Micronodular Lung Disease an algorithm

Transcription

1 Micronodular Lung Disease an algorithm H. Page McAdams, MD Department of Radiology Duke University Medical Center Durham, NC USA

2 Question Which of the following lung diseases is MOST likely to show a perilymphatic distribution of micronodules on thinsection CT? 1. Langerhans cell histiocytosis 2. Airway-disseminated tuberculosis 3. Hypersensitivity pneumonitis 4. Sarcoidosis 5. Respiratory bronchiolitis

3 Definition Rounded opacities < 3- to 5-mm Numerous

4 CT Detection Sliding MIPS improve detection of subtle disease 5-mm thick 1-mm increment

5 CT Detection Coronal

6 CT Detection Coronal disease distribution

7

8 Micronodules

9 Micronodules Distribution

10 Micronodules Distribution Random Perilymphatic Centrilobular

11 Micronodules Distribution Random Perilymphatic Centrilobular

12 Centrilobular Nodules

13 Centrilobular Nodules

14 Micronodules Distribution Random Perilymphatic Centrilobular Ground Glass Solid Tree-in-Bud

15 Micronodules Distribution Random Perilymphatic Centrilobular Ground Glass Solid Tree-in-Bud

16 Solid CL Nodules

17 Solid CL Nodules Silicosis/CWP Pulmonary LCH Infection Aspiration Metastases (rare)

18 Silicosis

19 Silicosis

20 Pulmonary LCH

21 Pulmonary LCH

22 Tree-in-Bud

23 Tree-in-Bud

24 Solid CL Nodules Silicosis/CWP Pulmonary LCH Infection TB, NTMB tree-in-bud viral Aspiration

25 Solid CL Nodules Silicosis/CWP Pulmonary LCH Infection TB, NTMB viral tree-in-bud Aspiration

26 Tree-in-Bud Tuberculosis Aspiration

27 Esophageal Stricture Courtesy Laura Heyneman, MD

28 Esophageal Stricture 6 months s/p PEG

29 Micronodules Distribution Random Perilymphatic Centrilobular Ground Glass Solid Tree-in-Bud

30 CL GG Nodules

31 CL GG Nodules Hypersensitivity pneumonitis Bronchiolitis respiratory infection (viral) Adenocarcinoma (BAC) OP/NSIP Edema/vasculitis

32 Hypersensitivity Pn

33 Bird Fancier s Lung

34 Hypersensitivity Pn Insp Exp

35 Hot Tub Lung Insp Exp

36 Resp Bronchiolitis

37 Resp Bronchiolitis Sliding MIPS

38 Adenocarcinoma

39 Micronodules Distribution Random Perilymphatic Centrilobular Ground Glass Solid Tree-in-Bud

40 Perilymphatic Nodules

41 Perilymphatic Nodules

42 Perilymphatic Nodules

43 Perilymphatic Nodules

44 Perilymphatic Nodules

45 Perilymphatic Nodules Sarcoidosis Lymphangitic carcinomatosis Silicosis/CWP majority Lymphocytic IP (rare) vast majority Amyloidosis (rare)

46 Sarcoidosis

47 Lymphangitic Carc * *

48 Lymphangitic Carc * *

49 Lymphangitic Carc PV MPR

50 Lymphangitic Carc PV Volume Rendered

51 Micronodules Distribution Random Perilymphatic Centrilobular Ground Glass Solid Tree-in-Bud

52 Random Nodules

53 Random Nodules

54 Random Nodules Disseminated infection (miliary) Sarcoidosis Metastatic disease Silicosis, CWP majority Langerhans cell histiocytosis vast majority

55 Histoplasmosis

56 Micronodules Distribution Random Perilymphatic Centrilobular Ground Glass Solid Tree-in-Bud

57 References Beigelman-Aubry C, et al. MDCT and postprocessing techniques in the assessment of diffuse lung disease. Radiographics 2005; 25: Devakonda A, et al. Bronchiolar disorders: a clinical-radiological diagnostic algorithm. Chest 2010; 137: Raoof S, et al. Pictorial essay: Multinodular disease: an HRCT diagnostic algorithm. Chest 2006; 129: Remy-Jardin M, et al. Diffuse infiltrative lung disease: clinical value of sliding-thin-slab maximum intensity projection CT scans in the detection of mild micronodular patterns. Radiology 1996; 200: Sakai M, et al. Can maximum intensity projection images with MDCT help to differentiate between the micronodular distribution of focal and diffuse infiltrative lung diseases? JCAT 2005; 29:

58 Question Which of the following lung diseases is MOST likely to show a perilymphatic distribution of micronodules on thinsection CT? 1. Langerhans cell histiocytosis 2. Airway-disseminated tuberculosis 3. Hypersensitivity pneumonitis 4. Sarcoidosis 5. Respiratory bronchiolitis

59 Micronodular Lung Disease an algorithm H. Page McAdams, MD Department of Radiology Duke University Medical Center Durham, NC USA