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3 signs can discriminate between UIP due to connective tissue disease (CTD) from UIP due to IPF
Anterior upper lobe sign, Exuberant honeycombing sign and Straight edge sign
Interesting case of a 32-year-old asymptomatic female underwent a chest X-ray during a routine medical checkup, leading to further assessment with a contrast-enhanced chest CT to investigate radiographic findings. What is the diagnosis?
Sharing HRCT images of four smokers with diverse diagnoses: Pulmonary Langerhans cell histiocytosis, non-specific interstitial pneumonia, pneumocystis jirovecii pneumonia, and desquamative interstitial pneumonia. Can you identify the accurate diagnosis for each patient?
Brilliant reference chart and diagrams for The Eighth Edition of TNM Staging of Lung Cancer published online 2018 by the Oncologist (doi: 10.1634/theoncologist.2017-0659). Personally, it helped me a lot to understand & to apply TNM staging to my cases. Let’s apply in our case
A 29-year-old female with a persistent month-long fever and cough. The challenge here – can you guide in localizing the suspected lung abscess solely based on the PA view CXR, without the aid of a lateral view?
Chronic pulmonary embolus filling defect has concave interface with contrast. Complete obstruction causes abrupt cut off or distal vascular attenuation. Incomplete obstruction can be central web (linear) filling defect or eccentric embolus forming obtuse angle with vessel wall
Based on radiological pattern, bacterial pneumonias classified: lobar, lobular (bronchopneumonia) & interstitial pneumonia. Lobar pneumonia is the typical appearance of community acquired pneumonia CAP. Bronchopneumonia most commonly encountered in hospital acquired pneumonia HAP
Acute pulmonary embolus filling defect has convex interface with contrast. Complete obstruction cause expansion of involved artery. Incomplete obstruction can be central globular filling defect with surrounding contrast or eccentric embolus forming acute angle with vessel wall
Multinodular lung diseases follows mainly three patterns of distribution. Perilymphatic distribution reflects lymphatic spread. Random distribution reflects hematogenous spread and centrilobular distribution reflects bronchiolar spread
Pneumocystis pneumonia (PCP) is fungal infection commonly present by perihilar GGO. Perihilar GGO has broad differential diagnosis. But if cysts are shown within GGO, this appearance is characteristic for Pneumocystis jirovecii.
When interpreting a case with diffuse bronchiectasis, tree-in-bud, and mucus plugging, begin by determining the bronchiectasis location (central or peripheral). In this instance, it's central. Proceed to assess the craniocaudal distribution; here, upper lobar predominant
A case of a 19-year-old male with middle lobe syndrome and a confirmed history of cystic fibrosis. When faced with the challenge of an absent medical history, how would you approach the diagnosis or explore alternative differentials relying solely on radiological findings?
Desquamative interstitial pneumonia DIP (smoking related intestinal pneumonia) is easiest to diagnose in HRCT when upper lobar emphysema accompanies predominantly lower lobar ground glass opacities GGO peripheral and bronchocentric in distribution and tiny cysts could be
What prompted the CT chest prone scan for the 47-year-old male patient? Could you specify the name of the observed sign and elaborate on its significance in terms of the patient’s condition?
Differentiation of acute vs chronic emboli is summarized in the following slides. Additional characteristic criteria for chronic embolus: calcification of embolus + systemic/bronchial collaterals. Don’t rely on mosaic attenuation or right ventricular strain for differentiation
Tree in bud if accompanied with central bronchiectasis and mucus plugging (bronchocele), think of specific disease associated with chronic infection. Differential diagnosis depends on either upper or lower lobar predominance of findings according to the following algorithm
Ultrasound is my second interest in Radiology, particularly vascular and musculoskeletal applications. I’d like to share an interesting case of male 48 years old underwent Color Duplex US for carotid and vertebral arteries. Request unfortunately lacks important clinical
Linear areas of atelectasis, known as platelike or discoid atelectasis, are common in individuals with reduced breathing depth or limited diaphragmatic excursions. Typically, they appear a few millimeters to 1 cm thick and extend several centimeters in length. Found at the lung
This image reveals paraseptal and centrilobular emphysema with diffuse cystic lung disease in the upper lobe, excluding NSIP and DIP. Differentials include PLCH and PJP. Although irregular cysts lean toward PLCH, a strong argument against it and in favor of PJP is the cysts'
Ghon complex is radiographic finding of primary TB reported by Anton Ghon (1866-1936). Combination of Ghon focus (tuberculoma) & affected lymph nodes termed Ghon complex. Should not be confused with Ranke complex which is healed primary tuberculosis Ghon complex by calcification
Nodal staging in Eighth Edition of TNM Staging of Lung Cancer is based on International Association for the Study of Lung Cancer IASLC lymph node map which includes the regional lymph nodes, as the non regional lymph nodes are considered metastasis
A case of a 19-year-old male with middle lobe syndrome and a confirmed history of cystic fibrosis. When faced with the challenge of an absent medical history, how would you approach the diagnosis or explore alternative differentials relying solely on radiological findings?
I consider myself lucky to work with clever pulmonologists. This case 13 years old female child sent for HRCT & already diagnosed immotile cilia syndrome (primary ciliary dyskinesia). I share it because patient doesn’t have dextrocardia. 50% of cases are not Kartagener's syndrome
Examining intriguing radiology findings: right lower lobe mosaic attenuation & left lower lobe cystic bronchiectasis. Which might be the primary pathology? What’s your diagnosis?
46-year-old man with a bone marrow transplant. Second image acquired 3 weeks after first image.
What is the correct answer?
A. Lung cancer
B. Mycobacterial pneumonia
C. Posttransplant lymphoproliferative disease
D. Invasive pulmonary aspergillosis
E. Septic emboli
In this case, various patterns of organizing pneumonia (OP) are observed. The Atoll sign (red arrows), bronchocentric pattern (yellow arrow), perilobular pattern (blue arrows), and band consolidation paralleling the costal margin (green arrows) are notable. Immediate subpleural
A 50-year-old female diagnosed with idiopathic organizing pneumonia (OP). Her HRCT reveals multiple patterns. What patterns do you identify in the HRCT scan? Check out this YouTube lecture for reference: [].
Pulmonary arterial hypertension PAH is diagnosed in CT by dilated main pulmonary artery above bifurcation more than 29mm. It can be manifested by centrilobular nodules of ground glass density
Sample of case review in subscription posts
■ Slowly progressive shortness of breath
1. What are the CT findings?
2. What is the differential diagnosis based on the imaging findings?
3. What is the most common lung parenchymal imaging manifestation of sarcoidosis?
4. Describe
Acute right-sided chest pain, with history of occasional recurrent monthly discomfort
1. What are the radiographic findings?
2. What is the differential diagnostic list, if this radiographic abnormality developed spontaneously?
3. What are the CT findings?
4. What is the
53-year-old male patient with neutropenia showing positive responses to voriconazole. Imaging reveals both Halo sign and Reversed Halo sign! Which fungal infections could be behind this dual phenomenon?
The features of interlobar (intrafissural) pneumothorax are little known. Spontaneous interlobar pneumothorax is a rare topographical finding and prompt diagnosis by a radiologist can help prevent complications and improve outcomes. Axial scan in the previous post of 34-year-old
Triad of Central bronchiectasis, Tree in bud & bronchocele is alarming for radiologists to consider underlying specific disease of chronic infection. Generally lobar predominance & age are helpful for diagnosis, particularly if delayed clinical diagnosis of the congenital causes
Pneumatoceles are among differential diagnosis of cavitating lung disease. They occur post infection (first image) or trauma (called laceration) second image
Rheumatoid pulmonary nodules are rare presentation. They are upper lobar in distribution. Location wise, upper lobar cavitating nodules DD, PLCH versus rheumatoid. Simply the former is numerous in number and bizarre in shape compared to few rheumatoid cavitary nodules
Lymphocytic interstitial pneumonia LIP pearls. One of interstitial pneumonias. Idiopathic or secondary to CTD. Typically show predominant lower lobar peripheral GGO and thin walled cysts in non GGO areas (spot diagnosis). Cysts are few in number compared to PLCH and LAM.
Discrimination between ground glass opacities and mosaic attenuation in crucial to avoid unnecessary misinterpretation. Clinical data will be posted later.
This presentation is characteristic of PLCH, featuring upper lobe cysts and a fine reticular pattern. Additionally, there are associated ground-glass opacities indicative of smoking-related respiratory bronchiolitis.
Classic scenario for diagnosis of chronic eosinophilic pneumonia CEP in HRCT. Here is a male patient 31 years old non smoker presented with cough and SOB for 3 months duration and blood eosinophilia. HRCT shows upper lobar predominant peripheral and bronchocentric consolidation
Multilobar pneumonia vs bronchopneumonia. Lobar pneumonia begins by filling alveoli at supleural space & spread between segments through interalveolar pores > appears pleural based, non segmental & progress to hilum. If subpleural space, spared still peripheral & nonsegmental 1/2
For a 30-year-old male with suspected tuberculosis and three negative AFB tests, the question is whether pulmonary tuberculosis is still a consideration based on HRCT findings.
Centrilobular nodules (due to bronchiolar spread) will present only in centrilobular location (centre of secondary pulmonary lobule), though nodules are not seen resting on pleural surface or along fissures
Female 12 years has recurrent chest infection since early childhood. Two years interval between posted scans, 2021 and 2023 respectively. What is the underlying cause of diffuse bronchiectasis according to the flowchart?
Highlighting the significance of honeycombing in UIP assessment: Begin by evaluating its distribution – typical UIP distribution (apicobasal gradient) or non-UIP distribution. Subsequently, delve into identifying signs of UIP-CTD. Lastly, scrutinize for features indicating
In literature, pneumonic-type invasive mucinous adenocarcinoma (IMA) can be relatively distinguished from infectious pneumonia by irregular air bronchogram (dilatation, rigidity or narrowing), cavitation, air bubbles or lucencies, Hypodense sign (low density within
Here is a case of female 47 years old known Sjögren's syndrome. Whenever radiologist encounter connective tissue disease related interstitial lung disease, usual interstitial pneumonia UIP has to be categorized (according to 2018 Fleischner Society White Paper and 2018 Joint
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Truly multicystic lung disease has limited differentials: Pulmonary Langerhans cell histiocytosis (PLCH), Lymphangioleiomyomatosis (LAM), Lymphoid interstitial pneumonia (LIP), Birt-Hogg-Dubé syndrome (BHD) and Neurofibromatosis type 1 (NF1). Which of them shows this appearance
24-year-old male here, well-versed in hyperimmunoglobulin E syndrome (HIES), a primary immunodeficiency disorder. Seeking insights on characteristic CT Chest findings for HIES that differentiate it from other immunodeficiency disorders and sinopulmonary infections. Any details on
In this challenging case of hemorrhagic pneumonia, a 75-year-old man with a 4-day febrile history (there was no known history of malignancy) unfolded into a complex clinical scenario. Initial assessment through HRCT on admission revealed concerning bronchopneumonia pattern.
Pneumocystis jiroveci pneumonia PJP is fungal pulmonary infection develops with low CD4 counts <200 and particularly to fewer than 100. The classical appearance is bilateral upper lobar parahilar GGO or consolidation (subpleural sparing). May show cysts within GGO (specific sign)
Centrilobular GGO nodules is one of 4 features of hypersensitivity pneumonitis. Other features are patchy GGO, mosaic attenuation and three density sign, consequent to inhaled dust into bronchioles > bronchiolar wall and peribronchiolar inflammation & bronchiolar lumen narrowing
Presenting a challenging case: a 33-year-old male patient with chronic sputum production, consistently reflected in HRCT scans since 2015. Radiologists, what differentials should be on your radar when faced with this recurring scenario? Pulmonologists, which additional scan do
Lymphangitis carcinomatosis-Lymphangitic spread of tumor (perilymphatic nodules) is one of 4 mechanisms of tumor spread. Other 3 mechanisms are intravascular metastasis, hematogenous spread (random nodules) and endobronchial spread (centrilobular nodules of soft tissue density)
MILIARY INFECTION is randomly distributed nodules seen along pleural surface and fissures, reflect hematogenous spread. INFECTIOUS BRONCHIOLITIS is due to endobronchial spread and presents by centrilobular nodules and tree in bud, no nodules along pleural surface or fissures
A case of a 33-year-old male with a six-year history of dialysis dependence. While the chest X-ray (CXR) in 2017 revealed no abnormalities, a recent CXR in 2023 displayed an expansile lesion on the right fourth rib. To further investigate this finding, a CT scan was subsequently
A challenging case: a 40-year-old female diagnosed with severe bronchiectasis and pulmonary hypertension. How would you approach diffuse bronchiectasis in this patient? Additionally, which group of pulmonary hypertension do you suspect she developed?
Perilymphatic nodules (due to lymphatic spread), present along all pulmonary interstitium, bronchovascular, interlobular, subpleural (fissures) and centrilobular interstitium
I’d like to share this unique case radiologist may rarely encounter in clinical practice. The quality of the videos are not what my followers are used to, but this is what I was able to get when I was invited to attend MDD. Female 30 years old with cough and dyspnea for 2 months.
Generally speaking, emphysema is either smoking related (common), upper lobar predominant; or Alpha-1-antitrypsin (A1AT) deficiency (uncommon) lower lobar predominant
This patient, presenting with initial HRCT for recently diagnosed scleroderma, exhibits a typical pattern consistent with mixed cellular and fibrotic NSIP. The HRCT findings reveal predominant reticular opacities alongside mild traction bronchiectasis, as well as ground glass
A 32-year-old woman with a history of scleroderma presents with distressing symptoms of shortness of breath and a dry cough. Her medical team has ordered a HRCT scan to rule out interstitial lung disease (ILD). What are the distinct subtypes of interstitial pneumonia pattern
Streptococcal pneumonia (gram positive typical bacterial infection) is common CAP. Most common pathogen in HIV infected patient. Presented by lobar consolidation with air bronchogram, lower lobar predilection. Small parapneumonic pleural effusion usually seen
Acquiring knowledge about interstitial pneumonias is essential for individuals interested in interstitial lung disease, as this category comprises the majority of interstitial lung diseases encountered in clinical practice, whether idiopathic or secondary. Our upcoming two-hour
Join us for a 2-hour online lecture via Zoom on March 29th at 3 PM Cairo time, covering updates on interstitial pneumonias and radiological tips and tricks. Contact our WhatsApp number +20 120 678 4555 for subscription details. Subscribers to X account will receive free access
Smoking-Related Interstitial Fibrosis (SRIF) is a specific form of interstitial fibrosis first described in 2010, and is also referred to as airspace enlargement with fibrosis (AEF). SRIF can affect existing centrilobular and paraseptal emphysema by developing dense, definable
64 years old lady had underwent HRCT in November 6, 2019, due to suspicion of interstitial lung disease. In next post, the most recent HRCT done at first of December 2022. What is the diagnosis for the 64 years old lady?
Congenital bronchial atresia presents with atretic bronchus and air trapping in the affected lobe, distinguishable from Swyer–James syndrome by the presence of bronchocele. But what if there’s no bronchocele? Can you identify which image corresponds to Congenital bronchial
The silhouette sign proves valuable in lobar localization in the PA view, with unanimous agreement correctly placing the abscess in the right lower lobe. However, attempts to pinpoint the abscess to a specific segment within the right lower lobe yielded varied comments. It’s
A 29-year-old female with a persistent month-long fever and cough. The challenge here – can you guide in localizing the suspected lung abscess solely based on the PA view CXR, without the aid of a lateral view?
Dear followers, while clinical history is generally crucial for radiologists, certain cases exhibit classical features in HRCT, allowing diagnosis based solely on imaging analysis. In this specific instance, do you require clinical data to diagnose this 34-year-old male patient,