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Expiratory High-Resolution CT

Diagnostic Value in Diffuse Lung Diseases

Hiroaki Arakawa1, Hiroshi Niimi1, Yasuyuki Kurihara1, Yasuo Nakajima1 and W. Richard Webb2

1 Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, 214-0015 Japan.
2 Department of Radiology, M396, University of California, 505 Parnassus Ave., San Francisco, CA 94143-0628.



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  		Fig. 1A. —43-year-old woman with bronchiolitis obliterans after bilateral lung transplantation. Inspiratory CT scan shows inhomogeneous lung attenuation. Vessels in low-attenuation areas appear smaller than those in high-attenuation areas, suggesting mosaic perfusion as cause of inhomogeneous lung attenuation.

 


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  		Fig. 1B. —43-year-old woman with bronchiolitis obliterans after bilateral lung transplantation. Expiratory CT scan obtained at slightly lower level than in A shows contrast between high- and low-attenuation areas as more conspicuous than in A, confirming air-trapping in low-attenuation areas. Area of normal lung shows decrease in volume as lung attenuation increased. Note postoperative metal artifact.

 


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  		Fig. 2A. —51-year-old woman with chronic pulmonary thromboembolism and pulmonary hypertension. On inspiratory CT scan, mosaic perfusion is identified with disparity in vessel size. Left lung shows higher attenuation and larger vessels than right lung. Localized area of high attenuation is noted in left upper lobe (arrows), which may be chronically hyperperfused area.

 


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  		Fig. 2B. —51-year-old woman with chronic pulmonary thromboembolism and pulmonary hypertension. Expiratory CT scan shows normal increase of lung attenuation and decrease of lung volume in both high- and low-attenuation areas, with exception of some small areas in left lung (arrows). This normal increase in attenuation suggests vascular obstruction as cause of mosaic perfusion. Note that superior segment of lower lobes remains relatively radiolucent compared with upper lobes, which is normal finding.

 


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  		Fig. 3A. —60-year-old man with idiopathic bronchiolitis obliterans. Inspiratory CT scan shows inhomogeneous opacity with mixed high- and low-attenuation areas. Vessels in high- and low-attenuation areas appear similar in size; it is difficult to determine with confidence which areas are abnormal.

 


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  		Fig. 3B. —60-year-old man with idiopathic bronchiolitis obliterans. Expiratory CT scan shows normal increase in lung attenuation in high-attenuation areas. Little or no increase in attenuation is noted in low-attenuation areas, which confirms air-trapping as cause of mosaic perfusion.

 


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  		Fig. 4A. —56-year-old man with chronic hypersensitivity pneumonitis. Inspiratory CT scan shows reticular and ground-glass opacities in bilateral lower lobes. Multiple lower attenuation areas are seen surrounded by areas of ground-glass opacity (arrows). Vessels appear equal in both high- and low-attenuation areas.

 


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  		Fig. 4B. —56-year-old man with chronic hypersensitivity pneumonitis. Expiratory CT scan shows areas of air-trapping in low-attenuation areas of right lung. However, normal increase of lung attenuation is noted in those areas of left lung. Note honeycombing in right lung.

 


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  		Fig. 5A. —57-year-old woman with chronic bronchitis. Inspiratory CT scan has almost normal findings.

 


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  		Fig. 5B. —57-year-old woman with chronic bronchitis. However, expiratory CT scan shows multifocal areas of air-trapping. Pulmonary function test results showed mild impairment with reduced forced expiratory flow at 50% and 25% of vital capacity, suggesting small airways obstruction. Forced expiratory volume in 1 sec was normal.

 


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  		Fig. 6A. —Bronchiolitis obliterans in 60-year-old woman after right lung transplantation for idiopathic pulmonary fibrosis. Inspiratory CT scan shows right lung that appears almost normal. Note postoperative lung herniation (arrows) through right chest wall.

 


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  		Fig. 6B. —Bronchiolitis obliterans in 60-year-old woman after right lung transplantation for idiopathic pulmonary fibrosis. Expiratory CT scan shows areas of air-trapping suggesting airway obstruction that was not observed on previous postoperative CT examination.

 


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  		Fig. 7A. —Biopsy-proven sarcoidosis in 62-year-old woman. Inspiratory CT scan has almost normal findings.

 


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  		Fig. 7B. —Biopsy-proven sarcoidosis in 62-year-old woman. Expiratory CT scan shows extensive air-trapping. Pulmonary function test in this patient showed mild obstruction with reduced forced expiratory flow at 50% and 25% of vital capacity.

 


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  		Fig. 8A. —Bronchiectasis in 64-year-old man. Inspiratory CT scan shows area of slightly lower attenuation, associated with fewer vessels and bronchiectasis, in right upper lobe. Left lung appears normal.

 


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  		Fig. 8B. —Bronchiectasis in 64-year-old man. Expiratory CT scan shows extensive air-trapping, not only in right upper lobe (note lack of change in lung attenuation) but also in left upper lobe.

 


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  		Fig. 9A. —Recently diagnosed diffuse panbronchiolitis in 57-year-old woman. Inspiratory CT scan shows diffuse small centrilobular nodules with tree-in-bud appearance. Minimal bronchial dilatation is identified in left lower lobe.

 


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  		Fig. 9B. —Recently diagnosed diffuse panbronchiolitis in 57-year-old woman. Expiratory CT scan shows air-trapping in left and right lower lobes (arrows). Note that bronchi collapsed after exhalation.

 


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  		Fig. 10A. —Summer-type hypersensitivity pneumonitis in 51-year-old man. Inspiratory CT scan shows inhomogeneous attenuation. Minimal reticulation is seen in high-attenuation areas suggesting that these areas represent ground-glass attenuation. Lower attenuation areas appear relatively normal.

 


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  		Fig. 10B. —Summer-type hypersensitivity pneumonitis in 51-year-old man. Expiratory CT scan confirms presence of air-trapping in low-attenuation areas, even though centrilobular ground-glass nodules representing bronchiolitis are not obvious on inspiratory scan.

 


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  		Fig. 11A. —58-year-old woman with sarcoidosis. Inspiratory CT scan shows nodular thickening of bronchovascular bundles and small nodular opacities. Note bilateral hilar lymphadenopathy.

 


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  		Fig. 11B. —58-year-old woman with sarcoidosis. Expiratory CT scan shows multifocal areas of air-trapping. Pulmonary function test in this patient showed moderate obstruction with forced expiratory flow in 1 sec and forced expiratory vital capacity of 63.7%.

 


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  		Fig. 12A. —Acute pulmonary embolism in 68-year-old woman with previous history of pulmonary embolism. Helical CT angiogram at mediastinal window setting shows pulmonary embolism in basal segmental arteries in both lungs.

 


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  		Fig. 12B. —Acute pulmonary embolism in 68-year-old woman with previous history of pulmonary embolism. Inspiratory CT scan shows inhomogeneous lung attenuation with patchy ground-glass attenuation. Note lobular areas of low attenuation (arrows).

 


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  		Fig. 12C. —Acute pulmonary embolism in 68-year-old woman with previous history of pulmonary embolism. Expiratory high-resolution CT scan shows multifocal areas of air-trapping both in low-attenuation areas and in regions appearing normal on inspiratory scan (arrows).

 

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