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High-Resolution CT of the Lungs

¹ Department of Radiology, 2910 Taubman Center, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0326.

View larger version (27K): [in a new window]   Fig. 1. —Line drawing of a secondary pulmonary lobule. Borders of lobule are interlobular septa. At center of each lobule is a bronchiole and a pulmonary artery (blue). Pulmonary vein (red) run in interlobular septa. Lymphatics (green) are found in interlobular septa and in central or axial interstitium that surrounds bronchovascular bundles.

View larger version (24K): [in a new window]   Fig. 2. —Line drawing of types of abnormalities found on high-resolution CT. (Reprinted with permission from [141])

View larger version (114K): [in a new window]   Fig. 3A. —63-year-old man with asbestosis and pleural plaques resulting from exposure to asbestos. Conventional CT scan at 10-mm collimation using standard reconstruction algorithm.

View larger version (122K): [in a new window]   Fig. 3B. —63-year-old man with asbestosis and pleural plaques resulting from exposure to asbestos. 1.5-mm collimation high-resolution CT scan reformatted using high-spatial-frequency reconstruction algorithm obtained at same level shows pleural plaques. However, thickened inter-and intralobular septa of asbestosis (arrowheads) are more clearly seen on B. On A, it is difficult to distinguish partial volume averaging adjacent to pleural plaques from lung abnormality.

View larger version (104K): [in a new window]   Fig. 4A. —57-year-old man with obliterative bronchiolitis of chronic lung transplant rejection with normal chest radiograph. Conventional CT scan through lung bases shows subtle areas of ground-glass opacity (arrows), representing partial volume averaging of bronchial walls.

View larger version (109K): [in a new window]   Fig. 4B. —57-year-old man with obliterative bronchiolitis of chronic lung transplant rejection with normal chest radiograph. High-resolution CT scan at same anatomic level as A shows diffuse cylindrical bronchiectasis. Signet ring sign of bronchiectasis is illustrated (arrowheads).

View larger version (161K): [in a new window]   Fig. 5A. —59-year-old obese woman who underwent high-resolution CT that was nondiagnostic because of patient's size. High-resolution CT scan is degraded by extensive noise and is uninterpretable.

View larger version (121K): [in a new window]   Fig. 5B. —59-year-old obese woman who underwent high-resolution CT that was nondiagnostic because of patient's size. Scout topogram from CT examinations reveals patient's body size. Although in most obese patients increasing scanning technique can improve image quality, in very obese patients to do so is not possible.

View larger version (99K): [in a new window]   Fig. 6A. —61-year-old man with dependent opacity mimicking lung disease. High-resolution CT scan through lung bases with patient supine reveals bilateral ill-defined ground-glass and faint reticular opacity confined to dependent portion of lungs.

View larger version (82K): [in a new window]   Fig. 6B. —61-year-old man with dependent opacity mimicking lung disease. High-resolution CT scan at same anatomic level as A and with patient prone reveals that opacity completely clears, indicating opacity shown on A was atelectasis.

View larger version (79K): [in a new window]   Fig. 7A. —29-year-old woman with dependent opacity representing usual interstitial pneumonitis. High-resolution CT scan through lung bases with patient supine reveals bilateral ill-defined ground-glass and reticular opacity confined to dependent portion of lungs.

View larger version (99K): [in a new window]   Fig. 7B. —29-year-old woman with dependent opacity representing usual interstitial pneumonitis. High-resolution CT scan at same anatomic level as A and with patient prone reveals that opacity persists, confirming lung parenchyma is abnormal.

View larger version (147K): [in a new window]   Fig. 8A. —55-year-old woman with hypersensitivity pneumonitis. Inspiratory high-resolution CT scan shows a few scattered thickened interlobular septa and very faint pattern of mosaic attenuation.

View larger version (145K): [in a new window]   Fig. 8B. —55-year-old woman with hypersensitivity pneumonitis. Expiratory high-resolution CT scan at same anatomic level as A reveals multifocal bilateral air trapping represented by low-attenuation lung parenchyma. High-attenuation areas represent normal lung that has developed atelectasis with expiration. Note internal bowing of posterior wall of bronchus intermedius as evidence that scan was taken at expiration.

View larger version (136K): [in a new window]   Fig. 9A. —54-year-old woman with idiopathic bronchiolitis obliterans. Inspiratory high-resolution CT scan shows diffuse cylindric bronchiectasis, with bronchi larger than adjacent arteries; signet ring sign of bronchiectasis (arrows); and subtle mosaic attenuation. All are findings of small airways disease.

View larger version (142K): [in a new window]   Fig. 9B. —54-year-old woman with idiopathic bronchiolitis obliterans. Expiratory high-resolution CT scan at same anatomic level as A reveals that expected decrease in lung size is absent, and lungs remain low in attenuation, indicating severe diffuse air trapping, with only normal lung parenchyma found as a few individual secondary pulmonary lobules that increased in attenuation (arrowheads).

View larger version (112K): [in a new window]   Fig. 10. —68-year-old woman with interstitial edema resulting from left heart failure. High-resolution CT scan through upper lobes shows smooth septal thickening in a gravity-dependent distribution, with no honeycombing or septal nodularity. Mild centrilobular emphysema is shown as small areas of abnormally low attenuation.

View larger version (117K): [in a new window]   Fig. 11. —66-year-old man with chronic pulmonary embolism. High-resolution CT scan through upper lobes shows pattern of mosaic attenuation caused by regional alterations in perfusion.

View larger version (132K): [in a new window]   Fig. 12A. —56-year-old man with hypersensitivity pneumonitis resulting from bird-fancier's lung. Posteroanterior chest radiograph, originally interpreted as showing normal findings, shows subtle hazy opacity in mid and lower lungs.

View larger version (120K): [in a new window]   Fig. 12B. —56-year-old man with hypersensitivity pneumonitis resulting from bird-fancier's lung. High-resolution CT scan obtained 1 hr after chest radiograph reveals diffuse ground-glass opacity with faint centrilobular nodules in less confluent areas, in addition to air trapping in scattered secondary pulmonary lobules (arrow).

View larger version (144K): [in a new window]   Fig. 13. —58-year-old man with usual interstitial pneumonitis. High-resolution CT scan through lung bases shows extensive honeycombing, indicating severe irreversible fibrosis. When this pattern is subpleural and lower-lobepredominant, it is characteristic of usual interstitial pneumonitis.

View larger version (126K): [in a new window]   Fig. 14A. —53-year-old woman with desquamative interstitial pneumonitis. High-resolution CT scan shows patchy ground-glass opacity.

View larger version (127K): [in a new window]   Fig. 14B. —53-year-old woman with desquamative interstitial pneumonitis. High-resolution CT scan after 6 months of medical therapy with azathioprine reveals that abnormality has almost completely resolved.

View larger version (111K): [in a new window]   Fig. 15A. —72-year-old woman with severe centrilobular emphysema. High-resolution CT scan at level of aortic arch shows severe emphysema, with normal lung parenchyma almost completely replaced by abnormally low attenuation.

View larger version (123K): [in a new window]   Fig. 15B. —72-year-old woman with severe centrilobular emphysema. High-resolution CT scan at lung bases shows mild emphysema, appearing as small round areas of low attenuation, often abutting centrilobular artery (arrows).

View larger version (131K): [in a new window]   Fig. 16. —65-year-old man with Langerhans' cell histiocytosis and a 3-year history of progressive dyspnea. High-resolution CT scan at level of aortic arch shows mixed pattern of irregular nodules and cysts that was less severe at lung bases.

View larger version (117K): [in a new window]   Fig. 17. —54-year-old woman with 20-year history of Langerhans' cell histiocytosis. High-resolution CT scan at level of aortic arch shows predominant pattern of cysts that was less severe at lung bases. Irregular nodules are relatively minor component.

View larger version (125K): [in a new window]   Fig. 18. —39-year-old woman with lymphangioleiomyomatosis. High-resolution CT scan at level of carina displayed at lung window on left and soft-tissue window on right. In addition to large bilateral pleural effusions, note small round low-attenuation areas with faint walls, representing cysts, that were uniformly distributed throughout lung parenchyma.

View larger version (113K): [in a new window]   Fig. 19. —40-year-old woman lymphangioleiomyomatosis. High-resolution CT scan at level of aortopulmonary window shows severe lung destruction, with almost complete replacement of normal lung parenchyma by cysts that were uniformly distributed throughout lungs.

View larger version (103K): [in a new window]   Fig. 20. —32-year-old man with hypersensitivity pneumonitis. High-resolution CT scan at level of carina shows diffuse centrilobular nodules.

View larger version (120K): [in a new window]   Fig. 21. —69-year-old woman with 12-year history of chronic hypersensitivity pneumonitis. High-resolution CT scan through mid lungs shows traction bronchiectasis, reticular abnormality superimposed on patchy ground-glass opacity, and a few centrilobular nodules. Unlike usual interstitial pneumonitis, distribution of abnormality is not predominantly subpleural.

View larger version (123K): [in a new window]   Fig. 22. —37-year-old man with lymphangitic carcinomatosis resulting from metastatic adenocarcinoma. High-resolution CT scan through right lung base shows irregular and nodular interlobular septa forming polygons, with thickening and irregularity of centrilobular arteries (arrows) and major fissure. Larger nodule in periphery of right lower lobe represents hematogenous metastasis.

View larger version (114K): [in a new window]   Fig. 23A. —55-year-old man with asbestos exposure. High-resolution CT scans at level of carina (A) and lung bases (B) show parenchymal bands (arrows, A), subpleural bands (arrowheads, B), and thick interlobular septa of asbestosis, in addition to pleural plaques.

View larger version (104K): [in a new window]   Fig. 23B. —55-year-old man with asbestos exposure. High-resolution CT scans at level of carina (A) and lung bases (B) show parenchymal bands (arrows, A), subpleural bands (arrowheads, B), and thick interlobular septa of asbestosis, in addition to pleural plaques.

View larger version (101K): [in a new window]   Fig. 24. —38-year-old woman with early pulmonary sarcoidosis. High-resolution CT scan just below level of carina shows miliary nodules predominantly located along central bronchovascular bundles. Her symptoms of arthralgias and erythema nodosum resolved after 4 weeks of daily high-dose oral prednisone.

View larger version (100K): [in a new window]   Fig. 25. —36-year-old man with sarcoidosis. High-resolution CT scan just below level of carina shows central bronchovascular thickening and nodularity on a background of small nodules, including subpleural nodules.

View larger version (99K): [in a new window]   Fig. 26. —58-year-old man with end-stage sarcoidosis. High-resolution CT scan through level of inferior pulmonary veins shows central bronchovascular thickening and nodularity with severe architectural distortion and posterior rotation of hila superimposed on background of miliary and subpleural nodules. Note associated peripheral bullous emphysema.

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