High resolution computer tomogtraphy.pptx

hrct

1. Muraly cp HRCT Basic interpretation

2. Introduction Technical aspects Secondary pulmonary lobue –anatomy Terminology Basic reading and interpretation Comon pathologies conclusion

3. ANATOMY

4. Secondary pulmonary lobule

5. Secondary lobule Basic anatomic unit of pulmonary structure and function surrounded by connective tissue septa Measures about 1-2 cm and is made up of 5-15 pulmonary acini , contain the alveoli for gas exchange.

6. Centrilobular area  is the central part of the secundary lobule. It is usually the site of diseases, that enter the lung through the airways ( hypersensitivity pneumonitis , respiratory bronchiolitis , centrilobular emphysema ).

7. Random distribution Nodules are randomly distributed relative to structures of the lung and secondary lobule.  Nodules can usually be seen to involve the pleural surfaces and fissures, but lack the subpleural predominance often seen in patients with a perilymphatic distribution.

8. HRCT PATTERNS OF LUNG DISEASES

9. HOW TO READ

10. Good day

11. PARENCHYMAL OPACITIES GGO Consolidation MASS( high attenuation) Calcification

12. GOOD DAY

13. lung pneumatocele   Staphylococcus aureus (most common)  Streptococcus pneumonia Haemophilus influenza  Escherichia  coli group A streptococci   Klebsiella pneumonia adenovirus.

14. Centrilobular area  is the central part of the secundary lobule. It is usually the site of diseases, that enter the lung through the airways ( i.e. hypersensitivity pneumonitis , respiratory bronchiolitis , centrilobular emphysema ). Perilymphatic area is the peripheral part of the secundary lobule. It is usually the site of diseases, that are located in the lymphatics of in the interlobular septa ( i.e. sarcoid , lymphangitic carcinomatosis , pulmonary edema ).  These diseases are usually also located in the central network of lymphatics that surround the bronchovascular bundle

15. SEPTAL THICKENING Thickening of the lung interstitium fluid, fibrous tissue infiltration by cells results in a pattern of reticular opacities due to thickening of the interlobular septa. Although thickening of the interlobular septa is relatively common in patients with interstitial lung disease, it is uncommon as a predominant finding and has a limited differential diagnosis (Table).

16. SEPTAL THICKENING Smooth septal thickening   seen in interstitial pulmonary edema ( Kerley B lymphangitic spread of carcinoma or lymphoma alveolar proteinosis .

17. Cardiogenic pulmonary edema  combination of septal thickening and ground-glass opacity.  hydrostatic edema perihilar and gravitational distribution. 

18. Cardiogenic pulmonary edema Thickening of the peribronchovascular interstitium Called peribronchial cuffing Fissural thickening are also common. Enlarged heart and PLEF

19. SEPTAL THICKENING Nodular or irregular septal thickening   Lymphangitic spread of carcinoma Lymphoma Sarcoidosis Silicosis.

20. IRREGULAR septal thickening RUL Known malignancy Typical of lymphangitic carcinomatosis Mediastinal LN Nodular lesion in the left lung,

21. Pulmonary lymphangitic carcinomatosis 50% septal thickening is focal or unilateral. Helpful in distinguishing PLC from other causes Sarcoidosis cardiogenic pulmonary edema .  .

22. Pulmonary lymphangitic carcinomatosis Hilar lymphadenopathy is visible in 50% usually there is a history of ( adeno )carcinoma. Identical findings can be seen in patients with Lymphoma and in children with HIV infection, who develop Lymphocytic interstitial pneumonitis (LIP), a rare benign infiltrative lymphocytic disease

23. Cardiogenic pulmonary edema  generally results in a combination of septal thickening and ground-glass opacity.  There is a tendency for hydrostatic edema to show a perihilar and gravitational distribution.  Thickening of the peribronchovascular interstitium , which is called peribronchial cuffing, and fissural thickening are also common. Common additional findings are an enlarged heart and pleural fluid. Usually these patient are not imaged with HRCT as the diagnosis is readily made based on clinical and radiographic findings, but sometimes unsuspected hydrostatic pulmonary edema is found.

24. SEPTAL THICKENING & GGO

25. CRAZY PAVING patchy distribution Some lobules are affected and others are not. Thought to be specific for alveolar proteinosis , also seen in many other PCP BACCa Sarcoidosis NSIP organizing pneumonia (COP) ARDS.

26. Honeycombing second reticular pattern re in a patient with UIP cystic appearance Pathologically, Honeycombing is defined by the presence of small cystic spaces lined by bronchiolar epithelium with thickened walls composed of dense fibrous tissue.

27. Nodular pattern