 5 years develops dry cough, dyspnea on exertion and shortness of breath. What is the proper management? 1. Surgical biopsy 2. Pulmonary function test 3. Bronchoscopic biopsy
67 Case 15
68
69 Case 15 : Question 15.1 What is the main pattern of this HRCT? 1. Groundglass opacity 2. Nodule 3. Reticulation
70 Case 15 : Question 15.2 What is the most likely diagnosis? 1. BOOP 2. Lymphoma 3. NSIP
71 Case 15 : Question 15.3 What is the best further management? 1. Bronchoscopic biopsy 2. Surgical biopsy 3. Steroid
72 Case 16
73
74 Case 16: Question 16.1 What is the main pattern of this HRCT? 1. Groundglass opacity 2. Nodule 3. reticulation
75 Case 16: Question 16.2 What is the craniocaudal distribution? 1. Upper 2. Diffuse 3. Lower
76 Case 16 : Question 16.3 What is the axial distribution? 1. Peripheral 2. Diffuse 3. Central
77 Case 17
78
79 Case 17 : Question 17.1 What about the lung volume? 1. Increased 2. Normal 3. Decreased
80 Case 17 : Question 17.2 What is the axial distribution? 1. Peripheral 2. Diffuse 3. Central
81 Case 17 : Question 17.3 What is the intralobular distribution? 1. Perilymphatic 2. Centrilobular 3. Random
82 Case 18
83
84 Case 18 : Question 18.1 What is the main pattern of this HRCT? 1. Ground glass opacity 2. Septal thickening 3. 1 and 2
85 Case 18: Question 18.2 What is the craniocaudal distribution? 1. Upper 2. Diffuse 3. Lower
86 Case 18: Question 18.3 What is the axial distribution? 1. Peripheral 2. Diffuse 3. Central
87 Case 18 : Question 18.4 What is intralobular distribution? 1. Perilymphatic 2. Centrilobular 3. Random
88 Case 18 : Question 18.5 What is the associated finding? 1. Lymph node enlargement 2. Lung mass 3. Pleural thickening
89 Case 18 : Question 18.6 What is the diagnosis? 1. Lymphangitic carcinomatosis 2. Pulmonary alveolar proteinosis 3. Pulmonary edema
90 Case 19
91
92 Case 19 : Question 19.1 What is the main pattern of this HRCT? 1. Ground glass opacity 2. Ill-defined nodule and 2.
93 Case 19: Question 19.2 What is the axial distribution? 1. Peripheral 2. Diffuse 3. Central
94 Case 19 : Question 19.3 What is the intralobular distribution? 1. Perilymphatic 2. Centrilobular 3. Random
95 Case 19 : Question 19.4 What is the diagnosis? 1. Hypersensitivity pneumonitis 2. NSIP 3. PAP
96 Case 20
97
98 Case 20 : Question 20.1 What is the main pattern of this HRCT? 1. Nodule 2. Ground glass opacity 3. Septal thickening 4. 2 and 3.
99 Case 20 : Question 20.2 What is the distribution of this HRCT in axial view? 1. Peripheral 2. Diffuse 3. Central
100 Case 20 : Question 20.3 What is the intralobular distribution? 1. Perilymphatic 2. Centrilobular 3. Random
101 Case 20: Question 20.4 What is the associated finding? 1. Lymph node enlargement 2. Pericardial thickening and 2.
102 Case 20: Question 20.5 What is the diagnosis? 1. Lymphangitic carcinomatosis 2. PAP 3. Pulmonary edema
103 Suspected diffused lung disease Chest radiograph Normal or equivocal Abnormal Suggestive of sarcoidosis HRCT with prone views HRCT Trans bronchial Bx Normal Abnormal See next slide Bx if clinical/physiologic evidence of disease See next slide
104 Suspected diffused lung disease Specific CT pattern(uip,eg,lam,h P, Lipoid Pneumonia) CT pattern suggestive of HP sarcoid, lymphagitic carcinoma,pap, alveolar carcinoma,eosinophillic pneumonia, BOOP Other CT pattern Accept CT diagnosis if clinical scenario is consistent Trans bronchial biopsy and/or brochoalveolar lavage (CT directed) Thoracosopic biopsy (CT directed)
105 Thank you
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