Diffuse High-Attenuation Pulmonary Abnormalities: A Pattern-Oriented Diagnostic Approach on High-Resolution CT
Edson Marchiori1,
Arthur S. Souza, Jr.2,
Tomás Franquet3 and
Nestor L. Müller3
1 Department of Radiology, Universidade Federal Fluminense and Hospital
Universitario Clementino Fraga Filho, Rio de Janeiro, Brazil.
2 Department of Radiology, Faculdade de Medicina (FAMERP) e Ultra X, São
José do Rio Preto, SP, Brazil.
3 Department of Radiology, Vancouver Hospital and Health Sciences Center and
University of British Columbia, 855 W 12th Ave., Vancouver, BC V5Z 1M9,
Canada.
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Fig. 1. —Residual postprimary pulmonary tuberculosis in 56-year-old
man. High-resolution CT scan obtained using tissue window settings at level of
aortic arch shows mediastinal left pleural thickening and multiple calcified
granulomatous lesions (arrow).
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Fig. 2A. —62-year-old woman with residual varicella infection.
High-resolution CT scan at level of inferior pulmonary veins shows numerous
bilateral small nodules. Nodules (arrows) are smoothly marginated and
sharply defined.
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Fig. 2B. —62-year-old woman with residual varicella infection. CT scan
obtained with soft-tissue window settings at approximately same level as
A clearly shows that many nodules (arrows) are calcified.
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Fig. 3A. —54-year-old woman with chronic renal failure. High-resolution
CT scan through lung apices shows diffuse bilateral and confluent fluffy
high-attenuation centrilobular nodules (arrows) involving upper
lobes. Note that nodules are a few milimeters away from pleura, a
characteristic finding of centrilobular nodules.
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Fig. 3B. —54-year-old woman with chronic renal failure. CT scan
obtained with soft-tissue window settings shows multiple vascular
calcifications in chest wall (arrows).
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Fig. 4. —30-year-old woman with idiopathic pulmonary hemosiderosis.
High-resolution CT scan shows extensive bilateral centrilobular ground-glass
opacities and both poorly defined and well-defined centrilobular nodules. Some
nodules have increased attenuation, but no calcification is evident on CT.
Patient had repeated episodes of diffuse pulmonary hemorrhage since early
childhood. High-resolution CT findings had not changed appreciably over
several years.
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Fig. 5A. —Silicosis in 50-year-old man. High-resolution CT scan
obtained using soft-tissue window settings shows conglomerate mass of fibrosis
containing multiple calcified small nodules. Also note characteristic
peripheral "egg-shell" calcification of mediastinal nodes
(arrows).
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Fig. 5B. —Silicosis in 50-year-old man. High-resolution CT scan
obtained using soft-tissue window settings shows bilateral areas of irregular
parenchymal bands and architectural distortion (arrows). Numerous
well-defined small calcified nodules are seen bilaterally with sparing of lung
periphery.
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Fig. 6A. —Stannosis in 48-year-old man. Chest radiograph shows multiple
calcified pulmonary nodules distributed randomly throughout both lungs.
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Fig. 6B. —Stannosis in 48-year-old man. High-resolution CT scan
obtained using lung window settings at level of carina shows small calcified
nodules. Nodules are sharply defined. Conglomeration of nodules is present in
right upper lobe. Calcified mediastinal nodes also are visible.
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Fig. 7A. —Pulmonary alveolar microlithiasis in 35-year-old woman.
(Courtesy of Ravin C, Durham, NC.) High-resolution CT scan obtained using lung
window settings shows diffuse scattered micronodules (arrows) through
both lungs. There is confluence of nodules in dependent lung regions.
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Fig. 7B. —Pulmonary alveolar microlithiasis in 35-year-old woman.
(Courtesy of Ravin C, Durham, NC.) High-resolution CT scan obtained at same
level as A using soft-tissue window settings shows numerous dense
calcific areas of attenuation in dependent lung regions and calcific
thickening of interlobular septa (arrows).
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Fig. 8A. —Talcosis in 26-year-old female IV drug user. High-resolution
CT scan obtained using lung window settings shows conglomerated masses in
upper lobes. Note diffuse fine granular and linear pattern surrounding
conglomerate masses.
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Fig. 8B. —Talcosis in 26-year-old female IV drug user. CT scan obtained
using soft-tissue window settings shows highly attenuated material within
masses (arrows), a finding that suggests talc deposition.
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Fig. 9. —Polymethyl methacrylate embolism in 56-year-old woman after
undergoing percutaneous vertebroplasty. Unenhanced CT scan shows radiopaque
emboli in superior vena cava (arrowhead) and in segmental and
subsegmental levels of pulmonary arteries (arrow). (Courtesy of
Verschakelen J, Leuven, Belgium)
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Fig. 10A. —Multiple pulmonary chondromas in 43-year-old woman with
gastrointestinal stromal tumor. Contrast-enhanced CT scan of upper abdomen
shows large heterogeneous lobulated mass arising from stomach
(arrows). Cystic component of mass and multiple intratumoral
low-attenuation areas of necrosis (arrowheads) also are seen.
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Fig. 10B. —Multiple pulmonary chondromas in 43-year-old woman with
gastrointestinal stromal tumor. Chest CT scan obtained using mediastinal
window settings shows multiple pulmonary calcified chondromas of different
sizes. (Courtesy of Llauger J, Barcelona, Spain)
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Fig. 11. —Multiple pulmonary metastases from osteosarcoma in
24-year-old man. Unenhanced CT scan obtained using mediastinal window settings
shows multiple calcified pulmonary metastases and large paraspinal partially
calcified mass (arrow), adjacent to thoracic aorta.
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Fig. 12A. —Nodular parenchymal amyloidosis in asymptomatic 48-year-old
man. CT scan obtained using lung window settings shows multiple, bilateral,
and randomly distributed pulmonary nodules. They range in diameter from 0.2 to
4 cm.
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Fig. 12B. —Nodular parenchymal amyloidosis in asymptomatic 48-year-old
man. CT scan obtained at different level than A using mediastinal
window settings shows that many nodules are calcified. Note small calcified
nodules in subpleural location.
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Fig. 13A. —Multiple pulmonary hyalinizing granulomas in asymptomatic
56-year-old man. Chest CT scan obtained using lung window settings shows
multiple circumscribed nodules and masses of different sizes.
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Fig. 13B. —Multiple pulmonary hyalinizing granulomas in asymptomatic
56-year-old man. CT scan corresponding to A obtained using mediastinal
window settings shows that many nodules are calcified irregularly.
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Fig. 14A. —Progressive massive fibrosis due to silicosis in 57-year-old
man. High-resolution CT scan obtained using lung window settings shows
bilateral conglomerate masses. Irregular linear opacities and distortion of
lung architecture (arrows), indicative of fibrosis, are evident.
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Fig. 14B. —Progressive massive fibrosis due to silicosis in 57-year-old
man. CT scan obtained using soft-tissue window settings at same level as
A shows areas of punctate calcification within conglomerate masses.
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Fig. 15A. —80-year-old man with idiopathic pulmonary fibrosis.
High-resolution CT scan obtained through lower lung zones shows bilateral fine
reticular opacities in subpleural lung regions (arrow).
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Fig. 15B. —80-year-old man with idiopathic pulmonary fibrosis. CT scan
obtained corresponding to A using mediastinal window settings reveals
multiple punctuate calcifications (arrows) within these opacities,
representing dendritic calcification.
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Fig. 16. —Pulmonary amiodarone toxicity in 60-year-old man. Unenhanced
CT scan shows focal area of dense lung consolidation in posterior segment of
right upper lobe.
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Fig. 17. —Oil embolism after chemoembolization of right hepatic lobe
for hepatocellular carcinoma in 46-year-old woman. Unenhanced CT scan obtained
1 day after chemoembolization shows bilateral deposition of ethiodized oil in
lower lobes. Bilateral pleural effusion is present also.
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Copyright © 2005 by the American Roentgen Ray Society.
