Micronodular Lung Disease an algorithm

Micronodular Lung Disease an algorithm H. Page McAdams, MD Department of Radiology Duke University Medical Center Durham, NC USA page.mcadams@duke.edu

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

Definition Rounded opacities < 3- to 5-mm Numerous

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

CT Detection Coronal

CT Detection Coronal disease distribution

Micronodules

Micronodules Distribution

Micronodules Distribution Random Perilymphatic Centrilobular

Micronodules Distribution Random Perilymphatic Centrilobular

Centrilobular Nodules

Centrilobular Nodules

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

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

Solid CL Nodules

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

Silicosis

Silicosis

Pulmonary LCH

Pulmonary LCH

Tree-in-Bud

Tree-in-Bud

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

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

Tree-in-Bud Tuberculosis Aspiration

Esophageal Stricture Courtesy Laura Heyneman, MD

Esophageal Stricture 6 months s/p PEG

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

CL GG Nodules

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

Hypersensitivity Pn

Bird Fancier s Lung

Hypersensitivity Pn Insp Exp

Hot Tub Lung Insp Exp

Resp Bronchiolitis

Resp Bronchiolitis Sliding MIPS

Adenocarcinoma

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

Perilymphatic Nodules

Perilymphatic Nodules

Perilymphatic Nodules

Perilymphatic Nodules

Perilymphatic Nodules

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

Sarcoidosis

Lymphangitic Carc * *

Lymphangitic Carc * *

Lymphangitic Carc PV MPR

Lymphangitic Carc PV Volume Rendered

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

Random Nodules

Random Nodules

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

Histoplasmosis

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

References Beigelman-Aubry C, et al. MDCT and postprocessing techniques in the assessment of diffuse lung disease. Radiographics 2005; 25:1639-52. Devakonda A, et al. Bronchiolar disorders: a clinical-radiological diagnostic algorithm. Chest 2010; 137:938-51. Raoof S, et al. Pictorial essay: Multinodular disease: an HRCT diagnostic algorithm. Chest 2006; 129:805-15. 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; 200:333-9. 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; 29:588-91.

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

Micronodular Lung Disease an algorithm H. Page McAdams, MD Department of Radiology Duke University Medical Center Durham, NC USA page.mcadams@duke.edu